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Asia-Pacific remains at risk of a devastating stroke crisis, according to regional health experts launching two new Reports published today, on World Stroke Day, by Action for Stroke Prevention (ASP). Building on ASP’s 2011 Report, How Can We Avoid a Stroke Crisis in the Asia-Pacific Region?, the launch of today’s supplementary Reports focus on specific action steps that can be taken by healthcare decisions makers and professional and patient organisations, to reduce the catastrophic personal and economic impact of AF-related stroke.

Alarmingly, the Reports highlight the fact that the first time many people will find out they have AF is when they have a stroke. Furthermore, approximately 70% of patients with known AF who had a stroke caused by a blood clot were not receiving anticoagulant therapy to prevent AF-related stroke at the time it occurred.^v,vi,vii With stroke placing a huge financial burden on countries in the Asia-Pacific region, more needs to be done to reduce the number of these serious, costly, and yet preventable strokes.

Reducing a Preventable Burden: Effecting Change

“We need to ensure that AF is recognised as a serious risk factor for stroke in national prevention plans and that concrete actions are defined in these plans that support earlier diagnosis and improved awareness, education and prevention,” said world-renowned Cardiology expert, John Camm, Professor of Clinical Cardiology at St George’s University, London, UK. “It is our hope that national governments will address this as they plan how to meet the United Nations’ commitment to reduce non-communicable diseases by 25% by the year 2025.”

Recommendations made by the Reports include:

• improving public awareness and understanding of AF and the risk of AF-related stroke
• implementing effective practice standards and targets for healthcare professionals; for example, targets for AF screening
• creating national strategies for the early diagnosis of AF
• developing strategies to support adherence to clinical guidelines and the provision of equal and adequate administration of therapy for people with AF

Professor Han Hwa Hu, Professor of Neurology, National Yang-Ming University, Taipei, Taiwan and President of the Taiwan Stroke Association commented, “We hope that the guidance provided in these Reports will be of use to healthcare decision makers and healthcare professionals alike. Patients are not being diagnosed early enough and too many are receiving no or sub-optimal anticoagulation leaving them unprotected and at risk of stroke.”

Lack of Knowledge Increases Risk

A recent survey by IPSOS MORI has underlined the urgent need to act on Action for Stroke Prevention’s recommendations. The survey of 9,211 people from 20 countries across the globe highlights that, whilst 40% of people within the specific Asia-Pacific sample (N=2,303) fear having a stroke above some^viii other serious health conditions including heart disease, diabetes and high cholesterol, only 5% are fearful of AF, despite it being a major risk factor for serious stroke.^ix

“There is an unnecessarily heavy burden being placed on patients and their families due to the under-diagnosis and poor management of people with AF. We must increase the general public’s knowledge about the symptoms of AF and that it is a risk for stroke. Importantly, once people are diagnosed they must have better access to stroke prevention treatments, including the non-Vitamin K Antagonists now available,” said Professor Byung-Woo Yoon, Department of Neurology, Seoul National University Hospital, Korea and Chairman of the Korean Stroke Society.

Despite the availability of clinical practice guidelines, such as the European Society of Cardiology Guidelines on AF, adherence to them is poor, and there remains a chronic under-use of effective stroke prevention therapies in AF with several studies reporting anticoagulant use in <50% of people with AF who are at high risk of stroke.

IPSOS MORI’s survey showed that, perhaps unsurprisingly, only 16% of the general public worldwide are aware that the risk of AF-related stroke can be reduced with anticoagulant treatment. This highlights the need for education to enable patients to participate in their own healthcare decisions.

The recommendations and actions identified by Action for Stroke Prevention must be initiated now, otherwise millions more lives will be devastated by AF-related stroke.

About AF and Stroke

• Stroke is a major public health issue. It is the second biggest cause of cardiovascular death, after ischaemic heart disease, killing an estimated 6.2 million people worldwide^x
• It is a condition which on its own represents the third single most common cause of death in industrialised countries^xi
• Atrial fibrillation (AF) is the most common sustained heart rhythm abnormality^xii and is a strong independent risk factor for stroke^xiii
• Patients with AF are five times more likely to have a stroke compared with the general population^xiv
• AF occurs when the upper chambers of the heart (the atria) tremble rapidly and irregularly. ^xvThis leads to blood stasis or pooling within the atria^xv,xvi , which can result in the development of blood clots. These clots can subsequently break away from the atria and travel to vessels in the brain causing a stroke

About the Reports

The authors are global leaders in cardiology, neurology, primary care, health economics and patient advocacy.

