New Report Confirms Europe is on the Brink of a Stroke Crisis
Europe remains at risk of a devastating stroke crisis, according to a major new Report, “How Can We Avoid a Stroke Crisis in Europe?” published today, on World Stroke Day, by Action for Stroke Prevention (ASP). Alarmingly, the Report highlights that the first time many people will find out they have AF is when they have a stroke. Furthermore, approximately 70% of patients with known AF who had a stroke caused by a blood clot were not receiving anticoagulant therapy to prevent AF-related stroke at the time. iv v vi With stretched healthcare budgets and the annual cost of stroke in Europe at approximately €64 billion, more needs to be done to reduce the number of these serious, costly, and yet preventable strokes.
In addition to their Report, ASP has launched two supplementary Reports for healthcare decision makers and healthcare professionals respectively, that provide concrete action steps that can be taken at a community level to reduce the personal and economic impact of AF-related stroke.
Reducing a Preventable Burden: Effecting Change
“We need to ensure that AF is recognised as a serious risk factor for stroke in national prevention plans and that concrete actions are defined in these plans that support earlier diagnosis and improved awareness, education and prevention,” said world-renowned Cardiology expert, John Camm, Professor of Clinical Cardiology at St George’s University, London, UK. “It is our hope that national governments will address this as they plan how to meet the United Nations’ commitment to reduce non-communicable diseases by 25% by the year 2025.”
The critical challenge is for key parties – healthcare professionals, policy-makers, medical societies, patient advocacy groups and industry alike – to work together to reduce the burden of AF-related stroke.
Recommendations made by the Report and supporting supplementary Reports include:
- improving public awareness and understanding of AF and the risk of AF-related stroke
- implementing effective practice standards and targets for healthcare professionals; for example, targets for AF screening
- facilitating the exchange of best practice between Member States
- developing strategies to support adherence to clinical guidelines and the provision of equal and adequate administration of therapy for people with AF
Cecilia Wikström, Member of European Parliament (MEP) and a co-author of the Report’s foreword commented, “I support the recommendations made by Action for Stroke Prevention and believe it is important that they are addressed in stroke, cardiovascular and non-communicable disease strategies. Their implementation will contribute to the prevention of stroke in people with AF and, in turn, reduce the dramatically increasing clinical, economic and social burden of stroke in Europe. It is important that governments and healthcare policy makers take action to ensure that diagnosis and appropriate treatment are available to all European citizens.”
Lack of Knowledge Increases Risk
A new IPSOS MORI survey of 9,211 people from 20 countries across the globe has underlined the urgent need to act on Action for Stroke Prevention’s recommendations. Findings in Europe highlight that whilst nearly a third (31%) of people fear having a stroke above somevii other serious health conditions including heart disease, diabetes and high cholesterol, 52% of people in Europe have not heard of AF. Worryingly, the survey also revealed that 85% of people in Europe are unaware that AF is a serious risk factor for stroke. Whilst 65% of Europeans identified high blood pressure as a stroke risk factor, only 15% know that AF is a risk factor for stroke, despite AF increasing the risk of stroke more than high blood pressure.
“Awareness of AF is very low and the detection and management of AF is poor,” said Eve Knight, Chief Executive and Co-Founder of the Charity AntiCoagulation Europe. “If we do not act now to ensure people are diagnosed prior to a stroke and get access to treatment, including the non-Vitamin K Antagonists now available, the situation will only get worse as the number of people with AF is predicted to vastly increase.”
Despite the availability of clinical practice guidelines, such as the European Society of Cardiology Guidelines on AF, adherence to them is poor and there remains a chronic under-use of effective stroke prevention therapies in AF, with several studies reporting anticoagulant use in <50% of people with AF who are at high risk of stroke.
IPSOS MORI’s survey showed that, perhaps unsurprisingly, only 16% of the general public worldwide are aware that the risk of AF-related stroke can be reduced with anticoagulant treatment, demonstrating the need for education to enable patients to participate in their own healthcare decisions. The recommendations and actions identified by Action for Stroke Prevention must be initiated now, otherwise millions of more lives will be devastated by AF-related stroke.
About AF and Stroke
- Stroke is a major public health issue. It is the second biggest cause of cardiovascular death, after ischaemic heart disease, killing an estimated 1.3 million people in Europe every year (14% of all deaths) and 6.2 million people worldwideviii
- It is a condition which on its own represents the third single most common cause of death in industrialised countriesix
- Atrial fibrillation (AF) is the most common sustained heart rhythm abnormalityx and is a strong independent risk factor for strokexi
- Patients with AF are five times more likely to have a stroke compared with the general populationxii
- AF occurs when the upper chambers of the heart (the atria) tremble rapidly and irregularly.xiii This leads to blood stasis or pooling within the atriaxiii xiv, which can result in the development of blood clots. These clots can subsequently break away from the atria and travel to vessels in the brain causing a stroke
- In Europe an estimated 10 million people have AFi and AF-related stroke is a growing health epidemic due to Europe’s ageing population, and as survival after conditions that predispose to AF (such as heart attack) improvesxv
About the Reports
The authors are global leaders in cardiology, neurology, primary care, health economics and patient advocacy.
