1
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Feigin VL, Martins SC, Brainin M, Norrving B, Kamenova S, Giniyat A, Kondybayeva A, Aldyngurov DK, Bapayeva M, Zhanuzakov M, Hankey GJ. Twenty years on from the introduction of the high risk strategy for stroke and cardiovascular disease prevention: a systematic scoping review. Eur J Neurol 2024; 31:e16157. [PMID: 38009814 PMCID: PMC11235671 DOI: 10.1111/ene.16157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND PURPOSE Early this century, the high risk strategy of primary stroke and cardiovascular disease (CVD) prevention for individuals shifted away from identifying (and treating, as appropriate) all at-risk individuals towards identifying and treating individuals who exceed arbitrary thresholds of absolute CVD risk. The public health impact of this strategy is uncertain. METHODS In our systematic scoping review, the electronic databases (Scopus, MEDLINE, Embase, Google Scholar, Cochrane Library) were searched to identify and appraise publications related to primary CVD/stroke prevention strategies and their effectiveness published in any language from January 1990 to August 2023. RESULTS No published randomized controlled trial was found on the effectiveness of the high CVD risk strategy for primary stroke/CVD prevention. Targeting high CVD risk individuals excludes a large proportion of the population from effective blood-pressure-lowering and lipid-lowering treatment and effective CVD prevention. There is also evidence that blood pressure lowering and lipid lowering are beneficial irrespective of blood pressure and cholesterol levels and irrespective of absolute CVD risk and that risk-stratified pharmacological management of blood pressure and lipids to only high CVD risk individuals leads to significant underuse of blood-pressure-lowering and lipid-lowering medications in individuals otherwise eligible for such treatment. CONCLUSIONS Primary stroke and CVD prevention needs to be done in all individuals with increased risk of CVD/stroke. Pharmacological management of blood pressure and blood cholesterol should not be solely based on the high CVD risk treatment thresholds. International guidelines and global strategies for primary CVD/stroke prevention need to be revised.
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Affiliation(s)
- Valery L. Feigin
- National Institute for Stroke and Applied Neurosciences, School of Clinical SciencesAuckland University of TechnologyAucklandNew Zealand
- Institute for Health Metrics EvaluationUniversity of WashingtonSeattleWashingtonUSA
| | - Sheila C. Martins
- Hospital de Clínicas de Porto AlegreHospital Moinhos de VentoPorto AlegreBrazil
| | - Michael Brainin
- Department of Neuroscience and Preventive MedicineDanube University KremsKremsAustria
| | - Bo Norrving
- Department of Clinical SciencesSkåne University Hospital, Lund UniversityLundSweden
- Department of NeurologySkåne University Hospital, Lund UniversityLundSweden
| | - Saltanat Kamenova
- Asfendiyarov Kazakh National Medical UniversityAlmatyRepublic of Kazakhstan
| | - Azhar Giniyat
- Minister of Healthcare of the Republic of KazakhstanAstanaRepublic of Kazakhstan
| | - Aida Kondybayeva
- Asfendiyarov Kazakh National Medical UniversityAlmatyRepublic of Kazakhstan
| | - Daulet K. Aldyngurov
- Department of Science and Human ResourceMinistry of Healthcare of the Republic of KazakhstanAstanaRepublic of Kazakhstan
| | - Magripa Bapayeva
- Department of Internal MedicineKazakhstan Medical University «KSPH»AlmatyRepublic of Kazakhstan
| | - Murat Zhanuzakov
- Higher School of Medicineal‐Farabi Kazakh National UniversityAlmatyRepublic of Kazakhstan
| | - Graeme J. Hankey
- Perron Institute Chair in Stroke Research, Medical SchoolUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Perron Institute for Neurological and Translational SciencePerthWestern AustraliaAustralia
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2
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Sebastian IA, Gandhi DB, Sylaja PN, Paudel R, Kalkonde YV, Yangchen Y, Gunasekara H, Injety RJ, Vijayanand PJ, Chawla NS, Oo S, Hla KM, Tenzin T, Pandian JD. Stroke systems of care in South-East Asia Region (SEAR): commonalities and diversities. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 17:100289. [PMID: 37849930 PMCID: PMC10577144 DOI: 10.1016/j.lansea.2023.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 10/19/2023]
Abstract
The Southeast Asia Region (SEAR) accounts for nearly 50% of the developing world's stroke burden. With various commonalities across its countries concerning health services, user awareness, and healthcare-seeking behavior, SEAR still presents profound diversities in stroke-related services across the continuum of care. This review highlights the numerous systems and challenges in access to stroke care, acute stroke care services, and health care systems, including rehabilitation. The paper has also attempted to compile information on the availability of stroke specialized centers, Intravenous thrombolysis (IVT) ready centers, Endovascular therapy (EVT) ready centers, rehabilitation centers, and workforce against a backdrop of each country's population. Lastly, the efforts of WHO (SEARO)-CMCL (World Health Organization-South East Asia region, Christian Medical College & Hospital Ludhiana) collaboration towards improving stroke services and capacity among the SEAR have been described.
