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Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization–Lancet Neurology Commission

2023; Elsevier BV; Volume: 22; Issue: 12 Linguagem: Inglês

10.1016/s1474-4422(23)00277-6

1474-4465

Valery L. Feigin, Mayowa Owolabi, Valery L. Feigin, Foad Abd-Allah, Rufus Akinyemi, Natalia V. Bhattacharjee, Michael Brainin, Jackie Cao, Valeria Caso, Bronte Dalton, Alan Davis, Robert J. Dempsey, Joseph Duprey, Wuwei Feng, Gary A. Ford, Seana Gall, Dorcas B.C. Gandhi, David C. Good, Vladimir Hachinski, Werner Hacke, Graeme J. Hankey, Marie Ishida, Walter D. Johnson, Julie Kim, Pablo M. Lavados, Patrice Lindsay, Ajay Mahal, Sheila Martins, Christopher J L Murray, Thuy Phuong Nguyen, Bo Norrving, Muideen T Olaiya, Oladotun Olalusi, Jeyaraj Pandian, Hoang Phan, Thomas Platz, Annemarei Ranta, Sabah Rehman, Greg Roth, Ivy Anne Sebastian, Amanda Smith, Nijasri C. Suwanwela, PN Sylaja, Rajshree Thapa, Amanda G. Thrift, Ezinne Uvere, Dan J. Stein, Dileep R. Yavagal, Joseph Yaria, Mayowa Owolabi, Mayowa Owolabi, Valery L. Feigin, Foad Abd-Allah, Semaw Ferede Abera, Rufus Akinyemi, Michael Brainin, Valeria Caso, Robert J. Dempsey, Gary A. Ford, Seana Gall, Dorcas B.C. Gandhi, Vladimir Hachinski, Werner Hacke, Graeme J. Hankey, Norlinah Mohamed Ibrahim, Walter D. Johnson, Pablo M. Lavados, Liping Liu, Patrice Lindsay, Sheila Martins, Bo Norrving, Muideen T Olaiya, Bruce Ovbiagele, Jeyaraj Pandian, Hoang Phan, М. А. Пирадов, Thomas Platz, Annemarei Ranta, Greg Roth, Ivy Anne Sebastian, Nijasri C. Suwanwela, PN Sylaja, Amanda G. Thrift, Ezinne Uvere, Joseph Yaria, Carlos Abanto, Adamu Addissie, Amos O. Adeleye, Yerzhan Adilbekov, B. Adilbekova, Thierry Adoukonou, Diana Aguiar de Sousa, З Б Ахметжанова, Albert Akpalu, Mustapha El Alaoui-Faris, Sebastián F. Ameriso, Silva Andonova, Anita Arsovska, Folorunso E Awoniyi, Moiz Bakhiet, Miguel A. Barboza, Hamidon Basri, Philip M. Bath, Dániel Bereczki, Simone Beretta, Aaron L. Berkowitz, Julie Bernhardt, Guna Bērziņa, Bhavan Bhavsar, Mher S Bisharyan, Manoj Bohara, Pascal Bovet, Hrvoje Budinčević, Dominique A. Cadilhac, Denis Čerimagić, Augustina Charway‐Felli, Christopher Chen, Jerome H. Chin, Hanne Christensen, Kamil Chwojnicki, Adriana Bastos Conforto, Manuel Correia, Daissy Liliana Mora Cuervo, Anna Członkowska, Marco D’Amelio, Kristine Edgar Danielyan, Stephen M. Davis, Vida Demarin, Andrew M. Demchuk, Martin Dichgans, Клара Докова, Geoffrey A. Donnan, Juan Carlos Durán, Gloria Ekeng, Mitchell S Elkind, Matthias Endres, Urs Fischer, Yuriy Flomin, Fortuné Gbètoho Gankpé, Martín Gavidia, A. Gaye Saavedra, Mehari Gebreyohanns, Mary G. George, Marek Gierlotka, Maurice Giroud, E. V. Gnedovskaya, Ivete Pillo Gonçalves, Fernando Góngora‐Rivera, Padma Gunaratne, Randah R Hamadeh, Talhatu K. Hamzat, Mirjam R. Heldner, Etedal Ahmed A. Ibrahim, Hanne Ihle-Hansen, Sungju Jee, Jeng Jiann-Shing, S Clay Johnston, D Jovanović, Kristaps Jurjāns, Rizwan Suliankatchi Abdulkader, Yogeshwar Kalkonde, Saltanat Kamenova, Bartosz Karaszewski, Peter J. Kelly, Stefan Kiechl, Аida Kondybayeva, Janika Kõrv, Grzegorz Kozera, Michael Kravchenko, Yakup Krespi, Rita Krishnamurthi, Jera Kruja, Kürşad Kutluk, Peter Langhorne, Zhe Kang Law, Dmytro Lebedynets, Tsong‐Hai Lee, Thomas Leung, David S Liebeskind, Patricio López‐Jaramillo, Paulo A. Lotufo, M. Julia Machline-Carrion, Luı́s F. Maia, Branko Malojčić, Hugh S. Markus, Juan Manuel Márquez-Romero, Marco T. Medina, Sabina Medukhanova, Man Mohan Mehndiratta, Evija Miglāne, Illa Mihejeva, Robert Mikulík, Erkin М Мirrakhimov, Hoang Phan, Sunil Munakomi, Seán Murphy, Kamarul Imran Musa, Ahmed Nasreldein, Raul G Nogueira, Christian H. Nolte, Jean Jacques Noubiap, Nelson Novarro, Cassandra Ocampo, Martin O’Donnell, Yomi Ogun, Adesola Ogunniyi, Mohammed I. Oraby, Dilek Neci̇oğlu Örken, Atilla Özcan Özdemi̇r, Şerefnur Öztürk, Mélanie Paccot, Telmo Pereira, André Peeters, Tatjana Potpara, Hariklia Proios, Farooq Azam Rathore, Ralph L. Sacco, Ramesh Sahathevan, Else S Sandset, Irving Renato Santos, Gustavo Saposnik, Fred Stephen Sarfo, João Sargento‐Freitas, Mukul Sharma, Louise Shaw, Kevin N. Sheth, Yong‐Il Shin, A Shobhana, S. Silva, Vítor Tedim Cruz, Kiran T. Thakur, Lekh Jung Thapa, Danilo Toni, M.A. Topcuoglu, Júlio Torales, Amytis Towfighi, Thomas Truelsen, Alexander Tsiskaridze, Marshall K. Tulloch‐Reid, Juan Nicolás Useche, Peter Vanacker, Sophia Vassilopoulou, Gorana Vukorepa, Vladimira Vuletić, Kolawole Wahab, Wenzhi Wang, Tissa Wijeratne, Bogdan Wojtyniak, Charles Wolfe, Mapoure Njankouo Yacouba, Jie Yang, Yared Mamushet Yifru, Adriana Yock‐Corrales, Naohiro Yonemoto, Laetitia Yperzeele, Paweł Zagożdżon,

Healthcare Systems and Practices

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.