STROKE PATIENTS IN CHINA

 

Delivering big, positive stroke outcomes for the world’s largest population is the aim of the American Stroke Association (ASA) and Chinese Stroke Association (CSA) with the launch of a quality improvement program adapted from the American Heart Association’s guidelines-based program called Get With The Guidelines.

 

Brain illustration
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The program works to improve treatment for, and prevention of, cardiovascular and stroke events by helping hospitals and providers consistently adhere to the latest scientific treatment guidelines. In the last 15 years, Get With The Guidelines has transformed patient care for heart and stroke patients in the U.S., helping hospitals and providers learn the correct treatment and translate guidelines into practice. This program has saved lives and resulted in more than 400 scientific publications that advance heart and brain health around the world.

The adapted Get With The Guidelines program, designed through a collaboration of the ASA and the CSA, endorsed by the China National Health and Family Planning Commission, and supported by Medtronic, is a set of “best practices” that aim to continuously improve treatment, enhance the quality of care, and prevent future stroke events in China.

While several evidence-based, highly effective, guideline-recommended therapies are known, adherence to guidelines for stroke care remains incomplete and highly variable from region to region, and country to country.

This effort aims to solve for that in China. Specifically, this program addresses the need for:

1.     Enhanced education for EMS and pre-hospital caregivers, especially since analysis shows only 13 percent of Chinese stroke patients arrive at the hospital by EMS, versus 50 percent in the U.S.

2.     A reduction in “door-to-needle” times for patients to receive the clot-busting drug tPA. To-date, analysis for rates of compliance with evidenced based therapies notes significant gaps in timeliness to tPA treatment.

3.     Increased awareness and application of mechanical endovascular reperfusion therapies in appropriate patients.

4.     Increased awareness and application of secondary prevention in appropriate stroke patients to fill significant gaps in venous thromboembolism (VTE) prophylaxis, lipid lowering therapy, anticoagulation for atrial fibrillation and rehabilitation assessment in Chinese patients.

With a population of 1.4 billion, stroke is the leading killer and claims the lives of 1.6 million Chinese people annually. Today, China faces cardiovascular and stroke risk factors similar to those in Western nations. Among risk factors, hypertension remains the most important for all types of strokes. Additionally, the concept of a “stroke belt” in China has emerged which identifies specific geographic regions where the mortality associated with stroke is 50 percent higher than that of other regions in the country. Currently, the areas with higher mortality are the northeast and the western/southwestern.

In 2007, the Ministry of Health — now National Health and Family Planning Commission — sponsored the Chinese National Stroke Registry and a five-year plan to increase comprehensive stroke centers in China. Establishing the registry also led to creating the Stroke Screening, Prevention and Treatment Project in 2009, and more recently the National Center of Stroke Care Quality Control in 2011.

“The American Stroke Association is deeply committed to having a transformative impact on healthcare systems and patients worldwide by working alongside countries, governments and international cardiovascular and cerebrovascular societies to facilitate the application of the tools and knowledge of our quality programs,” said Ying Xian, M.D., Ph.D, American Stroke Association spokesperson and Assistant Professor of Neurology and Medicine at the Duke University Medical Center and Duke Clinical Research Institute. “The U.S. marketplace has given us a road map to develop scalable and sustainable models for international quality improvement initiatives. Now, with our consult, the Chinese Stroke Association aims to adopt those models to achieve better outcomes for stroke patients in China.”

“It is with great excitement that we announce the launch of this collaborative stroke quality improvement project between the CSA and ASA to further enhance cooperation on clinical research, education, and the impact of acute stroke science,” said Jizong Zhao, President, CSA. “I congratulate both organizations’ dedication to improving stroke outcomes in China.”

Reaching healthcare providers with the Get With The Guidelines program at Chinese secondary and tertiary hospitals — and at all stages of the chain of survival, from pre-hospital advanced medical care (also known as EMS or emergency medical services) to neurologists to even hospital administrators — is the priority.

