Stroke Burden: Background, Definition And Epidemiology

Global Burden of Disease (GBD) study which was published at conducted in the year 1990 provided the mostfirst comprehensive measureestimate about the burden of 135 diseases, and ischemic heart diseases were ranked as the leading cause followed by cerebrovascular disease as the secondcerebrovascular disease was found to be the second most frequent cause of mortality after ischemic heart diseases. . During the past few decades, the database for GBD has significantly evolved and use advanced methodologies for modelling the range of conditions and their risk factors since 1988, covering two-thirds of the population. This vast database facilitated reasonably to estimate the stroke burden. In GBD 2016, a systematic analysis of global, regional and national burden of stroke was provided by the stroke collaborators according to the incidence, prevalence, deaths and disability-adjusted life years (DALYs)stroke collaborators provided a systematic analysis of global, regional and national burden of stroke in terms of incidence, prevalence, deaths and disability-adjusted life years (DALYs). Two-thirds of deaths were reported in developing countries in which 40% of the patients were below the age of 70 years. Also, cerebrovascular disease is is ranked as the leading cause of adult disability, and each year, millions of stroke survivors have to restrict their daily activities to adapt to the life. millions of stroke survivors have to adapt to a lifestyle with restricted activities of their day to day living. WHO has established four non communicable diseases (cardio vascular, diseases, cancer, diabetes, pulmonary diseases) that make people die prematurely, and four modifiable behavioral or life style risk factors (tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol) and featured a 4x4 principle. This concept featured as best buy principle, for mass actions on life style risk factors as the most cost-effective means of prevention. .Regard toWith respect to stroke this is quite important as stroke has shares many common features with other non -communicable diseases. Further to this WHO also added hypertension and aAtrial fibrillation were also added in the action plan on NCD . Cerebrovascular disorders can be prevented to a large extent byand providing awarnessan entry point consideration for public health initiatives to minimize the global burden of stroke. Current trends suggest that the number of annual deaths will rise up climb to 6.7 million by 2021 without appropriate action. Definitive treatment of stroke is thrombolytic therapythrombolysis which has to be delivered within 4.5 hours hrs of symptom onset. .But the earlier treatment given, the better the outcomes.But earlier the treatment given better outcomes will be. Treatment of acute stroke as well as preventative measurements should be given at the same time equal weightage to reduce the burden of stroke. Stroke is not only life- threatening, but also disabling with significant impact on quality of life. SoSo, all possible efforts should be provided made to treat acute stroke patients in therapeutic window and precautionary measures to identify risk factors like atrial fibrillation at community level to prevent a potential threat. This project aims to identify potential causes and recommend necessary changes to facilitate timely delivery of thrombolytic therapy. thrombolysis treatment.

Background

In humans, cerebral blood flow (CBF) is approximately 50ml per 100gm of brain volumetissue and if CBF falls below 10ml/100gm/min can cause tissue damage, and if lasted for several minutes, this can cause irreversible brain damage leading to infarction. The most common emergency traetmentreatment Primary treatment method for stroke is thrombolytic therapy, and this is aimed at dissolving the clot, which blocksis disrupting the blood flow. “TIME IS BRAIN”, 'TIME IS BRAIN',

The target of Aim of this project is to evaluate the time taken for every patient presents with a suspected diagnosis of stroke. This time taken is widely known as Door to Needle (DTN) time. Evidence-based recommendations on the assessment and early treatment according to NICE guidelines (National Institute for Health and Care Excellence) reported recommend that all patients should be scanned within 60 minutes or as early. National data show that the thrombolytic therapy rate is 11.6% of all stroke patients were thrombolysed, and 52.4% of all those patients were scanned within one hour. Current performance in our centercentre as recorded in the stroke sentinel national audit programme (SSNAP) shows that only 41.2% of the patients were scanned in one hour. While the national data shows suggests 52.4% of scanning within one hour of admission, itsit’s important to identify discover potential delays and rectify those delays to achieve obtain a national target. This performed with the aid of can be achieved by doing an audit with breakdown time of all events since patients gets admitted to hospital. This audit should supply could give us a clearer picture of where the delay happens and can pick out reasons identify causes for those delays. This evaluation study will also attempt to identify the number of all patients who were under thrombolytic therapythrombolysed and why other patients were not eligible for this treatment. Audit will also address the potential seasonal variation, whether seasonal patient load or availability of human workforce had an impact on any delay. If at all identified, recommendations will be made to correct those delays to improve door to needleDoor to needle time for thrombolytic therapy. in the treatment of stroke.

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Stroke definition

The World Health Organization (WHO) defines stroke as: 'Rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin'. While transient ischemic attack (TIA) . By applying this definition from WHO transient ischemic attack (TIA), which has been defined by the 1975 National Institutes of Health (NIH) as “episodes of temporary and focal cerebral (including retinal) dysfunction of vascular origin, rapid in onset which commonly last 2–15 min but occasionally up to a day (24 h)” where “resolution leaves no permanent neurologic deficitlasts for less than 24 hours, where and patients with stroke symptoms because of subdural haemorrhagehemorrhage, poisoning, tumourstumors, or trauma, are excluded.

Epidemiology-World Statistics about Stroke

Cardiovascular disease, along with stroke produces immense burdens on healthcare services and overall healthcare economics in the United States and worldwide countries . Approximately 152,000 new strokes happen in the UK annually, and the number of stroke survivors is reaching 1.1 million. More than half of the stroke survivors become dependent after stroke and one in five strokes are fatal. Despite of the steady decrease of the deaths from stroke globally atAlthough the number of deaths from stroke globally has been steadily decreasing for the last few years, stroke mortality rates depend substantially on geographic localities as well . The financial implication of stroke is enormous mounting up to 1.7 billion on NHS and social care.

Statistical analysis inIn 2005 reported that stroke was one of the three leading top three causes for death whichand accounted for 11% of total mortality in England and Wales. A report published by theThe National Audit office in 2005 reportedhighlighted the potential improvements in patient outcome and financial benefits by modern management of stroke care. This led to the publishing of national stroke strategy by the department of health in 2007. Since then, stroke was counted as a medical emergency, and radical changes occurred in stroke care. After that massive public awareness campaign was initiated about stroke symptoms, treatment and life after stroke. Priority was to gain rapid evaluation assessment and thrombolytic therapythrombolysis treatment as this would considerably reduce the rate risk of death and disability. .