The number of strokes is predicted to rise sharply by 2028 despite improvements in stroke prevention and management strategies that had seen a decline in stroke incidence and mortality over the past three decades.

This projected 40 per cent increase will be driven by population growth and more importantly, by an ageing population, says Associate Professor Anna Ranta.

Published in the New Zealand Medical Journal today, Dr Ranta’s paper, Projected stroke volumes to provide a 10-year direction for New Zealand stroke services, advises that New Zealand’s health sector will need to plan and implement appropriate strategies to manage the increased number of stroke patients.

“We need to invest in workforce and infrastructure to be ready,” says Dr Ranta. “We also need to raise public awareness around stroke prevention and recognition so people access treatment quickly.”

Awareness of stroke symptoms has increased via the FAST campaigns, says Dr Ranta. “But we have still a way to go.

“We want people to remember the FAST acronym: sudden onset of either Face (for droop), Arm weakness, Speech problem, and Time as in calling 111 fast.”

As for investments in prevention, Dr Rata estimates that New Zealand needs to achieve a 30 per cent reduction in stroke incidence to keep stroke volumes stable. “This will require public policy consideration and massive public awareness campaigns.”

It is believed that 90 per cent of the world’s stroke burden is attributable to modifiable risk factors and that achieving control of behavioural and metabolic risk factors could avert more than three-quarters of strokes worldwide.

In her paper Dr Ranta outlines, in order of impact, the top five modifiable risk factors in Oceania that contribute to the stroke burden: high blood pressure, high body mass index, diet low in fruits, smoking and diet low in vegetables. “National policy changes and public awareness campaigns as well as new ideas as to how to best address these issues are vitally needed.”

Dr Ranta believes the long-term stroke burden due to disability and aged residential care requirements could be reduced through improved acute and rehabilitation stroke care, “but this will require upfront service investments”.

She predicts that care will be complicated by a disproportionate growth in volumes in rural areas with high degrees of social deprivation and disadvantaged ethnic population. There will also be an increasing need to centralise stroke services due to the complexity of modern stroke therapies.

“Centralisation is inevitable in metropolitan areas and requires technology support in geographically dispersed areas to ensure that the disparity gap does not widen further.” She suggests that improving access to acute intervention and rehabilitation services is essential to ensure mortality and disability continue to decline and minimise the societal and individual impacts of New Zealand’s increasing stroke burden.

“A number of studies have shown that decentralised thrombolysis services (telestroke, mobile stroke units, local strokeready health centres) can achieve similar thrombolysis rates and door-to-needle times for rural populations as a centralised system can achieve for an urban population,” she writes. “However, especially in the metropolitan setting when one includes other key therapeutic components and considers both patient outcomes and cost-efficiency, centralised systems tend to fare better.”

Dr Ranta says defining the problem, via her research, is the first step in tackling the issue. “We now need to develop a model to be ready.”

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