Stroked out.... Sunday Star, May 22, 2011

Stroked out

Sunday Star, May 22, 2011

A stroke epidemic across the Asia-Pacific region, and indeed the rest of the world, is imminent if actions are not taken now to slow the rising tide of preventable strokes occurring every year.

ACCORDING to a new report, How Can We Avoid a Stroke Crisis in the Asia-Pacific Region?, urgent coordinated action is needed to avoid millions of preventable strokes, which leave many patients who have atrial fibrillation (AF) both mentally and physically disabled, or dead, every year.

The authors and reviewers are comprised of cardiologists, neurologists, primary care practitioners, haematologists, patient representatives, policymakers, hospital pharmacists, and health economists.

The report, launched during the 18th Asian Pacific Congress of Cardiology (APCC) by Action for Stroke Prevention, a group of health experts from across the globe, proposes urgent measures to prevent stroke in Asian-Pacific patients with AF, the most common, sustained abnormal heart rhythm and a major cause of stroke.

The congress was held in Kuala Lumpur recently.

The report’s recommendations are endorsed by 32 leading Asian-Pacific and other global medical societies and patient organisations, reinforcing and recognising the need for a call to action.

A stroke epidemic across the Asia-Pacific region, and indeed the rest of the world, is imminent if actions are not taken now to slow the rising tide of preventable strokes occurring every year.

Head of Department of Cardiology and Clinical Research Centre, Sarawak General Hospital, Dr Sim Kui Hian, commented: “The incidence of stroke across the Asia-Pacific region is continuing to grow, and constitutes both a major public health issue and a significant economic burden. “Members of Action for Stroke Prevention have come together to highlight the risk of a stroke crisis and urge policymakers, national governments, healthcare professionals, patient groups and medical societies to act together now to prevent the devastating impact stroke has on people, their families and carers.”

In AF, the two upper chambers of the heart (the atria) quiver instead of beating effectively, resulting in blood not being completely pumped out, which in turn causes pooling that can lead to clotting in the atria.

If a blood clot leaves the atria, it can become lodged in an artery in the brain, blocking the blood supply and causing the patient to suffer from an ischaemic stroke.

Approximately one in five ischaemic strokes are due to AF.

AF-related strokes are more severe, cause greater disability and have a worse prognosis than strokes in patients without AF. Although the current treatment for stroke – vitamin K antagonists, such as warfarin – can be effective, they are also associated with a number of drawbacks and are currently underused, particularly in elderly patients at greatest risk of stroke.

Preventing AF in patients at risk of arrhythmia, diagnosing AF before the first stroke occurs, and following recommendations regarding the use of anticoagulation therapies, including potential new treatment options, are critical for effective prevention of AF-related strokes.

Recommendations made by the report

• Improve awareness of the impact of AF and AF-related stroke.
• Develop methods for early and adequate diagnosis of AF and stroke risk assessment.
• Take new and better approaches to prevent stroke in patients with AF.
• Facilitate the exchange of best practice between national governments in the Asia-Pacific region.
• Develop strategies to support adherence to guidelines.
• Provide equal and adequate administration of therapy for patients with AF across countries in the Asia-Pacific region.
• Advance research into the causes, prevention and management of AF, and addressing the current paucity of epidemiological information available in Asia-Pacific.

Strokes are preventable – prevent them
“With the majority of AF-related strokes being preventable, we believe that implementation of these recommendations now will contribute to the prevention of stroke in patients with AF and, in turn, reduce the dramatically increasing clinical, economic, and social burden of stroke in Asia-Pacific,” said Professor Gregory Lip, professor of cardiovascular medicine, University of Birmingham Centre for Cardiovascular Sciences, City Hospital Birmingham, UK.

Every year, 15 million people worldwide experience a stroke. Approximately five million of these suffer permanent disabilities and over five million more die, accounting for 10% of all deaths worldwide.

In the Asia-Pacific region in 2004, the approximate number of patients who had survived a stroke at some point in their lifetime was 4.4 million in Southeast Asia and 9.1 million in the Western Pacific region. In the same year, the number of first-ever strokes was 5.1 million across these regions. This was higher than the estimated number of new cases of cancer.

People who suffer a stroke caused by AF are more likely to remain in hospital for longer, are less likely to be discharged home, and are 50% more likely to remain disabled than patients who have a stroke unrelated to AF.

An increasing number of people in the Asia-Pacific region are living with AF. In China alone, up to eight million people suffer from AF.

“Every year, millions of people with atrial fibrillation who suffer a stroke are left disabled, regardless of their age,” concluded Dr David KL Quek, President, Malaysian Medical Association. “If we do not suffer with atrial fibrillation ourselves, we will almost certainly care for or know someone who does.

“It is imperative that we all act together to improve the diagnosis and management of AF if we are to prevent the enormous life-changing consequences that stroke has for patients and carers.”

The current economic burden of strokes on national economies in Asia-Pacific is significant. For example, China will lose US$558bil (RM1,674bil) in national income due to the combined consequences of heart disease, stroke, and diabetes.

More significantly, the impact of stroke is predicted to rise dramatically as the number of individuals affected by AF is expected to increase due to an ageing population and improved survival of patients with conditions which predispose to AF (eg heart attack).