WHAT: 11th World Stroke Congress brings together leading international stroke experts and an unparalleled scientific program covering epidemiology, prevention, acute care, rehabilitation and recovery in 100s of sessions and oral posters. Congress is attended by close to 2500 stroke professionals, researchers, policy makers, survivors and caregivers from around the world. #worldstroke2018
WHERE: Montreal, Canada, Palais des Congrès
WHEN: October 17 - 20, 2018
MEDIA OPPORTUNTIES: Stroke experts and people with lived experience of stroke will be available for interviews.
TODAY'S CONGRESS HIGHLIGHTS
Late Breaking trials:
VERSE: Very Early Rehabilitation in SpEech (VERSE): A prospective, multicentre randomised, controlled, open-label, blinded-endpoint trial in patients with aphasia following acute stroke. Results will be presented by Dr. Erin Godecke of Australia (6:10 p.m., Hall A)
FIND-AF: The final 3-year results of the FIND-AF Randomized Trial (6:50 p.m., Hall A). Results will be presented by Dr. Rolf Wachter of Germany.
Time course of risk versus benefit of clopidogrel and aspirin in acute ischemic stroke and high-risk TIA: a planned secondary analysis from the POINT Trial, presented by Dr. Jordan Elm of the U.S.A. (6:30 p.m., Hall A)
The first of two presentations of results of studies evaluating the use of the drug dabigatran will be presented. Today's (7:30 p.m., Hall A) will examine the use of dabigatran against acetylsalicylic acid (ASA) to prevent secondary stroke in patients with embolic stroke of undetermined source (ESUS) while on Saturday, Oct. 20, results will be presented evaluating dabigatran versus dose-adjusted warfarin in patients with cerebral venous thrombosis (11:30 a.m., Hall B).
HOT TOPIC: Access to stroke rehabilitation in Canada
A Canadian study, conducted by Dr. Anita Mountain of Dalhousie University in Halifax and Dr. Patrice Lindsay of Heart & Stroke, found that while overall access to and efficiency of stroke rehabilitation in Canada improved from 2008 to 2017, significant provincial and regional differences exist.
Access to and efficiency of stroke rehabilitation is an important subject given that there are about 62,000 strokes in Canada every year and more than 400,000 people are living with long-term disability from stroke - a number that is expected to double in the next 20 years.
The study looked at data from 188 inpatient stroke rehabilitation facilities across Canada, of which 99 report statistics to the Canadian Institute for Health Information. Between 2008 and 2015, the number of stroke rehab admissions rose from 5,969 to 9,025.
The study also found that while 93 per cent of Canadians live less than one hour from an inpatient stroke rehabilitation facility, bed capacity continues to hamper prompt access. However, from 2013 to 2017 there was improved access to a dedicated stroke rehabilitation unit, interdisciplinary teams and specialized equipment.
"Canadian Stroke Best Practice Recommendations help guide the delivery of effective evidence-based stroke rehabilitation across Canada," said Dr. Mountain. "We know what needs to be done and have seen improvements in the access and efficiency of stroke rehabilitation over the past decade. However, the degree of improvement is not consistent across Canada. We need to ensure there is access to the same quality and intensity of stroke rehabilitation services for all Canadians regardless of what province or region they live in."
Rehabilitation needs to begin early after stroke when the brain is most amenable to recovery. More than 80 per cent of people now survive a stroke but more than 60 per cent are left with long-term disability, a figure that could be improved with broad and timely access to appropriate services.
HOT TOPIC: Gender differences in accessing stroke care
Another Canadian study, led by Dr. Noreen Kamal of the University of Calgary, looks at differences between women and men in access to a key type of acute stroke care in Canada, 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 analyzed Canadian hospital data over five years from 2011 to 2016. It found that more men presenting with ischemic stroke were transferred to a comprehensive stroke centre, compared to women. It also found that 17 per cent of patients were transferred to a comprehensive stroke centre to receive a clot-busting drug treatment. Among patients transferred, only 40.4 per cent were women. Additionally, the study found that men had a slightly shorter median time than women from when they first arrived to when they were transferred, 1.37 hours versus 1.50 hours. Researchers say that further investigation is needed to understand the results and determine what may be causing the gap in efficient stroke treatment for women.
Dr. Thalia Field, a stroke neurologist and fellowship program director for the Vancouver Stroke Program, will present a study tomorrow that analyses gender differences in stroke care and outcomes among 257,582 Canadian stroke patients from 2009 to 2016, of whom 49 per cent were female. This study found that women were less likely to receive alteplase clot-busting medication for ischemic stroke (13.7 per cent vs. 14.2 per cent for men), had longer times from entering hospital to receiving treatment (average median time from arrival to treatment of 103 minutes vs. 89 for men) and were more likely to die within seven days of their stroke (8.5 per cent vs. 7.9 per cent).
HOT TOPICS: Other presentations of interest on the first day of the Congress:
A major study of the impact of the consolidation of acute stroke care from nine community hospitals in southeastern Ontario to three specialized stroke units resulted in a huge increase in stroke unit care and a five-per-cent drop in the stroke mortality rate. "More people are getting stroke unit care and fewer people are dying," says Cally Martin, regional director of the Stroke Network of Southeastern Ontario.
An Australian study found women died more often within the first year after a stroke compared to men, and the causes of death varied by sex. By observing the outcomes of almost 10,000 Australians who experienced a stroke, researchers from the Florey Institute of Neuroscience and Mental Health and the Menzies Institute for Medical Research have been able to rule out any systemic bias in the healthcare received by men and women. However, researchers were not sure whether men and women have different causes of death following a stroke. They also weren't sure if the higher long-term death rate following a stroke could be traced back to a specific cause or causes, and whether these might differ by sex.
An interactive platform discussion with world experts will examine shaping a future of integrated care for stroke and non-communicable diseases (NCDs). Stroke and other NCDs are collectively driven by the same risk factors and often present as co-morbidities. They are often chronic, complex, and related to persistent handicaps. As stroke survivors know well, a more integrated care with a life-course approach is required. Yet, health systems are ill-equipped to respond to this need, as they focus on single diseases with specific therapies. A new policy brief on stroke and NCDs with key messages and action points on these issues will be presented at a 12:40 pm session in the Exhibition Hall featuring Dr. Marc Fisher, Professor of Neurology, Harvard Medical School, Editor-in-Chief of Stroke (USA), Dr. Sheila Martins, Founder and President of Brazilian Stroke Network (Brazil), Dr. Bo Norrving, Professor of Neurology, Lund University (Sweden), and Yves Savoie, CEO, Heart & Stroke Foundation (Canada)