TY - JOUR

T1 - Pragmatic solutions to reduce the global burden of stroke

T2 - a World Stroke Organization–Lancet Neurology Commission

AU - Feigin, Valery L.

AU - Owolabi, Mayowa O.

AU - World Stroke Organization–Lancet Neurology Commission Stroke Collaboration Group

A2 - Truelsen, Thomas

N1 - Funding Information: The survey part of the Commission was partly funded by the World Stroke Organization. Stroke burden projections 2020–50 were funded by the Bill & Melinda Gates Foundation. The thematic analysis was partly funded by the Australian National Health and Medical Research Council Synergy STOPstroke grant (GNT1182071) and the World Stroke Organization. MOO is supported by Stroke Investigative Research and Educational Network (U54HG007479), Systematic Investigation of Blacks with Stroke using genomics (R01NS107900), African Rigorous Innovative Stroke Epidemiological Surveillance (R01NS115944–01), Copy number variation and stroke risk (1R01NS114045-01), the Sub-Saharan Africa Conference on Stroke (1R13NS115395-01A1), and Training Africans to Lead and Execute Neurological Trials & Studies (D43TW012030). VLF declares grants from the Brain Research New Zealand Centre of Research Excellence (16/STH/36), the Australian National Health and Medical Research Council (APP1182071), and the World Stroke Organization. VLF is an executive committee member of the World Stroke Organization, honorary medical director of Stroke Central New Zealand, and chief executive of the New Zealand Stroke Education Trust. AGT has received funding from the Australian National Health and Medical Research Council (1143155, 1171966, 1182071) and the Medical Research Future Fund (2015976), and is a board member of the Australian Stroke Foundation. SG is funded by the World Stroke Organization and the National Heart Foundation of Australia Future Leader Fellowship (GNT102061), and has received grants from the Australian National Health and Medical Research Council (GNT1182071), the Medical Research Future Fund Cardiovascular Health Mission, and the Royal Hobart Hospital Research Foundation. AM has received support from the Nossal Institute for Global Health. TPN has received support from the World Stroke Organization and an Australian National Health and Medical Research Council STOPstroke Synergy Grant (GNT1182071). AR has received grants from the Health Research Council of New Zealand, and is an executive board member of the World Stroke Organization and Neurological Association of New Zealand, executive secretary of the Stroke Society of Australasia, and a board member of the New Zealand Stroke Foundation. SR is funded by STOPStroke. ROA has received grants from the National Institutes of Health (U01HG010273), the UK Royal Society and African Academy of Sciences (FLR/R1/191813, FCG/R1/201034), the US National Institute on Aging and National Institutes of Health (U19AG074865, R01AG072547), and Global Brain Health Institute and Alzheimer's Association (GBHI ALZ UK-21-24204). The World Federation for Neurorehabilitation Specialist Interest Group Clinical Pathways survey was supported by the BDH Bundesverband Rehabilitation. We acknowledge the contributions of of Prebo Barango, Alarcos Cieza, Tarun Dua, Wouter De Groote, Taskeen Khan, Pauline Kleinitz, Jody-Anne Mills, Alexandra Rauch, Nicoline Schiess, Slim Slama, and Cherian Varghese of WHO in reviewing and editing this Commission. Funding Information: The survey part of the Commission was partly funded by the World Stroke Organization. Stroke burden projections 2020–50 were funded by the Bill & Melinda Gates Foundation. The thematic analysis was partly funded by the Australian National Health and Medical Research Council Synergy STOPstroke grant (GNT1182071) and the World Stroke Organization. MOO is supported by Stroke Investigative Research and Educational Network (U54HG007479), Systematic Investigation of Blacks with Stroke using genomics (R01NS107900), African Rigorous Innovative Stroke Epidemiological Surveillance (R01NS115944–01), Copy number variation and stroke risk (1R01NS114045-01), the Sub-Saharan Africa Conference on Stroke (1R13NS115395-01A1), and Training Africans to Lead and Execute Neurological Trials & Studies (D43TW012030). VLF declares grants from the Brain Research New Zealand Centre of Research Excellence (16/STH/36), the Australian National Health and Medical Research Council (APP1182071), and the World Stroke Organization. VLF is an executive committee member of the World Stroke Organization, honorary medical director of Stroke Central New Zealand, and chief executive of the New Zealand Stroke Education Trust. AGT has received funding from the Australian National Health and Medical Research Council (1143155, 1171966, 1182071) and the Medical Research Future Fund (2015976), and is a board member of the Australian Stroke Foundation. SG is funded by the World Stroke Organization and the National Heart Foundation of Australia Future Leader Fellowship (GNT102061), and has received grants from the Australian National Health and Medical Research Council (GNT1182071), the Medical Research Future Fund Cardiovascular Health Mission, and the Royal Hobart Hospital Research Foundation. AM has received support from the Nossal Institute for Global Health. TPN has received support from the World Stroke Organization and an Australian National Health and Medical Research Council STOPstroke Synergy Grant (GNT1182071). AR has received grants from the Health Research Council of New Zealand, and is an executive board member of the World Stroke Organization and Neurological Association of New Zealand, executive secretary of the Stroke Society of Australasia, and a board member of the New Zealand Stroke Foundation. SR is funded by STOPStroke. ROA has received grants from the National Institutes of Health (U01HG010273), the UK Royal Society and African Academy of Sciences (FLR/R1/191813, FCG/R1/201034), the US National Institute on Aging and National Institutes of Health (U19AG074865, R01AG072547), and Global Brain Health Institute and Alzheimer's Association (GBHI ALZ UK-21-24204). The World Federation for Neurorehabilitation Specialist Interest Group Clinical Pathways survey was supported by the BDH Bundesverband Rehabilitation. We acknowledge the contributions of of Prebo Barango, Alarcos Cieza, Tarun Dua, Wouter De Groote, Taskeen Khan, Pauline Kleinitz, Jody-Anne Mills, Alexandra Rauch, Nicoline Schiess, Slim Slama, and Cherian Varghese of WHO in reviewing and editing this Commission. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.

