Could do better
The Government is falling down in promoting stroke prevention, researchers say, leaving an unsolvable rehabilitation burden.
For Auckland University of Technology stroke researcher Valery Feigin, the advances in treatment are encouraging, but fall a long way short of reducing the increasing burden of strokes, which affect 24 people a day in New Zealand – and numbers are rising.
The number of strokes has increased three-fold over the past 30 years, and that’s not explained away by our ageing population – people are having strokes younger, probably because of greater exposure to risk factors including poor diet, obesity, diabetes and alcohol.
It’s estimated that by 2050, New Zealand will be coping with more than 100,000 stroke survivors.
He criticises the Government’s strategy focusing on cardiovascular risk assessments. “Screening for risk doesn’t help to reduce the incidence or mortality from cardiovascular disease because people don’t follow the recommendations – the key is about what people do when they have the assessment. Screening is very costly and absolutely wasted.”
A population-wide strategy, such as a stop-smoking campaign or encouraging salt, sugar and alcohol reduction, would apply even when people didn’t know their risk. “Something needs to be done in primary prevention because the status quo is not working. We’re going through a crisis.”
AUT researchers are trialling two interventions – a mobile phone app that allows anyone to find out their personalised stroke risk when compared with others of the same age and ethnicity, and a programme assigning a health and wellness coach to people at moderate to high stroke risk. Coaches go through a six-week training course, and visit patients in their homes and later communicate by phone.
AUT senior research fellow Rita Krishnamurthi says only about 20% of stroke patients have rehabilitation after their discharge from hospital and rehab stops after three months, but improvement could continue for at least a year or more. Patients need therapy daily for that time, but even the most affluent societies can’t afford that. “It’s not a solvable problem,” says Feigin.
A stroke-awareness survey that questioned 400 people of Maori, Pasifika, Asian and European ethnicity found only 30% of respondents could name one or two risk factors for stroke, or identify symptoms.
Because 70% can’t recognise stroke symptoms, they risk missing the opportunity for early treatment. Pasifika people, who are at the highest risk of stroke at the youngest age because of diabetes and obesity prevalence, are the least aware of symptoms. The average age for stroke in Pasifika people is 56. In Europeans, it’s 75.
An ambulance is called in only about 70% of stroke cases, says Feigin, and that number is lower again in Maori and Pasifika communities. “It should be 100%. About 10% of people even drove a car to hospital after having a stroke – can you imagine?”
He says many older people hesitate before calling an ambulance because they are worried they might be causing problems, or misinterpret their symptoms as something that will pass.
It’s estimated that by 2050, New Zealand will be coping with more than 100,000 stroke survivors.