Stroke - the size of the problem. What is a stroke? What is a transient ischaemic attack? What is the size of the problem?

Stroke - the size of the problem

• What is a stroke?

• What is a transient ischaemic attack?

• What is the size of the problem?




Stroke = “brain attack” =

Rapid onset of focal (or at times global) cerebral deficit, lasting at least 24 hours (or leading to earlier death), and for which there is no cause other than a vascular one

3 main pathological types

• ~ 80% ischaemic

• ~ 15% primary intracerebral haemorrhage

• ~ 5% subarachnoid haemorrhage




• “Mini stroke”

• Definition as for stroke except lasts < 24 hours (and not fatal)

• Vast majority are ischaemic

TIA (transient ischaemic attack) = “brain attack” =




Measuring the burden of stroke

mortality

incidence

prevalence

outcome

cost

Causes of death worldwide in 1990: WHO /

World BankGlobal Burden of Disease Study

Causes of death worldwide in 1990: WHO /

World BankGlobal Burden of Disease Study

Millions

All causes 50.5

Coronary heart disease 6.3 (12% of total)

Cancer (all types) 6.1 (12% of total)

Cerebrovascular disease 4.4 (9% of total)

Global burden of stroke - mortality

• 4.4 million deaths worldwide in 1990

• 2/3 of these deaths in developing countries

• Stroke deaths likely to double by 2020

• 3rd commonest cause of death after coronary heart disease and cancer

• Mortality data do not tell the whole story, since most strokes are not fatal

• Major burden of stroke is chronic disability

Incidence of first-ever-in-a-lifetime stroke in the Oxfordshire Community Stroke Project

(Bamford et al 1990)

Cumulative percentage of first-ever-in-a-lifetime strokes by age in the Oxfordshire

Community Stroke Project, 1981-1984

years

Three quarters of the strokes occur in > 65 year olds

Half the strokes occur in > 75 year olds

Age and sex standardised annual incidenceof stroke, age 45 to 84 years, in 10 ‘ideal’

community- based studies in the 1980s and 1990s (Sudlow and Warlow 1997)

Stroke in the UKpopulation ~ 60 million

• 125,000 strokes each year

• GP (list = 2000) would see ~ 4 per year

• 250,000 disabled stroke survivors

• GP would have ~ 7 such patients on list

Outcome after a stroke

Describing the effects on an patient:

• (Death)

• WHO classification:

Impairment

Disability

Handicap

Outcome after a stroke

• About 20% will die within one month

• By one year over half will be either dead (30%) or dependent (25%)

• After a 1st stroke, 10% will have another stroke in the first year, and 5% per year thereafter

• Also at risk of serious vascular disease elsewhere. About half eventually die of coronary heart disease

% of patients with different outcomes one year after first-ever stroke

(Oxfordshire Community Stroke Project, n = 675)

0

20

40

60

80

100

All types PICH SAH Ischaemicstroke

%

Independent

Dependent

Dead

Cost of stroke

Accounts for about 6% of NHS and Social Services expenditure

= £2.3 billion per year

Percentage of hospital costs spent on different aspects of stroke care

(Western General Hospital, Edinburgh)

81%

14%5%

Doctoring 19%

Therapy 31% Drugs 10%

Investigations 40%

Other

Nursing

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Stroke - the size of the problem. What is a stroke? What is a transient ischaemic attack? What is the size of the problem?