PY - 2023

Y1 - 2023

N2 - Stroke is the second leading cause of death worldwide. The burden of disability after a stroke is also large, and is increasing at a faster pace in low-income and middle-income countries than in high-income countries. Alarmingly, the incidence of stroke is increasing in young and middle-aged people (ie, age <55 years) globally. Should these trends continue, Sustainable Development Goal 3.4 (reducing the burden of stroke as part of the general target to reduce the burden of non-communicable diseases by a third by 2030) will not be met.In this Commission, we forecast the burden of stroke from 2020 to 2050. We project that stroke mortality will increase by 50%—from 6·6 million (95% uncertainty interval [UI] 6·0 million–7·1 million) in 2020, to 9·7 million (8·0 million–11·6 million) in 2050—with disability-adjusted life-years (DALYs) growing over the same period from 144·8 million (133·9 million–156·9 million) in 2020, to 189·3 million (161·8 million–224·9 million) in 2050. These projections prompted us to do a situational analysis across the four pillars of the stroke quadrangle: surveillance, prevention, acute care, and rehabilitation. We have also identified the barriers to, and facilitators for, the achievement of these four pillars.On the basis of our assessment, we have identified and prioritised several recommendations. For each of the four pillars (surveillance, prevention, acute care, and rehabilitation), we propose pragmatic solutions for the implementation of evidence-based interventions to reduce the global burden of stroke. The estimated direct (ie, treatment and rehabilitation) and indirect (considering productivity loss) costs of stroke globally are in excess of US$891 billion annually. The pragmatic solutions we put forwards for urgent implementation should help to mitigate these losses, reduce the global burden of stroke, and contribute to achievement of Sustainable Development Goal 3.4, the WHO Intersectoral Global Action Plan on epilepsy and other neurological disorders (2022–2031), and the WHO Global Action Plan for prevention and control of non-communicable diseases.Reduction of the global burden of stroke, particularly in low-income and middle-income countries, by implementing primary and secondary stroke prevention strategies and evidence-based acute care and rehabilitation services is urgently required. Measures to facilitate this goal include: the establishment of a framework to monitor and assess the burden of stroke (and its risk factors) and stroke services at a national level; the implementation of integrated population-level and individual-level prevention strategies for people at any increased risk of cerebrovascular disease, with emphasis on early detection and control of hypertension; planning and delivery of acute stroke care services, including the establishment of stroke units with access to reperfusion therapies for ischaemic stroke and workforce training and capacity building (and monitoring of quality indicators for these services nationally, regionally, and globally); the promotion of interdisciplinary stroke care services, training for caregivers, and capacity building for community health workers and other health-care providers working in stroke rehabilitation; and the creation of a stroke advocacy and implementation ecosystem that includes all relevant communities, organisations, and stakeholders.