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Affiliation(s)
| | - Dorcas B.C. Gandhi
- Department of Neurology and Physiotherapy, Christian Medical College and Hospital, India
| | - Padmavati N. Sylaja
- Department of Neurology, Shree Chitra Thirunal Institute, Thiruvananthapuram, Kerala, India
| | - Raju Paudel
- Grande International Hospital, Kathmandu, Nepal
| | | | | | | | - Ranjit J. Injety
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Pranay J. Vijayanand
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Nistara S. Chawla
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - San Oo
- Department of Neurology, Yangon General Hospital, Yangon, Myanmar
| | - Khin Myo Hla
- Department of Physical Medicine & Rehabilitation, Yangon General Hospital, University of Medicine, Yangon, Myanmar
| | - Tashi Tenzin
- Jigme Dorji Wangchuck National Referral Hospital, Thimpu, Bhutan
| | - Jeyaraj D. Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
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3
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Abstract
A polypill-type strategy for primary prevention was first published at the turn of the century and advised that a multi-ingredient pill applied to an adult population would prevent up to 80% of cardiovascular and stroke events. Such a pill should contain small doses of antihypertensives, lipid-lowering drugs, and some nutrients. The startling increase of the global stroke burden has led to a revival of this concept and the propagation of a population-based prevention strategy. Recent cardiovascular fixed-dose combination trials have shown a significant effect in reducing not only blood pressure and cholesterol levels but also in reducing cardiovascular and stroke events. In most of the studies, the study population was for secondary prevention and the total number of strokes was small. Nevertheless, it is now clear that a large proportion of primary prevention must take this path. It is especially promising when combined with community health workers interventions for modifying risk behavior. While a polypill-type approach seems most efficacious in underserved regions of high-income countries as well as in low- and middle-income countries, it seems to have a large overall effect in spite of some problems with nonadherence or potential side effects. It should be available and affordable for large target populations. Larger phase 4 studies are under way.
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Affiliation(s)
- Michael Brainin
- Department for Clinical Neuroscience and Preventive Medicine, University for Continuing Education Krems, Austria (M.B., Y.T.)
| | - Yvonne Teuschl
- Department for Clinical Neuroscience and Preventive Medicine, University for Continuing Education Krems, Austria (M.B., Y.T.)
| | - Sheila Martins
- Neurology and Neurosurgery Service, Hospital Moinhos de Vento, Brazil (S.M.).,Neurology Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (S.M.)
