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:

- ADKA (The German Society of Hospital Pharmacists)
- Anticoagulation Europe
- Arrhythmia Alliance
- Arrhythmia Alliance China
- Arrhythmia Alliance Japan
- Asian Pacific Society of Cardiology
- Atrial Fibrillation Association
- Atrial Fibrillation Association Australia
- Cardiac Society Myanmar Medical Association
- Chinese College of Cardiovascular Physician
- Chinese Society of Cardiology
- Chinese Society of Pacing and Electrophysiology
- Clinical Research Center for Stroke, Korea
- European Heart Rhythm Association
- European Primary Care Cardiovascular Society
- European Stroke Conference
- German Competence Network on Atrial Fibrillation (AFNET)
- Heart Association of Thailand
- Hong Kong College of Cardiology
- Indonesian Heart Association
- Japanese Organization of Clinical Research Evaluation and Review
- Korean Stroke Society
- Lao Cardiac Society
- Malaysian Medical Association
- National Heart Association of Malaysia
- National Heart Foundation of Australia
- National Stroke Foundation of Australia
- Philippine Heart Association
- StopAfib
- Taiwan Stroke Association
- Taiwan Stroke Society
- World Stroke Organization

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

1. Liu LS, Caguioa ES, Park CG et al. Reducing stroke risk in hypertensive patients: Asian Consensus Conference recommendations. Int J Stroke 2006;1:150-7

2. Kannel WB, Benjamin EJ et al. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 1998;82:457-507

3. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983-8

4. American College of Cardiology. CardioSmart. Atrial fibrillation. 2010

5. 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

6. Wolfe CD. The impact of stroke. Br Med Bull 2000;56:275-86

7. White CL, Poissant L, Cote-LeBlanc G et al. Long-term caregiving after stroke: the impact on caregivers' quality of life. J Neurosci Nurs. 2006;38:354-60

8. Wei et al. Variations and determinants of hospital costs for acute stroke in China. PLoS One 2010;28; 5(9):e13041. doi:10.1371/journal.pone.0013041

9. Go AS, Hylek EM, Phillips KA et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management

10. Murphy NF, Simpson CR, Jhund PS et al. A national survey of the prevalence, incidence, primary care burden and treatment of atrial fibrillation in Scotland. Heart 2007;93:606-12

11. 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

12. Wolfe C, Rudd A. The Burden of Stroke White Paper: Raising awareness of the global toll of stroke-related disability and death, 2007. See here. Accessed March 2011

13. World Health Organization. The Atlas of Heart Disease and Stroke. 2004 See here. Accessed March 2011

14. World Health Organization. The global burden of disease: 2004 update. Disease and injury regional estimates for 2004. Prevalence for WHO regions. 2008. See here. Accessed March 2011

15. World Health Organization. The global burden of disease: 2004 update. 2008 See here. Accessed March 2011

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

17. Jørgensen HS, Nakayama H, Reith J et al. Acute stroke with atrial fibrillation. The Copenhagen Stroke Study. Stroke 1996;27:1765-9

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

19. Hu D, Sun Y. Epidemiology, risk factors for stroke, and management of atrial fibrillation in China. JACC 2008;52:865-8

20. World Health Organization. Cardiovascular diseases (CVDs): Fact sheet N°317. 2011 See here. Accessed March 2011

21. NHS Choices. Atrial fibrillation. 2009. See here. 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

Source:
Action for Stroke Prevention

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