Stopping stroke

Duke physician named Heart Association’s advocate of the year.

By Ret Boney

During a high school biology class, Larry Goldstein turned an old storage room in his school into a lab and taught goldfish to swim across a barrier in response to a light.

That sparked a lifelong interest in the brain for Goldstein, a neurologist who heads Duke’s Center for Cerebrovascular Disease and recently was named national Volunteer Advocate of the Year by the American Heart Association.

“He has the ability to articulate the problems of stroke and the impact it has on the communities we serve,” says David Markiewicz, executive vice president of the Mid-Atlantic affiliate of the Heart Association. “He has been able to use his influence as a physician to garner attention, and that attention moves people to action.”

Stroke is the third leading cause of death and one of the leading causes of adult disability, Goldstein says, costing the U.S. $57 billion a year in direct expenses and lost wages, and the problem will grow as the population ages.

To fight back, Goldstein backed the national Stroke Treatment and Ongoing Prevention Act, which would raise public awareness about the warning signs of stroke and the importance of quick treatment, and establish a national registry and a clearinghouse of best practices.

Dr. Larry Goldstein

Job: Professor of Medicine, Duke University, Durham V.A. Medical Center; director, Duke Center for Cerebrovascular Disease.

Education: B.A., biology, Brandeis University; M.D., Mount Sinai School of Medicine; neurology residency, Mount Sinai Hospital

Born: 1955, New York City

Family: Wife, Ricki, neonatologist, Duke; daughter, 18; son, 14

Hobby: Photography

Inspiration: Jim Davis, former director of the Duke Center for Cerebrovascular Disease

Now, he’s pushing for legislation to improve care systems in North Carolina, where 5,000 people die from stroke each year.

“We’re in the Stroke Belt,” he says. “In North Carolina, you’re 40 percent more likely to die of stroke than anywhere else in the country. That’s a huge problem.”

In response, he helped develop the Statewide Stroke Care Systems Act, introduced in the state legislature in April, which would identify hospitals that hold a certificate of distinction as a primary stroke center from a national accrediting group, while requiring all other hospitals to develop procedures for caring for stroke patients.

It would also require emergency medical personnel to use a protocol for identifying stroke patients and for rapidly transporting them to the appropriate facilities.

The legislation is based on findings that show how critical health systems are in identifying and treating stroke victims quickly, and on research Goldstein conducted that identified all the state’s stroke resources and showed virtually no progression in those systems over a five-year period.

“We have new therapies,” he says. “But if we can’t get them to the people that need them quick enough, then we’ve spun our wheels.”

While neurology was an interest for Dr. Goldstein beginning in high school, he decided to focus his work on stroke after completing medical school.

“When you’re starting out in an academic career, you pick something you see as a big problem,” he says. “An area where there’s room for growth and things that need to be done. I was looking for a disease where there was a lot of room to do good.”

That led him to a fellowship at the Duke Center for Cerebrovascular Disease in the mid 1980’s, a group he now leads.

Shortly after that, Goldstein became involved with the Heart Association, which publishes the foremost journal on stroke and runs the leading international conference on the disease.

Almost immediately, he became involved with the association’s Stroke Council, eventually serving on its leadership committee, and began serving on the Heart Association’s advocacy committee in 1999.

Today, he is incoming chair of the Stroke Council of the Heart Association and serves on the board of the Mid-Atlantic affiliate of the national group.

He is also a senior fellow of Duke’s Stroke Policy Program within the Center for Clinical Health Policy Research.

Patient care, research and teaching are critical components of fighting stroke, Goldstein says, but he believes advocacy is another critical way to attack the problem.

“Ignoring the fact that we live in a political society and not realizing that we have to operate in that framework is a lost opportunity,” he says. “There are some things that can only be done through the legislative process.”

So he fights the disease on all fronts, chipping away at the barriers to better detection and care.

“We hope that no opportunity for preventing stroke would be lost and no opportunity for treating a victim of stroke would be lost because of systems,” he says. “As a clinician, whenever you see one of these opportunities lost, it really hurts.”

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