A Medical Device Daily

A new report from independent market information firm Datamonitor (London) says that if patients suffering a stroke were taken by medical emergency services to stroke units/centers where they could receive immediate treatment from specialists, much of the suffering and expense that follows could be avoided.

It said that stroke is the second leading cause of death in Europe and also can leave survivors severely disabled and dependent on long-term care, which places “an enormous financial burden on national healthcare systems.” That burden is likely to further increase as the incidence of stroke increases concurrent with an aging population.

Datamonitor cardiovascular analyst Jasjeet Mohain said the prevalence of a number of risk factors associated with the incidence of stroke, such as blood pressure, smoking, pre-existing coronary heart disease, obesity and diabetes are increasing. “Approximately 25% of men and 20% of women can expect to suffer a cerebrovascular event if they reach the age of 85.”

She said that the incidence of stroke is similar to that of acute coronary events, but that the burden of stroke lies with long-term disability as opposed to death. “Stroke patients frequently require longer hospital stays followed by lengthy periods of rehabilitation, long-term nursing care or indefinite dependency on community care,” Mohain said.

Noting that stroke is “a major economic burden on healthcare systems,” she added: “Without more effective management strategies for stroke victims, the cost of this disease will continue to escalate.”

Increasing awareness of the symptoms and urgency of stroke are the keys for improved patient outcomes, Mohain said. “One of the biggest delays in patients receiving treatment is late presentation to hospital. Patients often perceive symptoms as not serious or do not recognize they are having a stroke,” Mohain said. “To improve patient outcomes radically for ischemic stroke patients, time to treatment needs to be improved so that suitable patients can receive tPA [tissue plasminogen activator] therapy.”

tPA is sold by Genentech (South San Francisco, California) under its brand name, Activase.

Across the seven major pharmaceutical markets – France, Germany, Italy, Japan, Spain, UK and U.S. – most patients presented within a six- to 24-hour time frame, with the exception of Japan and Italy, which were within the first three hours.

In those seven markets, the incidence of stroke is expected to increase to 1.5 million by 2012. According to the American Stroke Association (Dallas), the estimated direct and indirect cost of stroke in the U.S. in 2004 will be $53.6 billion, the association said.

A study carried out in 1997 found that only 25% of patients knew that they were having a stroke and even when patients know that they are having a stroke, most present late because they perceive their symptoms as “not serious,” Datamonitor said.

Mohain said tPA is the only acute intervention that offers any significant chance of the patient making a good, if not full recovery from an ischemic stroke. “But to be effective, tPA must be given within three hours of the onset of symptoms. This means the patient must present to the appropriate facility, be diagnosed, assessed and treatment initiated, all within three hours.”

She said hospital and emergency services’ protocols can go a long way to reducing the “time-to-needle” delays that can often lead to otherwise eligible candidates being excluded from tPA treatment. “Whether or not a patient is eligible for tPA will depend on the time at which a patient, relative or onlooker identifies the stroke and seeks medical help. Crucial to this is knowledge of what symptoms indicate a stroke.”

Ideally, said Mohain, emergency medical services personnel should be trained to recognize stroke and transport patients directly to stroke units equipped to treat stroke patients.

While the UK has a high percentage of stroke units, it also has the longest time to obtain test results. This further highlights the fact that even though the government has spent a lot of money in developing stroke units, more money needs to be ploughed into resources, such as equipment and stroke specialists, Mohain said. “Stroke units need to be adequately equipped in order for patients to receive optimum care.”

She said that in its simplest form, the question boils down to the government either spending money on facilities and resources or spending it on long-term care for those living with the after-effects of stroke. “With an aging population only increasing the incidence of stroke, it seems both more practical and prudent to loosen the purse strings.”

Interim head of CSIP gets post

The UK Department of Health has named the acting CEO of its Care Services Improvement Partnership (CSIP) to the post on a permanent basis. Richard Humphries has been acting CEO of the partnership for the past seven months and directed its development and progression in advance of the program’s launch on April 1.

As CEO, he will direct the integration of the eight improvement programs that form CSIP and steer its future development. He also will focus, the Department of Health said, “on delivery of service improvement across health and social care and in streamlining and improving services for all who use them.”

Humphries said he welcomes the opportunity “to continue working closely with our fellow service improvement partners and social care to improve the lives of vulnerable people.”

Newly named Minister for Care Services Liam Byrne said the appointment would “strengthen the role of CSIP in supporting reform of NHS and local government services and help to create and implement effective policy through a [joint] approach.”

Antony Sheehan, director of care services at the Department of Health, said Humphries’ appointment “will give clarity and stability to the leadership of CSIP and enable the program to develop and progress.”