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New Health Report Exposes Imminent Risk of a Stroke Crisis in Europe

Wednesday, December 9, 2009 Press Release J E 4
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Urgent coordinated action is needed to avoid the thousands of preventablestrokes that leave many atrial fibrillation (AF) patients mentally andphysically disabled or dead, every year. A report, How Can We Avoid a StrokeCrisis?, launched in the European Parliament today by Action for StrokePrevention, a group of health experts from across Europe, proposes measuresto tackle stroke in patients with AF, the most common, sustained abnormalheart rhythm and a major cause of stroke[1]. Their proposal, endorsed by 17leading European medical professional and patient organisations, calls for EUpolicy makers and Member State governments to act before the increasingfrequency of these strokes becomes a major public health crisis.

The Report warns of a stroke epidemic across Europe, if actions are nottaken now to slow the rising tide of preventable strokes occurring everyyear. Linda McAvan, Member of the European Parliament (MEP), commented, "Itis important that government and healthcare policy makers take action toaddress the unmet medical needs in stroke prevention. I support therecommendations made in the Report by Action for Stroke Prevention, andbelieve that their implementation will contribute to the prevention of strokein patients with AF and, in turn, reduce the dramatically increasingclinical, economic and social burden of stroke in Europe."

Recommendations made by the Report include: improving patient educationand stroke risk assessment, taking new approaches to prevention, facilitatingthe exchange of best practice between Member States, developing strategies tosupport adherence to guidelines, and the provision of equal and adequateadministration of therapy for patients with AF.

Unmet medical need to prevent stroke in atrial fibrillation patients

"It is clear that there is an unmet medical need for stroke prevention inatrial fibrillation patients," said Professor Gregory Lip, Professor ofCardiovascular Medicine, from the University of Birmingham Centre forCardiovascular Sciences, City Hospital Birmingham, UK. "The majority of suchstrokes are preventable but the under-diagnosis and poor management of AFpatients, as well as suboptimal use of anticoagulation and side-effects ofcurrent treatments, mean that an unnecessary and heavy burden is placed onpatients, their families and carers, as well as our healthcare systems."

Stroke is the most common cardiovascular disorder after heartdisease[11]. Current trends predict that the number of strokes in the EU willrise from 1.1 million per year in 2000 to 1.5 million per year by 2025[12].Furthermore, AF related strokes are more severe, cause greater disability andhave a worse outcome than strokes in patients without AF. People who have astroke caused by AF are more likely to remain in hospital for longer, areless likely to be discharged to their home and are 50% more likely to remaindisabled[3],[13].

"The impact of the physical, emotional and cognitive disability onpatients following a stroke can be considerable," said Eve Knight, CEO,AntiCoagulation Europe. "In turn, this can also have a profound impact on thequality of life for the carer and family, who can suffer emotional problemssuch as depression and anxiety."

The impact of stroke also stretches our healthcare systems. The economicburden it creates accounts for 2-3% of total healthcare expenditure in theEuropean Union[6]. Healthcare costs associated with stroke are higher forpatients with AF than for patients without AF[14]. AF is a strong independentrisk factor for stroke and accounts for 15-20% of all ischaemic strokes(strokes caused by blood clots)[2,3].

The number of people suffering from AF is around six million in Europealone[1]. People with AF are an important target population for reducing theoverall burden of stroke, which has been identified by the Heart HealthCharter and European Union policy as a key need in Europe[15].

About AF and stroke

AF is the most common, sustained abnormal heart rhythm[1]. It causes thetwo upper chambers of the heart (the atria) to quiver instead of beatingeffectively, resulting in blood not being completely pumped out, which inturn causes pooling and can lead to clotting in the atria. If a blood clotleaves the atria, it can become lodged in an artery in the brain blocking theblood supply and causing the patient to suffer from an ischaemic stroke[16].Approximately one in five ischaemic strokes are due to AF[3].

