October 17, 2018

TODAY’S CONGRESS HIGHLIGHTS

HOT TOPIC: Access to stroke rehabilitation in Canada

A Canadian study, conducted by Dr. Anita Mountain of Dalhousie University in Halifax and Dr. Patrice Lindsay of Heart & Stroke, found that while overall access to and efficiency of stroke rehabilitation in Canada improved from 2008 to 2017, significant provincial and regional differences exist.

Access to and efficiency of stroke rehabilitation is an important subject given that there are about 62,000 strokes in Canada every year and more than 400,000 people are living with long-term disability from stroke – a number that is expected to double in the next 20 years.

The study looked at data from 188 inpatient stroke rehabilitation facilities across Canada, of which 99 report statistics to the Canadian Institute for Health Information. Between 2008 and 2015, the number of stroke rehab admissions rose from 5,969 to 9,025.

The study also found that while 93 per cent of Canadians live less than one hour from an inpatient stroke rehabilitation facility, bed capacity continues to hamper prompt access. However, from 2013 to 2017 there was improved access to a dedicated stroke rehabilitation unit, interdisciplinary teams and specialized equipment.

"Canadian Stroke Best Practice Recommendations help guide the delivery of effective evidence-based stroke rehabilitation across Canada,” said Dr. Mountain. “We know what needs to be done and have seen improvements in the access and efficiency of stroke rehabilitation over the past decade. However, the degree of improvement is not consistent across Canada. We need to ensure there is access to the same quality and intensity of stroke rehabilitation services for all Canadians regardless of what province or region they live in."

Rehabilitation needs to begin early after stroke when the brain is most amenable to recovery. More than 80 per cent of people now survive a stroke but more than 60 per cent are left with long-term disability, a figure that could be improved with broad and timely access to appropriate services.

 

HOT TOPIC:  Gender differences in accessing stroke care

Another Canadian study, led by Dr. Noreen Kamal of the University of Calgary, looks at differences between women and men in access to a key type of acute stroke care in Canada, endovascular thrombectomy (EVT). With EVT, a person with an ischemic stroke has the clot physically removed as soon as possible after symptoms start. The process involves threading a thin tube through an artery, and guiding it with X-ray imaging through blood vessels to the brain. A retrievable stent is used to remove the clot. The procedure has shown remarkable results in studies, reducing the overall death rate by 50 per cent and greatly diminishing the lasting effects of stroke in many patients.

The study analyzed Canadian hospital data over five years from 2011 to 2016. It found that more men presenting with ischemic stroke were transferred to a comprehensive stroke centre, compared to women. It also found that 17 per cent of patients were transferred to a comprehensive stroke centre to receive a clot-busting drug treatment.  Among patients transferred, only 40.4 per cent were women. Additionally, the study found that men had a slightly shorter median time than women from when they first arrived to when they were transferred, 1.37 hours versus 1.50 hours. Researchers say that further investigation is needed to understand the results and determine what may be causing the gap in efficient stroke treatment for women.

Dr. Thalia Field, a stroke neurologist and fellowship program director for the Vancouver Stroke Program, will present a study tomorrow that analyses gender differences in stroke care and outcomes among 257,582 Canadian stroke patients from 2009 to 2016, of whom 49 per cent were female. This study found that women were less likely to receive alteplase clot-busting medication for ischemic stroke (13.7 per cent vs. 14.2 per cent for men), had longer times from entering hospital to receiving treatment (average median time from arrival to treatment of 103 minutes vs. 89 for men) and were more likely to die within seven days of their stroke (8.5 per cent vs. 7.9 per cent).

HOT TOPICS: Other presentations of interest on the first day of the Congress:

  • A major study of the impact of the consolidation of acute stroke care from nine community hospitals in southeastern Ontarioto three specialized stroke units resulted in a huge increase in stroke unit care and a five-per-cent drop in the stroke mortality rate. “More people are getting stroke unit care and fewer people are dying,” says Cally Martin, regional director of the Stroke Network of Southeastern Ontario.
  • An Australian study found women died more often within the first year after a stroke compared to men, and the causes of death varied by sex. By observing the outcomes of almost 10,000 Australians who experienced a stroke, researchers from the Florey Institute of Neuroscience and Mental Health and the Menzies Institute for Medical Research have been able to rule out any systemic bias in the healthcare received by men and women. However, researchers were not sure whether men and women have different causes of death following a stroke. They also weren’t sure if the higher long-term death rate following a stroke could be traced back to a specific cause or causes, and whether these might differ by sex.
  • An interactive platform discussion with world experts will examine shaping a future of integrated care for stroke and non-communicable diseases(NCDs). Stroke and other NCDs are collectively driven by the same risk factors and often present as co-morbidities. They are often chronic, complex, and related to persistent handicaps.  As stroke survivors know well, a more integrated care with a life-course approach is required. Yet, health systems are ill-equipped to respond to this need, as they focus on single diseases with specific therapies. A new policy brief on stroke and NCDs with key messages and action points on these issues will be presented at a 12:40 pm session in the Exhibition Hall featuring Dr. Marc Fisher, Professor of Neurology, Harvard Medical School, Editor-in-Chief of Stroke (USA), Dr. Sheila Martins, Founder and President of Brazilian Stroke Network (Brazil),  Dr. Bo Norrving, Professor of Neurology, Lund University (Sweden), and Yves Savoie, CEO, Heart & Stroke Foundation (Canada)

