World Stroke Organization welcomes WHO stroke classification and definition in ICD 11

The World Stroke Organization has welcomed the recent release by the World Health Organization (WHO) of the ICD 11. The ICD is the global system for clinicians, administrators, and governments to report health statistics at all levels. 

In the newly released ICD 11, cerebrovascular diseases form a single block under diseases of the nervous system. This is a major change compared to the previous classification, in which stroke was placed under diseases of the circulatory system. Furthermore, the new ICD 11 provides precise definitions of stroke and other cerebrovascular diseases for global use. 

WSO works to improve stroke prevention, treatment and support globally. It represents over 50,000 stroke experts worldwide and hasadvocated for the change.  In welcoming the classification, Prof Werner Hacke, President of WSO said ‘By categorizing stroke correctly under diseases of the Nervous System, WHO is supporting global efforts by stroke professionals, survivors and carers to increase public recognition of stroke and to improve access to stroke treatment and care. Stroke is a leading cause of death and disability worldwide, accountable for 14m deaths and 116 DALYs in 2016.  We firmly believe that correct classification will help to save millions of lives and reduce the massive individual and global impact of stroke-related disabilities in years to come. With the world now focused on reducing the burden of Non-Communicable Diseases, this is a timely and important step.’

In recent years, opportunities to improve stroke outcomes have improved due to the development of effective acute stroke treatments such as thrombolytic therapy and thrombectomy. Access to effective acute therapies such as these are contingent upon the early recognition of symptoms from the brain and fast access to appropriately designed stroke treatment facilities with the appropriate neurovascular expertise. ‘Classifying stroke as a disease of the brain is important to facilitate awareness and early recognition, and reporting stroke accurately is instrumental to recognize the true burden of stroke among the spectrum of diseases.’ Said Prof Bo Norrving, Chair of the WSO Global Policy Committee, member of the ICD 11 neurology advisory group and Chair of the working group on cerebrovascular diseases.

Stroke and heart disease share most risk factors and several heart and circulatory conditions increase individual risk of stroke. Strokes and TIAs (mini-stroke) are also leading contributors to cognitive decline and dementia.

WSO will continue to prioritize clinical and public education on the linkages between stroke and heart disease, dementias and other Non-Communicable Diseases. The Organization already works in close partnership with the World Heart Federation and the World Hypertension League and partners in the wider non-communicable disease space as a member of the NCD Alliance and in the Coalition for Vascular Health. It will continue to advocate strongly for improved primary prevention policy to address common NCD risk factors, as well as for increased and more equitable access to screening and treatment for conditions including hypertension (high blood pressure), atrial fibrillation (irregular heartbeat) and hyperlipidemia (high cholesterol) all of which are specifically associated with higher stroke risk.

Stroke Foundation Uganda, a new WSO member, gives hope to stroke survivors and their families

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Ibrahim Bukenya is the founder and principal physiotherapist at the Stroke Rehabilitation Center, home to the Stroke Foundation Uganda, in Kampala. 

What has inspired you to be involved in stroke support?

The inspiration was when I had a challenge in taking care of a mother who had a stroke and later passed away and the fact that I had worked with the Stroke Rehabilitation Center for the last 8 years by then. There were challenges other stroke survivors were going through and Uganda’s burden of stroke is increasing every day. I want to help prevent people from going through this challenging condition, to minimise adult disability caused by stroke and to have a stroke free Uganda.

What does stroke support look like in your country?

Stroke support in Uganda is mainly about stroke survivors coming together and encouraging each other to reach a common goal which is recovery and to go back to work. The Stroke Rehabilitation Center helps the survivors who cannot afford the rehabilitation costs. Our stroke support groups have volunteers who go to visit the survivors to encourage them. The stroke support group organises the World Stroke Day event with different activities to help increase awareness.

How did the project come about?

The project came about after realising the challenges the stroke survivors go through and the       national stroke burden.                                                                                                                                                          

What have been some of the outcomes of the project?

About 2% of stroke survivors have recovered to 90% and gone back to work.

Stroke survivors who have attended stroke support groups and rehabilitation treatments are promoting our name across the country, thanking and talking good about giving them hope again and families have been saved from tearing apart due to the counselling given to both care givers and survivors.

What has been the response from others- community, doctor’s politicians?

In the community the mindset about stroke has changed from the witchcraft perspective to rehabilitation and seeking early treatment from hospitals rather than traditional healers.

Doctors are increasingly understanding how important rehabilitation is to the survivors and we are already collaborating with some of them from the primary health facilities, however, other doctors still think negatively that rehabilitation treatment is competition to their work.

Politicians are getting to understand rehabilitation treatment through the parliamentary health weeks and through their relatives that have attended the support groups.

Stroke can attack any one at any time affecting the economic viability of someone, therefore stroke awareness prevention should be taken so seriously by knowing the risk factors for stroke, the signs and symptoms and in case someone gets a stroke to rush the person to the nearest hospital.

For more information:

www.strokeuganda.org

New ICD 11 stroke classification will support global efforts to improve prevention, treatment and outcomes

After sixty-two years of officially categorizing stroke as a Disease of the Circulatory System, the newly published WHO ICD 11, has correctly classified stroke as a Disease of the Nervous System. 

