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Prioritizing stroke care globally: in conversation with Philips and the World Stroke Organization

Oct 29, 2024 | 7 minute read

Left untreated, stroke can have a catastrophic effect on patients and their families, and place a huge burden on society. If the patient survives, it typically has a long-term impact on both their mental and physical health. People who have had a stroke may encounter challenges with perception, memory, speech, and muscle control. Due to these challenges, their ability to be independent, economically active, interact with others, and participate in social activities is often limited [1].

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Yet the majority of strokes – so called ischemic strokes caused by a blocked blood vessel – are treatable. With the right treatment, enabled by the latest technologies, procedures, and clinical insights, stroke can be treated and even reversed if treatment is initiated as soon as possible.

However, despite a strong clinical and economic evidence base [2], and the latest guidance from the World Health Organization (WHO) [1], this is not yet the norm. Why is that?

We talked to Sheila Martins, neurologist and outgoing President of the World Stroke Organization (WSO),* and Carla Goulart Peron, Chief Medical Officer at Philips, about the role of advocacy in changing the mindset around stroke, establishing it as a disease in its own right, and the investment required to facilitate access to treatments that can cure it.

As founder of the Brazilian Stroke Network over 16 years ago, Sheila Martins knows more than most about what’s involved.

Sheila Martins (SM): “We have come a long way in treating ischemic stroke, but we need to learn from the past and take action. The impact of thrombolysis – the administration of clot dissolving drugs – on stroke patient outcomes was established before the turn of the century. I remember that when the thrombolytic drug tPA became widely available in the late 1990s and we asked the Brazilian Ministry of Health to offer it via the public health service, they had concerns. With limited resources and many other pressing health issues in Brazil, it was considered too expensive to create stroke units that serve only one disease.”

“So, I decided to work with a private hospital to see what could be done with thrombolysis. The results were so impressive that I was able to go back to the public university hospital, where I previously worked, to convince them they needed to offer the treatment, because 80% of strokes in Brazil occur in patients that use the public healthcare system. In 2005, we created a small room in the hospital emergency unit where myself and another neurologist were on-call 24/7 to treat patients.”

Philips Chief Medical Officer Carla Peron, who was born and trained as a physician in Brazil, was also part of that journey.

Carla Goulart Peron (CP): “At that time in Brazil working in the med tech industry, I was assigned to support one of Sheila’s studies to prove that better stroke care could be delivered in the country’s public health service. During that period, the standard treatment for most stroke patients in small towns or rural areas was taking an aspirin once a day. And I remember thinking to myself that it would be quite a leap from that situation to build the required expertise and infrastructures to offer thrombolysis. But thanks to her determination, Sheila made important steps towards making stroke a very treatable disease in Brazil.”

The journey from an aspirin a day to the game-changing use of thrombolysis in Brazil clearly took many years. But the fact is, even today, limited investment in stroke care means it is only administered to around 3% of the world’s stroke patients that meet the eligibility requirements [2,3].

Based on the World Health Organization global evaluation, the treatment is available in public health system in only 41% of the countries [3]. According to Sheila, we may be at risk of allowing a similar situation to arise for another game-changing procedure – mechanical thrombectomy – which is a minimally invasive procedure that physically removes blood clots via a catheter inserted through the patient’s arteries.

SM: “If you have a severe ischemic stroke, thrombolysis is less effective. But around 2015 major clinical studies confirmed that mechanical thrombectomy, if performed soon enough, can open up the blocked artery and really reduce disability. But it needs a hospital with a cath lab and trained neuro-interventionalists and anesthetists, and these studies were only performed in high-income countries. In Brazil, we had the opportunity to prove through the only clinical trial conducted in a developing country – sponsored by the Ministry of Health – that even in a country with a limited public healthcare budget, mechanical thrombectomy is both feasible and cost effective.”

However, despite its demonstrated clinical and economic benefits, especially in terms of reducing the high financial and societal costs associated with long-term stroke care, by the end of 2021 only a fraction of eligible stroke patients globally had access to mechanical thrombectomy treatment. The median global score for mechanical thrombectomy access has been assessed as less than 3% [4], with several low- and middle-income countries lacking access to this technology altogether.

