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Updated guidelines make stroke management easier

Article-Updated guidelines make stroke management easier

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The UAE has an advanced medical infrastructure that allows for rapid investigation and treatment for stroke patients.

According to healthcare experts, updated stroke guidelines and newer-generation medication have made stroke clinical management more convenient.

The NCD Alliance, World Stroke Organization and American Stroke Association recently published an update to their policy brief, ‘Acting on stroke and non-communicable diseases: preventing and responding to stroke to work towards universal health coverage’. This was conducted as part of their efforts to address the global and individual impact of stroke within the broader Non-Communicable Diseases (NCDs) response.

The newly updated policy brief focuses on the stroke and NCD response in light of the Covid-19 pandemic and provides evidence-based recommendations to healthcare providers, policymakers and civil society across the stroke continuum of care, from prevention to treatment and rehabilitation, as they work towards Universal Health Coverage (UHC) and other Sustainable Development Goal (SDG) targets.

In the UAE, updated guidelines have focused on several areas. Dr. Haider Ali, Consultant Family Medicine at Medcare Medical Centre Town Square, explained: “The new guidelines have updated information about several areas such as what clinical scenarios to consider for rapid blood pressure lowering therapy. The use of neuroimaging markers alongside clinical markers helps determine risks of haematoma (clot) expansion and helps guide management as well as instructions to hospital physicians to the lack of evidence of compression stockings, corticosteroids, and hyperosmolar fluid.”

He said that Tenecteplase, a newer-generation medication administered through a single injection into a blocked blood vessel has proved to be a game changer. “Previously we were reliant on another medication (alteplase) which needed an hour-long infusion following its injection into the affected blood vessel(s). The fantastic news with Tenecteplase is that we found it caused half as many serious complications when compared to the previously relied upon medication,” he explained.

Dr. Ali also said that those who had this newer treatment were far less likely to need further procedures to remove the brain clot that caused the stroke in the first place (thrombectomy).

Dr. Haider Ali, Consultant Family Medicine, Medcare Medical Centre Town Square.png

Dr. Haider Ali, Consultant Family Medicine at Medcare Medical Centre Town Square

Stroke remains the world’s second leading cause of mortality accounting for 6.6 million deaths a year. It is also the third leading cause of disability. Over 100 million people in the world currently live with the impact of stroke, which can include devastating loss of mobility, cognition and communication as well as negative effects on mental health, social inclusion, and income.

With the global lifetime risk of stroke standing at one in four (an increase from one in six just a decade ago), it is shocking that only 38 per cent of governments around the world report having a national strategy to specifically address stroke, and that only three per cent have identified resources to deliver it. Meanwhile, the upward trajectory of stroke continues, driven by an increased incidence in low- and middle-income countries where public stroke care systems are often underdeveloped.

With an estimated global cost of about US$1 trillion per year, stroke represents a significant brake on international and national efforts to develop sustainable economic growth. Government action remains too slow and investment remains too low, especially when every US$1 spent on stroke prevention yields a return on investment of over US$10.

The statistics are not any different in the UAE where between 8,000 and 10,000 people suffer a stroke annually. It is also estimated that around half of all stroke patients are below the age of 45 compared to figures internationally where 80 per cent of those suffering a stroke are aged 65 or over. “In the UAE, strokes are one of the main causes of disability other than road traffic accidents,’ said Dr. Ali.

He also said that the UAE has an advanced medical infrastructure that allows for rapid investigation and treatment to be possible for life-threatening, and potentially life-changing conditions such as stroke.

“We need to continue working on educating the population on the risk factors for stroke and cardiovascular disease to reduce the incidence we have in the UAE.”

Given the existing backdrop on NCD and stroke mortality, it is imperative that health systems reorient from a single disease approach to integrated care packages across multiple NCDs through a holistic person-centred approach. The integration of NCDs into UHC must be at the core of national and global preparedness for future health threats. UHC ensures financial protection from high out-of-pocket payments and aims to leave no one behind, prioritising marginalised communities, according to the new policy update by the World Stroke Organisation.

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