The burden of stroke in Europe

Sorin Ursoniu

• The Burden of Stroke in Europe Report, commissioned by Stroke Alliance for Europe (SAFE), conducted by King’s College in London and published in May 2017, has projected that between 2015 and 2035, overall there will be a 34% increase in the total number of stroke events in the EU (from 613,148 in 2015 to 819,771 in 2035).

• In many European countries people, in general, do not know what causes stroke and how to prevent it.

• For most of them, stroke is still an act of God, for which mistakenly they believe there is no treatment.

• Risk factors such as High Blood pressure and high cholesterol, Atrial Fibrillation, diet and lack of exercise can all be combated.

• Despite over thirty years of evidence showing the difference stroke units make and despite their inclusion in European and national guidelines, it is estimated that only about 30% of stroke patients receive stroke unit care across Europe.

• This figure masks amazing inequalities between countries, and in particular the East-West divide in stroke unit provision.

EU - costs

• In 2015, direct healthcare costs alone added up to €20 billion.

• Indirect costs of stroke due to the opportunity cost of informal care by family and friends and lost productivity caused by morbidity or death were estimated to be another €25 billion.

RISK FACTORS / PREVENTION

ROMANIA (2015)

• The National Program for Health Evaluation started 2007 and aims to improve the detection and treatment of stroke risk factors. A sustained mass media campaign for improvement of healthy lifestyle was undertaken

• Estimated prevalence of high blood pressure: 32.5%, high cholesterol 45.8%, smoking: 30.5%, raised glucose: 8.4%

• Self-reported use of high blood pressure medication: 13.9%

• Use of oral anticoagulants in AF-patients: 76.4% (BALKAN-AF survey)

SERBIA (2015)

• Public prevention campaigns cover risk factor knowledge and promotion of a healthy lifestyle.

• Estimated prevalence of high blood pressure: 34.5%, high cholesterol 49.8%, smoking: 42.1%, raised glucose:8.6 %

• Use of oral anticoagulants in AF-patients: 79.0% (BALKAN-AF survey)

• Dedicated TIA clinics with immediate or same day evaluation of patients by a stroke specialist exist

EMERGENCY RESPONSE

ROMANIA (2015)

• No data found

SERBIA (2015)

• The Serbian Stroke Organization has launched a Serbian version of a FAST public health campaign on stroke awareness ("HITNO")

MOŽDANI UDAR – VODIČ ZA

PREVENCIJU, LEČENJE I

REHABILITACIJU

ACUTE CARE ORGANISATION & DELIVERY

ROMANIA (2015)

• National stroke guidelines have been issued by the Ministry of Health in 2009

• According to data from the CEESS Working group there are currently 7 stroke units and about 1% of stroke patients are treated in stroke units.

• There is no telemedicine system in operation.

SERBIA (2015)• There is no national stroke

strategy in Serbia, so pathways of stroke care differ between hospitals and regions. National clinical guidelines for acute care have been developed.

• There are currently 20 stroke unitsand over 100 General Hospitals and Neurology Clinics providing acute stroke treatments. There are no hyperacute stroke units. 40% of stroke patients are currently being treated in stroke units.

• There is no stroke telemedicine system in operation

TREATMENT RATES & AUDITSROMANIA (2015)

• According to a 2013 publication, thrombolysiswas only available in Bucharest, the capital covering 10% of the population).

• 2 thrombolysis procedures were performed nation-wide in 2005, compared to 205 procedures between 2008 and 2014.

SERBIA (2015)

• Thrombolysis was started in 2006 and 10 thrombolysis procedures were performed between January and June 2006. The national thrombolysis rate was estimated to be 1.25% in a 2015 report .

• Thrombectomy is currently available in 2 hospitals only

REHABILITATION ORGANISATION & DELIVERY

ROMANIA (2015)

• Acute rehabilitation is included in the national stroke guidelines

• There is very limited information. It has been described as "insufficient, but efforts made". In 2005/6 it was estimated that 30% of patients had access to rehabilitation.

• Early supported discharge is not available

SERBIA (2015)• Early rehabilitation is stipulated in the national

stroke guideline. All stroke units and departments of neurology in general hospitals offer early rehabilitation. Patients are assessed as soon as possible after admission and a rehabilitation plan rehabilitation is confirmed by the following day. Patients spend typically 2-3 days in acute phase, then 3-4 weeks on rehabilitation ward. There is no speech therapy. The rehabilitation wards admit various conditions and are usually at capacity so there are delays for new patients.

• Long-term rehabilitation is not available and private care is expensive.

• Rehabilitation data is not routinely collected.

• No data regarding early supported discharge

LONGER TERM CARE & SUPPORT

ROMANIA (2015)

• No data found regarding primary healthcare involvement with rehabilitation once the patient is at home

• There is a focus on institutional care for people with disabilities, e.g. investment in creating new neuro-rehabilitation centers. Some parts of the country have made more progress than others in developing community services

SERBIA (2015)

• There is some primary healthcare involvement with rehabilitation once the patient is at home

• No data found regarding community services

Some Recommendations to

address The Burden of stroke

• “Time is brain” is a concept that perfectly encapsulates the need for swift action when stroke strikes.

• The sooner stroke symptoms are realized, the sooner the person gets the care they need, the greater the chances for survival and life with fewer disabilities.

• The chances of having a normal life after a stroke depend largely on the recovery stage.

• The first six months post stroke are essential in restoring damaged functions.

• Total or partial recovery depends on the location and size of the brain injury, the patient's comorbidities, and the intensity of subsequent efforts.

• Statistics show that among the approximately 65,000 Romanians who suffer from stroke annually (178 cases/day), one third remain with varying degrees of disability.

• The treatment schedule for secondary prevention is established by the neurologist after a complete clinical and paraclinical assessment of the patient.

• This is essential in the treatment of a stroke patient, as the risk of repeating it is 9 times greater.

• These patients also have a 4-5 times higher risk of myocardial infarction and a 3-4 times higher risk of peripheral vascular disease.

• A correct secondary prevention treatment decreases these risks on average by over 30%.

• Other unhealthy consequences of stroke are behavioral disorders and cognitive dysfunction, important signs of vascular dementia.

• Secondary stroke prevention treatment can slow the progression of vascular dementia.