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Editorial Stroke —acting FAST at all ages
On Feb 1, Public Health England released new estimates for the incidence of first stroke in England and relaunched its Act FAST campaign. FAST is aimed at the public, encouraging them to call 999 —the UK's emergency number—if there are tell-tale signs of stroke in themselves or anyone they see. FAST stands for face, arms, speech, and time (to call). The new estimates showed that about 57 000 new strokes and 32 000 stroke-related deaths occur every year in England. Of those who have e xperienced a stroke, about a quarter leave hospital with moderate or severe disability.
Source: LANCET - February 9, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

Comment Hypertension in China: the gap between policy and practice
The high prevalence of hypertension in China is well known, with stroke being the most common cause of death and disability.1 Two large nationwide studies reported in The Lancet2,3 highlight that although the prevalence of hypertension in China is similar to that suggested in previous studies, it is simple deficiencies in the country's health system that make a large contribution to the disease burden. Both studies used data from the PEACE (Patient-Centred Evaluative Assessment of Cardiac Events) Million Persons Project (MPP), which enrolled 1 ·7 million adults aged 35–75 years from across China.
Source: LANCET - October 25, 2017 Category: General Medicine Authors: Therese Hesketh, Xudong Zhou Tags: Comment Source Type: research

Correspondence Unmet challenges for rehabilitation after stroke in China
Stroke is an important public health problem in China, and is one of the leading causes of death and disability. About 2  500 000 people have a stroke in China every year, and 70–80% of patients lose the ability to perform routine activities and require care, resulting in an economic burden for both the country and their family.1 Japan has a similar incidence of stroke because of similar ancestry, but outcomes a fter stroke are better in Japan than in China. In Japan, 64·2% of young patients (age
Source: LANCET - July 7, 2017 Category: General Medicine Authors: Tetsuya Asakawa, Liang Zong, Liang Wang, Ying Xia, Hiroki Namba Tags: Correspondence Source Type: research

Comment Does intensity matter in aphasia rehabilitation?
Aphasia is a serious acquired communication disability, that affects approximately 30% of stroke survivors.1 It is chronic in nature: 50% of people diagnosed with aphasia have persistent communication problems 1 year after stroke.2 Aphasia compromises an individual's ability to undertake many activities of daily living, resulting in reduced mood and quality of life.3,4 In addition to the personal cost of aphasia, health-care costs for people with aphasia are the highest in stroke care.5 Therefore, the recent identification of recovery from aphasia as one of the top ten research priorities related to life after stroke is unsurprising.
Source: LANCET - February 27, 2017 Category: Journals (General) Authors: Linda Worrall, Abby Foster Tags: Comment Source Type: research

Editorial Atrial fibrillation and stroke: unrecognised and undertreated
When did you or your primary care physician last palpate your wrist to check for a regular heart rate? This simple action, followed by an electrocardiogram if the heart rate is irregular, might be crucial in preventing death and disability from ischaemic stroke, heart failure, or myocardial infarction. In this week's issue, we publish a clinical Series of three papers on atrial fibrillation ahead of the annual European Society of Cardiology (ESC) meeting held in Rome, Italy, Aug 27 –31. Atrial fibrillation is estimated to affect 33 million people worldwide.
Source: LANCET - August 19, 2016 Category: Journals (General) Authors: The Lancet Tags: Editorial Source Type: research

Comment Platelets after intracerebral haemorrhage: more is not better
Spontaneous intracerebral haemorrhage has a disproportionally high burden of mortality and disability compared with other subtypes of stroke.1,2 As a clinician, when faced with a condition as devastating as intracerebral haemorrhage, one feels compelled to use any and all therapies available, even though at times evidence of effectiveness of those therapies is not yet established.1 This is particularly the case for many health-care providers on the front lines of emergency diagnosis and treatment for patients who have had an intracerebral haemorrhage while taking antiplatelet therapy.
Source: LANCET - May 9, 2016 Category: Journals (General) Authors: Calin I Prodan Tags: Comment Source Type: research

Correspondence Could upright posture be harmful in the early stages of stroke? – Author's reply
The AVERT trial1 delivered a surprising result; higher dose of out-of-bed activity soon after stroke (very early mobilisation) led to a less favourable outcome than lower dose, but still early, out-of-bed activity. This finding will prompt revision of current guidelines,2 which have increasingly recommended early mobilisation. Precisely what should be recommended, however, is less clear at this point. Usual care did not consist of prolonged bed rest; 623 (59%) of 1050 patients in the usual care group started out-of-bed activity within 24 h of stroke onset, 525 (50%) patients had little or no disability (modified Rankin sca...
Source: LANCET - October 30, 2015 Category: Journals (General) Authors: Julie Bernhardt, AVERT investigators Tags: Correspondence Source Type: research

