Emergency Medical ServicesStroke Training Curriculum

1. Burden of Disease

Introduction

About 15 million people suffer from stroke each year worldwide. 1 Strokes are the second leading

cause of death worldwide and are the leading cause of adult disability.2 Strokes can have an

impact on many levels and pose a challenge for survivors of stroke and their relatives. The

management and treatment of stroke are a burden for individuals, societies and healthcare

systems.1,4 Although the incidence of strokes is higher within the elderly, two-thirds of strokes in

the world occur in people under the age of 70 years.3 People who have survived a stroke often

have to deal with long-term disabilities and are in need of care.1,4

To reduce the burden of stroke, there are many areas that require further work. Examples include

finding better treatment and prevention strategies, gaining a better understanding of the needs

of the stroke patients and their relatives, establishing effective treatments and monitoring

stroke trends.1. Mackay J, Mensah GA. The atlas of heart disease and stroke. World health organization and center for disease control and prevention. 2004. [cited 2019 April 4]. Available from:http://www.who.int/cardiovascular_diseases/resources/atlas/en 2. Maredza M, Betram MY, Tollman SM. Disease burden of stroke in rural South Africa: an estimate of incidence, mortality and disability adjusted life years. BMC Neurology2015;15(54):1-12. 3. Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circulation Research 2017;120:439-448. 4. World Stroke Organization. Facts and figures about stroke. [cited 2019 April 12]. Available from:https://www.world-stroke.org/component/content/article/16-forpatients/84-facts-and-figures-about-stroke

Stroke - a major public health problem

STROKE CAN AFFECT ANYONE AT ANY TIME

6 MILLIONWORLDWIDE, NEARLY 6 MILLION PEOPLE DIE

EACH YEAR FROM A STROKE1,4

1 IN 6WORLDWIDE, 1 IN 6

PEOPLE ON AVERAGE WILL SUFFER A STROKE

IN THEIR LIFETIME4

EVERY 6 SECONDS

EVERY 6 SECONDS, SOMEONE DIES FROM

A STROKE4

1. Mackay J, Mensah GA. The atlas of heart disease and stroke. World health organization and center for disease control and prevention. 2004. [cited 2019 April 4]. Available from:http://www.who.int/cardiovascular_diseases/resources/atlas/en 4. World Stroke Organization. Facts and figures about stroke. [cited 2019 April 12]. Available from: https://www.world-stroke.org/component/content/article/16-forpatients/84-facts-and-figures-about-stroke

IN CHINA8,9IN EUROPE

795 000 STROKES/YEAR

IN THE US5

PREVALENCE 2,8 %

ESTIMATED COST 312,6 BILLION US-$

1,6 MILLION DEATHS/YEAR8

PREVALENCE 1,6 % (RURAL) – 9,3 % (URBAN) 9ESTIMATED COST 64,1 BILLION €

( € 38 BILLION IN THE EU) 6,7ESTIMATED COST 40 BILLION RMB8

STROKE IS THE THIRD MOST COMMON CAUSE OF DEATH IN DEVELOPED COUNTRIES, EXCEEDED ONLY BY CORONARY HEART DISEASE AND CANCER 1

Global Epidemiology

1,1 MILLION DEATHS/YEAR6

5. Alan SG, Mozaffarian D, Roger VL et al. AHA and stroke statistics writing group. Heart disease and stroke statistics- 2013 Update. A report from the American Heart Association. Circulation 2013;127:e6-e245. 6. Nichols M, TownsendN, Scarborough P et al. European cardiovascular disease statistics. 2012 edition. ©European heart network and European society of cardiology, September 2012. 7. Gustavsson A, svensson M, Jacobi et al. Cost of disorders of the brainin Europe 2010. European Neurpsychopharmacology 2011;21:718-779. 8. Liu L, Wang D, Lawrence Wong KS et al. Stroke and stroke care in china. Huge burden, significant workload, and a national priority. Stroke 2011;42:3651-3654. 9.Ferri CP, Schoenborn C, Karla L et al. Prevalance of stroke and related burden among older people living in Latin America, India and China. Journal of neurology, neurosurgery and psychiatry 2011;82:1074-1082.

