Primary stroke prevention worldwide: translating evidence into action
Mayowa O Owolabi, Amanda G Thrift, Ajay Mahal, Marie Ishida, Sheila Martins, Walter D Johnson, Jeyaraj Pandian, Foad Abd-Allah, Joseph Yaria, Hoang T Phan, Greg Roth, Seana L Gall, Richard Beare, Thanh G Phan, Robert Mikulik, Rufus O Akinyemi, Bo Norrving, Michael Brainin, Valery L Feigin, Carlos Abanto, Semaw Ferede Abera, Adamu Addissie, Oluwadamilola Adebayo, Amos Olufemi Adeleye, Yerzhan Adilbekov, Bibigul Adilbekova, Thierry Armel Adoukonou, Diana Aguiar de Sousa, Temitope Ajagbe, Zauresh Akhmetzhanova, Albert Akpalu, Jhon Álvarez Ahlgren, Sebastián Ameriso, Silva Andonova, Foloruso Emmanuel Awoniyi, Moiz Bakhiet, Miguel Barboza, Hamidon Basri, Philip Bath, Olamide Bello, Dániel Bereczki, Simone Beretta, Aaron Berkowitz, Antonio Bernabé-Ortiz, Julie Bernhardt, Guna Berzina, Mher Bisharyan, Pascal Bovet, Hrvoje Budincevic, Dominique Cadilhac, Valeria Caso, Christopher Chen, Jerome Chin, Kamil Chwojnicki, Adriana Conforto, Vitor Tedim Cruz, Marco D'Amelio, Kristine Danielyan, Stephen Davis, Vida Demarin, Robert Dempsey, Martin Dichgans, Klara Dokova, Geoffrey Donnan, Mitchell S. Elkind, Matthias Endres, Urs Fischer, Fortuné Gankpé, Andrés Gaye Saavedra, Artyom Gil, Maurice Giroud, Elena Gnedovskaya, Vladimir Hachinski, Melanie Hafdi, Randah Hamadeh, T. Kolapo Hamzat, Graeme Hankey, Mirjam Heldner, Etedal Ahmed Ibrahim, Norlinah Mohamed Ibrahim, Manabu Inoue, Sungju Jee, Jiann-Shing Jeng, Yogesh Kalkonde, Saltanat Kamenova, Bartosz Karaszewski, Peter Kelly, Taskeen Khan, Stefan Kiechl, Aida Kondybayeva, Janika Kõrv, Michael Kravchenko, Rita V. Krishnamurthi, Jera Kruja, Mongkol Lakkhanaloet, Peter Langhorne, Pablo M. Lavados, Zhe Kang Law, Abisola Lawal, Maria Lazo-Porras
Abstract
Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course.