TUESDAY, Nov. 10 (HealthDay News) -- Although many wedding vows include the phrase "in sickness and in health," a stroke can put that promise to the test by causing major relationship problems for married couples, according to British researchers.

The University of Ulster study included 16 married stroke survivors (nine males, seven females), aged 33 to 78. The time since their stroke ranged from two months to four years, with an average of 18 months.

The researchers found that the stroke significantly affected sexual activity, led to blurred relationship roles, and feelings such as anger and frustration were confounded by persistent fatigue and lack of independence.

Among the findings:

• All but one of the stroke survivors experienced a reduction or total loss of sexual desire. Some believed this was due to the effects of medication or fear of another stroke.
• Most of the females lost interest in their appearance, regardless of age.
• All the survivors said they'd changed since their stroke. Many said they experienced irritability, anger, agitation and intolerance due to their frustration at not being able to perform daily activities. In some cases, over-protective spouses increased feelings of anger and frustration.
• Many survivors were reluctant to resume social activities with their spouses because of fatigue, anxiety and swallowing problems.
• Fatigue was often associated with reduced independence and guilt because survivors didn't know how they'd feel from day to day and couldn't plan ahead.

"All the participants perceived a stroke as a life-changing event. They faced a continuous daily struggle to achieve some sense of normality and that required huge amounts of physical and mental effort," study co-author Assumpta Ryan, of the University of Ulster's Nursing Research Institute, said in a university news release.

The study was published online in the Journal of Clinical Nursing.

More information

The National Stroke Association has more about life after stroke.

TUESDAY, Nov. 10 (HealthDay News) -- Exposure to several common pathogens may increase the risk of having a stroke, a new study shows.

Led by Dr. Mitchell Elkind, an associate professor of neurology at Columbia University Medical Center in New York City, the research team found that the pathogens Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus and herpes simplex virus 1 and 2 may be implicated in accelerating arterial disease, which in turn increases the risk of stroke.

The team's work appears in the Nov. 9 online edition of the Archives of Neurology, and will be published in the January 2010 print issue of the journal.

"These are infections that regularly pop up when we study heart disease," said Elkind. "They are very common in the population."

Scientists are not completely sure how the pathogens harm arterial function, but several theories offer suggestions. One possibility is that chronic infection leads to inflammation in the blood vessels, which can constrict blood flow. Another possibility, said Elkind, is that the pathogens disrupt the normal functioning of the arterial walls.

Strokes occur when there is a disruption in the blood supply to the brain, such as a blockage in an artery or other blood vessel. When this happens, brain cells begin to die, causing brain damage and even death. Common functions affected or lost during a stroke include speech, movement and memory.

Stroke is the third-leading cause of death in the United States, according to the National Stroke Association. Strokes have many causes, but it is widely known that certain risk factors increase the chances of having a stroke. These include high blood pressure, diabetes, high cholesterol, smoking and obesity.

In recent years, evidence has been uncovering the role of pathogens in cardiovascular disease, particularly the pathogens featured in Elkind's research. Scientists reported several years ago that untreated gum disease and other oral infections can spread and cause heart disease.

Elkind's study tracked 1,625 adults from a multi-ethnic community in Manhattan for 7.6 years. During that time, 67 patients suffered a first stroke. Even taking into account other risk factors, such as high blood pressure and diabetes, Elkind's team found that the majority of the patients tested positive for one or more of the suspected pathogens.

"Each individual infection was positively, though not significantly, associated with stroke risk after adjusting for other risk factors," the researchers wrote. "The infectious burden index was associated with an increased risk of all strokes after adjusting for demographics and risk factors."

It is too early to tell which pathogens contributed to the strokes, to what extent they contributed and how they contributed (through simple exposure or chronic infection), said Elkind. What's more, there may be other pathogens involved that were not included in the study, he added.

It is also too early to make any clinical recommendations. If scientists conclusively determine that pathogens are capable of causing strokes years after people come in contact with them, possible treatments may include wider and longer use of antibiotics, Elkind added.

Dr. Kishore Ranade, a neurologist affiliated with the Mount Kisco Medical Group in New York, said he was impressed with the findings. He suspects that pathogens work with other risk factors to cause strokes.

"Cumulative data have been suggesting that pathogens play a role in heart disease in general," said Ranade. "And what's bad for the heart is bad for the brain."

More information

The National Stroke Association   has more on strokes, their causes and treatments.