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4
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Feigin VL, Owolabi M, Hankey GJ, Pandian J, Martins SC. Digital Health in Primordial and Primary Stroke Prevention: A Systematic Review. Stroke 2022; 53:1008-1019. [PMID: 35109683 DOI: 10.1161/strokeaha.121.036400] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The stroke burden continues to grow across the globe, disproportionally affecting developing countries. This burden cannot be effectively halted and reversed without effective and widely implemented primordial and primary stroke prevention measures, including those on the individual level. The unprecedented growth of smartphone and other digital technologies with digital solutions are now being used in almost every area of health, offering a unique opportunity to improve primordial and primary stroke prevention on the individual level. However, there are several issues that need to be considered to advance development and use this important digital strategy for primordial and primary stroke prevention. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines we provide a systematic review of the current knowledge, challenges, and opportunities of digital health in primordial and primary stroke prevention.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, New Zealand (V.L.F.).,Institute for Health Metrics Evaluation, University of Washington, Seattle (V.L.F.).,Research Centre of Neurology, Moscow, Russia (V.L.F.)
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, University College Hospital Ibadan and Blossom Specialist Medical Center, Ibadan, Nigeria (M.O.O.)
| | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia. Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia (G.J.H.)
| | | | - Sheila C Martins
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Hospital Moinhos de Vento & Brazilian Stroke Network (S.M.)
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5
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Wang WT, Wu TC, Tseng WK, Wu YW, Lin TH, Yeh HI, Chang KC, Wang JH, Leu HB, Yin WH, Wu CC, Chen JW. Prognostic indicators for the onset of ischaemic versus haemorrhagic stroke in stable coronary artery disease. Medicine (Baltimore) 2021; 100:e27973. [PMID: 35049202 PMCID: PMC9191570 DOI: 10.1097/md.0000000000027973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022] Open
Abstract
The incidence of stroke may be increased in patients with coronary artery disease (CAD). We aimed to investigate the specific risk factors for the development of ischaemic and haemorrhagic stroke in stable CAD patients.Patients with stable CAD were prospectively enrolled for future cardiovascular events in Taiwan. All the patients had received coronary interventions and were stable for least 1 month before enrolment. The incidence of ischaemic stroke was identified and confirmed by telephone and hospital records. Baseline characteristics, including demographic data, lipid profiles, medications, and biomarkers for potential inflammatory and atherosclerosis, were analysed.In total, 1428 patients (age, 63.07 ± 11.4 years; 1207 males) were under standard medical treatment and regularly followed-up for at least 4 years. Multivariate logistic regression analysis showed that baseline serum myeloperoxidase (MPO) level (hazard ratio [HR]: 1.89, 95% CI: 1.16-3.10, P = .01) and statin use (HR: 0.37; 95% CI: 0.17-0.79, P = .01) were independently associated with the onset of ischaemic stroke. Age (HR: 1.07, 95% CI: 1.00-1.14, P = .04) and angiotensin receptor blocker (ARB) use (HR: 0.37, 95% CI: 0.17-0.79, P = .01) were independently associated with future onset of intracranial haemorrhage (ICH), implying the different mechanisms of ischaemic stroke and ICH.Age and ARB use were related to ICH onset. Baseline MPO level and statin use were independently associated with longer and shorter future ischaemic stroke onset in stable CAD patients, respectively. Further studies are indicated to confirm the potential mechanisms and advance individual risk stratification for the onset of different types of stroke in clinical CAD.
