News Release

Medical and patient communities call for urgent action to prevent stroke crisis in Latin America

Peer-Reviewed Publication

TogoRun

  • Medical and patient communities call on national policymakers in Latin America to take urgent action against preventable strokes that strike millions of people with atrial fibrillation (AF) each year
  • AF increases the risk of stroke fivefold and is responsible for one in five of all ischemic strokes caused by a blood clot blocking a blood vessel in the brain 1,2,3,4
  • Millions of people in Latin America suffer from AF
    • In Brazil, there are around 1.5 million patients living with AF 5
    • In Venezuela, it is thought there are 230,000 AF sufferers, with this figure predicted to rise to one million by 2050 6
  • The consequences of stroke can devastate not only a patient's life, but also that of families and carers. 7,8 Long-term help and care is required for most survivors 9
  • The economic implications of stroke are significant. For example, in Argentina and Brazil, national healthcare spending on initial hospitalization for stroke patients has been calculated at approximately US$434 million and US$450 million, respectively 10,11
  • The impact of stroke is predicted to rise dramatically as the population ages and it has been predicted that deaths due to stroke in Latin America will triple by 2024 12

Mexico City, 8 September 2011 – Urgent coordinated action from national governments, medical societies and patient organizations is needed to avoid a public health crisis resulting from the tide of preventable strokes that leave many people with atrial fibrillation (AF) mentally and physically disabled or dead, every year. How Can We Avoid a Stroke Crisis in Latin America?, a report from Action for Stroke Prevention – a group of health experts from around the world - reveals the huge economic, social and personal burden of AF-related strokes across the region. Launched today at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 3rd Latin America Conference, the report proposes measures to tackle stroke in patients with AF, the most common, sustained abnormal heart rhythm and a major cause of stroke.

"This is an epidemic that is already happening. Stroke is a serious public health threat in Latin America," said Dr. Carlos Cantú, Professor of Stroke Program at the Universidad Nacional Autónoma de México; Founding Member of the Mexican Stroke Association. "Compared with the general population, people with atrial fibrillation have a significantly higher risk of stroke and these strokes tend to be more severe, cause greater disability and have worse outcomes. It is therefore likely that these strokes incur greater costs to healthcare systems, survivors and their families."

Atrial Fibrillation-Related Strokes Are Preventable

Action for Stroke Prevention's report highlights the magnitude of the impact of stroke in Latin America and outlines measures to prevent stroke in people who have AF. The under-diagnosis of AF, as well as suboptimal use of anticlotting therapies and side-effects of current treatments, mean that an unnecessary and heavy burden is placed on patients, their families and carers, as well as healthcare systems across the region. There are simple actions, which if taken now could prevent a substantial number of deaths, disabilities, and costs resulting from stroke.

Action for Stroke Prevention's recommendations, which are endorsed by 37 medical and patient organizations from Latin America and around the world include:

  • Improving awareness of the impact of AF and AF-related stroke
  • Developing methods for early and adequate diagnosis of AF and stroke risk assessment
  • Taking new and better approaches to prevent stroke in patients with AF
  • Facilitating the exchange of best practice between national governments in Latin America
  • Developing strategies to support adherence to guidelines
  • Providing equal and adequate administration of therapy for patients with AF across countries in Latin America
  • Advancing research into the causes, prevention and management of AF, and addressing the current paucity of epidemiological information in Latin America

"The majority of AF-related strokes are preventable through earlier detection and better disease management. Our report's recommendations offer strategic measures that can be taken to prevent a potentially devastating epidemic," said Dr. Jorge Gonzalez-Zuelgaray, Chief of Service of Arrhythmias and Electrophysiology, Sanatorio de la Trinidad San Isidro, Buenos Aires; president, Arrhythmia Alliance and Atrial Fibrillation Association, Argentina. "Increasing understanding of AF and AF-related stroke among governments, healthcare providers and the public, encouraging the development and use of new approaches to the management of AF, and improving adherence to clinical guidelines are the first steps."

Improving Access to Better Patient Care

In addition to a high risk of stroke, patients with AF suffer from more severe strokes and have a poorer prognosis after the event than patients without AF. For many patients, surviving a stroke can be worse than dying from one. Stroke often results in widespread and long-lasting damage and disability to patients. Basic functions many of us take for granted, such as walking and speaking, can be severely affected and the sudden onset of stroke means that the affected individual and their family members are not prepared to deal with the physical, psychological and financial burden it can impose.

