Be a stroke superhero – Be FAST

Recognising the signs of stroke and getting fast access to treatment is vital in saving lives and improving outcomes for stroke survivors. Awareness of the FAST message is a core strand of World Stroke Campaign and of the WSO’s members around the world.  But one important audience for this message - and one which has not been traditionally included in awareness programs - is children. 

While the prevalence of stroke in children is much lower than in the adult population, with the global lifetime risk of stroke now standing at 1 in 4, equipping kids with basic knowledge about what stroke looks like and what to do in an emergency could prove life-saving.

This is why WSO has recently endorsed the FAST Heroes program and will be working to pilot and evaluate this kindergarten-level education initiative and help with localisation of resources and activities for communities around the world.  

The FAST Heroes program has created an animated character-based education program with a central character, Timmy, who becomes a FAST Hero by learning how to beat the Evil Clot and save the Grandheroes in his life (his grandparents). Resources for use in class are age appropriate and include learning materials such as short film animations, classroom activities and take-home materials to literally hit the message home. There are even ideas to help schools and communities raise funds to broaden participation and make the program more sustainable in the longer-term.

Michael Brainin, President of WSO said of the partnership, ‘We’re excited to pilot this program which we hope will not only convey life-saving information but will also help us to understand how to better work with children to support broader community awareness of stroke and FAST.’

Jan van der Merwe, Project Lead for the Angels Initiative in Europe which supports the FAST Heroes program commented.  “Since launching the Angels Initiative, we realized that there are two big issues that somehow need to be addressed. The first of which is that patients arrive too late for treatment. This can be due to misdiagnosis or not seeing the symptoms as serious enough to warrant going to a hospital. The second big issue is that too many patients go to and are then admitted to hospitals that are not “Stroke Ready”. Both of these mistakes very often result in much worse outcomes post stroke. To help solve one of these issues, the Angels Initiative supported The Department of Educational and Social Policy of the University of Macedonia to develop the FAST Hero program. 

Stroke steals lives, and through engaging children and their families we can do something to make sure that when stroke strikes we are as prepared as we can be. This could be the difference not only between life and death, but also between “life as we know it” and a life lived with permanent disablity.”

Pilot FAST Hero programs will be delivered in partnership with WSO members in a number of countries including Brazil, Singapore and South Africa. For more information about participating in the WSO FAST Heroes program, please contact campaigns@world-stroke.org

WSO President welcomes WHO inclusion of hypertension ‘polypill ‘on essential medicines list

On July 9^th the WHO added fixed-dose combination anti-hypertension medication to its list of essential medicines.  WSO has welcomed the announcement as a watershed moment, which has the potential to address the single biggest risk factor for stroke worldwide. 

In a WSO jointly authored letter, published in The Lancet on 15^th July, WSO President Michael Brainin (alongside the American Heart Association, European Society of Hypertension, International Society of Hypertension, Lancet Commission on Hypertension Group, Latin American Society of Hypertension, Resolve to Save Lives, World Heart Federation and the World Hypertension League) expressed support for the inclusion of single pill combination treatment as a way to improve access to effective treatment for hypertension; particularly in low- and middle-income countries where rates of hypertension, are on the increase and where the proportion of people receiving treatment is low.

Currently 1.4 billion people worldwide have hypertension (classified as measurements equal or over 130/80) but only 1 in 7 have their blood pressure effective treated and controlled. Controlling hypertension often requires more than one medication which can create challenges for healthcare systems and for patients. Combining generic treatments is a safe and affordable way to overcome these; firstly, by making procurement and prescribing easier in low resource settings and secondly, by making it easier for patients to keep track of and comply with their medication ‘regime’.

WSO President Michael Brainin indicated that the decision by WHO may offer further encouragement to WSO's emergent stroke prevention strategy. ‘The decision by WHO to include a hypertension ‘polypill’ in their essential medicines list, is not only a massive boost to our global effort to prevent stroke, but potentially paves the way for the future inclusion of single pill combinations to address a number of stroke risk factors. WSO is currently working with an international network of researchers to explore the potential for such treatments alongside development of community healthworker networks and mobile technologies as an integrated strategy to improve diagnosis of clinical stroke risk factors and to improve access to preventive treatment. While we will continue to push that work forward, it is clear that it is now time for governments around the world to take action and to start putting in place policies and systems that will put single-pill combinations in the hands of patients who need them.’

Cerebral microbleeds: beyond the microscope. Vincent Berezowski PODCAST

Cerebral microbleeds: beyond the microscope. Vincent Berezowski

Link to the article published in the International Journal of Stroke



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Alteplase (rtPA) now included on the WHO’s List of Essential Medicines (EML) for acute ischemic stroke

Alteplase (rtPA) has made it on to the WHO’s List of Essential Medicines (EML) for acute ischemic stroke

 In the last 25 years, several studies have shown the efficacy of alteplase for acute ischemic stroke. If given within three hours, about one in four patients will have a reduced long-term handicap. This important effect of alteplase already includes its haemorrhage risk of 3-4%.