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Affiliation(s)
- Wei-Ting Wang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- From the Divison of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | - Tao-Cheng Wu
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- From the Divison of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C
| | - Wei-Kung Tseng
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan, R.O.C
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan, R.O.C
| | - Yen-Wen Wu
- Cardiology Division of Cardiovascular Medical Center and Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Taiwan, R.O.C
| | - Hung-I Yeh
- Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan, R.O.C
| | - Kuan-Cheng Chang
- Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, R.O.C
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan, R.O.C
| | - Ji-Hung Wang
- Department of Cardiology, Buddhist Tzu-Chi General Hospital, Tzu-Chi University, Hualien, Taiwan, R.O.C
| | - Hsin-Bang Leu
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- From the Divison of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C
- Heath Care and Management Center (H.-B.L., J.-W.C.), Taipei Veterans General Hospital, Taiwan
| | - Wei-Hsian Yin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, R.O.C
| | - Chau-Chung Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan, R.O.C
- Department of Primary Care Medicine, College of Medicine, National Taiwan University, Taipei
| | - Jaw-Wen Chen
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- From the Divison of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C
- Heath Care and Management Center (H.-B.L., J.-W.C.), Taipei Veterans General Hospital, Taiwan
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
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6
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Martins SCO, Lavados P, Secchi TL, Brainin M, Ameriso S, Gongora-Rivera F, Sacks C, Cantú-Brito C, Alvarez Guzman TF, Pérez-Romero GE, Muñoz Collazos M, Barboza MA, Arauz A, Abanto Argomedo C, Novarro-Escudero N, Amorin Costabile HI, Crosa R, Camejo C, Mernes R, Maldonado N, Mora Cuervo DL, Pontes Neto OM, Silva GS, Carbonera LA, de Souza AC, de Sousa EDG, Flores A, Melgarejo D, Santos Carquin IR, Hoppe A, de Carvalho JJF, Mont'Alverne F, Amaya P, Bayona H, Navia González VH, Duran JC, Urrutia VC, Araujo DV, Feigin VL, Nogueira RG. Fighting Against Stroke in Latin America: A Joint Effort of Medical Professional Societies and Governments. Front Neurol 2021; 12:743732. [PMID: 34659101 PMCID: PMC8517273 DOI: 10.3389/fneur.2021.743732] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden. In 2018, at the first Latin American Stroke Ministerial Meeting, stroke physician and healthcare manager representatives from 13 countries signed the Declaration of Gramado with the priorities to improve the region, with the commitment to implement all evidence-based strategies for stroke care. The second meeting in March 2020 reviewed the achievements in 2 years and discussed new objectives. This paper will review the 2-year advances and future plans of the Latin American alliance for stroke. Method: In March 2020, a survey based on the Declaration of Gramado items was sent to the neurologists participants of the Stroke Ministerial Meetings. The results were confirmed with representatives of the Ministries of Health and leaders from the countries at the second Latin American Stroke Ministerial Meeting. Results: In 2 years, public stroke awareness initiatives increased from 25 to 75% of countries. All countries have started programs to encourage physical activity, and there has been an increase in the number of countries that implement, at least partially, strategies to identify and treat hypertension, diabetes, and lifestyle risk factors. Programs to identify and treat dyslipidemia and atrial fibrillation still remained poor. The number of stroke centers increased from 322 to 448, all of them providing intravenous thrombolysis, with an increase in countries with stroke units. All countries have mechanical thrombectomy, but mostly restricted to a few private hospitals. Pre-hospital organization remains limited. The utilization of telemedicine has increased but is restricted to a few hospitals and is not widely available throughout the country. Patients have late, if any, access to rehabilitation after hospital discharge. Conclusion: The initiative to collaborate, exchange experiences, and unite societies and governments to improve stroke care in Latin America has yielded good results. Important advances have been made in the region in terms of increasing the number of acute stroke care services, implementing reperfusion treatments and creating programs for the detection and treatment of risk factors. We hope that this approach can reduce inequalities in stroke care in Latin America and serves as a model for other under-resourced environments.
