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Stroke: working toward a prioritized world agenda

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Title: Stroke: working toward a prioritized world agenda
Author(s): Hachinshki, Vladimir; Gorelick, Philip B.; et al.
Subject(s): prevention rehabilitation
Abstract: Background and Purpose—The aim of the Synergium was to devise and prioritize new ways of accelerating progress inreducing the risks, effects, and consequences of stroke. Methods—Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Results—Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent “silo” mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (eg, social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and registries. Foster Cooperation Among Stakeholders (large stroke organizations, nongovernmental organizations, governments, patient organizations and industry) to enhance stroke care. Educate and energize professionals, patients, the public and policy makers by using a “Brain Health” concept that enables promotion of preventive measures. Conclusions—To accelerate progress in stroke, we must reach beyond the current status scientifically, conceptually, and pragmatically. Advances can be made not only by doing, but ceasing to do. Significant savings in time, money, and effort could result from discontinuing practices driven by unsubstantiated opinion, unproven approaches, and financial gain. Systematic integration of knowledge into programs coupled with careful evaluation can speed the pace of progress.
Issue Date: 2010-06
Publisher: American Heart Association
Citation Info: Hachinski, V., Donnan, G. A., Gorelick, P. B., Hacke, W., Cramer, S. C., Kaste, M., Fisher, M., Brainin, M., Buchan, A. M., Lo, E. H., Skolnick, B. E., Furie, K. L., Hankey, G. J., Kivipelto, M., Morris, J., Rothwell, P. M., Sacco, R. L., Smith, S. C., Wang, Y. L., Bryer, A., Ford, G. A., Iadecola, C., Martins, S. C. O., Saver, J., Skvortsova, V., Bayley, M., Bednar, M. M., Duncan, P., Enney, L., Finklestein, S., Jones, T. A., Kalra, L., Kleim, J., Nitkin, R., Teasell, R., Weiller, C., Desai, B., Goldberg, M. P., Heiss, W. D., Saarelma, O., Schwamm, L. H., Shinohara, Y., Trivedi, B., Wahlgren, N., Wong, L. K., Hakim, A., Norrving, B., Prudhomme, S., Bornstein, N. M., Davis, S. M., Goldstein, L. B., Leys, D., & Tuomilehto, J. 2010. Stroke: Working Toward a Prioritized World Agenda. Stroke, 41(6): 1084-1099. DOI: 10.1161/STROKEAHA.110.586156
Type: Article
Description: Post print version of article may differ from published version. The definitive version is available through American Heart Association at DOI: 10.1161/STROKEAHA.110.586156
ISSN: 0039-2499
Sponsor: G.A.D.1 received other research support from Boehringer Ingelheim (BI) and Sanofi-Aventis; Consultant/Advisory Board for BI, Servier, Sanofi-Aventis, Bristol Myer Squibb. P.B.G. received Speakers Honoraria from BI; Consultant/Advisory Board for Bayer, Abott, Takeda. S.C.C.4* received research grant from GlaxoSmithKline (GSK) and Stem Cell Therapeutics; Consultant/Advisory Board for GSK, Stem Cell Therapeutics, Johnson and Johnson, Photothera (all significant) and Pfizer Inc, Allergan Inc, Grupo Ferrer SA (all modest). M.K.5* received Honoraria from BI , PAION AG, Servier, Forest Research Laboratories Inc, Neurobiological Technologies Inc, and Lund beck AS for participating in the Steering Committee meetings of ProFESS, PERFORM, ANCROD, and all ECASS, DIAS and CEPO trials, and for giving lectures in national and international meetings sponsored by the above mentioned companies and Sanofi-Aventis and BMS; Consultant/Advisory Board for BI, PAION AG, Servier, Forest Research Laboratories Inc, Neurobiological Technologies Inc, and Lund beck AS. B.E.S.1 is an employee of Novo Nordisk. K.L.F.2 received IRIS trial funding through National Institute of Neurological Disorders and Stroke (NINDS). G.J.H.2 received Speakers Honoraria from Pfizer, Sanofi-Aventis; Consultant/Advisory Board for BI, Sanofi-Aventis. J.C.M.2 participated/ is currently participating in clinical trials of antidementia drugs sponsored by Elan, Eli Lilly and Company, Wyeth; Consultant/ Speaking Honoraria from AstraZeneca, Bristol-Myers Squibb, Genentech, Lilly, Merck, Novartis, Pfizer, Schering Plough, Wyeth Elan. R.L.S.2 received a research grant from NINDS (Northern Manhattan Stroke Study). Y.W.2 is CEO and serves as/on Consultant/ Advisory Board of InTouch Health, Goleta, Calif. G.A.F.3: payment to institution from companies undertaking stroke research including Lund beck, Mitsubishi, PAION, BI for trial related activities; payment to institution for administrative support of UK SITS database, BI; personal payment for educational lectures (modest) and advisory board (modest), BI, Lund beck. S.C.O.M.3 received lecture fees from BI. J.S.3 is employed at University of California; received research grants from National Institutes of Health (NIH); Consultant/Advisory Board of Talacris, Syquil, EV3, AGA, Brainsbok.
Date Available in INDIGO: 2011-04-29

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