Joint statement of the WSO, ESO, EAN and WFN on stroke on the occasion of the 68th WHO-Europe meeting 2018, Rome

This statement was jointly prepared by the World and European Stroke Organizations (WSO and ESO), the World Federation and the European Academy of Neurology (WFN and EAN) all of which are specialty societies for neurology and brain health.

Statement

NCDs continue to increase worldwide. Cardiovascular diseases, stroke and dementia are a major concern. Stroke is now ranked the 2nd greatest cause of both disability and death worldwide.

Stroke threatens everyone. Stroke causes paralysis of limbs, impairs vision, gait, language and cognition. It contributes to dementia. Of particular concern is the increasing stroke burden in young adults and its effect on keeping employment, as more than 40% of working age adults with stroke fail to return to work.

The burden of stroke disproportionately affects people living in countries with limited resources, also in Europe. Most stroke survivors carry lifelong physical, cognitive, mental, and socio-economic burdens. A significant proportion of European and Global NCD burden can be attributed to stroke and stroke-related dementia. This issue of NCDs, including stroke and dementia, is highlighted at this month’s UN High Level Meeting in New York.

The importance of stroke is acknowledged by the WHO in ICD 11 where stroke is now included as a disease of the nervous system. This most important change will have dramatic impact on the promotion of brain health and the distribution of resources.

For stroke prevention, it is important to know that 90 % of strokes are linked to 10 modifiable risk factors including hypertension, smoking, obesity, physical inactivity, and unhealthy diet. The same factors apply to ischemic heart disease, the other main cause of global disability and death. The occurrence of an acute stroke has to be considered a major emergency which needs a seamless chain of interventions until recovery. Quality care needs to be provided timely by competent personnel and teams across the whole pathway in an organized and audited manner. This kind of access to adequate stroke expertise should be independent of region, time of day and socio-economic status. These stroke facts were highlighted during last year’s WFN World Brain Day.

Dementia on the other hand is growing globally with ageing populations, and stroke contributes with other NCDs such as hypertension, heart disease, chronic kidney disease and diabetes mellitus to the development of dementia.  Rates of dementia may be reduced by modifying these risk factors and both stroke and dementia may be prevented through coordinated action.

Developments in vascular neurology has made stroke and dementia preventable, treatable and increasingly reversible, thus reducing the burden on patients, families and societies. To ensure these developments are more evenly distributed, we will require national, regional and global efforts to increase awareness, make available quality acute stroke treatment, primary and secondary prevention and rehabilitation.

ESO and the patient organization SAFE (Stroke Action for Europe – https://www.safestroke.eu) have just finalized the Action Plan for Stroke in Europe 2018-2030, which is aligned with the UN’s Sustainable Development Goals. The plan has four overarching goals:

1) to reduce the absolute number of strokes in Europe by 10%

2) to treat 90 % or more of all patients with stroke in Europe in a dedicated stroke unit as the first level of care

3) to have national plans for stroke encompassing the entire chain of care, and 4) to fully implement national strategies for multisector public health interventions In this context WSO, ESO, EAN and WFN call upon the WHO European Regional Committee to support its member states to increase their efforts based on these three domains: 

  1. Awareness: WHO-Europe should help to strengthen programs that increase awareness of stroke, as risk factors, therapy and rehabilitation.
  2. Access: We will support WHO-Europe with its efforts to remove financial barriers for patients for prevention, detection and treatment of NCDs, including European wide health coverage.
  3. Action: The neurology specialist societies will support WHO-Europe in the development of regional and national strategies, to develop the health-relatedSustainable Development Goals, with the goal to reduce premature deaths caused by NCD by one-third by 2030.