Canadian-led international study shows huge costs of delayed access to stroke care

October 18, 2018

TODAY'S CONGRESS HIGHLIGHTS

Late-breaking trials

HOT TOPIC: Canadian study finds that delays of just an hour result in poorer outcomes for patients and greatly increased healthcare costs

It has been known for years that it is important to get stroke patients treatment as soon as possible to increase their chances of recovery. A Canadian-led international study being presented today to the World Stroke Congress in Montreal quantifies how important every hour can be - both for patients and for costs to society and the healthcare system.

The study, led by clinicians at the University of Calgary, found that every hour of delay resulted in shortened or diminished quality of life as well as substantially higher healthcare and societal costs.

"Faster treatment results in better outcomes and better quality of life," said Dr. Michael Hill of the Department of Clinical Neurosciences at the University of Calgary, one of the study authors. "The speed of treatment is one of the modifiable factors that will improve outcomes and reduce cost at both the system and the hospital level."

Study collaborators from the U.S., U.K., France, Spain, Netherlands and Australia joined the Canadian researchers in examining outcome records and treatment costs for patients who had an ischemic stroke and were eligible for endovascular thrombectomy (EVT). With EVT, a person with an ischemic stroke has the clot physically removed as soon as possible after symptoms start. The process involves threading a thin tube through an artery and guiding it with X-ray imaging through blood vessels to the brain. A retrievable stent is used to remove the clot. The procedure has shown remarkable results in studies, reducing the overall death rate by 50 per cent and greatly diminishing the lasting effects of stroke in many patients.

The study concluded that within the first six hours, every hour of delay in starting the EVT procedure resulted in an average loss for the patient of 9 months at full quality of life (known as a quality-adjusted life year or QALY), or 18 months less at 50 per cent quality of life due to disabilities.

As for cost, the study found every hour of delay within the first six hours resulted in increased healthcare costs of $6,173 per QALY and society costs of $7,597 per QALY.

The losses are even greater during the very first hours after a stroke occurs. Within the first three hours, the study found, treatment delay of two hours - that are typically spent getting a patient to a stroke centre, evaluated, and brain imaged, even in relatively good circumstances - would result in average losses for the patient of close to 2 QALYs (2 years) and extra healthcare and societal costs of $11,000 and $15,000 per QALY (year), respectively.

HOT TOPIC: Young people, especially women, are less likely to take an ambulance to the hospital after stroke, causing harmful delays, Canadian researchers find

A study, led by Dr. Patrice Lindsay of Heart & Stroke, looked at pre-hospital behaviour of young stroke patients compared to older ones and found that young adults (ages 18-44), especially women, were less likely to take an ambulance to the hospital when they had a stroke.

Researchers studied 2003-2016 data from the Canadian Institute for Health Information to compare hospital arrival times after stroke based on gender and age. At the same time, they looked at public polling data to analyze stroke awareness among different groups.

Hospital arrival time was an average 7 hours for older adults and younger men, but 9 hours in younger women. Yet, polling showed that more women knew at least one FAST sign of stroke compared to men.

"Young adults, especially women, are less likely to use ambulance services and more likely to arrive to hospital late, even though they have more knowledge of stroke," Dr. Lindsay says. "Targeted public health messaging is required to ensure younger adults seek timely stroke care." Every hour of delay causes poorer outcomes after stroke and diminished quality of life.

HOT TOPIC: Canadian study looks at impact of aerobic exercise on cognitive improvement of stroke patients

A study from Atlantic Canada being presented at the Congress today shows that aerobic exercise combined with cognitive training improved executive function by almost 50 per cent in chronic stroke patients who were presumed to have reached their recovery plateau.

The study, involving clinicians from Memorial University of Newfoundland in St. John's and Dalhousie University in Halifax, assigned patients who were greater than six months post-stroke - beyond the period when major recovery was thought to occur - to separate groups to do different motion activities - aerobic exercise (Aerobic) and less strenuous movements and tasks (Activity) - and paired them with one of two cognitive activities, computerized cognitive training (COG) and non-adapted computer games (Games).

