To better visualise the differences between countries and how stroke strains their public health systems, we designed graphs comparing 20 countries and regions [1–19]. Each graph represents a "plantlet" with petals showing stroke incidence per 100,000 people and roots illustrating the average number of people depending on each specialised Stroke Unit—dedicated medical units designed to provide focused care for stroke patients—, measured in hundreds of thousands.
The second measure –the roots– aims to normalise the amount of Stroke Units each country or region has. For instance, the United States has over 1,600 units, whereas Spain has slightly over 70, and Malta only 1. By normalising the number of specialised Stroke Units with the population number, we obtained a narrower variance with which we could work easier.
Think of each plantlet as a weed: the larger the petals and the more extensive the roots, the more resources it "steals" from the garden.
But besides geographical differences, stroke also affects certain demographics differently. In Spain, cerebrovascular diseases, including strokes, are the leading cause of death among women, underscoring a gender-specific aspect of this condition. Various biological and lifestyle factors contribute to the higher stroke risk in women. Hormonal changes, particularly those related to pregnancy and menopause, play a critical role. Pregnancy-related complications, such as pre-eclampsia, and the hormonal fluctuations that occur during and after menopause increase vulnerability. Additionally, post-menopausal women are more likely to develop risk factors like hypertension, obesity, and diabetes, which further exacerbate the problem [22].
Women often experience atypical symptoms during a stroke, such as general weakness, confusion, and fatigue, which can be easily mistaken for other health issues. This often delays diagnosis and treatment, with many women unaware of the connection between these symptoms and the onset of a stroke. Delayed treatment can have devastating consequences, as early intervention is crucial for improving recovery outcomes. This lack of awareness, combined with the increased prevalence of risk factors in women, makes stroke prevention and education particularly vital for this demographic.
But stroke's impact is not limited to death rates alone. It is a condition that leaves survivors with a wide range of long-term physical, cognitive, and emotional challenges. In fact, about 50% of stroke survivors are left with severe sequelae, which can include significant impairments in motor skills, speech, and cognition.
The disabilities caused by stroke also have a ripple effect on families and caregivers. In many cases, family members are thrust into the role of primary caregivers, which can lead to emotional, physical, and financial strain [23] [24]. Caregivers often experience stress, depression, and burnout, as they try to balance caregiving responsibilities with their own lives. The burden of caregiving is especially heavy in low-resource settings, where access to rehabilitation services is limited or unavailable. Stroke survivors in these areas are often unable to regain their independence, further compounding the social and economic toll of the condition.
Stroke is also a major contributor to cognitive decline and dementia. It ranks as the second leading cause of dementia, trailing only behind Alzheimer’s disease. The brain damage caused by stroke can lead to memory problems, difficulties with planning and decision-making, and other forms of cognitive impairment. In some cases, these issues progress to vascular dementia, a condition that requires specialised long-term care [26].
The cognitive decline that follows a stroke can significantly diminish the quality of life for survivors, making it difficult for them to return to work or engage in social activities. The emotional toll of this cognitive loss is often as profound as the physical disabilities, affecting both the individuals and their families[20] [21].
This personal and social burden, both on the survivors and their families, deeply motivated us to focus on how we can better support those who experience these life-altering effects.
Current public health efforts tend to concentrate on prevention and acute care, yet there remains a substantial gap in the long-term rehabilitation and support systems available for survivors. Our project aims to fill that gap by addressing the needs of individuals post-stroke, helping them regain as much independence as possible.
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But the gap in care contributes to the high percentage of stroke survivors who are unable to return to their previous levels of independence [20]. Even with access to rehabilitation, many survivors face ongoing challenges. Motor impairments, such as difficulty walking or using their arms, can persist, while speech and communication disorders can make it difficult to engage in daily conversations. Cognitive issues, such as memory loss and poor concentration, can affect a survivor’s ability to work or maintain relationships [21]. These long-term effects underscore the need for more comprehensive support systems for stroke survivors.
Looking to the future, the urgency of addressing stroke becomes even clearer. The incidence of stroke is projected to increase by 27% over the next 25 years, largely due to an ageing population and the continued prevalence of risk factors such as hypertension, diabetes, and unhealthy lifestyles [25]. This anticipated rise in stroke cases highlights the need for ongoing investment in both prevention and treatment.
Our project was driven by the magnitude of this problem. We committed to listening to the needs of stroke survivors and collaborating with experts to develop a meaningful and effective solution. In the face of increasing stroke cases, it is more important than ever to promote public awareness, improve healthcare services, and ensure that stroke survivors receive the support they need to regain their independence and quality of life.
