Increasing burden of stroke in young people a particular concern

Stroke threatens everyone and its increasing burden in young people has been highlighted as a “particular concern,” by a number of international specialty societies for neurology and brain health.

In a joint statement issued recently, the World and European Stroke Organisations (WSO and ESO), the World Federation and the European Academy of Neurology (WFN and EAN) said that stroke now ranked the 2nd greatest cause of disability and death worldwide and “threatens everyone”.

Stroke also causes paralysis of limbs, impairs vision, gait, language and cognition and contributes to dementia, they added.

According to the statement, “of particular concern is the increasing stroke burden in young adults and its effect on keeping employment, as more than 40 per cent of working age adults with stroke fail to return to work.”

Commenting Mr Chris Macey, Head of Advocacy at the Irish Heart Foundation said, “Our own research in Ireland has shown the alarming extent to which younger stroke survivors are being abandoned after their hospital stay is over. Community rehabilitation services that are vital to address the often profound physical and psychological impact of their stroke are grossly inadequate. The vast majority of working age survivors either don’t return to work or cannot retain employment for the want of often basic supports. And homecare packages are almost always designed to meet the needs of older people even for someone in their 30s who may be living with the effects of stroke for half a century.”

The WSO, ESO, WFN, EAN joint statement also highlighted that the burden of stroke disproportionately affected people living in countries with limited resources, and this included Europe.

“Most stroke survivors carry lifelong physical, cognitive, mental, and socio-economic burdens. A significant proportion of European and Global NCD burden can be attributed to stroke and stroke-related dementia. This issue of NCDs, including stroke and dementia, is highlighted at this month’s UN High-Level Meeting in New York,” the statement read.

In relation to stroke prevention, the groups said it was important to know that 90 per cent of strokes were linked to ten modifiable risk factors including high blood pressure, smoking, obesity, physical inactivity, and unhealthy diet.

It was noted that these same risk factors also applied to ischaemic heart disease, the other main cause of global disability and death.

According to the statement, “The occurrence of an acute stroke has to be considered a major emergency which needs a seamless chain of interventions until recovery. Quality care needs to be provided timely by competent personnel and teams across the whole pathway in an organized and audited manner. This kind of access to adequate stroke expertise should be independent of region, time of day and socio-economic status.”

The specialty societies also stated that dementia was growing worldwide with ageing populations, and that stroke, along with other diseases such as hypertension, heart disease, chronic kidney disease and diabetes, contributed to the development of dementia.

“Rates of dementia may be reduced by modifying these risk factors and both stroke and dementia may be prevented through coordinated action,” they added.

“Developments in vascular neurology has made stroke and dementia preventable, treatable and increasingly reversible, thus reducing the burden on patients, families and societies. To ensure these developments are more evenly distributed, we will require national, regional and global efforts to increase awareness, make available quality acute stroke treatment, primary and secondary prevention and rehabilitation,” the statement concluded.

ESO and the patient organization SAFE (Stroke Action for Europe) of which the Irish Heart Foundation is a member, have finalised the Action Plan for Stroke in Europe 2018-2030, which is aligned with the UN’s Sustainable Development Goals. The plan has four overarching goals:

1. to reduce the absolute number of strokes in Europe by 10 per cent
2. to treat 90 per cent or more of all patients with stroke in Europe in a dedicated stroke unit as the first level of care
3. to have national plans for stroke encompassing the entire chain of care, and
4. to fully implement national strategies for multisector public health interventions