Building on ASP’s 2011 Report, How Can we Avoid a Stroke Crisis in the Asia-Pacific Region?, the two new Reports launched today are entitled Atrial Fibrillation-Related Stroke: An Avoidable Burden and Stroke in Patients with Atrial Fibrillation in the Asia-Pacific Region: A Preventable Problem. These Reports can be viewed and downloaded via http://slideshare.net/actionforstrokeprevention

Collectively, the Reports are endorsed by 93 leading medical professional and patient organisations.

ASP has been initiated and funded by Bayer HealthCare as an independent alliance of experts with the aim to increase the awareness of atrial fibrillation and the associated risk of stroke. These Reports have been produced by ASP with the aid of financial support from Bayer HealthCare. Bayer HealthCare has also been given the opportunity to comment upon the reports from a regulatory and compliance perspective. However, the content of these reports has been determined and full editorial control retained by the authors, independently of Bayer HealthCare, in order to ensure the independence of the reports and outputs of the group. The views expressed in this publication are not necessarily those of the sponsor.

About the Ipsos MORI Survey

On behalf of Bayer HealthCare, Ipsos MORI interviewed 9,211 adults aged 40+ across 20 countries – UK (501), Germany (500), Spain (500), Italy (502), France (500), Portugal (400), Ireland (404), Russia (500), Bulgaria (400), Poland (500), Hungary (501), China (501), South Korea (501), Taiwan (500), Malaysia (401), Indonesia (400), Mexico (400), Argentina (500), Brazil (400) and Colombia (400). The Asia-Pacific sample consists of China, South Korea, Taiwan, Malaysia and Indonesia (2,303).

Interviews in China, Taiwan and Malaysia were conducted by telephone, interviews in South Korea were online and interviews in Indonesia were face to face. All interviews were conducted between 3rd – 17th September 2012.

Quota controls were set upon the interviews to the known population profile of this audience (40+ years of age) for age, sex and region. Population data source: National Bureau of Statistic of China, 2011 (China), Population and Housing Census, 2010 (South Korea), Department of Household Registration, 2011 (Taiwan), Department of Statistics Malaysia, 2011 (Malaysia), Statistics Indonesia, 2011 (Indonesia).

For queries regarding the Ipsos MORI survey, please contact elizabeth.stoneman@ipsos.com or natalie.gunning@ipsos.com (+44 (0)203 059 5000).

ⁱ Wolfe C, Rudd A. The Burden of Stroke White Paper: raising awareness of the global toll of stroke-related disability and death. 2007. http://www.safestroke.org/Portals/10/FINAL Burden of Stroke.pdf. Accessed October 2012
ⁱⁱ Zhou Z, Hu D. An epidemiological study on the prevalence of atrial fibrillation in the Chinese population of mainland China. J Epidemiol 2008;18:209-16
ⁱⁱⁱ Hu D, Sun Y. Epidemiology, risk factors for stroke, and management of atrial fibrillation in China. JACC 2008;52:865–8
^iv Marini C, De Santis F, Sacco S et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke 2005; 36:1115–9
^v Ahmad O et al. Intern Med J 2009;39:752–756
^vi Hannon N et al. Cerebrovasc Dis 2010;29:43–49
^vii Palm F et al. Eur J Neurol 2012
^viii Conditions listed were blood clots, heart disease, stroke, atrial fibrillation, high blood pressure, high cholesterol and diabetes
^ix Benjamin E, Wolf P, D’Agostino R, et al. Impact of Atrial Fibrillation on the Risk of Death. Circulation 1998;98:946-952
^x World Health Organisation. Cause-specific mortality: regional estimates for 2008 http://www.who.int/gho/mortality_burden_disease/global_burden_disease_DTH6_2008.xls. Accessed September 2012
^xi European Stroke Organisation. Stroke facts. http://www.eso-stroke.org/stroke_facts.php?cid=5. Accessed September 2012
^xii Kannel WB, Benjamin EJ. Status of the epidemiology of atrial fibrillation. Med Clin North Am 2008;92:17-40
^xiii Benjamin E, Wolf P, D’Agostino R, et al. Impact of Atrial Fibrillation on the Risk of Death. Circulation 1998;98:946-952
^xiv Kannel WB, Wolf PA, Benjamin EJ, et al. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 1998;82:2N-9N
^xv Falk RH. Atrial fibrillation. N Engl J Med 2001;344:1067-1078
^xvi Camm AJ, Kirchhof P, Lip GYH et al. Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010;31:2369-2429