The UK remains at risk of a devastating stroke crisis, according to UK health experts launching Reports published today, on World Stroke Day, by Action for Stroke Prevention (ASP), an alliance of renowned health experts and patient organisations. One of the Reports entitled, How Can We Avoid a Stroke Crisis in Europe?, highlights that the first time many people will find out they have AF is when they suffer a stroke. The major Reports call for policy makers and the medical and patient communities to collectively act to prevent strokes that strike thousands of people with atrial fibrillation (AF) each year.
Furthermore, approximately 70% of patients with known AF who had a stroke caused by an AF-related blood clot were not receiving essential anticoagulant therapy at the time.v vi vii With stretched healthcare budgets and the annual cost of stroke in Europe approximately €64 billion, more needs to be done to reduce the number of these life-destroying, costly, and yet preventable strokes.
In addition to their main Report, ASP has launched two supplementary Reports. These outline 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 action encourages earlier diagnosis and improved awareness and prevention,” said world renowned Cardiology expert, John Camm, Professor of Clinical Cardiology at St George’s University, London, UK. “Reducing AF-related stroke will be a key component in the UK in reaching the United Nations commitment to reduce non-communicable diseases by 25% by the year 2025. We hope the UK government and Department of Health will give all initiatives that address this crisis their full backing.”
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 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 the UK highlight that whilst almost a quarter of people (23%) surveyed in the UK sample (N=501) fear having a stroke above someviii other serious health conditions including diabetes and high cholesterol, only 3% are fearful of AF despite it being a major risk factor for serious stroke.
“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 clinically proven treatments 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 remains poor and there continues to be 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. This demonstrates the need for education to enable patients to participate in their own healthcare decisions. Until the recommendations identified by Action for Stroke Prevention are initiated, not just across the UK, but on a European wide scale, millions of people will continue to have their lives devastated by AF-related stroke. The community must act collectively and it must act now.
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 worldwideix
- It is a condition which on its own represents the third single most common cause of death in industrialised countriesx
- Atrial fibrillation (AF) is the most common sustained heart rhythm abnormalityxi and is a strong independent risk factor for strokexii
- Patients with AF are five times more likely to have a stroke compared with the general populationxiii
- AF occurs when the upper chambers of the heart (the atria) tremble rapidly and irregularly.xiv This leads to blood stasis or pooling within the atria,xiv xv 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) improvesxvi
i Stefansdottir H, Aspelund T, Gudnason V et al. Trends in the incidence and prevalence of atrial fibrillation in Iceland and futureprojections. Europace 2011;13:1110-7
ii Atrial Fibrillation Association. What is Atrial Fibrillation? Accessed October 2012
iii Wolfe C, Rudd A. The Burden of Stroke White Paper: raising awareness of the global toll of stroke-related disability and death. 2007. Accessed October 2012
iv Marini C, De Santis F, Sacco S et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from apopulation-based study. Stroke 2005; 36:1115–9
v Ahmad O et al. Intern Med J 2009;39:752–756
vi Hannon N et al. Cerebrovasc Dis 2010;29:43–49
vii Palm F et al. Eur J Neurol 2012
viii Conditions listed were blood clots, heart disease, stroke, atrial fibrillation, high blood pressure, high cholesterol and diabetes
ix World Health Organisation. Cause-specific mortality: regional estimates for 2008. Accessed September 2012
x European Stroke Organisation. Stroke facts. Accessed September 2012
xi Kannel WB, Benjamin EJ. Status of the epidemiology of atrial fibrillation. Med Clin North Am 2008;92:17-40
xii Benjamin E, Wolf P, D’Agostino R, et al. Impact of Atrial Fibrillation on the Risk of Death. Circulation 1998;98:946-952
xiii 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
xiv Falk RH. Atrial fibrillation. N Engl J Med 2001;344:1067-1078
xv 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
xvi Briffa T, Hickling S, Knuiman M, et al. Long term survival after evidence based treatment of acute myocardial infarction andrevascularisation: follow-up of population based Perth MONICA cohort, 1984-2005. BMJ 2009; 338:b36
Source: Action for Stroke Prevention