AF-related strokes are more severe, cause greater disability and have aworse prognosis than strokes in patients without AF[3]. Although the currenttreatment for stroke--vitamin K antagonists such as warfarin--can beeffective, they are also associated with a number of drawbacks and arecurrently underused in Europe, especially in elderly patients at greatestrisk of stroke[17].

Preventing AF in patients at risk of arrhythmia, diagnosing AF before thefirst stroke occurs and following recommendations regarding the use ofanticoagulation therapies, including potential new treatment options, arecritical for effective prevention of AF-related strokes[10].

About the Report

The authors are global leaders in cardiology, neurology, healtheconomics, policy and patient advocacy.

References

[1] Kannel WB, Benjamin EJ. Status of the epidemiology of atrialfibrillation. Med Clin North Am 2008;92:17-40

[2] Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a majorcontributor to stroke in the elderly. The

Framingham Study. Arch Intern Med 1987;147:1561-4

[3] Marini C, De Santis F, Sacco S et al. Contribution of atrialfibrillation to incidence and outcome of ischemic stroke: results from apopulation 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 caregivingafter stoke: the impact on caregivers' quality of life. J Neurosci Nurs2006;38:354-60

[6] Allender S, Scarborough P, Peto V et al. European cardiovasculardisease statistics 2008 edition.http://www.heartstats.org/uploads/documents%5Cproof30NOV2007.pdf. AccessedNovember 2009

[7] Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrialfibrillation in adults: national implications for rhythm management andstroke prevention: the AnTicoagulation and Risk Factors in AtrialFibrillation (ATRIA) Study. JAMA 2001;285:2370-5

[8] Miyasaka Y, Barnes ME, Gersh BJ et al. Secular trends in incidence ofatrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, andimplications on the projections for future prevalence. Circulation2006;114:119-25

[9] Briffa T, Hickling S, Knuiman M, et al. Long term survival afterevidence based treatment of acute myocardial infarction andrevascularisation: follow-up of population based Perth MONICA cohort,1984-2005. BMJ 2009;338:b36

[10] Kirchhof et al. Early and comprehensive management of atrialfibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on AFentitled 'Research perspectives in AF', EurHJ 2009

[11] World Health Organization. The global burden of disease: 2004update.http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html. Accessed November 2009

[12] Truelsen T, Piechowski-Jozwiak B, Bonita R et al. Stroke incidenceand prevalence in Europe: a review of available data. Eur J Neurol2006;13:581-98

[13] Lamassa M, Di Carlo A, Pracucci G et al. Characteristics, outcome,and care of stroke associated with atrial fibrillation in Europe: data from amulticenter multinational hospital based registry (The European CommunityStroke Project). Stroke 2001;32:392-8

[14] Bruggenjurgen B, Rossnagel K, Roll S et al. The impact of atrialfibrillation on the cost of stroke: the Berlin acute stroke study. ValueHealth 2007;10: 137-43

[15] Health-EU: Cardiovascular disorders.http://ec.europa.eu/health-eu/health_problems/cardiovascular_diseases/index_en.htm. Accessed November 2009

[17] Olsson SB, Helperin J. Prevention of stroke in patients with atrialfibrillation. Seminars in Vascular Medicine 2005;5(3):285-92BRUSSELS, December 9 /PRNewswire/ -- - A report launched today by experts from medical and patient communities calls on Europe's policy makers to take urgent action against preventable strokes that strike thousands of atrial fibrillation (AF) patients each year - Affecting over six million people in Europe[1], AF, the most common, sustained abnormal heart rhythm, increases the risk of stroke five- fold[2] and is responsible for 15-20% of all strokes caused by blood clots (ischaemic stroke)[2],[3] - The consequences of stroke can devastate not only a patient's quality of life[4], but also that of families and carers[5] - The economic burden of stroke on the European economy is estimated at a staggering EUR 38 billion per annum[6] - 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[7],[8] due to an ageing population[7] and improved survival of patients with conditions which predispose AF (e.g. heart attack) [9] - Many AF-related strokes could be prevented by earlier detection and improved treatment of AF[10]

SOURCE Action for Stroke Prevention (ASP) Alliance
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