"Policymakers and payers need to better understand AF and AF-related stroke to inform their decision making," said Trudie Lobban, Founder and Trustee, Arrhythmia Alliance, and co-founder and CEO, Atrial Fibrillation Association. "The risk of an AF-related stroke increases with age. We each have a one in four lifetime chance of developing AF so it is clear that there is an unmet medical need for stroke prevention in people with atrial fibrillation."

Patients with AF often do not have sufficient access to information about their condition and its treatment but a number of organizations are working to improve access to information on AF in Latin America.

"When diagnosed with AF, people can feel uniformed and unsupported. They are on an emotional rollercoaster living with the distress that can be caused by AF symptoms and the fear of stroke," said Mellanie True Hills, Founder and CEO of StopAfib.org. "It is essential that we remove the barriers to patient care, and support the improvement of patient and physician communication and education. If we act now – strategically and deliberately – prevention is possible."

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About AF and Stroke

AF is the most common, sustained abnormal heart rhythm. 13 It causes the two upper chambers of the heart (the atria) to quiver instead of beating effectively, resulting in blood not being completely pumped out, which in turn causes pooling that can lead to clotting in the atria. If a blood clot leaves the atria, it can become lodged in an artery in the brain blocking the blood supply and causing the patient to suffer from an ischemic stroke. 14 AF is responsible for 20 percent of all ischemic strokes. 14

Although the current treatment for stroke – vitamin K antagonists, acenocoumarol and phenprocoumon – can be effective, they are also associated with a number of drawbacks and are currently underused, particularly in elderly patients who are at greatest risk of stroke. 15

Preventing AF in patients at risk of arrhythmia, diagnosing AF before the first stroke occurs and following recommendations regarding the use of anticlotting therapies, including potential new treatment options, are critical for effective prevention of AF-related strokes. 16

About the Report

The authors and reviewers are comprised of cardiologists, neurologists, primary care practitioners, hematologists, patient representatives and hospital pharmacists.

The Report's call-to-action and recommendations are endorsed by:

Action for Stroke Prevention's report was made possible by sponsorship from Bayer HealthCare Pharmaceuticals. The report, and all related materials, has been determined by the authors independently of Bayer HealthCare Pharmaceuticals.

References

1 Kannel WB, Benjamin EJ et al. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 1998;82:457–507

2 Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983–8

3 American College of Cardiology. CardioSmart. Atrial fibrillation. 2010

4 Marini C, De Santis F, Sacco S et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population based study. Stroke 2005;36:1115–19

5 Zimerman LI, Fenelon G, Martinelli Filho M et al. Sociedade Brasileira de Cardiologia. [Brazilian guidelines on atrial fibrillation]. Arq Bras Cardiol 2009;92:1–39

6 Fuenmayor AJ, Fuenmayor AM. Nonpharmacological treatment of atrial fibrillation. Avances Cardiol 2009;29:286–95

7 Mayo NE, Wood-Dauphinee S, Ahmed S, et al. Disablement following stroke. Disabil Rehabil 1999;21:258-68

8 Kappelle LJ, Adams HP Jr, Heffner ML, et al. Prognosis of young adults with ischemic stroke. A long-term follow up study assessing recurrent vascular events and functional outcome in the Iowa Registry of Stroke in Young Adults. Stroke 1994;25:1360–5

9 Wolfe C, Rudd A. The Burden of Stroke. White Paper: Raising awareness of the global toll of stroke-related disability and death. 2007. http://www.safestroke.org/Portals/10/FINAL Burden of Stroke.pdf. Accessed March 2011

10 Christensen MC, Previgliano I, Capparelli FJ et al. Acute treatment costs of intracerebral hemorrhage and ischemic stroke in Argentina. Acta Neurol Scand 2009; 119:246-53

11 Christensen MC, Valiente R, Sampaio SG et al. Acute treatment costs of stroke in Brazil. Neuroepidemiology 2009; 32:142-9

12 World Health Organization. The global burden of disease: 2004 update. 2008. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf. Accessed March 2011

13 Kannel WB, Benjamin EJ et al. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 1998;82:457–507

14 Marini C, De Santis F, Sacco S et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke 2005;36:1115–9

15 Rane A, Lindh JD. Pharmacogenetics of anticoagulants. Hum Genomics Proteomics 2010;2010:754919

16 Kirchhof et al. Early and comprehensive management of atrial fibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on AF entitled ‘research perspectives in AF’. EurHJ 2009

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