Latin American Health Experts Call for Urgent Action to Prevent a Stroke Crisis

Critical Action Steps Outlined to Reduce Strokes Caused by Atrial Fibrillation

• Two new Reports published today by Action for Stroke Prevention, an alliance of globally renowned health experts and patient organisations, including representatives from Brazil, Mexico and Argentina, call for policy makers, and medical and patient communities, to implement specific actions that can be taken at a community level to prevent strokes that strike thousands of people with atrial fibrillation (AF) each year across Latin America
• Although the majority of AF-related strokes are preventable, AF is an under-diagnosed, under-treated abnormal heart rhythm which increases stroke risk five-fold compared to the general populationⁱ
• It is estimated that millions of people in Latin America suffer from AF; in Brazil, an estimated 1.5 million people live with AF and in Venezuela, it is thought that there are 230,000 AF sufferers, with this figure predicted to rise to one million by 2050^ii,iii
• Yet a new IPSOS MORI survey shows that 77% of people in Latin America are unaware of AF, highlighting a critical educational challenge for policy makers and healthcare providers
• AF-related strokes are more serious than those resulting from other causes.^iv This means that people who do suffer an AF-related stroke are less likely to be able to return to their own homes and will need more care from their families or nursing homes

LONDON--(BUSINESS WIRE)--Latin America 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 Latin-America Region?, the launch of today’s supplementary Reports focus on specific action steps that can be taken by healthcare decision makers, and professional and patient organisations, to reduce the catastrophic personal and economic impact of AF-related stroke.

Alarmingly, the Reports highlight that the first time many people will find out they have AF is when they have a stroke, and 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 Latin America region,^viii 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

“There is a clear unmet medical need for improved stroke prevention in people with atrial fibrillation,” said Dr Walter Reyes-Caorsi, Director of the Electrophysiology Service, Chief, Casa de Galicia Hospital, Montevideo, Uruguay. “Compared with the general population, people with atrial fibrillation have a significantly higher risk of stroke. AF-related strokes tend to be more severe, cause greater disability and have worse outcomes. As a result these strokes incur greater costs to healthcare systems, survivors and their families.”

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 41% of people surveyed in the Latin America sample (N=1,700) fear having a stroke above some^ix other serious health conditions including heart disease, diabetes and high cholesterol, only 1% are fearful of AF, despite it being a major risk factor for serious stroke^x.

“Our Report’s recommendations offer action steps that can be taken to limit this devastating epidemic,” said Dr Álvaro Avezum, Director, Research Division, Dante Pazzanese, Institute of Cardiology, São Paulo, Brazil. “The first steps are increasing understanding of risk factors for stroke, including AF, among governments, healthcare providers and the public, encouraging the implementation of existing prevention strategies, improving adherence to clinical guidelines and the development and use of new approaches to the management of AF."

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 6.2 million people worldwide^xi
• It is a condition which on its own represents the third single most common cause of death in industrialised countries^xii
• Atrial fibrillation (AF) is the most common sustained heart rhythm abnormality^xiii and is a strong independent risk factor for stroke^xiv
• Patients with AF are five times more likely to have a stroke compared with the general population^xv
• AF occurs when the upper chambers of the heart (the atria) tremble rapidly and irregularly.^xvi This leads to blood stasis or pooling within the atria,^xvi,xvii 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 Latin America?, the two new Reports launched today are entitled Atrial Fibrillation-Related Stroke: An Avoidable Burden and Stroke in Patients with Atrial Fibrillation in Latin America: 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 Latin America sample consists of Mexico, Argentina, Brazil and Colombia (1,700).

Interviews in Mexico, Argentina and Brazil were conducted face to face, and interviews in Colombia were conducted by telephone, 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: INEGI, 2010 (Mexico); INDEC, 2010 (Argentina); IBGE, 2010 (Brazil); Census DANE, 2005 (Colombia).

For queries regarding the Ipsos MORI survey, please contact [e-mail] or [e-mail] ([phone]).

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 Zimerman LI, Fenelon G, Martinelli Filho M, et al. Sociedade Brasileira de Cardiologia [Brazilian guidelines on atrial fibrillation]. Arq Bras Cardiol 2009;92:1-39
ⁱⁱⁱ Fuenmayor AJ, Fuenmayor AM. Nonpharmacological treatment of atrial fibrillation. Avances Cardiol 2009;29:286-95
^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 Christensen MC, Valiente R, Sampaio SG, et al. Acute treatment costs of stroke in Brazil. Neuroepidemiology 2009; 32:142-9
^ix Conditions listed were blood clots, heart disease, stroke, atrial fibrillation, high blood pressure, high cholesterol and diabetes
^x Benjamin E, Wolf P, D'Agostino R, et al. Impact of Atrial Fibrillation on the Risk of Death. Circulation 1998;98:946-952
^xi 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
^xii European Stroke Organisation. Stroke facts. http://www.eso-stroke.org/stroke_facts.php?cid=5. Accessed September 2012
^xiii Kannel WB, Benjamin EJ. Status of the epidemiology of atrial fibrillation. Med Clin North Am 2008;92:17-40
^xiv Benjamin E, Wolf P, D'Agostino R, et al. Impact of Atrial Fibrillation on the Risk of Death. Circulation 1998;98:946-952
^xv 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
^xvi Falk RH. Atrial fibrillation. N Engl J Med 2001;344:1067-1078
^xvii 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