Abbas KharalAbbas Kharal, MD, MPH

The global burden of stroke continues to increase as stroke still remains amongst the highest causes of morbidity and mortality worldwide. Per the 2013 global burden of disease (GBD) report1, a greater than 3-fold increase in the burden of stroke was reported over the past two decades. A total of 11.6 million incident ischemic stroke cases were reported worldwide in the past two decades, of which one third occurred in those less than age 65, thus adding significantly more to the disability adjusted life years (DALYs) and economic burden of stroke worldwide. Beyond DALYs lost, stroke also has a large physical, psychological, and financial impact on the millions of patients affected, their families, the health care system, and the society at large, therefore suggesting that the true global burden of ischemic stroke is perhaps much more than what we measure it to be2,3.

Despite the fact that acute stroke therapy has revolutionized in the past two decades, with intravenous thrombolysis and mechanical thrombectomy as the new standard of care,  stroke remains the second largest contributor to DALYs lost globally in developing countries, and the third largest contributor to DALYs lost in developed countries1,4. Despite the revolution in stroke care, where the IV thrombolysis window has been extended to 4.5 hours and mechanical thrombectomy has been extended to 24 hours since last seen well for selected patients, access to these lifesaving and disability-preventing therapies remains a privilege of most developed nations only, and even in such developed nations, it is still restricted to large comprehensive stroke centers in larger cities. Moreover, millions of patients in many developing nations across the world still remain deprived from access to acute stroke care4.

On World Stroke Day, it is important that we join hands to collectively fight the battle against stroke worldwide and work on ways to improve global access to stroke care. This firstly requires global efforts at increasing public awareness about acute stroke, its signs and symptoms, and the range of acute stroke therapies available in the current era of stroke revolution. In addition to improving awareness, increasing further access and availability of acute stroke care, by further expanding the number of primary and comprehensive stroke centers globally, is an effort that is largely needed. This will require a unifying global approach with multiple efforts by local and specialty societies — both nationally and internationally, local governments, health care agencies, clinicians, and health policy makers — to collaborate to accelerate access to primary acute stroke services worldwide.

Mission Thrombectomy 2020 — a worldwide campaign to increase access to acute stroke care, particularly to mechanical thrombectomy, across the globe — is one such global effort in which a team of stroke experts, including myself, aim to join forces with other stroke experts, governments, and policy makers around the globe in an attempt to raise awareness about stroke and increase access to mechanical thrombectomy. The goal of this campaign is to increase the rate of mechanical thrombectomy for eligible patients from less than 100,000 procedures in 2016 to 202,000 annually by 2020, thereby reducing global stroke disability5. Global support of such efforts and ongoing collaborations will be needed across the globe to help decrease the global burden of stroke-related death and disability worldwide.

World Stroke Day should serve as a reminder of all the work that is still needed to help fight the battle against stroke and allow us to come together as a unifying global effort to mitigate stroke-related morbidity and mortality and work on ways to improve education about stroke signs and symptoms and improve access to stroke care worldwide. #UpAgainAfterStroke

References:

  1. Feigin VL, Krishnamurthi R V., Parmar P, et al. Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study. Neuroepidemiology [Internet] 2015 [cited 2017 Nov 23];45(3):161–76. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26505981
  2. Preventing stroke: saving lives around the world. Lancet Neurol [Internet] 2007 [cited 2017 Nov 24];6(2):182–7. Available from: https://www-sciencedirect-com.ezp-prod1.hul.harvard.edu/science/article/pii/S1474442207700315
  3. Caro JJ, Huybrechts KF, Duchesne I. Management patterns and costs of acute ischemic stroke : an international study. For the Stroke Economic Analysis Group. Stroke [Internet] 2000 [cited 2017 Nov 24];31(3):582–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10700489
  4. Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet (London, England) [Internet] 2014 [cited 2017 Nov 24];383(9913):245–54. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24449944
  5. “SVIN Announces Worldwide Effort to Increase Use of Mechanical Thrombectomy for Stroke.” Endovascular Today, 30 Nov. 2016, evtoday.com/2016/11/30/svin-announces-worldwide-effort-to-increase-use-of-mechanical-thrombectomy-for-stroke.