“Medtronic is a leading stroke care solution provider in stent retriever therapy with more than 20 years of experience in China. We provide clinical education and training systems for Chinese physicians and, together with medical societies, we consistently promote a hierarchical treatment system, raise public awareness, and speed up patient admission and treatment to ensure the proper care for patients,” said Chris Lee, President, Medtronic Greater China. “We are very proud to collaborate with both the CSA and ASA, and we will continuously work together to improve China’s stroke care quality.”

Stroke has also had a significant impact on healthcare expenditures and the Chinese economy. The cost for stroke care by the government-funded hospitals was 1.17 billion RMB (approx. $170M USD) in 2003 and 8.19 billion RMB (approx. $1.3B USD) in 2009, a 117 percent increase annually. Now, the annual cost of stroke care in China is approximately 40 billion RMB ($5.8B USD).

Many people have misconceptions about high blood pressure. That may help explain why only about half of those with the condition have it under control. One misconception is that stress and anxiety cause high blood pressure. A potential contributor to this notion is the disorder’s medical name, hypertension, which some people misinterpret to mean too much (hyper) emotional stress (tension).

The word hypertension came into general use around 1895, and its “tension” refers to the physical tenseness caused by excessive pressure of the pumping blood on increasingly inflexible artery walls. Several studies show that, despite the explanations their doctors may give them, many people with hypertension nevertheless associate the disorder with emotional distress and think their blood pressure goes up primarily when they feel stressed. In light of that, some of them hope that stress reduction techniques will control their blood pressure, and promoters of such techniques often encourage this idea.

It’s not illogical to think that stress could contribute to hypertension. After all, stress and anxiety are among the many psychological and physiological factors that can boost blood pressure—temporarily. However, blood pressure normally fluctuates throughout the day, and after such rises it falls back to its usual range.

Moreover, chronic stress (especially when combined with a sense of lack of control) is associated with poor health, notably coronary artery disease. But the research concerning hypertension is far from clear. Some studies have found that certain stress reduction methods (such as meditation) can lower blood pressure somewhat, at least for a while. However, several research reviews have concluded that the evidence overall is mixed and inconsistent and that any benefit is likely to be modest.

There are many good reasons to reduce excessive stress or at least learn to cope with it. Besides its adverse effects on the body and mood, stress may encourage unhealthy behavior, such as smoking, overeating, and drinking too much alcohol, which among other things can increase blood pressure. But if people think that stress management is enough to treat their hypertension, that’s a concern since it may distract them from effective treatments such as diet, exercise, weight control, and medication.

Hypertension pills have different functions. Sevikar lowers the calcium in arteries. Piramil lowers an enzyme in arteries.  That’s why taking different pills together have more drastic results.  I usually take Sevikar, but if the pressure continues I also take Piramil.

Taking one aspirin every week helps preventing an initial heart attack or stroke. Aspirin is an inexpensive, easy-to-obtain medicine cabinet stalwart that has been used for decades to prevent a second heart attack or stroke. Using aspirin to prevent a first heart attack or stroke – known as primary prevention – has historically been a topic of debate.

Most heart attacks and strokes occur when blood flow to the heart or brain is blocked by a blood clot. Aspirin works by thinning the blood and preventing the formation of clots. In some people, aspirin can lead to complications, including excessive bleeding or a hemorrhagic stroke caused by a burst blood vessel in the brain. Bleeding in the stomach or gastrointestinal tract can also occur, although upset stomach and heartburn are the most common side effects.

Stroke is when poor blood flow to the brain results in cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. They result in part of the brain not functioning properly. Signs and symptoms of a stroke may include an inability to move or feel on one side of the body, problems understanding or speaking, feeling like the world is spinning, or loss of vision to one side. Signs and symptoms often appear soon after the stroke has occurred. If symptoms last less than one or two hours it is known as a transient ischemic attack (TIA) or mini-stroke. A hemorrhagic stroke may also be associated with a severe headache. The symptoms of a stroke can be permanent. Long-term complications may include pneumonia or loss of bladder control. FAST acronym describes the symptoms of a stroke: face drooping, arm weakness, speech difficulty, time to call 911.