TUESDAY, Nov. 10 (HealthDay News) -- Almost a quarter of the people on Medicare who are hospitalized for heart failure are back in the hospital within a month of discharge, a new study reveals.

That should not be happening, said Dr. Joseph S. Ross, an assistant professor of geriatrics and palliative medicine at the Mount Sinai School of Medicine in New York City, who added that there's plenty of blame to go around. Ross was lead author of the study, published online Nov. 10 in Circulation: Heart Failure.

"It's not just an issue for physicians," Ross said. "The whole clinical team, nurses, pharmacists, even patients play a role. If we want to do better, everyone has to get in the game together."

Heart failure, which is the progressive loss of the heart's ability to pump blood, affects an estimated 5.7 million people in the United States, with 670,000 new cases diagnosed every year, and is one of the more common reasons for hospitalization, according to the American Heart Association.

Hospitalization affords the chance to get treatment for heart failure properly organized, Ross said. But he added that the high re-admission rate found by the study -- more than half a million a year from 2004 through 2006 -- shows that this often is not done.

"The challenge is that there are multiple physicians involved -- the physician who manages the person as an outpatient, the cardiologist, the primary care physician," he said. "They have to touch base and make sure the patient has all the proper medications, that if they start to get sick again, if there are any red flags, proper treatment is started."

But too often, trouble means an emergency room visit, "and the emergency room admits them to the hospital without coordinating with the physician," Ross said.

Measures must be taken before someone is discharged from the hospital, he said. "Physicians and the hospital have to work together to make sure the patient has a smooth discharge out of the hospital, knows how to manage the disease, how to get in touch with the pharmacist, how to take the medications, knows how to eat," Ross said.

To remedy the problem, he has two suggestions. "One is that there needs to be incentives to help encourage physicians and hospitals to work together," Ross said. "There is this proposed Medicare move toward bundled payment -- one lump sum for all hospital care and 30 days afterward -- so that hospitals and physicians have to work together."

Second, there are "existing programs that we know work," Ross said. "We can pay physicians to make phone calls just to touch base with the patient and also reimburse them for e-mail. That would allow patients better communication with physicians, but they are not reimbursed in the current situation."

Dr. Gregg A. Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles, and a spokesman for the American Heart Association, said that efforts are under way to reform the current system.

He cited a Heart Association initiative, dubbed "Target: Heart Failure," that he said was "designed to improve clinical care for patients hospitalized for heart failure" and also an American College of Cardiology program, called "H2H," for hospital-to-hospital, "which helps hospitals work together to lower the 30-day readmission rate."

Also, the health-care reform effort now under consideration in Congress includes provisions for pilot programs to improve "these pretty dismal outcomes and mortality rates," Fonarow said.

But the existing situation "is in a sense shocking -- that despite all the advances for heart failure treatment, patients have not reaped the benefits," Fonarow said. "What is behind this remains one of the biggest challenges for cardiology."

"The most effective therapies, such as beta blockers, are underused, and when they are used, are applied at lower doses than are shown to be effective in clinical trials," he said. "So, many of these patients end up bouncing in and out of hospitals, not receiving important therapies at the right doses and not getting proper monitoring."

More information

The American Heart Association has more about heart failure  .

MONDAY, Nov. 9 (HealthDay News) -- Obesity is a major risk factor for left atrial enlargement, which increases the risk of atrial fibrillation, stroke and death, a new study shows.

Atrial fibrillation is the most common type of arrhythmia (an irregular heart rhythm or heartbeat).

Researchers analyzed data on 1,212 men and women, aged 25 to 74, in Germany who were followed for 10 years. The study authors concluded that obesity and hypertension cause structural and functional changes in the heart and are independent predictors of left atrial enlargement (LAE).

The highest incidence of LAE after 10 years was seen in obese people -- 31.6 percent compared to baseline prevalence of 10 percent among all study participants.

The findings, published in the Nov. 17 issue of the Journal of the American College of Cardiology, confirm the strong association between obesity and LAE reported in previous research. Some of those studies found that excess weight may affect left atrial size at an early age, potentially predisposing young obese people to future heart problems.

The authors of the new study said early assessment and intervention, especially among younger obese patients, is crucial to prevent the premature onset of cardiac remodeling -- changes in heart size, shape and function -- caused by LAE.

But they noted that it isn't clear how much weight management or moderate weight loss can improve LAE. Further research is needed.

More information

The American Heart Association has more about atrial fibrillation  .