Global Incidence

IN 2010, 16,9 MILLION STROKES OCCURRED WORLDWIDE10,11

THE ANNUAL NUMBER OF STROKES IS INCREASING DUE TO THE EXPANDING GLOBAL POPULATION AND

INCREASING LONGEVITY 10

THIS IS DESPITE A REDUCTION IN AGE-ADJUSTED RATE – PROBABLY DUE TO EDUCATION,

PREVENTION, DIAGNOSIS AND MANAGEMENT 10

THE MAJORITY OF STROKES (69 %) OCCUR IN LOW- AND MIDDLE-INCOME COUNTRIES 11,12

INCIDENCE, TYPE AND OUTCOME OF STROKE VARIES BETWEEN COUNTRIES12,13

10. Hankey G. The global and regional burden of stroke. Lancet 2013;1:e239-e240. 11. Feigin VL, Forouzanfar H, Krishnamurthi R et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of DiseaseStudy 2010. Lancet 2014;383:245-255. 12. Krishnamurthi RV, Feigin VL, Forouzanfar MH et al. Global and reginal burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of DiseaseStudy 2010. Lancet of global health 2013;1:e259-281. 13. Thrift AG, Thayabaranathan T, Howard G et al. Global stroke statistics. International journal of stroke 2014;9:6-18.

STROKE IS THE SECOND MOST

COMMON CAUSE OF DEATH IN THE

WORLD14,15

APPROXIMATELY ONE THIRD OF

PATIENTS WITH A NEW STROKE WILL

DIE11

THE 10 LEADING CAUSES OF DEATH IN THE WORLD, 2016 14,15

Global Mortality

5,8 million deaths a year worldwide1,4,14,15

Source: Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2016. Geneva, World Health Organizations 2018.14

3,0 M

1,7 M

1,6 M

3,0 M

3,0 M

1,4 M

1,3 M

2,0 M

9,5 M

1. Mackay J, Mensah GA. The atlas of heart disease and stroke. World health organization and center for disease control and prevention. 2004. [cited 2019 April 4]. Available from: http://www.who.int/cardiovascular_diseases/resources/atlas/en 4. World Stroke Organization. Facts and figures about stroke. [cited 2019 April 12]. Available from: https://www.world-stroke.org/component/content/article/16-forpatients/84-facts-and-figures-about-stroke 11. Feigin VL, Forouzanfar H, Krishnamurthi R et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet 2014;383:245-255. 14. The top 10 causes of death. World Health Organization [cited 2019, April 8]. Available from: https://www.who.int/health-topics/news-room/fact-sheets/detail/the-top-10-causes-of-death 15. Global Health Estimates 2016: Deaths by cause, age, sex, by country and by region, 2000-2016. World Health Organization, Geneva 2018 [cited 2019, April 8]. Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwiCvOGBgq_iAhUjt3EKHUgZBncQFjAAegQIAhAC&url=https%3A%2F%2Fwww.who.int%2Fhealthinfo%2Fglobal_burden_disease%2FGHE2016_Deaths_WBInc_2000_2016.xls&usg=AOvVaw19T1-OVLDZ2gJS3Jk9Ni-7

