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Preventing Stroke: Uneven Progress

Preventing Stroke: Uneven Progress – Economist Intelligence Unit Report Highlights Gaps in Screening and Diagnosis of Stroke Risk Factors

Today, stroke remains the second leading cause of death, although many cases are preventable.

The Economist Intelligence Unit (EIU) “Preventing Stroke: Uneven Progress,” report –sponsored by The Bristol-Myers Squibb-Pfizer Alliance – includes an analysis of the progress made by 20 countries in implementing stroke prevention policies. One finding was that efforts to screen people for stroke risk factors, including A Fiband hypertension, remain low, even in countries with established health care and developed economies. For example, on average, more than 75 percent of people aged 65 and older are not being screened for AFib during routine primary care examinations, even though this population is at high risk for stroke. Additionally, the report highlighted a disconnect between established best practices and everyday clinical practice, including gaps in the training of health care professionals to properly identify and treat stroke risks.

Stroke is an enormous burden and costs more than US $80 billion each year in the United States and Europe, including both healthcare costs and other expenses such as lost productivity.1,2 Data amassed from population studies in different countries tell us that as many as about one of every four people who suffers an ischemic stroke – the most common kind – had underlying AFib that went undiagnosed.3 Additionally, in more than one-quarter of patients with no history of cardiovascular disease, stroke is the first clinical manifestation of AFib.3 Modest improvements in diagnosis and treatment of stroke risk factors could save billions of dollars and help prevent many deaths.1

The Bristol-Myers Squibb-Pfizer Alliance has committed to investing in initiatives that drive insights, education, awareness and action to improve screening of stroke risk factors and reduce the incidence of stroke. It is working to drive better understanding of the barriers to earlier detection and identify potential strategies to address these through a multifaceted approach that includes support of investigator-initiated studies, investment in innovative commercial pilots, and support of advocacy and payer initiatives throughout the world.

One of these barriers is the absence of clear screening protocols and guidance on when and how to assess a patient for AFib, which remains an obstacle to early diagnosis and treatment. Existing data shows that opportunistic screening (screening conducted when a patient consults a healthcare professional for another purpose) for AF not showing any symptoms is cost-effective.4 Medical guidelines, including from the European Society of Cardiology, are beginning to recommend screening for AF in patients over the age of 65.5

However, to implement broader screening approaches (systematic screening) at the clinic level, the results of large, randomized controlled screening studies will be important to demonstrate cost-effectiveness, identify which populations may benefit the most, and inform guidelines and policy development. There is emerging evidence in support of systematic screening, including through the 27,000-patient StrokeSTOP trial in Sweden expected to report out data in 2019.5

Among other things, the “Preventing Stroke: Uneven Progress,” report concluded that future policies to prevent stroke should focus on integrated strategies to improve education around risk factors and implement opportunistic and/or systematic screenings to detect risk factors. By improving screening and early diagnosis, The Bristol-Myers Squibb-Pfizer Alliance –in collaboration with other key partners–can potentially help prevent strokes and related deaths.

1https://www.cdc.gov/stroke/facts.htm
2Wolfe DA, et al. The Burden of Stroke in Europe Report. King’s College London for the Stroke Alliance for Europe (SAFE).
3Freedman, B et.al. Stroke prevention in atrial fibrillation. Lancet 2016; 388: 806–17.
4Fitzmaurice et al. BMJ.2007;335:383
5Svennberg E et al. Circulation. 2015;131:2176-2184.