SM: “There is still insufficient focus on research funding and healthcare expenditure to really advance acute stroke care. Stroke is the leading cause of disability and is increasingly affecting younger people. Investing in acute stroke treatments provides governments with an unmissable opportunity to reduce the burden of stroke on individuals and society and deliver on their commitment to provide health and well-being for all. The payback in terms of increased GDP productivity and reduced long-term care costs far outweighs the initial investment.”

Acute stroke care requires investment in specialized stroke units equipped with the diagnostic imaging required for precision diagnosis and the interventional imaging technology needed to guide mechanical thrombectomy. Just as importantly, it requires investment in a highly skilled healthcare workforce, which is currently in short supply, and a system in which patients can be triaged and treated as quickly as humanly possible. However, as is the case for many other diseases with which stroke care competes for investment – technologies such as telehealth and AI can help reduce costs as well as increase diagnostic confidence and improve outcomes.

SM: “Telehealth is fundamental to advancing stroke care, allowing specialists to advise less experienced staff how to treat each patient. Artificial intelligence to rapidly identify ischemic stroke, hemorrhagic stroke or large vessel occlusions, or assist in deciding which patients need to be transferred to a comprehensive stroke center will also play a part.”

CP: “I recently spoke to a representative from Indonesia’s Ministry of Health, who told me he had 16,000 islands under his administration. If telehealth and AI could help to decide where to send the helicopter to pick up the patients most in need, that would make the job a whole lot easier.”

Sheila stresses that none of this can be achieved without strong partnerships and a coordinated program of advocacy to bring stroke to the fore.

SM: “Stroke is the second leading cause of death in the world and in several low- and middle-income countries it’s the number one. Yet many healthcare managers still don't appreciate that stroke is just as important as myocardial infarction, which seems to get more attention. The burden of stroke is also much higher. So, we work hard with ministers globally to convince them of the importance of organizing stroke services, through initiatives such as the WSO Global Stroke Alliance, and together with Philips we recently published our joint ‘Time for a revolution in stroke care’ policy paper.” 

Carla also believes there are cultural barriers that need to be overcome.

CP: “Stroke is a silent disease that in some countries is seen as a consequence of unhealthy behavior that should be tackled by prevention. But that's not the reality. Of course, we know all our patients deserve preventive care, but those that do suffer a stroke also deserve treatment, because it’s a curable disease. So, we need to make sure the voices of stroke patients are heard.”

Asking what they would both like to see happen next solicited the following answers.

SM: “I would like to see a truly global task force to put all the required actors together and cover the whole world. It's a big challenge but we have already made significant progress, so it is eminently possible. The mindset has definitely changed as a result of our work. For example, the World Health Organization previously focused on stroke prevention. But now we are working with the WHO on a framework for implementing acute stroke care to advise governments around the world that patients need to be treated.”

CP: “At Philips we offer stroke care solutions for the ambulance, the diagnostic imaging scans, and image-guided therapy solutions for performing mechanical thrombectomy. We also have post-discharge solutions to monitor risk factors such as atrial fibrillation. But there are other parts of the solution that need to come from governments, healthcare providers, pharmaceutical companies, rehabilitation services and others. So, it not only requires forums in which to create awareness about stroke, but also an ecosystem offering that is procurable by healthcare authorities.”
 

* On October 29, 2024, Sheila Martens was succeeded by Jeyaraj Pandian as president of the World Stroke Organization. She will continue to co-chair the newly formed World Stroke Organization Advocacy Coalition, which Philips has also joined.


The physicians’ opinions and clinical experiences presented herein are specific to the featured physician and featured patients and are for information purposes only. The results from their experiences may not be predictive of all patients. Individual results may vary depending on a variety of patient-specific attributes and related factors. Nothing in this article is intended to provide specific medical advice or to take the place of written law or regulations.

Sources

 

[1] World Health Organization: Intersectoral global action plan on epilepsy and other neurological disorders 2022–2031: implementation toolkit.
[2] Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization–Lancet Neurology Commission; Feigin, V.L. and O Owolabi, M.; The Lancet Neurology 2023; Volume 22, Issue 12; 1160-1206.
[3] World Health Organization: Assessing national capacity for the prevention and control of noncommunicable diseases - Report of the 2021 global survey.
[4] Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study; Asif, K.S., Otite, F.O., Desai, S.M. et al., Global Executive Committee of the MT-GLASS Study; Circulation 2023; Apr 18; 147(16): 1208-1220.

Media contacts

Joost Maltha--Philips Global External Relations
Joost Maltha
Philips Global External Relations
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