Cardiac arrest occurs when the heart malfunctions and stops beating unexpectedly. Cardiac arrest is an electrical problem. Cardiac arrest is triggered by an electrical malfunction in the heart that causes an irregular heartbeat (arrhythmia). With its pumping action disrupted, the heart cannot pump blood to the brain, lungs and other organs. Seconds later, a person becomes unresponsive, is not breathing or is only gasping. Death occurs within minutes if the victim does not receive treatment.

Cardiac arrest can be reversible in some victims if it’s treated within a few minutes.
•  First, call 9-1-1 and start CPR right away.
•  Then, if an Automated External Defibrillator (AED) is available, use it as soon as possible.
•  If two people are available to help, one should begin CPR immediately while the other calls 9-1-1 and finds an AED.

Cardiac arrest is a leading cause of death. Each year, more than 350,000 out-of-hospital cardiac arrests occur in the United States. Most heart attacks do not lead to cardiac arrest. But when cardiac arrest occurs, heart attack is a common cause. Other conditions may also disrupt the heart’s rhythm and lead to cardiac arrest.

A heart attack occurs when blood flow to the heart is blocked. A heart attack is a circulation problem. A blocked artery prevents oxygen-rich blood from reaching a section of the heart. If the blocked artery is not reopened quickly, the part of the heart normally nourished by that artery begins to die.

Symptoms of a heart attack may be immediate and may include intense discomfort in the chest or other areas of the upper body, shortness of breath, cold sweats, and/or nausea/vomiting. More often, though, symptoms start slowly and persist for hours, days or weeks before a heart attack. Unlike with cardiac arrest, the heart usually does not stop beating during a heart attack. The longer the person goes without treatment, the greater the damage.

Even if you’re not sure it’s a heart attack, call 9-1-1 or your emergency response number. Every minute matters! It’s best to call EMS to get to the emergency room right away. Emergency medical services staff can begin treatment when they arrive — up to an hour sooner than if someone gets to the hospital by car. EMS staff are also trained to revive someone whose heart has stopped. Patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too.

Heart failure means the heart can’t keep up with its workload — providing your body with the oxygen and nutrients it needs — by pumping enough blood. While initially understood to occur when the heart was severely weakened by heart attacks, viruses or genetic mutations, heart failure can occur without any apparent weakness of the heart muscle.

In heart failure with preserved ejection fraction, or HFpEF, the heart can’t fill normally with blood because the muscle is stiff or thickened. HFpEF, which affects about half of adults with heart failure, remains an enigma to many researchers.

HFpEF hits older people, especially women, more frequently. And because of the aging population, the prevalence of the condition is increasing. It frustrates doctors because it’s hard to diagnose, and there is no test to implicate the disease when people experience symptoms such as shortness of breath. And while there are treatments for heart failure’s risk factors, there is no cure for the condition.

HFpEF is one of the few heart diseases affecting increasing numbers of people each year. It accounts for a disparate amount of Medicare spending. Heart failure, one of the most common reasons people 65 and older go into the hospital, is being studied from different angles. Some people with high blood pressure, a major risk factor for heart disease, develop heart failure while others don’t.

A fainting spell can be brought on by sudden emotional distress. Sometimes, severe dehydration or standing still for too long can lead to a blackout. But when unexplained fainting leads to hospitalization, blood clots in the lungs may be the reason far more often than doctors realize. Whenever a patient with a first episode of syncope is admitted to a hospital ward, unless he is already on anticoagulation medicine, a pulmonary embolism should be suspected.

A pulmonary embolism is a clot that breaks free from a vein, usually in the leg, and travels to the lung, where it gets stuck and blocks some or all of the blood supply. Every year, an estimated 300,000 to 600,000 Americans either get pulmonary embolisms, deep vein thrombosis (blood clots in their legs), or both, according to government figures. An estimated 60,000 to 100,000 will die from them.

If doctors believe a lung clot may be behind the fainting spell, additional screenings must be conducted, such as a blood test known as a D-dimer that can help rule out a lung clot, and a specific assessment that estimates pretest clinical probability based on various factors.

Those results can determine whether more tests, such as a CT scan, are warranted and, if so, a therapeutic dose of an anticoagulant drug should be promptly administered while awaiting the imaging tests, according to the available recommendations delivered by all major international guidelines for patients with a high probability of pulmonary embolism.

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