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Affiliation(s)
- Sheila Cristina Ouriques Martins
- Hospital Moinhos de Vento, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Brazilian Stroke Network, Porto Alegre, Brazil.,World Stroke Organization, Geneva, Switzerland
| | - Pablo Lavados
- Clinica Alemana, Universidad del Desarollo, Santiago, Chile
| | - Thaís Leite Secchi
- Hospital Moinhos de Vento, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Brazilian Stroke Network, Porto Alegre, Brazil
| | - Michael Brainin
- World Stroke Organization, Geneva, Switzerland.,Department of Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems an der Donau, Austria
| | - Sebastian Ameriso
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia, Buenos Aires, Argentina
| | - Fernando Gongora-Rivera
- Servicio de Neurología - Unidad Neurovascular, Hospital Universitario José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.,Instituto de Neurología y Neurocirugía, Centro Médico Zambrano Hellion, Tec Salud, San Pedro Garza García, Mexico.,Centro de Investigación y Desarrollo en Ciencias de la Salud, Universidad Aiutónoma de Nuevo León, Monterrey, Mexico
| | - Claudio Sacks
- Department of Neurology, Universidad del Valparaiso, Valparaiso, Chile
| | - Carlos Cantú-Brito
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Tony Fabian Alvarez Guzman
- Hospital Regional Manuela Beltran, Socorro, Colombia.,Asociación Colombiana de Neurología, Bogotá, Colombia
| | - Germán Enrique Pérez-Romero
- Asociación Colombiana de Neurología, Bogotá, Colombia.,Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.,Fundación Hospital San Carlos, Bogotá, Colombia
| | | | - Miguel A Barboza
- Hospital Dr. Rafael A. Calderon, Neuroscience Department, San José, Costa Rica
| | - Antonio Arauz
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Clínica de Enfermedad Vascular Cerebral, Ciudad de México, Mexico
| | - Carlos Abanto Argomedo
- Departamento de Enfermedades Neurovasculares, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | | | | | | | | | - Ricardo Mernes
- Hospital de Clinicas, Faculdad de Medicina, Universidad Nacional de Asuncion, San Lorenzo, Paraguay
| | - Nelson Maldonado
- Hospital Central del Instituto de Previsión Social, Asunción, Paraguay
| | | | - Octávio Marques Pontes Neto
- Brazilian Stroke Network, Porto Alegre, Brazil.,Universidad San Francisco de Quito, Hospital de los Valles, Quito, Ecuador.,Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Gisele Sampaio Silva
- Brazilian Stroke Network, Porto Alegre, Brazil.,Brazilian Stroke Society, São Paulo, Brazil.,Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Ana Claudia de Souza
- Hospital Moinhos de Vento, Porto Alegre, Brazil.,Brazilian Stroke Network, Porto Alegre, Brazil
| | | | - Alan Flores
- Hospital de Clinicas, Faculdad de Medicina, Universidad Nacional de Asuncion, San Lorenzo, Paraguay
| | - Donoban Melgarejo
- Hospital de Clinicas, Faculdad de Medicina, Universidad Nacional de Asuncion, San Lorenzo, Paraguay.,Hospital Central del Instituto de Previsión Social, Asunción, Paraguay
| | - Irving R Santos Carquin
- Emergency Hospital Public Assistance, Santiago, Chile.,Faculty of Medicine, University of Chile, Santiago, Chile.,Ministry of Health, Santiago, Chile
| | - Arnold Hoppe
- Clinica Alemana, Universidad del Desarollo, Santiago, Chile.,Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | | | - Francisco Mont'Alverne
- Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile.,Sociedade Brazileira de Neurorradiologia Diagnóstica e Terapêutica, São Paulo, Brazil
| | - Pablo Amaya
- Servicio de Neurología - Unidad Neurovascular, Hospital Universitario José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.,Asociación Colombiana de Neurología, Bogotá, Colombia.,Fundación Valle del Lili, Cali, Colombia
| | - Hernan Bayona
- Asociación Colombiana de Neurología, Bogotá, Colombia.,Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | | | | | - Victor C Urrutia
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Denizar Vianna Araujo
- Ministry of Health, Brasília, Brazil.,Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Raul G Nogueira
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University, Atlanta, GA, United States
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7
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Brainin M. Polypills for stroke prevention: they work and are effective. Eur J Neurol 2021; 28:3879-3880. [PMID: 34510625 DOI: 10.1111/ene.15100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
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8
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Pandian JD, Sebastian IA. Integrated approach to stroke burden: are we doing enough? Lancet Neurol 2021; 20:774-775. [PMID: 34487724 DOI: 10.1016/s1474-4422(21)00287-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/24/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Jeyaraj Durai Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, Punjab 141008, India; World Stroke Organisation, Geneva, Switzerland; Indian Stroke Association, Chennai, India.
