Stroke care – timely diagnosis and treatment in the short window available – remains suboptimal in emerging and developed economies alike. In Europe, only 7% of stroke sufferers receive best practice care. In low-income countries, underdiagnosis is more likely than elsewhere. Prevalence is evenly distributed around the world.
It is fairly evenly among males and females too, Carla Goulart Perón, the chief medical officer of Royal Philips, told In Vivo on the release of the company’s joint policy paper with the World Stroke Organization (WSO), “Time for a Revolution in Stroke Care.” Perón, successor to Jan Kimpen in 2023, has a long involvement in stroke – dubbed “the silent killer” – and played a key support role in the Brazilian RESILIENT trial 12 years ago.
That study, which randomized stroke patients with large vessel occlusion (LVO) to mechanical thrombectomy within eight hours of symptom onset, demonstrated the efficacy of the minimally invasive surgery. The new Philips/WSO policy paper reiterates that finding, and highlights the value of mechanical thrombectomy in both transforming patient outcomes and reducing the wider societal impacts of stroke.
However, access to, and availability of, mechanical thrombectomy remains limited, the paper contends, despite evidence from RESILIENT and from 19 scientific articles showing cost-effectiveness from a payer perspective. More than half of these studies went much further, suggesting that mechanical thrombectomy lowers overall costs and provides better results compared to the current standard of care.
Stroke incidence annually totals some 12 million cases worldwide and is on the rise in younger and middle-aged individuals. Its direct and indirect costs in 2017 were estimated to be $912bn annually. Over the coming 25 years, this cost could reach around $1.5-1.6tn.
While communicable diseases and cancer, among other diseases, have gained a lot of government attention, stroke – a curable disease that remains the world’s second biggest killer – has often been overlooked. Perón explained how stroke is a “silent disease.” Its impact is often seen only at the acute, late stage of onset. “We end up sometimes forgetting about stroke, but it is one of the biggest burdens we have in the health system,” she stressed.
WHO, WHA Focus Is Turning More To Stroke
Signs of changing attitudes to stroke have been evident in the recent past, however.
In January 2023, the World Health Organization issued a policy guidance update on non-communicable diseases, specifically mentioning in an appendix the treatment of acute ischemic stroke with mechanical thrombectomy and stressing the effectiveness of thrombectomy/thrombolytic medicine.
Some 18 months later, the WHO featured stroke in its “Intersectional global action plan (IGAP) on epilepsy and other neurological disorders 2022-2031,” which was accompanied by an implementation toolkit.
Significantly, in May 2024, as a side event to the 77th World Health Assembly in Geneva, the WSO and Philips jointly hosted the “United in Action to Transform Stroke Care” meeting. Stroke specialists and health ministers from Jamaica, Costa Rica and Indonesia were in attendance. The group highlighted disparities in stroke outcomes across regions and populations and concluded that collaborations, including with the private sector, were essential. The Lancet published a paper on the meeting.
Four Policy Pillars For Stroke Care
The “Time for a Revolution” policy paper sets out four pillars, one of which is to encourage health authorities to install more stroke units that allow patients to receive both intravenous thrombolysis and mechanical thrombectomy. “Both have their specific places, and both are critical,” said Perón, stressing the stroke mantra that “time is brain.”
Improving prevention, expanding access to thrombectomies and embedding coordinated approaches to stroke diagnosis and treatment were the policy paper’s other three priority pillars.
Philips’ stroke care is housed within its image-guided therapy business (part of Diagnosis + Treatment) and centers around the Azurion platform. At ECR2024, Philips launched the Azurion Biplane system featuring enhanced 2D and 3D imaging and X-ray detector positioning flexibility.
Enhancing Triaging Expertise
Perón noted the “huge opportunity” for CT and MR to be used in stroke triaging and mentioned how Philips’ patient monitoring technologies are also used in the ambulance.
The company is collaborating with two startups to advance patient triaging and stroke care:
- Nico.Lab, a partnership developing StrokeViewer, a cloud-based, end-to-end AI based stroke triaging and management solution to optimize stroke workflows by analyzing CT scan data with AI. After detecting and locating the LVO, the analysis is shared with primary stroke centers and intervention centers; and
- CVAid Medical, which has developed an AI diagnosis and treating platform for stroke whereby clinicians can perform neurological examinations based on video and patient voice recording using a smartphone. The image and voice data are sent to the company’s cloud server.
Perón said: “We need to work around the essential services and define the pre-hospital scenario that will give the ability for those patients to get triaged properly and sent to hospitals where they can receive specific care.” The WSO policy paper reinforces that need, she said.
She stressed the need to educate healthcare workers to enable them to triage well.
Mechanical thrombectomy is really the core of what Philips can do in stroke,” Perón stressed. “It is the ideal treatment for LVO patients, who should be sent to advanced stroke services straight away. Mild occlusions could be treated by intravenous therapy, which requires only very basic infrastructure,” she said.
Raising Awareness Of Stroke Needs At Government Level
At the government level, Philips is driving to make decision makers aware of the economics of stroke, and that investing in stroke centers that include mechanical thrombectomy capabilities is an upfront investment that lowers the overall cost of the stroke care over time, including aftercare, caregivers’ costs and an individual’s inability to work.
“[Users] still too often look too hard at the first investment cost when reviewing hospital costs,” Perón continued. “The economic impact of investing in advanced stroke units to enable mechanical thrombectomy becomes very clear when seen against the overall cost of the disease.”
The bottom line is that stroke is not getting the attention it needs, and health systems are not well enough organized to detect stroke early and make timely interventions, Perón concluded.
Adoption of the joint WSO/Philips policy paper’s recommendations by governments would be a “giant step” towards fostering understanding of where the gaps are, prioritizing all aspects of pre-hospital and in-hospital stroke care and installing the necessary stroke infrastructures.
