Miller School Neurologist Highlights Need for Global Investments in Stroke Care

Dileep R. Yavagal, M.D., advocates for a comprehensive approach to reduce the impact of the second-leading cause of death worldwide.

Greater investments in population health care are needed to address the rapidly growing global burden of stroke, according to a new report co-authored by Dileep R. Yavagal, M.D., professor of clinical neurology and neurosurgery at the University of Miami Miller School of Medicine.

“A comprehensive approach to evidence-based interventions could dramatically reduce worldwide death and disabilities from stroke over the next decade,” said Dr. Yavagal, who is also director of interventional neurology, co-director of endovascular neurosurgery, and director of the Miller School’s neurological stem cell platform in the Interdisciplinary Stem Cell Institute.

Mitigating the Global Burden of Stroke

Dr. Yavagal was a co-author of a new report, “The World Stroke Organization Lancet Neurology Commission: Pragmatic Solutions to Reduce the Global Burden of Stroke,” published in the journal Lancet Neurology on October 9, with co-authors from U.S. and international academic institutions.

Lead authors were Professors Valery L. Feigin, Auckland University of Technology in New Zealand, and Mayowa O. Owolabi, University of Ibadan in Nigeria.

“With the overall worldwide cost of stroke care and rehabilitation expected to reach $2.31 trillion in 2050, there is a strong economic case for mitigating this global burden,” said Dr. Yavagal, co-author of the Lancet Neurology Commission report. “Hopefully, this report will inspire government leaders, policymakers, patient advocates, and others to focus on the need for better systems of care.”

Jose G. Romano, M.D., professor and interim chair of neurology, interim chief of service, neurology, for UM/Jackson Health System, and director, Comprehensive Stroke Program, UM/Jackson Memorial Hospital, noted the importance of the Lancet Neurology Commission’s report.

“We hope these findings demonstrate the many benefits of investing in stroke surveillance, prevention, treatment and rehabilitation,” he said.

Advocating for Acute Stroke Care

Dr. Yavagal said his contribution to the report focused on acute stroke interventions, drawing on his expertise at the Miller School as well as his leadership roles as past president of the Society of Vascular and Interventional Neurology, and founder of the society’s Mission Thrombectomy global initiative, which focuses on emergency, catheter-based mechanical interventions to remove large blood clots blocking arteries in the brain in stroke.

“Through Mission Thrombectomy, we have shown the need and advocated for developing national plans to implement and strengthen thrombectomy and acute stroke care programs,” he said. “For example, India’s national insurance program significantly increased reimbursements for thrombectomy following our recommendations for building stroke systems of care, and advocacy by the country’s stroke societies.”

According to the Lancet Commission on Stroke Report, stroke is the second-leading cause of death worldwide and its burden is increasing at a particularly fast pace in low- and middle-income countries, according to the commission’s report. Stroke mortality is projected to increase from 6.6 million in 2020 to 9.7 million in 2050, with a similar rise in stroke-related disabilities, including dementia.

Ways to Improve Stroke Care

To reduce the global burden of stroke, the researchers presented population-based recommendations in four key areas, including:

• Surveillance: Establishing a framework for regular monitoring of stroke and stroke services at a national level through community-based surveys and electronic health records
• Prevention: Integrated strategies for people at any level of increased risk, including motivational, mobile-health interventions with emphasis on early detection and control of elevated blood pressure
• Acute care: Establishment of stroke units, reperfusion therapies for ischemic stroke, workforce training and capacity building, with monitoring of quality indicators
• Rehabilitation: Promoting access to interdisciplinary care, training for caregivers, and capacity building of community health workers and other healthcare providers

The researchers also called for active stroke advocacy, including all relevant organizations and stakeholders to engage healthcare policy makers and governments.

“Adopting these pragmatic solutions can go a long way to improving care for patients and families,” said Dr. Yavagal. “Reducing the global burden of stroke is vital for promoting brain health, brain capital and overall health and wellbeing across the globe.”

Tags: Dileep Yavagal, neurology, stroke, stroke care guidelines