A real chance to reduce death and disability from stroke

 Still totally fucking useless, we have NO leadership in stroke that will direct this work to be done.  This is just lips flapping in the breeze!

A real chance to reduce death and disability from stroke

• The Lancet Neurology

Published:August, 2024DOI:https://doi.org/10.1016/S1474-4422(24)00283-7

Stroke remains a major cause of death and disability worldwide, despite developments such as thrombolysis and endovascular thrombectomy. As highlighted at the 77th World Health Assembly (WHA) on May 27, 2024, in a side-event organised by the World Stroke Organization (WSO), stroke prevention and care(NOT RECOVERY!) need to improve. Guidance for policy makers on how they can tackle this challenge and reduce the burden of stroke, along with that of other neurological disorders, has been developed by WHO as an Implementation Toolkit to accompany their Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022–2031 (IGAP). By making neurological disorders, including stroke, a higher priority, policy makers(We need DOERS INSTEAD!) have an excellent opportunity to save and improve the lives of many people.

Stroke is estimated to have caused more than 7 million deaths in 2021, when it was the third leading cause of death after ischaemic heart disease and COVID-19. According to the WSO–Lancet Neurology Commission, the number of deaths caused by stroke is expected to rise to nearly 10 million in 2050, and about 90% of these deaths are expected to occur in low-income or middle-income countries. Among neurological disorders, stroke is already the leading cause of disease burden, assessed as disability-adjusted life years, globally and in almost all regions. Total global direct and indirect costs of stroke were estimated to be around US$900 billion in 2017, possibly reaching more than US$1500 billion by 2050. But, according to WSO, “We have the ability to change this.”

The WSO event—entitled United in Action to Transform care(NOT RECOVERY!)—was the first ever WHA satellite session dedicated specifically to stroke. Its aim was to raise awareness(WHAT FUCKING BULLSHIT! At a minimum lay out a strategy to get stroke solved to 100% recovery!) of the burden of stroke among policy makers, to highlight advances in treatment and their potential health and economic benefits, and to argue for the role of stroke care(NOT RECOVERY!) in achieving health for all, echoing the theme of the 77th WHA: All for Health, Health for All. The WSO event report makes five recommendations for policy makers: to assess gaps and prioritise stroke care(NOT RECOVERY!) in global, national, and regional health plans; to invest in infrastructure to support services, including thrombolysis and thrombectomy; to increase skills in the workforce; to ensure that payment structures can support state-of-the-art stroke care(NOT RECOVERY!); and to build a strategy to apply savings related to state-of-the-art acute stroke care(NOT RECOVERY!) downstream in health systems.

State-of-the-art acute stroke care(NOT RECOVERY!) with thrombolysis and mechanical thrombectomy have proven benefits for many people with stroke and, since 2023, have been included in the WHO list of cost-effective interventions for noncommunicable diseases; endovascular thrombectomy has a has a number needed to treat to reduce disability of 2·6, and improved blood pressure control could avert 120 million strokes between 2023 and 2050. Yet, according to WSO, many of these chances to avert stroke or improve outcomes are not being taken, for reasons that vary between countries and can include scarcity of specialist health-care professionals and equipment, and logistical issues such as distances to specialist centres.

The WSO event, the WSO–Lancet Neurology Commission, and the WHO Implementation Toolkit all suggest practical ways in which stroke prevention and services might be improved. The Implementation Toolkit is intended to help WHO Member States meet the targets of the IGAP and promotes an integrated approach, in terms of considering all neurological disorders and working across health policy and services, given that people often have multiple conditions that share risk factors. The Implementation Toolkit not only provides broad advice, such as on how to engage with stakeholders, including those with lived experience, and how to do a situational analysis, but also presents disorder-specific approaches. For stroke, the recommended actions cover policy (eg, addressing national capacity for prevention, prioritising stroke in budgets, integrating stroke into social and development agendas, and raising public awareness), clinical care(NOT RECOVERY!) (eg, establishing national guidelines for acute treatment, ensuring provision of neuroimaging and neurosurgical facilities, and establishing rehabilitation services), prevention (eg, promoting brain health throughout life, including reducing hypertension), and research.

With the call to action from WSO and new guidance from WHO, in addition to recommendations in the WSO–Lancet Neurology Commission, policy makers have an ideal opportunity to reduce the burden and costs of stroke in their countries and regions, and to prevent many deaths and much disability. The burden of neurological disorders, and particularly stroke, must be reduced if we are to achieve “health for all”.