The Lancet Global Health: a need to re-focus efforts about stroke prognosis in China
A need to re-focus efforts to improve long-term prognosis after stroke in China is called for by researchers from The George Institute China and West China Hospital. The commentary was published by The Lancet Global Health recently.
Stroke is a leading cause of death and disability worldwide. Yet, despite successful efforts to improve acute stroke care in China in the past two decades, and more recently in raising awareness of early symptoms and the need for rapid access to stroke centres, much less attention has been given to post-discharge care.
The commentary speaks highly of the article by Yiping Chen and colleagues in the issue of The Lancet Global Health. From the ongoing China Kadoorie Biobank study, the team analysed a cohort of 489586 residents from 10 regions of China and found similar 5-year rates of recurrent stroke and major vascular events for both acute intracerebral haemorrhage and acute ischaemic stroke among 28-day survivors.
Co-author Professor Craig Anderson, Executive Director at The George Institute China said, “In view of the inadequate secondary preventative treatment situation in China, more accessible and easily monitored, cost-effective prevention strategies are urgently needed, especially in settings in which primary healthcare services are underdeveloped.”
The other key finding of Chen and colleagues was the high proportion (41%) of recurrent acute ischaemic stroke after a first event of intracerebral haemorrhage. A meta-analysis of three observational cohorts involving 2801 patients with intracerebral haemorrhage suggests that antiplatelet therapy after intracerebral haemorrhage, is safe and does not increase adverse outcomes. However, more randomised evidence from larger and more diverse populations is required to influence clinical practice.
Lead author, Professor Simiao Wu from West China Hospital said “In line with strategies for primary prevention and acute management, widely accessible and cost-effective strategies for secondary prevention that cover post-discharge care is urgently needed.”