AB - Stroke is the second leading cause of death worldwide. The burden of disability after a stroke is also large, and is increasing at a faster pace in low-income and middle-income countries than in high-income countries. Alarmingly, the incidence of stroke is increasing in young and middle-aged people (ie, age <55 years) globally. Should these trends continue, Sustainable Development Goal 3.4 (reducing the burden of stroke as part of the general target to reduce the burden of non-communicable diseases by a third by 2030) will not be met.In this Commission, we forecast the burden of stroke from 2020 to 2050. We project that stroke mortality will increase by 50%—from 6·6 million (95% uncertainty interval [UI] 6·0 million–7·1 million) in 2020, to 9·7 million (8·0 million–11·6 million) in 2050—with disability-adjusted life-years (DALYs) growing over the same period from 144·8 million (133·9 million–156·9 million) in 2020, to 189·3 million (161·8 million–224·9 million) in 2050. These projections prompted us to do a situational analysis across the four pillars of the stroke quadrangle: surveillance, prevention, acute care, and rehabilitation. We have also identified the barriers to, and facilitators for, the achievement of these four pillars.On the basis of our assessment, we have identified and prioritised several recommendations. For each of the four pillars (surveillance, prevention, acute care, and rehabilitation), we propose pragmatic solutions for the implementation of evidence-based interventions to reduce the global burden of stroke. The estimated direct (ie, treatment and rehabilitation) and indirect (considering productivity loss) costs of stroke globally are in excess of US$891 billion annually. The pragmatic solutions we put forwards for urgent implementation should help to mitigate these losses, reduce the global burden of stroke, and contribute to achievement of Sustainable Development Goal 3.4, the WHO Intersectoral Global Action Plan on epilepsy and other neurological disorders (2022–2031), and the WHO Global Action Plan for prevention and control of non-communicable diseases.Reduction of the global burden of stroke, particularly in low-income and middle-income countries, by implementing primary and secondary stroke prevention strategies and evidence-based acute care and rehabilitation services is urgently required. Measures to facilitate this goal include: the establishment of a framework to monitor and assess the burden of stroke (and its risk factors) and stroke services at a national level; the implementation of integrated population-level and individual-level prevention strategies for people at any increased risk of cerebrovascular disease, with emphasis on early detection and control of hypertension; planning and delivery of acute stroke care services, including the establishment of stroke units with access to reperfusion therapies for ischaemic stroke and workforce training and capacity building (and monitoring of quality indicators for these services nationally, regionally, and globally); the promotion of interdisciplinary stroke care services, training for caregivers, and capacity building for community health workers and other health-care providers working in stroke rehabilitation; and the creation of a stroke advocacy and implementation ecosystem that includes all relevant communities, organisations, and stakeholders.

U2 - 10.1016/S1474-4422(23)00277-6

DO - 10.1016/S1474-4422(23)00277-6

M3 - Review

C2 - 37827183

AN - SCOPUS:85175304380

VL - 22

SP - 1160

EP - 1206

JO - The Lancet Neurology

JF - The Lancet Neurology

SN - 1474-4422

IS - 12

ER -