Leading experts call for urgent action to avoid stroke crisis across Asia-Pacific region

Experts from medical and patient communities call on national policymakers in the Asia-Pacific region to take urgent action against preventable strokes that strike millions of people with atrial fibrillation (AF) each year

Countries in the Asia-Pacific region carry a disproportionate share of the burden of stroke with millions of people affected; a burden that will grow as life expectancy rises1

AF, the most common, sustained abnormal heart rhythm, increases the risk of stroke five-fold and is responsible for 15-20% of all strokes, and for 20% of all ischaemic strokes (caused by a blood clot blocking a blood vessel in the brain)2,3,4,5

The consequences of stroke can devastate not only a patient’s life, but also that of families and carers.6,7

Long-term help and care is required
for most survivors

The economic implications of stroke are significant. For example, in China, the overall mean cost of hospitalization for stroke in 2010 equated to more than half the average annual wage8

The impact of stroke is predicted to rise dramatically as the number of individuals affected by AF is expected to increase 2.5 fold by 2050, due to an ageing population and improved survival of patients with conditions which predispose AF (e.g., heart attack)9,10

Kuala Lumpur, 6 May 2011 /PRNewswire/ — 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 report, launched today 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 Asia-Pacific patients with AF, the most common, sustained abnormal heart rhythm and a major cause of stroke.2 The report’s recommendations are endorsed by 32 leading Asia-Pacific and other global medical societies and patient organizations, reinforcing and recognizing 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. Dr. Sim Kui Hian, Head, Department of Cardiology and Head, Clinical Research Centre, Sarawak General Hospital, Malaysia, 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.”

Recommendations made by the Report include:

  • Improving awareness of the impact of AF and AF-related stroke
  • Developing methods for early and adequate diagnosis of AF and stroke risk assessment
  • Taking new and better approaches to prevent stroke in patients with AF
  • Facilitating the exchange of best practice between national governments in the Asia-Pacific region
  • Developing strategies to support adherence to guidelines
  • Providing equal and adequate administration of therapy for patients with AF across countries in the Asia-Pacific region
  • Advancing 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.12 Approximately five million of these suffer permanent disabilities and over five million more die, accounting for 10 percent of all deaths worldwide.12-14

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.14 In the same year, the number of first-ever strokes was 5.1 million across these regions.15 This was higher than the estimated number of new cases of cancer.15

People who suffer a stroke caused by AF are more likely to remain in the hospital longer, are less likely to be discharged home, and are 50 percent more likely to remain disabled16,17 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.18,19

“Every year millions of people with AF who suffer a stroke are left disabled, regardless of their age,” said Trudie Lobban, Founder and Trustee, Arrhythmia Alliance, and Co-founder and CEO, Atrial Fibrillation Association. “If we do not suffer with AF 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 $558 billion in national income due to the combined consequences of heart disease, stroke, and diabetes.20

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 AF (e.g., heart attack).

About AF and stroke

AF is the most common, sustained abnormal heart rhythm.2 It causes the two upper chambers of the heart (the atria) to 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.21 Approximately one in five ischaemic strokes are due to AF.5

AF-related strokes are more severe, cause greater disability and have a worse prognosis than strokes in patients without AF.16 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.22

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.11

About the Report

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

The Report’s call-to-action and recommendations are endorsed by:

Action for Stroke Prevention is supported by an educational grant from Bayer HealthCare. The report, and all related materials, has been determined by the authors independently of Bayer HealthCare

References

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  3. Marini C, De Santis F, Sacco S et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population based study. Stroke 2005;36:1115-19
  4. Wolfe CD. The impact of stroke. Br Med Bull 2000;56:275-86
  5. White CL, Poissant L, Cote-LeBlanc G, et al. Long-term caregiving after stoke: the impact on caregivers’ quality of life. J Neurosci Nurs 2006;38:354-60
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  10. Kirchhof et al. Early and comprehensive management of atrial fibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on AF entitled ‘research perspectives in AF’, EurHJ 2009
  11. World Health Organization. The global burden of disease: 2004 update. www.who.int/healthinfo/global_burden_ disease/2004_report_update/en/index.html. Accessed November 2009
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  14. Bruggenjurgen B, Rossnagel K, Roll S et al. The impact of atrial fibrillation on the cost of stroke: the Berlin acute stroke study. Value Health 2007;10: 137-43
  15. Health-EU: Cardiovascular disorders. http://ec.europa.eu/health-eu/health_problems/cardiovascular_diseases/index.htm.Accessed November 2009
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  18. Zhou Z, Hu D. An epidemiological study on the prevalence of atrial fibrillation in the Chinese population of mainland China. J Epidermiol 2008;18:209-16
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  20. World Health Organization. Cardiovascular diseases (CVDs): Fact sheet N°317. 2011 http://www.who.int/mediacentre/factsheets/fs317/en/index.html. Accessed March 2011
  21. NHS Choices. Atrial fibrillation. 2009. www.nhs.uk/conditions/Atrial-fibrilation. Accessed March 2011
  22. Hylek EM. Contra: ‘Warfarin should be the drug of choice for thromboprophylaxis in elderly patients with atrial fibrillation’. Caveats regarding use of oral anticoagulation therapy among elderly patients with atrial fibrillation. Thromb Haemost 2008;100:16-7

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