The Report foreword has been written by the following Members of the European Parliament (MEP); Liam Aylward (ALDE, Ireland), Cristian Silviu Buþoi (ALDE, Romania), Jim Higgins (EPP, Ireland), Antigoni Papadopoulou (S&D, Cyprus), Cecilia Wikström (ALDE, Sweden).
To support implementation of the How Can We Avoid a Stroke Crisis in Europe? Report’s recommendations there are two supplementary Reports: Stroke in Patients with Atrial Fibrillation across Europe: a Preventable Problem and Stroke in Patients with Atrial Fibrillation across Europe: an Avoidable Burden. These Reports can be viewed and downloaded via http://slideshare.net/actionforstrokeprevention
Collectively, the Reports are endorsed by 93 leading medical professional and patient organisations.
ASP has been initiated and funded by Bayer HealthCare as an independent alliance of experts with the aim to increase the awareness of atrial fibrillation and the associated risk of stroke. These Reports have been produced by ASP with the aid of financial support from Bayer HealthCare. Bayer HealthCare has also been given the opportunity to comment upon the reports from a regulatory and compliance perspective. However, the content of these reports has been determined and full editorial control retained by the authors, independently of Bayer HealthCare, in order to ensure the independence of the reports and outputs of the group. The views expressed in this publication are not necessarily those of the sponsor.
About the IPSOS MORI survey
On behalf of Bayer HealthCare, Ipsos MORI interviewed 9,211 adults aged 40+ across 20 countries – UK (501), Germany (500), Spain (500), Italy (502), France (500), Portugal (400), Ireland (404), Russia (500), Bulgaria (400), Poland (500), Hungary (501), China (501), South Korea (501), Taiwan (500), Malaysia (401), Indonesia (400), Mexico (400), Argentina (500), Brazil (400) and Colombia (400). The European sample consists of UK, Germany, Spain, Italy, France, Portugal, Ireland, Russia, Bulgaria, Poland, Hungary (5,208).
Interviews in all markets except Bulgaria were conducted by telephone; in Bulgaria interviews were face to face. All interviews were conducted between 3rd – 17th September 2012.
Quota controls were set upon the interviews to the known population profile of this audience (40+ years of age) for age, sex and region. Population data source: Eurostat, 2011 and NRS July 2011-June 2012 (UK); Eurostat, 2011 (Germany); Eurostat, 2011 (Spain); Istat (national statistic office), 2011 (Italy); Eurostat, 2011 (France); INE, Estimativas Anuais da População Residente. National Statistics Institute. 2010 Annual estimation of resident Population, 2011 (Portugal); Eurostat, 2011 (Ireland); Census 2010 (Russia); Census 2011 (Bulgaria); Central Statistical Office 2011 (Poland); Microcensus 2005 (Hungary). Please note that all UK data has been weighted. This has been done in accordance to publically available statistics relating to the representation of the 40+ population in the UK in terms of age, gender, education and region.
In Spain, “stroke” was translated “apoplejia” in the local version of the questionnaire for questions 3, 4, 7 and 8.
i Stefansdottir H, Aspelund T, Gudnason V et al.
Trends in the incidence and prevalence of atrial fibrillation in Iceland
and future projections. Europace 2011;13:1110-7
ii Wolfe C, Rudd A. The Burden of Stroke White Paper: raising awareness of the global toll of stroke-related disability and death. 2007. http://www.safestroke.org/Portals/10/FINAL Burden of Stroke.pdf. Accessed October 2012
iii 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; 36:1115–9
iv Ahmad O et al. Intern Med J 2009;39:752–756
v Hannon N et al. Cerebrovasc Dis 2010;29:43–49
vi Palm F et al. Eur J Neurol 2012
vii Conditions listed were blood clots, heart disease, stroke, atrial fibrillation, high blood pressure, high cholesterol and diabetes.
viii World Health Organisation. Cause-specific mortality: regional estimates for 2008 http://www.who.int/gho/mortality_burden_disease/global_burden_disease_DTH6_2008.xls. Accessed September 2012
ix European Stroke Organisation. Stroke facts. http://www.eso-stroke.org/stroke_facts.php?cid=5. Accessed September 2012
x Kannel WB, Benjamin EJ. Status of the epidemiology of atrial fibrillation. Med Clin North Am 2008;92:17-40
xi Benjamin E, Wolf P, D'Agostino R, et al. Impact of Atrial Fibrillation on the Risk of Death. Circulation 1998;98:946-952
xii Kannel WB, Wolf PA, Benjamin EJ, et al. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 1998;82:2N-9N
xiii Falk RH. Atrial fibrillation. N Engl J Med 2001;344:1067-1078
xiv Camm AJ, Kirchhof P, Lip GYH et al. Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010;31:2369-2429
xv Briffa T, Hickling S, Knuiman M, et al. Long term survival after evidence based treatment of acute myocardial infarction and revascularisation: follow-up of population based Perth MONICA cohort, 1984-2005. BMJ 2009; 338:b36