Stroke Work Vital To Better Health
7 June 2002
A comprehensive approach to improve the prevention, treatment and rehabilitation of people who suffer a stroke is our best chance of minimising a projected increase in death from stroke, Ministry of Health spokesman Dr Colin Tukuitonga said today.
"We have already developed a toolkit for District Health Boards, and an action plan. We are now working on guidelines for health professionals on prevention, treatment and rehabilitation, as well as information for New Zealanders on risks associated with stroke, and how best to manage them, " Dr Tukuitonga, Director of Public Health said.
A study released today, which models future trends on the basis of existing knowledge, indicates a 57 percent increase in people 25 and over dying from stroke between 1991 and 2011 if incidence and case fatality do not change. That scenario would imply 4608 deaths from stroke in 2011, compared with an estimated 2935 in 1991.
"These figures confirm what the Ministry of Health already knows about the impact of stroke and reinforces the need to improve cardiovascular health for New Zealanders, as flagged in the New Zealand Health Strategy. All of us working in health need to do our best to reduce the incidence and impact of strokes."
Dr Tukuitonga said recognition and management of risk factors is the best prevention.
"The main risk factor is high blood pressure, however, strokes may happen because of a combination of factors including inherited characteristics, an unhealthy lifestyle (which may include smoking or a poor diet) and high blood pressure."
"We are working on guidelines for health practitioners so they can: offer timely advice to people at risk of cardiovascular disease including stroke, provide guidance for managing people who have had a stroke, and help prevent further strokes once a person has had one."
"We also want the public to be able to recognise when they are at risk of cardiovascular disease or stroke, and be aware of the services available to them."
The guidelines, being produced by expert advisory groups, are planned for 2003.
Dr Tukuitonga said the Ministry was also working on a national service framework to ensure New Zealanders get the best possible treatment no matter where they live.
"We want every patient who has had a stroke to have timely access to the appropriate services, assessment, treatment and rehabilitation."
Dr Tukuitonga said many of New Zealand's most serious diseases and conditions, such as heart disease, stroke, hypertension, type 2 diabetes, some cancers, osteoporosis, anaemia and dental caries are closely associated with physical inactivity, poor nutrition and obesity.
Work being done to reduce the impact of stroke sits alongside a new strategy, Healthy Action - Healthy Eating: Oranga Pumau - Oranga Kai which addresses the burgeoning health consequences of lack of physical activity and increasing obesity.
The New Zealand Health Strategy has identified thirteen priority areas for improving New Zealanders' health. One of the thirteen priority areas is reducing the incidence and impact of cardiovascular disease, which includes strokes.
Modelling Stroke: A multi-state life table model is the twelfth report in a series of occasional bulletins dealing with different aspects of the health status of New Zealanders and published over the past two years by the Ministry of Health. It is available on the Ministry of Health website www.moh.govt.nz
The model estimated that in 1991, over 4,600 first-in-a-lifetime strokes occurred in New Zealand, there were about 26,300 people living who had suffered one or more strokes (about 6,000 of whom were severely disabled as a result), and about 2935 people died that year as a direct result of a stroke.
The model shows that over 70 percent of first strokes happen in people aged 65 years and over, and only 5 percent of strokes happen in people under the age of 45 years.
The model also shows the average age for first stroke for males is 67.5 years and for females it is 73.6 years.
Other information, from the Cardiovascular Disease Toolkit, shows that for Maori, the average age of stroke is 56 years and for Pacific peoples it is 60 years.
Stroke incidence in the population can be reduced by a number of measures including stopping smoking, weight management, exercise, a balanced diet and early treatment of cardiovascular risk factors like high blood pressure. Having a ministroke or a disturbance of the heart rhythm called atrial fibrillation are also important warning signals of stroke.
Modelling Stroke: A multi-state life table model includes one example to illustrate how the model can be used. The rudimentary example looks at what difference a slight reduction in salt intake might have on stroke and shows that a reduction in the use of salt as a food additive of just 4 percent a year would prevent approximately 435 deaths from cardiovascular disease each year within little more than a decade. Much more work would have to be done before such modelling could be used to develop policy advice.