Despite this important reduction of brain damage, alteplase is only available in two thirds of countries and remains much underused in low and middle income countries. In order to increase access and use of thrombolysis around the globe, the World Stroke Organization (WSO) assembled 13 stroke experts from five continents under the leadership of Patrik Michel (Switzerland) and Michael Brainin (Austria). In 2018, this group submitted a 30 page application to the World Health Organization (WHO) for alteplase to be included in the EML (https://apps.who.int/iris/handle/10665/325771) describing all the pros, cons, conditions, and costs of alteplase.

This week, the WHO informed the WSO that the application was successful: alteplase is now included in the 21st EML, to be used in specialized diagnostic or monitoring facilities and with specialist medical care, as described for example in the WSO's Road Map for Quality Stroke Care.

This new inclusion of alteplase in the EML marks a major step forward for better stroke treatment worldwide, in particular in less affluent countries. All UN-member states are now encouraged to offer thrombolysis for a reasonable cost or for free, such as through Universal Health Coverage (UHC).

And in other good news for the stroke community, the new EML also increases the options for stroke prevention: it now lists fixed-dose dual combinations of antihypertensives, and four direct oral anticoagulants (dabigatran, apixaban, edoxaban and rivaroxaban) as essential medicines. Furthermore, a WSO expert group is currently working with WHO on a list of Priority Medical Devices for stroke prevention and treatment.

These new treatment options are likely to have an important impact on stroke incidence and long-term outcome worldwide, especially in combination with health policy, organized stroke care systems and lifestyle changes. 

Promoting life after stroke at the Stroke Games in Malaysia

World Stroke Organization SSO member the National Stroke Association of Malaysia (NASAM) was founded in 1995 by Janet Yeo after her remarkable recovery from a crippling stroke. NASAM’s mission is to promote stroke prevention awareness and to inform the public that there can be life after stroke with rehabilitation and long term support.

Stroke is the second leading cause of death in Malaysia, where six strokes occur every hour and over 50,000 new cases are reported each year. At its nine stroke centres, NASAM therapists conduct rehabilitation sessions which include physiotherapy, occupational and speech therapy to help stroke survivors regain their confidence and independence. NASAM also organises a range of activities to support daily living, these include cooking, art and craft, singing, music and movement and games.

NASAM recognises that as well as the physical effects of stroke, there are also emotional effects such as depression, anxiety, anger and denial. NASAM therefore also offers counselling services to enable people affected by stroke to find relief and to reinforce the importance of their view and significance of them as a person. At times, counselling is also provided to family members who have trouble coping or adapting to the responsibilities that have changed their lifestyles in caring for a stroke survivor.

NASAM’s objective to increase general awareness about stroke is the impetus behind their talks and forums. Open to the public, NASAM invites medical doctors, and other stroke-related specialists to talk about stroke prevention and stroke rehabilitation.

On an annual basis NASAM organizes nation-wide campaigns to raise public awareness of the risks of stroke and to encourage the public to take positive steps to adopt a healthier lifestyle to reduce their risk of stroke. The programme includes events to encourage the public to be more physically active.  There are also forums, chat shows on TV and radio, and open days at NASAM centres.

From 19-20 October 2019 NASAM will organize its second STROKE GAMES at the Panasonic National Sports Complex, Shah Alam, Selangor. The goal of the STROKE GAMES is to help stroke survivors in their recovery and to develop the “never give up” attitude. NASAM’s tagline is “CELEBRATING LIFE AFTER STROKE”. 

The Games showcase the abilities of stroke survivors and the possibilities of life after a stroke. The event helps people to regain confidence and dignity and instils a new outlook to living life.Sports include individual and group challenges such as basketball shoots, darts, obstacle races, baton relays, seated volleyball, lawn bowling, distance throws, modified weightlifting, modified archery, hand cycle, triathlon, 50m walk, 50m walk with hurdles, 300m walk, table and cognitive games.

The Games are also an opportunity to generate awareness of stroke in Malaysia where stroke awareness is still low and many people experiencing a stroke do not seek medical help fast enough.

For more details on the STROKE GAMES, please visit:

https://www.youtube.com/watch?v=cSgbtvvScM0

https://youtu.be/TKBdkmSq7zc

https://m.facebook.com/story.php?story_fbid=10156246771918845&id=96974848844

www.facebook.com/NationalStrokeAssociationMalaysia

www.nasam.org/event-details/?id=20

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