They found that while both groups doing COG saw significantly improved fluid intelligence scores, only the COG group doing Aerobic exercise was significantly different from the control group doing Activity+Games, showing a 50% higher level of improvement.

"Although many people with stroke may have some cognitive impairment, cognition is rarely a target of rehabilitation interventions, yet those with impaired attention and executive functions likely don't receive the full benefits of physical rehabilitation," said Dr. Michelle Ploughman, lead author of the study from Memorial. "As a result, several years later, even if discharged from rehabilitation, they continue to have problems with cognition and participation in their communities. Our study shows that it is conceivable that aerobic exercise could serve to 'prime' the brain to enhance relearning of tasks and that such efforts can improve multiple outcomes at the same time."

HOT TOPICS: Other presentations of interest on the second day of the Congress:
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11th World Stroke Congress

The 11th World Stroke Congress, being held Oct. 17-20, 2018, at the Palais des Congrès in Montreal, Quebec, brings together leading international stroke experts and an unparalleled scientific program covering epidemiology, prevention, acute care and recovery in hundreds of sessions and oral posters. The Congress is attended by stroke professionals, researchers, policy makers and people with lived experience from around the world. This is the first time the biennial Congress has been held in North America in 12 years; the 2016 Congress was held in Hyderabad, India. This year's Congress is jointly organized by the World Stroke Organization (WSO) and the Canadian Stroke Consortium (CSC). Co-presidents are Dr. Werner Hacke, WSO President, and Dr. Mike Sharma, CSC Chair. WorldStrokeCongress.org/2018

ABOUT STROKE

A stroke happens when blood stops flowing to a part of the brain or bleeding occurs in the brain. This interruption in blood flow or bleeding into the brain leads to damage to the surrounding brain cells which cannot be repaired or replaced; 1.9 million brain cells die every minute during a stroke. Stroke can happen at any age. Stroke affects everyone: survivors, family and friends, workplaces and communities.

The effects of a stroke depend on the part of the brain that was damaged and the amount of damage done. Ischemic stroke is the most common form of stroke, caused by a sudden blocked artery (about 85% of all stroke). A transient ischemic attack (TIA) is sometimes called a mini-stroke and is the mildest form of ischemic stroke. A TIA is an ischemic stroke, caused by a briefly blocked artery with rapid spontaneous unblocking of the artery leading to only a short period of brain malfunction. However TIAs are an important warning that a more serious stroke may occur. Hemorrhagic stroke occurs when a blood vessel ruptures, causing bleeding in or around the brain (about 15% of all stroke).

Recovery from stroke starts right away. The quicker the signs are recognized, and the patient is diagnosed and treated, the greater likelihood of a good recovery, with less chance of another stroke, and decreased healthcare costs. The first few hours after stroke are crucial, affecting the recovery journey for years to come.

The impact of stroke around the world

There are over 80 million people currently living with the effects of stroke globally.

Stroke in Canada

World Stroke Organization

The World Stroke Organization (WSO) is the only global organization with a sole focus on fighting stroke. WSO's mission is to reduce the global burden of stroke through prevention, treatment and long term care. WSO provides a strong voice for stroke professionals, survivors and caregivers in global and regional policy. The Organization is a WHO implementing partner and has UN approved consultative status. http://www.world-stroke.org

Canadian Stroke Consortium

The Canadian Stroke Consortium is the professional organization for stroke neurologists and other physicians interested in stroke. Our members are committed to reducing the burden of stroke through the translation of clinical research into routine patient care. Increasing capacity for high quality research, enhancing the capability of stroke services, leading comprehensive knowledge translation programs, and advocating in health policy and systems of care affecting stroke represent the four pillars of CSC's activities. strokeconsortium.ca

Heart and Stroke Foundation of Canada

Life. We don't want you to miss it. That's why Heart & Stroke leads the fight against heart disease and stroke. We must generate the next medical breakthroughs, so Canadians don't miss out on precious moments. Together, we are working to prevent disease, save lives and promote recovery through research, health promotion and public policy. heartandstroke.ca

For more information and to set up interviews contact: Diane Hargrave, dhprbks@interlog.com
416-467-9954, ext. 102

Heart and Stroke Foundation of Canada

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