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9
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Lehmann J, Riedl D, Sztankay M, Boehme C, Fischnaller J, Kiechl S, Holzner B, Knoflach M, Rumpold G. The Attitude towards Polypills Questionnaire (APPQ): a phase I-III development and validation study in patients with cerebrovascular disease. Eur J Neurol 2021; 28:4039-4050. [PMID: 34463018 PMCID: PMC9292587 DOI: 10.1111/ene.15088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/27/2022]
Abstract
Background and purpose The polypill approach has been proposed to reduce patients’ pill burden, increase medication adherence and lower stroke incidence. However, little is known about patients’ attitudes towards polypills for cerebrovascular medication. Methods Based on the European Organization for Research and Treatment of Cancer Quality of Life Group questionnaire development guidelines, a questionnaire to measure patients’ attitudes towards polypills for the secondary prevention of stroke (phase I–III) was developed. In phase I, issues were generated via literature review and interviews with patients and healthcare professionals. The issues were operationalized into items in phase II. In phase III the questionnaire was validated in a large single‐centre sample, and test–retest and internal validity were evaluated. Results In phase I, 34 relevant issues were identified through literature search and interviews. Pre‐testing the questionnaire indicated high applicability and comprehensibility. The final Attitudes towards Polypills Questionnaire was tested in N = 260 patients and showed a two‐factor structure. The factors were labelled ‘concerns’ and ‘benefits’. The scales showed acceptable and good internal validity (concerns, Cronbach's α = 0.85; benefits, α = 0.93), but the scales’ test–retest validity was ambiguous. On a 0 to 3 rating scale, concerns were rated lower than benefits (mean 1.07, SD 0.69 vs. mean 1.87, SD 0.89). Conclusions The Attitudes towards Polypills Questionnaire showed high comprehensibility and content validity to assess German language patients’ attitudes towards a polypill medication. Our data and questionnaire may aid the implementation of polypill treatments in clinical practice and can be used in the design of future clinical trials on polypill therapy. Further validation of the questionnaire is advised.
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Affiliation(s)
- Jens Lehmann
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - David Riedl
- University Clinic of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Monika Sztankay
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,VASCage-Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Bernhard Holzner
- University Hospital of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria.,Evaluation Software Development GmbH, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,VASCage-Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Gerhard Rumpold
- University Clinic of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria.,Evaluation Software Development GmbH, Innsbruck, Austria
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10
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Chen YH, Sawan M. Trends and Challenges of Wearable Multimodal Technologies for Stroke Risk Prediction. SENSORS (BASEL, SWITZERLAND) 2021; 21:E460. [PMID: 33440697 PMCID: PMC7827415 DOI: 10.3390/s21020460] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 02/07/2023]
Abstract
We review in this paper the wearable-based technologies intended for real-time monitoring of stroke-related physiological parameters. These measurements are undertaken to prevent death and disability due to stroke. We compare the various characteristics, such as weight, accessibility, frequency of use, data continuity, and response time of these wearables. It was found that the most user-friendly wearables can have limitations in reporting high-precision prediction outcomes. Therefore, we report also the trend of integrating these wearables into the internet of things (IoT) and combining electronic health records (EHRs) and machine learning (ML) algorithms to establish a stroke risk prediction system. Due to different characteristics, such as accessibility, time, and spatial resolution of various wearable-based technologies, strategies of applying different types of wearables to maximize the efficacy of stroke risk prediction are also reported. In addition, based on the various applications of multimodal electroencephalography-functional near-infrared spectroscopy (EEG-fNIRS) on stroke patients, the perspective of using this technique to improve the prediction performance is elaborated. Expected prediction has to be dynamically delivered with high-precision outcomes. There is a need for stroke risk stratification and management to reduce the resulting social and economic burden.
