The United Arab Emirates has donated $50 million to Johns Hopkins Medicine to create an institute to transform treatment for stroke patients across the globe.
Officials from the Baltimore health system and the Middle Eastern nation gathered in New York City Thursday, at the United Arab Emirates’ permanent mission to the United Nations, to announce plans for the Sheikh Khalifa Stroke Institute.
The new stroke institute will operate two centers, one focusing on treatment and rehabilitation and the other on detection and diagnosis of the disease. The institute will be operated jointly at Johns Hopkins in Baltimore and a yet-to-be-determined hospital in Abu Dhabi, the capital of the UAE.
Strokes, which occur when blood is cut off to part of the brain, usually because of a blood clot, are the second-leading cause of death around the world and a leading cause of adult disability, according to the American Heart Association.
The institute’s researchers will aim to build on recent advancements in stroke treatment, including technology that allows doctors to remove blood clots quickly from the brain and imaging that helps locate clots more easily. On the rehabilitation side, they will study new approaches to get blood vessels to regrow and teach the brain to relearn movement after a stroke.
“What we have decided to do with UAE is really think outside the box,” said Dr. Paul Rothman, dean of the medical faculty and CEO of Johns Hopkins Medicine, whose father died from a stroke. “Think of a new type of institute that will not only have neurologists and neurosurgeons, but have biomedical engineers and people from public health. People who could all get together and take an interdisciplinary approach.”
About 795,000 people in the United States suffer a stroke each year, according to the Centers for Disease Control and Prevention. Strokes kill 5.5 million people worldwide each year, including 140,000 Americans, according to the World Health Organization. Two-thirds of stroke survivors end up with some level of disability and face a drastic change in lifestyle that leaves some dependent on others for daily living.
Strokes have become a particularly vexing and growing problem in the UAE, where victims tend to be much younger than in other parts of the world and there are not enough stroke centers. Half of all stroke victims in the UAE are under 46, compared to the average of 65 for stroke victims globally.
In 2014, UAE President Sheikh Khalifa bin Zayed Al Nahyan suffered a stroke and required emergency surgery. Johns Hopkins doctors have been involved in the care of the president, who has kept largely out of the public eye since the stroke.
The president’s illness was a decisive factor in choosing strokes, said Yousef Al Otaiba, the UAE’s ambassador to the United States.
“We hope that by bringing the greatest minds together we can discover some medical breakthroughs to help treat a condition that affects so many people,” Al Otabia said. “The institute is essentially an advanced [research and development] and clinical center that will transform treatment for stroke victims and develop new therapies to help them recover.”
The new partnership builds on a relationship that began in the 1970s when Johns Hopkins doctors began treating Emiratis who traveled to Baltimore for specialized care not offered in their own country. Johns Hopkins also helped the country build up its own health system and assists with the management and oversight of three hospitals in the UAE.
The oil-rich nation in turn has provided Johns Hopkins with substantial financial support over the years, including an undisclosed but “transformational” amount to build a new, two-tower hospital building that opened in 2012. The adult tower was named for Sheikh Zayed bin Sultan Al Nahyan, the first president of the United Arab Emirates, who created the country by bringing together his emirate, Abu Dhabi, and six smaller sheikhdoms.
The UAE’s hospitals are part of an international portfolio at Johns Hopkins spanning five continents aimed at improving health care overseas, creating research opportunities and opening up new sources of revenue. Hopkins’ International division has helped overseas partners modernize their medical care, introduced cutting-edge procedures in developing nations, and assisted in running an entire health system in Saudi Arabia.
Stroke care has advanced in recent years with procedures that go far beyond treating patients after a stroke.
“We traditionally have focused on preventing strokes and we still want to focus on preventing strokes, but we did not 20 years ago have anything for people who are in the middle of having stroke,” said Dr. Marcella A. Wozniak, associate professor of neurology at the University of Maryland School of Medicine and medical director of the University of Maryland Medical Center Comprehensive Stroke Center. “That has changed and it continues to change.”
The new UAE and Johns Hopkins stroke center will look at ways to improve rehabilitation procedures after stroke, which have not changed much in 50 years, said Justin McArthur, a Johns Hopkins professor and neurologist who is director of the new institute. He said the center will seek new ways to use gaming technology and robotics to help patients recover their ability to move. The institute also will look at ways to change the culture of rehab to make it more deliberate and aggressive, he said.
“We think intervening as early and as aggressively as we can is crucial in the recovery process,” said Dr. Pablo Celnik, director of the Center of Excellence in Stroke Treatment, Recovery and Rehabilitation at Johns Hopkins Hospital. He will head up rehabilitation research at the new institute.
The researchers also will look at ways to make blood-clot-busting medications and technology available to more patients. New guidelines from the American Heart Association and the American Stroke Association said more people should be considered for a procedure in which doctors remove blood clots using a device that is guided through a blood vessel and then grabs the clot and pulls it out. The old rule said the procedure could only be used within six hours after symptoms began, according to the associations. Some patients may now get the procedures within 24 hours, the associations decided.
The guidelines also recommend making more people eligible for drugs that dissolve clots. Under the previous guidelines, patients who had mild strokes were not allowed to get the drugs.
In the UAE, the new institute researchers are looking to use CT-equipped ambulances that can detect a blood clot in a patient’s brain while en route to the hospital so emergency workers can administer clot-busting drugs while in transit. Some parts of the country are far from stroke centers and treatment may be delayed, increasing the chance of disability. The institute also will explore using mobile rehabilitation tools as well.
“I think we are at a pivotal point in stroke care where we now have the tools, technology and drugs to apply to the right patients at the right time,” McArthur said. “Some of the barriers to delivering care we are still trying to figure out.”
Michael R. Bloomberg, the former New York City mayor and Johns Hopkins alumnus who has given extensively to his alma mater, was also on hand for Thursday’s announcement. He is a strong proponent of preventive medicine and transforming public health. One of Johns Hopkins’ hospital towers is named after Bloomberg’s mother.
“Strokes are one of the biggest causes of death in every country and also one of the most preventable,” said Bloomberg, noting that his foundation supports a program called “Resolve to Save Lives,” which works to prevent heart disease and stroke globally. “If we combine prevention and better diagnosis and treatment, we really can make a very big difference.”