American Heart Association

World Stroke Day

World Stroke Day: Stroke Care Advances in Armenia

David Sahakyan, MD
General and Endovascular Neurosurgeon, Head of Cerebrovascular Neurosurgery Service, Erebouni Medical Center, Yerevan, Republic of Armenia

Stroke is the primary worldwide healthcare problem, especially for developing countries. Armenia was one of those countries, where the implementation of modern, time-sensitive stroke treatment modalities like intravenous thrombolysis and mechanical thrombectomy was insufficient and sometimes impossible due to the high cost and underdeveloped stroke care system. For years, neurologists and neurosurgeons willing to provide state-of-the-art treatment to stroke patients were unable to do so because patients and their families had to pay for the procedures and medications out of their pocket before the treatment could be delivered. 

Everything changed in 2019. A collective effort of stroke specialists from Armenia and abroad, combined with the willingness of the new government to recognize the disability burden imposed by this devastating disease, led to amazing transformations in stroke care for the entire country. A national stroke program developed by a group of stroke specialists from the United States, Canada, France, and Armenia and supported by governmental funding made modern acute stroke care accessible for everyone in need in Armenia. In a small country with a population of 3 million, out of 5000 annual ischemic stroke patients, more than 300 patients have received acute stroke treatment for free since the beginning of 2019. More than 240 intravenous rTPA and 120 endovascular thrombectomies have already been performed at two stroke centers. In patients who received treatment, marked reduction of morbidity and mortality was achieved. It is worth mentioning that the budget of the program is around $1 million US dollars. And this is just the beginning. Further development of the stroke network is on the way.

Armenia is an excellent example of how a small developing country with limited financial resources can develop a world-class stroke care system with the help of experienced specialists from developed countries, motivated local physicians, and a supportive government.   

World Stroke Day: October 29

Richard Jackson, MD

This is an exciting time for the acute treatment of ischemic strokes with innovations in thrombectomy and advancements in imaging-based tissue evaluation for thrombolysis. Yet the percentage of patients being treated with these advancements remains low at around 15%. The treatment of ischemic cerebral disease is following in the footsteps of ischemic cardiac disease with the creation of hospital-led evidence-based programs and regional treatment programs involving primary and comprehensive stroke centers collaborating with local EMS providers. 

However, as the director of a primary stroke center, I am continually surprised by the delays in presentation to the hospital for care. I remember, as an intern on the telemetry rotation, admitting what seemed like a never-ending amount of chest pain patients for evaluation. Every night on call for stroke, I, like all neurologists, face questions regarding the disposition of patients with resolved symptoms, patients with delayed presentation to the emergency room, patients not wanting to come into the hospital for treatment, and the questions surrounding acute treatment. These nights, I am always left wondering, what has cardiology done better than neurology? Why don’t people in the community present for evaluation at the slightest possible acute cerebral insult? Is it that our treatments and programs need time to create the system they have, or do we need to do more on the community education programs?

NASAM Stroke Games 2019 and Stroke in Malaysia

Lin Kooi Ong, PhD
@DrLinOng

The National Stroke Association of Malaysia (NASAM) Stroke Games 2019, an amazing event showcasing remarkable possibilities of #LifeAfterStroke, kicked off with an inspiring start at the Panasonic National Sports Complex in Malaysia on October 19. This event is in conjunction with the World Stroke Organisation – World Stroke Day, Southeast Asia Route. Over 800 participants from different states, including Penang, Sabah and Johor, as well as Singapore, participated in 25 events. The youngest athlete was 16 years old, and the oldest was 81 years old. The games kicked off with seated volleyball and hand cycle. The event closed on October 20 with Janet Yeo, stroke survivor and founder chairman of NASAM, putting out the flame.

The NASAM Stroke Games 2019 was declared open.
The NASAM Stroke Games 2019 was declared open. Left to right are: Dato’ Wan Hashimi Albakri, Acting Group CEO, Sime Property Berhad; Tun Jeanne Abdullah, Patron of the Malaysian Paralympic Council; Janet Yeo, NASAM Founder Chairman; Hannah Yeoh, Deputy Minister, Ministry of Women, Family and Community Development; Stuart Milne, CEO, HSBC Bank Malaysia Berhad; Toh Puan Dato’ Seri Hajjah Dr Aishah Ong, Patron of NASAM; and Ruchira Gupta, NASAM Senior Advisor. Photo provided by Frankie Goh, NASAM, with permission.

“The Games is NASAM’s contribution to the stroke community around the world,” said Yeo. “We wish that this fighting spirit of a stroke champion is ignited into every person affected by a stroke no matter where they are.”

World Stroke Day: Staying Above the Fray

Burton J. Tabaac, MD

Join the fight against stroke!

