Study also finds stroke death rates levelling off or increasing in some countries.

New research, published today (Wednesday 15 August) in the European Heart Journal, has found that death rates from stroke, are declining overall in Europe. However, in some countries this decline is levelling off and in others the death rates are even increasing.

Cerebrovascular disease includes strokes, mini-strokes, and narrowing, blockage or rupturing of the blood vessels supplying blood to the brain, and it is the second single largest cause of death in Europe after heart disease, accounting for 9 per cent of deaths in men and 12 per cent of deaths in women each year.

This new study used data from the World Health Organization (WHO) to examine death trends for three types of stroke in Europe between 1980 and 2016. These were: ischaemic stroke (where a clot leads to a lack of blood flow to the brain), haemorrhagic stroke (bleeding in the brain) and sub-arachnoid haemorrhage (SAH), in which bleeding occurs in the space between the brain and tissue that covers the brain. Not all countries had data available for the full 37 years.

The researchers, led by Dr Nick Townsend, Associate Professor in Public Health Epidemiology at the University of Bath in the UK, found that across the whole of the WHO European region for the most recent period for which data were available, there had been significant decreases in death rates from all three types of stroke in 33 (65%) countries for men and women.

However, there had been increases in three countries (6%) for men (Azerbaijan, Georgia and Tajikistan) and in two countries (4%) for women (Azerbaijan and Uzbekistan).

The findings also revealed evidence of a recent plateau or levelling off in trends (where the rate of reductions in mortality in the most recent period was less pronounced than in the previous period) in seven countries in men (Austria, Denmark, France, Germany, Greece, Czech Republic and Hungary) and six countries in women (Austria, Belgium, France, Germany, Ireland and Switzerland).

There were also a number of countries (eight in men and ten in women) in which death rates showed no change over the most recent period. This means that in both sexes, more than one third of countries showed either a slowing of the decrease in death rates, no decrease, or an increase in the most recent trend, the study revealed.

According to Dr Townsend, “Over the last 35 years there have been large overall declines in deaths from cerebrovascular disease in the majority of European countries. While these declines have continued in more than half of the countries, these have not been consistent across Europe and our analysis has revealed evidence of recent plateauing and even increases in stroke deaths in certain countries. We have seen this in both sexes and in countries across the whole of Europe, particularly in eastern and central Europe and central Asia. We have also found differences in death rates by stroke type. Therefore, it is not enough to consider cerebrovascular disease as just one condition and we must consider each individual stroke type.

“Many countries have been able to reduce the mortality burden from stroke in recent years. We must understand why this is not happening in all countries and identify barriers to the implementation of evidence-based recommended practice in countries that are slow to adopt them. In addition, we only studied between-country inequalities, but we must consider within-country inequalities as well if we are to have an impact on the disease.”

Commenting on the findings Mr Chris Macey, Head of Advocacy at the Irish Heart Foundation said, “Significant reductions in death and discharge to long-term care have been achieved by Ireland’s stroke services with minimal investment. While mortality continues to fall, the rate of severe disability and therefore the cost of stroke is rising again, however. This can be linked directly to a lack of investment in services in the face of an annual increase in the stroke rate of around 2.5 per cent. And with an estimated increase of 59 per cent in stroke incidence by 2030 looming, we now face a rapid deterioration in outcomes and an over spill that will significantly affect patients across the acute care system.

“In order to address this, we need investment that we can show will improve outcomes, future proof services and ultimately reduce overall costs. The main actions required include completing the stroke unit network so that at least 90 per cent of stroke patients spend at least 90 per cent of their hospital stay in stroke units ; national roll-out of early supported discharge programmes which get people home quicker after stroke; and the development of clot retrieval treatment called thrombectomy which has proved to massively reduce risk of death and severe disability.”

“Reductions in deaths in the midst of increasing numbers of strokes being suffered means that more people are returning home after stroke than ever. But their recoveries are being squandered by the failure to deliver the therapy services either in hospital or the community that will help rebuild their lives. This makes no sense either from a moral or economic viewpoint,” Mr Macey added.

“Epidemiology report: trends in sex-specific cerebrovascular disease mortality in Europe based on WHO mortality data”, by Rushabh Shah et al. European Heart Journal. doi:10.1093/eurheartj/ehy378