The road ahead for a more stroke-ready region to improve patient outcomes

Prof Dr Mohamed Meshref, medical director at Boehringer Ingelheim IMETA, says there is a critical need to ensure everyone has access to modern stroke care centres

Prof. Dr. Mohamed Meshref, Medical Director at Boehringer Ingelheim IMETA

Ischemic stroke is a medical emergency and occurs when there is a blockage or clot in a blood vessel that supplies blood to the brain, leading to a lack of oxygen and nutrients to brain tissue. According to a recently published study, the incidence of stroke in the Middle East and North Africa region is estimated to be over 1,500 per 100,000 people, making it a significant health concern.

The burden of ischemic stroke is expected to increase in the future due to ageing populations and the increasing prevalence of risk factors in the region. Risk factors for stroke include hypertension, diabetes, obesity, smoking, and physical inactivity.

For strokes to be managed effectively, three key factors need to be considered. Firstly, the symptoms and signs of stroke need to be recognised by the individual or close ones. Second, it is of utmost importance to address the situation as quickly as possible. The time between a stroke occurring and receiving treatment is critical and the window for receiving effective treatment is limited to 4.5 hours. Third, those who experience a stroke need to be taken to a facility that is equipped to handle stroke cases and is staffed by healthcare professionals trained in stroke management.

The evolution of stroke management

Stroke management has evolved significantly over the years, moving from a time when stroke was not treated as a medical emergency and there were no specialised units or protocols in place to a modern approach that focuses on rapid assessment and treatment.

In the past, patients affected by stroke were often treated on general medical wards without the benefit of specialised equipment or expertise. This could lead to delayed diagnosis and treatment, resulting in higher rates of disability and death. With the recognition of the importance of early intervention, stroke management has shifted towards a more specialised approach.

Key to this is specialised stroke units that are equipped with the necessary equipment and staff to provide comprehensive care to stroke patients. The development of life-saving stroke codes, such as the FAST assessment, has helped healthcare providers quickly identify stroke symptoms and begin treatment as soon as possible. This includes the use of treatments such as thrombectomy therapy to physically remove clots, dissolve blood clots and restore blood flow to the brain.

Studies have shown that these interventions – specifically administering treatment within 3 to 4.5 hours of the onset of symptoms – have had a positive impact on stroke outcomes, including lower death rates and reduced irreparable brain damage.

What makes a hospital acute-stroke emergency ready?

To be acute-stroke emergency ready, a hospital should have the necessary equipment, staff, and protocols in place to provide rapid and effective care to stroke patients. Key elements include:

· Having a dedicated stroke unit or stroke beds and staff – including a neurologist – trained in stroke assessment, diagnosis, and treatment.

· Using rapid assessment protocols or stroke ‘codes’ such as the FAST protocol to help healthcare providers quickly identify stroke symptoms and begin treatment as soon as possible. FAST stands for Face, Arm, Speech, and Time and involves looking for signs of drooping of the face, weakness or numbness on one side of the body, or slurred speech.

· Emergency medical service staff alert the hospital prior to arrival to activate the stroke code, so the hospital is ready to receive the patient and refer for immediate imaging.

· Point-of-care testing and advanced imaging capabilities such as a CAT scanner.

· The ability to administer thrombolytic ‘clot busting’ therapy within a short window of time.

· Having access to rehabilitation services to help patients regain their abilities and prevent future strokes.

· Implementing a systematic approach to quality monitoring of stroke management in a hospital-based or international registry. This has been shown to lead to improvement in performance and stroke care delivery.

The role of awareness in reducing the ill-effects of stroke

Preventative programmes should be implemented with a focus on metabolic risk factors. There is an ongoing need across the region for sustained joint efforts between health authorities, pharma and the medical community towards raising awareness on the prevalence of stroke, its risk factors and best practices for prevention. Investing in awareness campaigns, screening programmes, and lifestyle interventions has the potential to make a real difference in the number and outcome of strokes annually.

A key element of public education efforts must focus on how to act when detecting signs of stroke and being aware that stroke is an emergency and must be treated fast at an appropriate hospital. Healthcare professional education is important too, and Boehringer Ingelheim is active in this area, particularly in supporting healthcare professionals to develop their stroke awareness.

The need for standardised care and innovation

Regulatory bodies play an important role in standardising care for stroke management. This includes committing to evidence-based guidelines set out by the European Stroke Organisation that support physicians in making clinical decisions with regard to intravenous thrombolysis for acute ischemic strokes.

Moreover, the adoption of telehealth and mobile stroke units has become more prevalent with the aim of improving outcomes for those living outside urban centres.

Conclusion

While there have been great advances in stroke management in recent years, there is a critical need to ensure everyone has access to a modern stroke care facility. By having the necessary equipment, staff, protocols, and trained emergency medical services in place, hospitals can provide the highest level of care to stroke patients and improve their outcomes. Public education about stroke prevention and recognition of symptoms is also essential in saving as many lives as possible. Through these necessary interventions, we can evoke new hope for the 1,500 per 100,000 people in the Mena region experiencing a stroke each year.