Ischaemic heart disease

Stroke

Chronic obstructive pulmonary disease

Lower respiratory infections

Alzheimer disease and other dementias

Trachea, bronchus, lung cancers

Diabetes mellitus

Road injury

Diarrhoeal diseases

Tuberculosis

CAUSE GROUP

Communicable, maternal, neonatal and nutritional conditions

Noncommunicable diseases

Injuries

Global Disability & Cost of Stroke

BETWEEN 1990 AND 2010, DALYs DUE TO

STROKE INCREASED BY 19 % 10

STROKE IS THE THIRD LEADING CAUSE OF

DISABILITY WORLDWIDE, MEASURED AS

DISABILITY-ADJUSTED LIFE-YEARS (DALYs) 10,11,16

THE WORLD HEALTH ORGANISATION (WHO) PREDICTS THAT DALYs LOST TO STROKE WILL

RISE FROM 38 MILLION IN 1990 TO 61 MILLION IN

2020 1

1. Mackay J, Mensah GA. The atlas of heart disease and stroke. World health organization and center for disease control and prevention. 2004. [cited 2019 April 4]. Available from:http://www.who.int/cardiovascular_diseases/resources/atlas/en 10. Hankey G. The global and regional burden of stroke. Lancet 2013;1:e239-e240. 11. Feigin VL, Forouzanfar H, Krishnamurthi R et al. Global and regional burden ofstroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet 2014;383:245-255. 16. Murray CJL, Vos T, Lozano R et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2197-2223.

National Epidemiology

2ND LEADING CAUSE OF DEATH AFTER COMMUNICABLE

DISEASES, MATERNAL, PERINATAL,

NUTRITIONAL CONDITIONS AND

INJURY.17,18

82 000 DEATHS ANNUALLY, WITH 1 IN

5 DEATHS DUE TO CVD.20

4th BIGGEST NATURAL KILLER.17,19

STROKES ARE THE LEADING CAUSE OF

LONG TERM DISABILITY.20

POST STROKE CARE PLACES A BURDEN ON

THE ECONOMY AND HEALTH SYSTEM.1

1, Mackay J, Mensah GA. The atlas of heart disease and stroke. World health organization and center for disease control and prevention. 2004. [cited 2019 April 4]. Available from: http://www.who.int/cardiovascular_diseases/resources/atlas/en17. Statistics South Africa. Mortality and causes of death in South Africa, 2016: Findings from death notifications. Stats SA, Feb 2019. 18. The heart and stroke foundation South Africa. Cardiovascular disease statistics reference document. [cited2019 April 4]. Available from: http://www.heartfoundation.co.za/wp-content/uploads/2017/10/CVD-Stats-Reference-Document-2016-FOR-MEDIA-1.pdf 19. Connor M, Bryer A. Chronic diseases of lifestyle in South Africa since 1995 – 2005,Medical Research Company, Technical Report, May 2006. 20. The heart and stroke foundation South Africa. Stroke. [cited 2019 April 4]. Available from: http://www.heartfoundation.co.za/

Strokes in South Africa

per year2087 600

per day20240

per hour2010

Deaths per day2070

Disabled per day380

National Incidence

3. Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circulation Research 2017;120:439-448. 20. The heart and stroke foundation South Africa. Stroke. [cited 2019 April 4]. Available from: http://www.heartfoundation.co.za/

17. Statistics South Africa. Mortality and causes of death in South Africa, 2016: Findings from death notifications. Stats SA, Feb 2019.

National Mortality17

Percentage

Strokes, CVD & …

2%

40%

23%

12%

15%

8%0: No symptoms

1: No disability despite symptoms

2: Slight disability

3: Moderate disability

4: Moderately severe disability

5: Severe disability

33 % of SA stroke sufferers die within 1 month

Rankin scores for stroke survivors

2. Mandy Maredza et al. Disease Burden of stroke in rural South Africa: an estimate of incidence mortality and disability adjusted life years. BMC Neurol. 2015; 15.54 (PMC ID – PMC 4396076) 21. Bertram MY, Katzenellenbogen J, Vos T et al. The disability adjusted life years due to stroke in South Africa in 2008. International Journal of Stroke 2013;1-5.

National Morbidity21

15 %

12 %

23 %

40 %

8 %

2 %

0%

5%

10%

15%

20%

25%

0-1

2

13

-29

30

-39

40

-49

50

-59

60

-69

70

-79

80

+

Male

Female

22. Hexor report: July, 2014. Results for stroke patients from medical scheme data. Stroke episodes from 2010 – 2013 captured in 45 % of medical aid claims.

Strokes occur at ALL AGES

National Age Distribution22

Multiple Choice Questions for CPD Accreditation

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