Correspondence The future of stroke therapy must not be mired by past arguments
Stroke is the leading cause of disability and the fifth leading cause of death in the UK, costing the UK economy more than £7 billion per year.1 At present, the only therapeutic approved by the UK National Institute for Health and Care Excellence (NICE) for the treatment of ischaemic stroke is thrombolysis using recombinant tissue-type plasminogen activator (rtPA). However, rtPA is only effective in patients who present within 4·5 h of stroke onset, with a number needed to treat for benefit of 3·6 before 90 min, rising to 5·9 between 3 h and 4·5 h.
Source: LANCET - August 14, 2015 Category: Journals (General) Authors: Alastair M Buchan, Hasneen G Karbalai, Brad A Sutherland Tags: Correspondence Source Type: research

Correspondence Thrombolysis in acute stroke
In their meta-analysis of intravenous thrombolysis with alteplase for acute ischaemic stroke, Jonathan Emberson and colleagues (Nov 29, p 1929)1 concluded that the increased risk of early death from intracranial haemorrhage in patients taking alteplase was offset by an increase in disability-free survival. This interpretation gives the impression that the high level of mortality in the acute phase tends to diminish with time, but that is not the case. In the latest Cochrane analysis of thrombolysis for acute ischaemic stroke,2 thrombolysis gave no survival advantage between 7 days after thrombolysis and the end of follow-up.
Source: LANCET - April 10, 2015 Category: Journals (General) Authors: Peter Appelros, Andreas Terént Tags: Correspondence Source Type: research

Correspondence Questions about authorisation of alteplase for ischaemic stroke
Stroke thrombolysis can cause potentially fatal intracerebral haemorrhage, but advocates claim the potential reduction in disability justifies this risk. Alteplase was authorised following the National Institute of Neurological Disorders and Stroke (NINDS) trial. A 2004 review raised concerns over the trial data. Outcomes across the centres differed considerably. Bias could explain the observation that the plot of outcome (modified Rankin score 0–1) against number of patients recruited does not resemble the expected symmetrical funnel ().
Source: LANCET - August 23, 2014 Category: Journals (General) Authors: Roger Shinton Tags: Correspondence Source Type: research

Correspondence Global burden of stroke: an underestimate – Authors' reply
We are pleased to respond to Desmond O'Neill's comments on our paper about the global burden of stroke. We fully agree that the burden of stroke goes far beyond the reported data on incidence, prevalence, mortality, and disability-adjusted life-years. Stroke also has a large physical, psychological, and financial effect on patients, their families, the health-care system, and society. Additionally, as rightly emphasised by O'Neill, stroke is just one of the many manifestations (although the most catastrophic) of cerebrovascular disease, and there are clinically silent minor strokes and occult cerebrovascular disorders that...
Source: LANCET - April 4, 2014 Category: Journals (General) Authors: Valery L Feigin, Mohammad H Forouzanfar, Rita Krishnamurthi, George A Mensah Tags: Correspondence Source Type: research

Comment Training caregivers of disabled patients after stroke
At least a third of stroke survivors remain disabled, making stroke the third leading cause of disability-adjusted life-years (DALYs) worldwide. Assistance is often provided informally by family and friends who might be ill-informed or ill-prepared physically and emotionally. Informal caregiving imposes a persistent burden on 25–50% of caregivers, dependent on the mental health, mood, and requirements of the caregiver as well as on the age, mental health, and function of the patient. Caregiver burden can compromise caregivers' health and patients' rehabilitation and recovery.
Source: LANCET - December 20, 2013 Category: Journals (General) Authors: Graeme J Hankey Tags: Comment Source Type: research

Seminar Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy is a common inherited cardiovascular disease present in one in 500 of the general population. It is caused by more than 1400 mutations in 11 or more genes encoding proteins of the cardiac sarcomere. Although hypertrophic cardiomyopathy is the most frequent cause of sudden death in young people (including trained athletes), and can lead to functional disability from heart failure and stroke, the majority of affected individuals probably remain undiagnosed and many do not experience greatly reduced life expectancy or substantial symptoms.
Source: LANCET - January 18, 2013 Category: Journals (General) Authors: Barry J Maron, Martin S Maron Tags: Seminar Source Type: research