ICD 11 is a foundation document for health policy and treatment globally and the decision on stroke classification has been warmly welcomed by the World Stroke Organisation. WSO actively advocated for the change, arguing that positioning stroke as a disease of the brain will support global efforts to increase recognition of stroke and improve access to services and treatments that save lives and reduce post-stroke disabilities. Stroke was responsible for 14m deaths and 116 DALYS in 2016 alone, directing attention to the brain and what can be done to reduce premature deaths.

To find out more about why the WSO has made it a priority to achieve this change, I talked to Bo Norrving, Chair of the organization’s Global Policy Committee. Bo has also been chair of the Cerebrovascular Diseases group for the ICD 11 and is a member of the WHO Neurology Topical Advisory Group, chaired by Raad Shakir. 

Why does it really matter that stroke is classified as a brain disease, not a disease of the circulatory system – aren’t the two closely related?

It’s true that there are close links between cardiovascular disease and stroke; many risk factors are shared and primary prevention will target both disorders jointly.  We work closely with colleagues in the Non-Communicable Disease (NCD) and cardiovascular (CVD) sphere to advance our common prevention agenda. 

The simple fact, however, is that when strokes happen, they happen in the brain. 

Delivering stroke treatment early and efficiently with effective acute therapies such as thrombolytic therapy and thrombectomy, depends on the early recognition of symptoms from the brain and early actions to call an ambulance. This is why in many countries campaigns to increase public knowledge of stroke symptoms (like the FAST campaign) have been conducted. These campaigns are founded on in recognition that ‘time is brain’. Similarly, providing early treatment of transient ischemic attacks (TIAs), which are linked to stroke and are a significant contributing factor to dementia, depends on public awareness of the symptoms and rapid admittance to hospital. 

The impact of delivering effective treatment for acute stroke - and the opportunity to prevent a stroke - present huge opportunities to reduce the global burden of disease and cannot be missed if we are to are to achieve global goals on NCD reduction. Thinking beyond prevention, understanding the role of the brain in residual stroke symptoms and disabilities from stroke is critically important to providing patients with effective long-term rehabilitation and support.  

Classifying stroke under diseases of the circulatory system has kept stroke in the shadows where it couldn't easily be seen or dealt with.  We are delighted that this is no longer the case and that more light can be cast to the specifics of stroke and the opportunities we have to improve prevention and treatment.

How do you think this change will help with the achievement the global goal to reduce avoidable deaths from stroke? 

Stroke is the second biggest killer and the largest single cause of disability worldwide and yet still struggles to get the policy attention and resources commensurate with its global impact. Identifying stroke as a disease of the brain and pulling all types of cerebro-vascular diseases into a single block in the ICD 11 will, we believe, guide policy attention to the right place and enable us to develop 21^st century services for stroke. 

Stroke is probably the best example there is of a non-communicable disease that is highly preventable and highly treatable. With the right focus and commitment to stroke we can make a massive impact on the achievement of global health and development goals .

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Time to Deliver on NCDs

World Stroke Organization Calls for Bolder Commitments and Action to Reverse the Tide of Non-Communicable Diseases 

The World Stroke Organization has joined partners in the NCD Alliance and over 210 civil society organisations (CSOs) to welcome the Report of the WHO Independent High-­Level Commission on Noncommunicable Diseases (NCDs), Time To Deliver, launched on Friday 1 June in Geneva, Switzerland, ahead of crucial negotiations for the United Nations High-Level Meeting on NCDs (UN HLM), which will take place in New York on 27 September.

The Commission's report follows hot on the heels of the Report of the UN Secretary General, which showed inadequate attention, investment and innovation in relation to SDG 3. Time to Deliver, draws a line in the sand on the need for political leaders to accept that progress to date has been severely inadequate and out of step with the growing burden of NCDs and mental and neurological health.

All evidence points to the same unpleasant reality: if the current pace of progress continues unabated, by 2030 the agreed Sustainable Development Goal (SDG) target to reduce premature NCD mortality by 30% will remain a distant reality. Without action now, millions of people will have been failed. Millions of people and communities will have lost loved ones of all ages to avoidable death. Millions more will have had to adjust to living with, or supporting someone with a disability. Millions more will have struggled with the entrenched poverty and untold misery that are often the product of weak health and social protection systems.

40 million people who die every year due to NCDs, 14m people of those die of stroke and 50m people are left permanently disabled as a result of stroke. Behind every statistic is a person, with a family and a story, with a right to the enjoyment of the highest attainable standard of physical and mental health. But accidents of geography and poverty are still tragically cutting lives short and reducing the quality of life of everyone touched by stroke.

As stroke clinicians and representatives of stroke survivors and supporters around the world, the WSO is all too familiar with the realities on the ground and the consequences of political inertia to people, communities and the most vulnerable. We have had enough of political inaction and the glacial progress on NCDs which is having such a disastrous effect on the lives of stroke patients, families and societies.

We are impatient for change, and we not only join the Commission in saying is it time for our governments to deliver, but that delivery on commitments is overdue and vital. If countries want to avoid sleepwalking into a sick future, the UN HLM must result in bold commitments and action.

Read full statement and list of over 200 signatories here

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