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Affiliation(s)
- Yun-Hsuan Chen
- CenBRAIN Lab., School of Engineering, Westlake University, Hangzhou 310024, China
- Institute of Advanced Study, Westlake Institute for Advanced Study, Hangzhou 310024, China
| | - Mohamad Sawan
- CenBRAIN Lab., School of Engineering, Westlake University, Hangzhou 310024, China
- Institute of Advanced Study, Westlake Institute for Advanced Study, Hangzhou 310024, China
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11
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Krishnamurthi R, George A, Merkin A, Bhattacharjee R, Feigin VL. Can we stop the stroke tsunami? Mitigating the barriers, amplifying the facilitators. J R Soc N Z 2020. [DOI: 10.1080/03036758.2020.1798477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Rita Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Ann George
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Alexander Merkin
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | | | - Valery L. Feigin
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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12
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Chao BH, Yan F, Hua Y, Liu JM, Yang Y, Ji XM, Peng B, Zhao GG, Wang YJ, Kang DZ, Wang YL, Zeng JS, Chu L, Li TX, Xu YM, Liu M, He L, Xu Y, Wu J, Lou M, Yue W, Cao L, Tu WJ, Wang LD. Stroke prevention and control system in China: CSPPC-Stroke Program. Int J Stroke 2020; 16:265-272. [PMID: 32223541 DOI: 10.1177/1747493020913557] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In China, stroke is a major cause of mortality, and long-term physical and cognitive impairment. To meet this challenge, the Ministry of Health China Stroke Prevention Project Committee (CSPPC) was established in April 2011. This committee actively promotes stroke prevention and control in China. With government financial support of 838.4 million CNY, 8.352 million people from 536 screening points in 31 provinces have received stroke screening and follow-up over the last seven years (2012-2018). In 2016, the CSPPC issued a plan to establish stroke centers. To shorten the pre-hospital period, the CSPPC established a stroke center network, stroke map, and stroke "Green Channel" to create three 1-h gold rescue circles, abbreviated as "1-1-1" (onset to call time <1 h; pre-hospital transfer time < 1 h, and door-to-needle time < 1 h). From 2017 to 2018, the median door-to-needle time dropped by 4.0% (95% confidence interval (CI), 1.4-9.4) from 50 min to 48 min, and the median onset-to-needle time dropped by 2.8% (95% CI, 0.4-5.2) from 180 min to 175 min. As of 31 December 2018, the CSPPC has established 380 stroke centers in mainland China. From 1 November 2018, the CSPPC has monitored the quality of stroke care in stroke center hospitals through the China Stroke Data Center Data Reporting Platform. The CSPPC Stroke program has led to a significant improvement in stroke care. This program needs to be further promoted nationwide.
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Affiliation(s)
- Bao-Hua Chao
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
| | - Feng Yan
- Department of Neurosurgery, Beijing Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yang Hua
- Department of Neurosurgery, Beijing Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jian-Min Liu
- Department of Neurology, Shanghai Changhai Hospital, Shanghai, China
| | - Yi Yang
- Department of Neurology, Jilin University First Hospital, Changchun, China
| | - Xun-Ming Ji
- Department of Neurosurgery, Beijing Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Guo-Guang Zhao
- Department of Neurosurgery, Beijing Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yong-Jun Wang
- Department of Neurology, Beijing Tiantan Hospital of Capital Medical University, Beijing, China
| | - De-Zhi Kang
- Department of Neurology, Fujian Medical University First Hospital, Fuzhou, China
| | - Yi-Long Wang
- Department of Neurology, Beijing Tiantan Hospital of Capital Medical University, Beijing, China
| | - Jin-Sheng Zeng
- Department of Neurology, Sun Yat-sen University First Hospital, Guangzhou, China
| | - Lan Chu
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Tian-Xiao Li
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yu-Ming Xu
- Department of Neurology, Zhengzhou University First Hospital, Zhengzhou, China
| | - Ming Liu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Li He
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Yun Xu
- Department of Neurology, Nanjing Gulou Hospital, Nanjing, China
| | - Jian Wu
- Department of Neurology, Chang Gung Hospital of Tsinghua University, Beijing, China
| | - Min Lou
- Department of Neurology, Zhejiang University Second Hospital, Hangzhou, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Lei Cao
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
| | - Wen-Jun Tu
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing, China.,Institute of Radiation Medicine, China Academy of Medical Science & Peking Union Medical College, Tianjin, China
| | - Long-De Wang
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China.,School of Public Health, Peking University, Beijing, China
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