Stroke is the leading cause of death and disability in Portugal
Cerebral Vascular Accident (CVA) is a medical emergency, currently the main cause of death and permanent disability in Portugal. Every hour three Portuguese have a Cerebral Vascular Accident, one of them does not survive, and half of the survivors will be left with disabling sequelae.
Impact of COVID on stroke patients
The last 18 months have had consequences, some of them irremediable, in the treatment of stroke patients, both in the acute phase and in terms of rehabilitation. The pandemic has placed enormous pressure on health services, with a natural implication for the healthcare provided to COVID-19 patients, but as we have confirmed, with an extremely negative impact on non-COVID-19 patients, including stroke patients. .
We found that at the beginning of the pandemic there was a decrease in the demand for hospital health care and when this occurred it was late. In the case of stroke patients, this delay often prevented treatment in the acute phase, leading to more marked sequelae. The marked decrease in the offer of rehabilitation cures, practically non-existent during the state of emergency, further limited the possible recovery of these patients.
At this stage we are trying to return to “normality”, although still with uncertainties regarding what will happen this winter, it is necessary to alert the population to avoid further damage.
Stroke Signs and Symptoms
Thus, it is important to record the need for early identification of alarm signals and rapid contact with 112, which will provide specific means of assistance, activating the Via Verde do AVC (VVAVC), transporting the patient to the hospital with the capacity to provide adequate treatment . Among the most frequent symptoms, a set of manifestations known by “5 F’s”. They are: the Face sagging, giving a feeling of asymmetry of the face; a decrease in Fluffs in one arm (with or without a decrease in leg strength); a difficulty in Fala, difficulty in having any kind of speech, slurred speech or existence of barely understandable and meaningless speech; an Fsudden high vision, altered vision or sudden decrease in both eyes or double vision; and the Forth headache, very intense headache and different from usual. Time is brain! The earlier the treatment, the greater the chance of success.
Stroke Recovery
In addition to diagnosis and treatment in the acute phase, it is essential not to neglect rehabilitation. Rehabilitation plays a preponderant role at several levels: in functional, cognitive and psychosocial recovery; in social integration; in improving the quality of life; in the maintenance of professional activity and the degree of dependence. The consequences of stroke can be diverse: difficulty in mobilizing a limb, language alteration with difficulty in expressing or understanding, altered vision, altered swallowing, altered balance, altered sensitivity, among others. About a third of stroke survivors may be left with cognitive impairment and many with chronic pain. A rehabilitation plan tailored to the needs of each patient is important.
Stroke Prevention
No less important is prevention. Stroke can be avoided in about 80% of cases. We have to prevent a first event, but also avoid recurrence. Although some factors are not passive to intervention, such as genetics, age or gender, controlling blood pressure, treating diabetes and dyslipidemia; adopt an adequate diet, low in fat and salt; exercise regularly; do not smoke (smoking doubles the risk of having a stroke), or drinking alcohol, these are ways to reduce the risk of having a stroke. In many cases, changing habits is not enough, it is mandatory to start the pharmacological one.
Action Plan for Stroke in Europe
We know that the burden of stroke will increase in the coming decades due to the increase in the number of people aged 60 years and over, which is predicted to increase by 23% in Europe by 2030. In an attempt to reduce the consequences of this aging population the European Stroke Society (ESO- European Stroke Organization) and the Stroke Alliance for Europe -SAFE, a non-governmental organization for stroke patients, jointly developed the Action Plan for Stroke in Europe. This plan targets each of the stroke intervention domains: primary prevention, organization of stroke care, acute stroke care, secondary prevention, rehabilitation, outcome assessment, and post-stroke life. 4 goals were defined for 2030:
- Reduce by 10% the absolute number of strokes in Europe.
- Treat at least 90% of all stroke patients in Europe in a dedicated stroke unit as the first level of care.
- Have national stroke plans that cover the entire chain of care, from primary prevention to post-stroke life.
- Implement fully planned multi-sectoral public health interventions to promote and facilitate a healthy lifestyle and reduce environmental (including atmospheric species), socioeconomic and educational factors that increase stroke risk.
At the end of August 2021 Portugal, in the person of Dr Graça Freitas, in a group of 55 European countries, signed an agreement in which it commits to promoting the development and implementation of public, integrated, sustainable and evidence-based policies for prevention and treatment of stroke in Europe, in order to achieve the outlined goals.
This commitment opens the way to improve the care provided to stroke patients in Portugal.
Author: Luisa Fonseca, Hospital Assistant Graduated in Internal Medicine, Coordinator of the Stroke Unit at Centro Hospitalar Universitário S. João, Guest Assistant at the Faculty of Medicine of the University of Porto and Coordinator of NEDVC at SPMI.