Optimising policy and digitisation in stroke treatment

Caring female physical therapist helps stroke victim in rehab centre
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Professor Michael Brainin, President of the World Stroke Organization, tells HEQ about the burden, treatment and prevention of stroke

The World Stroke Organization (WSO), which represents more than 55,000 stroke specialists, is the only global body to focus exclusively on strokes, which have affected 80 million people living in the world today. In 2014 the WSO launched its Global Stroke Bill of Rights campaign, aimed at identifying key priorities for the care of stroke patients. Professor Michael Brainin, President of the WSO, tells HEQ about the burden, treatment and prevention of stroke.

What are the most egregious impacts of stroke and how can they be alleviated?

14 million people will have a stroke this year and 5.5 million will die as a result of a stroke. Globally the disease accounts for 116 million years of healthy life lost each year. The incidence and prevalence of stroke have a profound impact socially and for individuals and families, the results can be catastrophic.

Around half of stroke survivors are likely to experience life-changing disabilities. Because stroke is a trauma in the brain, the effect of stroke can be wide-ranging, from loss of mobility, communication difficulties, changes in cognition and emotional impact. Relationships, work and family finances can all be adversely affected.

Stroke is however preventable, treatable and beatable. Almost all strokes are linked to a small number of risk factors such as hypertension, exercise, smoking and diet, that can be addressed through low cost public health interventions. Public awareness of stroke symptoms can help people to recognise the signs of stroke and seek emergency treatment in hospital. Access to clot-busting drugs, development of stroke units and specialist rehabilitation can significantly improve the outcomes for patients, while stroke support in the long term can also really improve the quality of life for survivors and caregivers.

WSO is working to advance policy drive change on all of these fronts – from our alliances and partnerships with other NGOs and the UN, to providing health system roadmaps to drive improvements to quality stroke care. We also work with our members around the world to raise awareness of stroke risks and symptoms.

How can digital solutions help with the detection and prevention of stroke?

Digital solutions have a huge role to play across the continuum of stroke – many of us now have sophisticated apps and tools, either on our wrist and or in our pocket that have the potential help us to address stroke risk factors or even recognise a stroke. The Stroke Riskometer is a stroke-specific example: it helps people identify their five-year risk of stroke and to identify and measure the impact of their prevention steps.

Digital technology also has a role to play in improving the speed of diagnosis by enabling mobile brain scanning, diagnosis and treatment en route to hospital. In countries such as Brazil, Philippines and India, mobile solutions are helping neurologists to work with remote healthcare teams to improve diagnosis and treatment for acute stroke patients.

The potential is enormous, the challenge is perhaps is to keep firmly focused on evidence of patient benefit digital technologies, like any other intervention, need to have a robust clinical evidence base.

What are the key goals of the Global Stroke Bill of Rights?

The Global Stroke Bill of Rights is the product of a significant global consultation which aimed to identify key aspects of stroke care that survivors and caregivers felt would have made the biggest difference to the care they, or their loved one received. The document doesn’t have the legal obligations of an international human rights agreement, but it does provide a set of solid patient-centred principles that providers and professionals can use to guide their decision making.

The Bill of Rights is also useful as an advocacy tool for stroke support organisations and health professionals to use to drive improvement in local services. Ideally, we would want to see any institution or organisation providing stroke treatment and support to sign up to the Global Stroke Bill of Rights, display it prominently in their institution and to regularly review and benchmark services against the principles it contains.

How can policymakers and healthcare providers collaborate more with each other on educational initiatives?

Collaboration around the development and implementation of national stroke strategies, that identifies and addresses gaps in current knowledge and stroke expertise across the care continuum is essential.

From developing and supporting public education programmes to building the knowledge and skills of consultants that will broaden access to game-changing thrombectomy treatment, healthcare providers can provide invaluable insights on how governments can turn the tide on stroke.

With its global perspective and membership WSO can provide advice and support with the development of these strategies. Our Roadmap to Quality Stroke Care provides a tool to continuously improve the quality stroke care in every resource setting, Drawing on a strong evidence base, the resource can support clinicians and managers to work together to prioritise action, address capacity gaps and monitor impact.

There is a growing body of stroke research that provides strong advocacy content for professionals. The recent European Stroke Organisation survey highlights key regional challenges and priorities for the development of stroke services.

Stroke Alliance for Europe (SAFE) has worked with researchers at King’s College London, to quantify the economic burden of stroke and show how investment in stroke units – which significantly improve patient outcomes – could free up resources across the health and social care system. All of these resources together provide models and compelling evidence for policymakers that healthcare professionals can use to help identify gaps and advocate effectively.

What should be done at a policy level to provide more and better support for the health sector on strokes?

The complex nature of stroke requires specialist service across the continuum which is best achieved through the development of integrated national stroke strategies that address prevention, acute treatment, rehabilitation and long-term support for survivors and caregivers.

Firstly, we really need to prioritise implementation of population-based prevention strategies that will help address the stroke ‘pipeline’ action on smoking, alcohol, diet and exercise will also help governments to address other non-communicable diseases like diabetes, cancer and dementia. Specific to stroke a focus on detecting and managing hypertension and atrial fibrillation would address two key clinical contributors to stroke.

For treatment, access to stroke units and looking at maximising the opportunities provided by thrombolysis and endovascular treatments would reduce the severity of stroke-related disability which, alongside investment in specialist rehabilitation, has the potential to massively reduce the long term health and social care.

Professor Michael Brainin
President
World Stroke Organization

Please note, this article will appear in issue 12 of Health Europa Quarterly, which will be available to read in February 2020.

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