In 2015, the World Stroke Campaign focused on raising awareness of stroke prevention and risk among women using the tagline “I am Woman – Stroke Affects Me, Stroke Affects Everyone.” In 2016, World Stroke Day was marked by recognizing that although stroke is a complex medical issue, there are ways to significantly reduce its impact. The World Stroke Organization built a campaign to underscore that “Stroke is Treatable.” The World Stroke Day 2017 campaign focused on risk awareness and prevention. Last year, World Stroke Day 2018 emphasized that there are resources and a network to assist those who have suffered from stroke, underscoring that you are not in it alone. #UpAgainAfterStroke was used as a rallying cry to inform the public about the well-developed network for caregivers, families, and friends affected by stroke who can help their loved ones.

This year, 2019, calls attention to prevention.

World Stroke Day and the Global Burden of Stroke: Miles to Go Before We Sleep

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.

Increasing Stroke Awareness and Care: Moving in the Right Direction

Danielle de Sa BoasquevisqueDanielle de Sa Boasquevisque, MD

Stroke is a leading cause of death and a major source of disability worldwide. A Brazilian study performed by Martins and colleagues found that the percentage of hospitals with stroke centers, Emergency Medical Services (EMS), telemedicine, and endovascular services increased significantly between 2008 and 2017, after implementing a task force on stroke by neurologists with the assistance of the Brazilian Ministry of Health. However, these hospitals, equipped with specialized stroke centers, were concentrated in dense urban areas, neglecting the impoverished areas.

Now, the Brazilian Stroke Network aims to expand this model already tested in the urban regions to other parts of the country. Using mobile health technology and telemedicine, it has successfully provided the patients direct access to senior neurologists, who can diagnose complex cases and recommend treatment, hence shortening door-to-needle time and achieving better functional outcomes after stroke. However, it is still too expensive to be implemented nationwide.

World Stroke Day: Get Involved! Share Your Story.

Burton J. TabaacBurton J. Tabaac, MD

Stroke recovery is a global endeavor currently affecting about 80 million people living in the world today. More than 50 million stroke survivors live with some form of permanent disability.

Join the fight against stroke! In 2015, The World Stroke Campaign focused on raising awareness of stroke prevention and risk among women using the tagline, “I am Woman – Stroke Affects Me, Stroke Affects Everyone.” In 2016, World Stroke Day was marked by recognizing that although stroke is a complex medical issue, there are ways to significantly reduce its impact. The World Stroke Organization built a campaign to underscore that “Stroke is Treatable.” Last year, the World Stroke Day 2017 campaign focused on risk awareness and prevention. This year, World Stroke Day 2018, emphasizes that there are resources and a network to assist those who have suffered from stroke. You are not in it alone! There is a well-developed network for caregivers, families, and friends affected by stroke who can help their loved ones #UpAgainAfterStroke.

Stroke Care in India

Deepak GulatiDeepak Gulati, MD

I am writing this blog post on stroke care in India given my strong interest and a recent encounter with one of my family members requiring stroke care services in Chennai and New Delhi.

The stroke burden in India is enormous with more than 1.5 million stroke cases per year, much higher than Western industrialized countries. Stroke is the second most common cause of death in India. The most common cause of ischemic stroke in India is intracranial atherosclerosis as per some of the studies conducted in large academic centers from northern and southern India. There are reports of a high proportion of young stroke (first-ever stroke onset below 40 years of age), ranging between 15 and 30% of ischemic strokes.

World Stroke Day: A Call for Action to Get #UpAgainAfterStroke

Alan Charles CameronAlan Charles Cameron, MB ChB, BSc (Hons), MRCP

On World Stroke Day 2018, we are fortunate to have many therapies that reduce the burden of stroke, including intravenous thrombolysis, endovascular therapy, acute stroke unit care, primary and secondary prevention, and multi-modality rehabilitation. We have recently discovered that the substantial benefits achieved with intravenous thrombolysis and endovascular therapy can extend to imaging-selected patients with wake-up stroke, whilst dual anti-platelet therapy with aspirin and clopidogrel is associated with maximum benefit and lowest risk in the first 21 days after high-risk TIA or minor stroke. However, access to effective treatments for stroke remains limited in many developed countries, and basic aspects of stroke care are not available in many developing countries. There is clear global and regional variation in access to stroke care when we speak with colleagues and friends from around the world.

World Stroke Day: Improving Stroke Care in Low-Income Countries

Robert W. RegenhardtRobert W. Regenhardt, MD, PhD
@rwregen

Regenhardt RW, Biseko MR, Shayo AF, Mmbando TN, Grundy SJ, Xu A, et al. Opportunities for intervention: stroke treatments, disability and mortality in urban Tanzania. International Journal for Quality in Health Care. 2018

As the second leading cause of death in the world, stroke is a global problem. With the recent advances in treatment of acute stroke from large vessel occlusion, World Stroke Day reminds us that in many parts of the world, these therapies are unavailable. There are large disparities between high- and low-income countries and opportunities to dramatically influence outcomes by implementing system changes in resource-limited settings. As stroke care providers, there are different levels within stroke care systems where we can implement changes to improve care. These levels include prevention at the population level, access to acute therapies at the community infrastructure level, guideline adherence during the acute admission at the hospital system level, and rehabilitation and follow-up care thereafter. Each of these is critically important.