Globally, stroke is the 2nd leading cause of death, and the 3rd leading cause of death and disability combined. While risk of stroke increases with age, the prevalence of stroke among adults over the age of twenty-five is staggering, with 1 in 4 expected to experience a stroke at some point in their lifetime. This year alone, that means an estimated 13.7 million people worldwide will have their first stroke, out of which 8.2 million will survive.
Over the last 10 years a great deal has been achieved to improve acute care in the minutes, hours, and days after a stroke, and as a result stroke survival rates have dramatically improved. While this reflects incredible progress in the way we treat stroke at its acute phase, surviving a stroke is only the first step in what for many is a long journey of recovery, as they go on to live with often debilitating consequences such as paralysis, fatigue, and muscle stiffness, known as spasticity, which can affect more than 25% of stroke survivors.
As more and more people survive stroke, the need for improved patient pathways which seek to minimize the risk of complications and deliver timely and effective rehabilitation for stroke survivors has become evident. Many survivors lose the ability to properly function in everyday life, are unable to work and require extensive care from both professionals and family members or carers. The complications that follow a stroke are therefore not only a deeply personal challenge for each individual and their caregivers, but the wider social impact that can be incurred from delayed or uncoordinated post-stroke care can also be far-reaching and costly, with estimations that stroke costs $891 billion per year, or 1.12% of global GDP.
For example, if we focus on stroke survivors with spasticity, they may experience reductions in their ability to perform activities of daily living negatively impacting their health-related quality of life. The occurrence of spasticity in stroke survivors may also result in an increased burden on their caregivers, who often develop poorer physical and emotional health issues, such as anxiety or depression, as compared with the general population.
As stroke survival rates have increased, innovative treatment options for some post-stroke conditions, including spasticity, have emerged but these often require patients to start treatment as early as possible to deliver their full benefits long-term. To maximize outcomes for stroke survivors and wider society, it is key that stroke survivors have access to timely diagnosis, treatment and coordinated post-stroke care - including pharmacological treatment and rehabilitation - to gain the greatest benefit, minimizing the impact of stroke and increasing their chances of a successful recovery and improved quality of life. However, in many countries around the world, this timely and coordinated diagnosis and management simply is not available, and the lack of co-ordination is often reflected in the poorly defined post-stroke care pathways at a national level, resulting in many patients being lost in the system.
One country determined to lead progress on post-stroke care is Italy, aiming to re-define and re-calibrate long-term post-stroke care and relevant pathways, to better serve stroke survivors and their families. In Italy, they have set out to fully understand the data surrounding the existing gaps in post-stroke care, and to identify solutions to best benefit stroke survivors across the different regions. These findings, highlight a lack funding for the longer-term effects of a stroke, a need for additional medical awareness of how to effectively treat complications of stroke, particularly post-stroke spasticity, and increased access to clinics for people in need of post-stroke care. Italy is a frontrunner in their commitment to improving patient pathways for stroke survivors, however, the lack of access to timely and coordinated care identified by Italian experts is often observed at different extent, in many other geographies across the globe.
The care that patients receive following a stroke is critical in the prevention of stroke recurrence, as well as in maintaining and optimizing a stroke survivor’s quality of life. However, here is still a significant lag in consistent long-term post-stroke funding as well as in the development and adherence to guidelines and pathways, compared to the advances made in acute stroke management and prevention. Recent advances in policy prioritization of neurological disorders and non-communicable diseases at the global and EU levels recognize the magnitude of the challenge we face in addressing existing stroke care inequalities in care and tackle this burden.
It is only by delivering better and more equitable and timely access to holistic post-stroke care, including treatment, rehabilitation, and support services on a global scale, we can improve long-term patient outcomes, allowing stroke survivors to regain a good quality of life in the long-term, while reducing the burden on families, healthcare systems, and the wider economy.
