The treatment gap in acute ischemic stroke around the world: a call for improved care

Acute stroke care is cost-effective at all levels in low-, middle- and high-income countries; therefore, the call of the hour is to encourage a collaborative effort to close the gap in rapid therapeutic advancements and its access to patients who are eligible to receive them worldwide. These are the conclusions of a recent study published in Neurology.

The total direct medical costs of stroke, the second leading cause of disability and death worldwide, are expected to reach $ 94.3 billion by 2035. Over the past 5 years, eligibility for thrombolysis IV (IVT) extended beyond 4.5 hours, based on authorized imaging. Criteria. The patient population eligible for acute stroke procedures subsequently increased, but access to acute stroke care, mechanical thrombectomy (MT) and IVT remains limited.

The objective of the present study was to examine the global burden of stroke and the dramatic geographic disparities in stroke incidence and access to AIS interventions.

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From 2010 to 2017, stroke incidence and mortality each increased by 5.3%, prevalence by 19.3%, and disability-adjusted life years (DALY) lost by 2.7 in the world. Death rates for ischemic (SI) and hemorrhagic (HS) strokes declined from 1990 to 2010, but the number of people with SI increased by 37% and the number of people with HS increased. increased by 47% and associated deaths each increased by about 20%. %.

Globally, less than 5% of patients with acute IS received IVT within the treatment window. Less than 100,000 MT were achieved in 2016.

The incidence of SI increased from 11.6 million in 2010 to 13.7 million in 2016. There were 5.5 million stroke deaths in 2016, while the stroke prevalence was 80.1 millions. In 2016, the global prevalence of stroke was approximately 1,322 per 100,000 people, compared to about 2,320 per 100,000 people in the United States, which has 900 of the approximately 2,000 comprehensive stroke centers capable of TM in the United States. the world. The 30-day stroke case fatality rate was highest (42%) in Calcutta, India (2003-2010), compared to 10% in Dijon, France (2000-2004).

The incidence of stroke in patients aged 18 to 50 years (10% to 15%) is higher in low- and middle-income countries.

Prehospital delays represent the most important delays in acute stroke care. The lack of advanced perfusion imaging modalities in low-income countries and in rural areas of high-income countries makes it difficult to assess patient eligibility for TM within the treatment window. There is also no central data repository to identify the number of MTs performed in most countries.

The researchers concluded: “This highlights the large gap between eligible patients and the low rates of use of these advances across the world. Multiple global initiatives are underway to investigate interventions aimed at improving systems of care and closing this gap. “

Disclosures: One study author reported affiliations with biotech, pharmaceutical, and / or device companies. Please see the original reference for a full list of author disclosures.

Reference

Saini V, Guada L, Yavagal DR. Global stroke epidemiology and access to acute ischemic stroke interventions. Neurol. Published online November 16, 2021. doi: 10.1212 / WNL.00000000000012781