 

11th World Stroke Congress

The 11th World Stroke Congress, being held Oct. 17-20, 2018, at the Palais des Congrès in Montreal, Quebec, brings together leading international stroke experts and an unparalleled scientific program covering epidemiology, prevention, acute care and recovery in hundreds of sessions and oral posters. The Congress is attended by stroke professionals, researchers, policy makers and people with lived experience from around the world. This is the first time the biennial Congress has been held in North America in 12 years; the 2016 Congress was held in Hyderabad, India. This year’s Congress is jointly organized by the World Stroke Organization (WSO) and the Canadian Stroke Consortium (CSC). Co-presidents are Dr. Werner Hacke, WSO President, and Dr. Mike Sharma, CSC Chair.  WorldStrokeCongress.org/2018

ABOUT STROKE

A stroke happens when blood stops flowing to a part of the brain or bleeding occurs in the brain. This interruption in blood flow or bleeding into the brain leads to damage to the surrounding brain cells which cannot be repaired or replaced; 1.9 million brain cells die every minute during a stroke. Stroke can happen at any age. Stroke affects everyone: survivors, family and friends, workplaces and communities.

The effects of a stroke depend on the part of the brain that was damaged and the amount of damage done.Ischemic strokeis the most common form of stroke, caused by a sudden blocked artery (about 85% of all stroke). A transient ischemic attack (TIA)is sometimes called a mini-stroke and is the mildest form of ischemic stroke. A TIA is an ischemic stroke, caused by a briefly blocked artery with rapid spontaneous unblocking of the artery leading to only a short period of brain malfunction. However, TIAs are an important warning that a more serious stroke may occur. Hemorrhagic strokeoccurs when a blood vessel ruptures, causing bleeding in or around the brain (about 15% of all stroke). 

Recovery from stroke starts right away. The quicker the signs are recognized, and the patient is diagnosed and treated, the greater likelihood of a good recovery, with less chance of another stroke, and decreased healthcare costs. The first few hours after stroke are crucial, affecting the recovery journey for years to come. 

The impact of stroke around the world

  • There are over 80 million people currently living with the effects of stroke globally. 
  • Stroke is the second leading cause of death and disability globally.
  • There are 13.7 million strokes around the world each year.
  • Five and a half million people die of stroke each year globally. 
  • One person dies of stroke every six seconds globally.
  • One in four survivors will have another stroke.

Stroke in Canada

  • Nine in ten Canadians have at least one risk factor for stroke.
  • There are 62,000 strokes in Canada each year – that is one stroke every nine minutes.
  • Stroke is the third leading cause of death in Canada and a leading cause of disability.
  • Each year, more than 13,000 Canadians die from stroke.
  • More than 400,000 Canadians live with long-term disability from stroke and this will almost double in the next 20 years.
  • Stroke among people under 65 is increasing and stroke risk factors are increasing for young adults.

World Stroke Organization

The World Stroke Organization (WSO) is the only global organization with a sole focus on fighting stroke. WSO’s mission is to reduce the global burden of stroke through prevention, treatment and long term care. WSO provides a strong voice for stroke professionals, survivors and caregivers in global and regional policy. The Organization is a WHO implementing partner and has UN approved consultative status. www.world-stroke.org

CanadianStrokeConsortium

TheCanadianStrokeConsortiumis theprofessionalorganizationforstrokeneurologists and other physicians interested in stroke. Our members are committed to reducing the burden of stroke through the translation of clinical research into routine patient care. Increasing capacity for high quality research, enhancing the capability of stroke services, leading comprehensive knowledge translation programs, and advocating in health policy and systems of care affecting stroke represent the four pillars of CSC’s activities. strokeconsortium.ca

Heart and Stroke Foundation of Canada

Life. We don’t want you to miss it. That’s why Heart & Stroke leads the fight against heart disease and stroke. We must generate the next medical breakthroughs, so Canadians don’t miss out on precious moments. Together, we are working to prevent disease, save lives and promote recovery through research, health promotion and public policy. heartandstroke.ca

For more information and to set up interviews contact: Diane Hargrave, dhprbks@interlog.com
416-467-9954, ext. 102