Salt Substitutes Reduce Stroke Risk, Access to Rehab Disrupted by COVID-19, Headache Infusion Centers Limited

This week Neurology News Network covered a study which found significant associations between reduced sodium levels and stroke, as well as the impact the COVID-19 pandemic had on access to rehabilitation services, and the limited availability of infusion headache centers.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus.

Data from the Salt Substitute and Stroke Study (SSaSS), presented at the European Society of Cardiology Congress 2021, suggest that salt substitutes with reduced sodium levels and increased potassium levels could significantly reduce the risk of stroke and death in older individuals with hypertension or a history of stroke. The results of the open-label study conducted in 600 villages across rural China showed that the use of a salt substitute was associated with a lower rate of stroke, major adverse cardiovascular events, and death over a follow-up period of 5 years, which investigators noted could have implications for the larger, global population. The data included a total of 20,995 patients who were enrolled in the trial, who were randomly assigned to the salt-substitute group (n = 10,504) or the regular salt group (n = 10,491). Those randomized to the salt substitute reported stroke rates of 29.14 events per 1000 person-years compared with 33.65 events per 1000 person-years in the regular salt group.

Children with motor impairment experienced interrupted access to rehabilitation therapies during the COVID-19 pandemic, with those reporting fewer interventions also showing lower satisfaction with treatment delivery, higher rates of decline in mobility, and increased caregiver stress. With the continued use of telehealth, study investigators propose integrating patient and caregiver feedback to improve outcomes. Investigators found that because of the pandemic there was a significant difference in total therapies received compared with the total prior to COVID-19. There was no correlation in difference in number of therapy hours prepandemic and at the time of the survey with child age, presence of Stay-at-Home order, or recent change in medical status. When considering participant home location—categorized as either urban, suburban, or rural—there was no statistically significant association with the, although the majority of survey respondents were suburban residents.

Despite the various treatments and paradigms that are being implemented and offered by headache infusion centers, recently conducted research indicates that there are a limited number of centers, creating several barriers that impact the expansion of this specific type of care. Senior author Mia T. Minen, MD, PhD, and colleagues aimed to understand the operations of infusion centers across the United States. They distributed a survey developed by the Emergency Department, Inpatient, Refractory (EDIR) Special Interest Group of the AHS to the listservs of both the Inpatient Headache & Emergency Medicine specialty section and the Academic Program Directors, which combined included academic and private practices. Of the 127 members of the combined group of both listservs, 50 responded (39%). One-fifth (10 of 50) of the responses were from duplicate programs, leaving 40 unique headache programs surveyed, most of which were academic (34 of 40; 85%). Most of the programs surveyed offered infusion therapy (27 of 40; 68%); however, based on respondents, only 18 of 50 US states had headache infusion centers, the majority concentrated in the Northeast and Midwest regions of the US.

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