Women less likely to return to work after acute stroke – ScienceDaily

According to new research, about a third of people who had a large (severe) stroke who were treated with mechanical clot removal resumed work three months after their stroke treatment. However, women were almost half as likely to return to work after a severe stroke as men, according to the study published today in brain attackthe leading, peer-reviewed journal of the American Stroke Association, a division of the American Heart Association.

A stroke due to blockage of a large blood vessel is an indicator of a severe stroke and the potential for continued loss of function, making it less likely for people to return to work. According to the American Heart Association, while ischemic strokes are responsible for 87% of strokes in the United States, occlusions of large vessels only account for approximately 24%-46% of ischemic strokes.

Endovascular therapy (mechanical clot removal) and clot-busting drugs are now standard treatment for select patients with severe stroke. Endovascular therapy involves passing a thin catheter through a vessel in the leg to remove a clot that mechanically blocks a brain vessel. In 2018, the American Heart Association’s Stroke Treatment Guidelines were updated to recommend mechanical clot removal for selected stroke patients to improve the odds of functional recovery.

Marianne Hahn, MD, lead study author and a clinical scientist in the Department of Neurology at Johannes Gutenberg University in Mainz, Germany. “Unlike most return-to-work studies, we included only a large group of subjects treated with mechanical clot removal; a subgroup of stroke patients at high risk of severe and persistent disability.”

The researchers examined data from the German Stroke Registry – Vascular Therapy Study Group. The analysis included more than 600 men and women (28% of women), ages 18 to 64 who had had a major ischemic stroke between 2015 and 2019.

All study participants were recruited prior to stroke and treated with mechanical thrombectomy. More than half of the study participants also received intravenous thrombolysis (a clot-busting medication).

The researchers compared people who returned to work after 90 days of mechanical thrombectomy with those who did not return to work. After accounting for age, gender, health conditions, type and severity of stroke, and treatment characteristics, the analysis found:

  • About a third of stroke survivors have resumed work after three months.
  • The amount of persistent functional disability after a stroke was the main reason people were unable to return to work.
  • Women were 58% less likely to return to work three months after mechanical thrombectomy than men.
  • Individuals treated with both mechanical thrombectomy and intravenous thrombolysis were approximately two times more likely to return to work than individuals who underwent mechanical thrombectomy only.

After examining the data further, we also found that the women in our group were younger at the time of their stroke, were more likely to be non-smokers and were more likely to have no significant disability present at hospital discharge compared to the men in our study. However, we did not observe a higher rate of re-employment among women before considering these differences,” Han said.

The researchers noted that more study is needed to explain the discrepancy between men and women who return to the labor market after a major stroke. Intensive and supportive vocational rehabilitation programs may be valuable to help women return to work.

“There is more to re-employment after mechanical thrombectomy than functional outcomes,” Han said. “Targeted occupational and workplace rehabilitation interventions have been shown to improve rates of return to work. Previous studies have also found that return to work is associated with increased well-being, self-esteem and life satisfaction.”

The study authors believe that their findings may be transferable to other countries with similar healthcare and rehabilitation systems. However, confirmation and in-depth analysis of national policies are necessary to explain the observation where there may be differences, such as services and social benefits, that have been shown to affect return to work.

The study was limited in that the data lacked detailed information about the types of jobs and job opportunities available. The German stroke registry does not include the social determinants of health, and whether the individual was rehired in the same job or worked full or part time. The researchers note that these limitations may help explain and play a role in whether people return to work after a severe stroke.

In the United States, stroke is the fifth leading cause of death and a leading cause of disability, according to the latest data from the American Heart Association. To recognize stroke symptoms that require immediate medical attention, the American Stroke Association recommends that everyone remember the acronym FAST. Fdrooping myrtle, adouble rm, sdifficulty speaking TIME for calling 9-1-1.

Co-authors are Sonja Gröschel, MD; Iyad Elhayani, MD; Mark A. Brockmann, MD; Muthuraman Muthuraman, Ph.D.; Klaus Groschel, MD; Timo Abhaus, MD

The researchers reported a lack of external funding sources for this study.

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