Pragmatic Solutions to Reduce the Global Burden of Stroke: Key Points

Feigin VL, Owolabi MO, on behalf of the World Stroke Organization–Lancet Neurology Commission Stroke Collaboration Group.
Pragmatic Solutions to Reduce the Global Burden of Stroke: A World Stroke Organization–Lancet Neurology Commission. Lancet Neurol 2023;Oct 9:[Epub ahead of print].

The following are key points to remember from the World Stroke Organization–Lancet Neurology Commission on pragmatic solutions to reduce the global burden of stroke:

  1. Stroke is the second leading cause of death, the third leading cause of disability, and a leading cause of dementia worldwide. The age-standardized incidence of stroke in younger individuals (i.e., <55 years) is increasing in both high-income countries and in low-income and middle-income countries.
  2. The absolute number of people affected by stroke has almost doubled during the past three decades, with >86% of the stroke burden in low-income and middle-income countries. The global burden of stroke (i.e., deaths and disability-adjusted life-years) will continue to grow, with widening gaps between high-income countries and poorer countries.
  3. Multiple factors contribute to the high burden of stroke in low-income and middle-income countries, including undetected and uncontrolled hypertension, lack of easily accessible, high-quality health services, insufficient attention to and investment in prevention, air pollution, population growth, unhealthy lifestyles (e.g., poor diet, smoking, sedentary lifestyle, obesity), an earlier age of stroke onset and greater proportion of hemorrhagic strokes than in high-income countries, and the burden of infectious diseases resulting in competition for limited health care resources.
  4. There is a need to incorporate stroke event and risk factor surveillance into national stroke action plans and establish low-cost surveillance systems, ideally within existing systems for noncommunicable diseases, to adequately guide prevention and treatment. Regular national risk factor surveillance for stroke can be embedded in national censuses.
  5. Furthermore, there is a need to establish an intersectoral system for population-wide primordial, primary, and secondary stroke prevention. Preventive strategies, with emphasis on lifestyle modification, should be implemented for people at any level of risk of stroke and cardiovascular disease. Primary and secondary stroke prevention services should be freely accessible and supported by universal health coverage, with access to affordable drugs for management of hypertension, dyslipidemia, diabetes, and clotting disorders.
  6. Governments must allocate a fixed proportion of their annual health care funding for prevention of stroke and related noncommunicable diseases. This funding could come from taxation of tobacco, salt, alcohol, and sugar.
  7. Public awareness should be raised to encourage a healthy lifestyle and prevent stroke via population-wide deployment of digital technologies (a so-called motivational mass individual strategy for stroke prevention) with simple, inexpensive screening for cardiovascular disease and modifiable risk factors. This strategy should be reinforced by health care professionals through digital technologies for person-centered primary and secondary prevention of stroke and cardiovascular disease, linked to national electronic health databases.
  8. Effective planning of acute stroke care services should be prioritized with capacity building, training, and certification of a multidisciplinary workforce; provision of evidence-based equipment and affordable medicines; and adequate resource allocation at national and regional levels.
  9. Acute care networks across the pillars of the quadrangle of resources should be integrated, including surveillance, prevention, and rehabilitation services, by involving all relevant stakeholders (i.e., communities, policy makers, nongovernmental organizations, national and regional stroke organizations, and public and private health care providers) in the stroke care continuum.
  10. Finally, multidisciplinary rehabilitation services should be established and adapt evidence-based recommendations to the local context, including the training, support, and supervision of community health care workers and caregivers to assist in long-term care.

Clinical Topics: Prevention

Keywords: Delivery of Health Care, Secondary Prevention, Socioeconomic Factors, Stroke, Vascular Diseases

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