References
[1] Stroke Foundation. (2024). Stroke care units. https://strokefoundation.org.au/about-stroke/learn/treatment-for-stroke/stroke-care-units#units
[2] SAFE. (2017). SAFE stroke Austria. https://www.safestroke.eu/wp-content/uploads/2017/12/SAFE_STROKE_AUSTRIA.pdf
[3] Tu, W. J., Wang, L. D., & on behalf of the Special Writing Group of China Stroke Surveillance Report. (2023). China stroke surveillance report 2021. Military Medical Research, 10, 33. https://doi.org/10.1186/s40779-023-00463-x
[4] Leys, D., Falcou, A., & Mas, J.-L. (2022). Acute stroke care in France: Survey in the 138 stroke units. Revue Neurologique, 178(10), 1072–1078. https://doi.org/10.1016/j.neurol.2022.07.010
[5] Neumann-Haefelin, T., Bartig, D., Faiss, J., Schwab, S., & Nabavi, D. (2024). The acute care of stroke patients in German stroke units—an analysis of DRG data from 2021 and 2022. Dtsch Arztebl Int, 121, 200–201. https://doi.org/10.3238/arztebl.m2023.0266
[6] The cost of ensuring every hospital treating patients with acute stroke has a properly resourced stroke unit. (n.d.). https://assets.gov.ie/80384/d5c306d1-621a-4bc8-843e-d476a96d0059.pdf
[7] Cantarini, S. (2023, November 20). Italy needs tools to follow the patient in post-stroke phase, improve rehabilitation. Euractiv.com. https://www.euractiv.com/section/health-consumers/news/italy-needs-tools-to-follow-the-patient-in-post-stroke-phase-improve-rehabilitation/
[8] Hara, K., Kanda, M., Kuwabara, H., Kobayashi, Y., & Inoue, T. (2024). Association between the quantity of stroke care units and the complement of neurosurgical and neurology specialists in Japan: A retrospective study. Journal of Stroke and Cerebrovascular Diseases, 33(8), 107734. https://www.sciencedirect.com/science/article/pii/S1052305724001794
[9] SAFE. (2017). SAFE stroke Malta. https://www.safestroke.eu/wp-content/uploads/2017/12/SAFE_STROKE_MALTA.pdf
[10] SAFE. (2017). SAFE stroke Norway. https://www.safestroke.eu/wp-content/uploads/2017/12/SAFE_STROKE_NORWAY.pdf
[11] SAFE. (2017). SAFE stroke Poland. https://www.safestroke.eu/wp-content/uploads/2017/12/SAFE_STROKE_POLAND.pdf
[12] King's College London. (2020). The burden of stroke in Europe: Report - Appendix. Stroke Alliance for Europe. https://www.safestroke.eu/wp-content/uploads/2020/06/The_Burden_of_Stroke_in_Europe_Report_-_Appendix.pdf
[13] Aguiar de Sousa, D., von Martial, R., Abilleira, S., Gattringer, T., Kobayashi, A., Gallofré, M., Fazekas, F., Szikora, I., Feigin, V., Caso, V., & Fischer, U. (2019). Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries. European Stroke Journal, 4(1), 13–28. https://doi.org/10.1177/2396987318786023
[14] Salinas, N. (2022, May 24). Sólo el 34% de los pacientes que sufren un ictus ingresan en unidades especializadas. El Periódico de España. https://www.epe.es/es/sanidad/20220524/ictus-espana-hospitales-unidades-especializadas-13684075
[15] SAFE. (2017). SAFE stroke Sweden. https://www.safestroke.eu/wp-content/uploads/2017/12/SAFE_STROKE_SWEDEN.pdf
[16] SAFE. (2017). SAFE stroke Ukraine. https://www.safestroke.eu/wp-content/uploads/2017/12/SAFE_STROKE_UKRAINE.pdf
[17] Getting It Right First Time. (n.d.). Stroke services: Overview of the review. https://gettingitrightfirsttime.co.uk
[18] Bulwa, Z., & Chen, M. (2021). Stroke center designations, neurointerventionalist demand, and the finances of stroke thrombectomy in the United States. Neurology, 97(20 Suppl 2), S17–S24. https://doi.org/10.1212/WNL.0000000000012780
[19] Fundació Ictus. (n.d.). Xarxa d'atenció al ictus a Catalunya. https://www.fundacioictus.com/informacio/xarxa-datencio-dictus-a-catalunya/
[20] Sociedad Española de Neurología. (2020). Atlas del Ictus Catalunya. https://www.sen.es/images/2020/atlas/Informes_comunidad/Informe_ICTUS_Cataluna.pdf
[21] Sociedad Española de Neurología. (2020). Atlas del Ictus España. https://www.sen.es/images/2020/atlas/Atlas_del_Ictus_de_Espana_version_web.pdf
[22] Unidad de la Mujer. (2022, March 7). Ictus en la mujer: infarto cerebrovascular. https://www.unidaddelamujer.es/ictus-mujer-infarto-cerebrovascular/
[23] Fundació Ictus. (n.d.). Información y consejos para familiares y cuidadores. https://www.fundacioictus.com/es/apoyo/a-familiares-y-cuidadores/informacion-consejos/
[24] Grupo de Estudio de Enfermedades Cardiovasculares de la Sociedad Española de Neurología. (n.d.). El papel de la familia. http://ictus.sen.es/?page_id=95
[25] Sociedad Española de Neurología. (2023, October 29). El 90% de los casos de ictus se podrían evitar con una adecuada prevención de los factores de riesgo y un estilo de vida saludable. https://www.sen.es/saladeprensa/pdf/Link223.pdf
[26] Ministerio de Sanidad. (2022, October 28). Día Mundial del Ictus. Revista Española de Salud Pública, 96. https://www.sanidad.gob.es/biblioPublic/publicaciones/recursos_propios/resp/revista_cdrom/VOL96/EDITORIALES/RS96C_202210084.pdf