When we talk about forecast data with an estimate of more than a quarter of a century, we are always a little skeptical. A 2021 study published in the Journal of the American Heart Organization does give us some guidance. The study is based on a larger analysis of the economic impact of diseases worldwide. A study that aims to set the main milestones in the creation of strategic policy frameworks in the health sector.
In the following lines, we will try to lift the curtain a little on analysts' expectations for stroke in 2050 and relate them to the current picture in our country. We will try to follow the trends in our country over the past 6 years in an attempt to give more clarity about what should be done.
Trends in the fight against stroke
Over the past few years, the fight against stroke has received serious "reinforcement". Firstly, there is greater clarity regarding risk factors, including their role and relative severity, their combined impact and specific methods of controlling them. This happened thanks to both technological developments and increased investment in research. Humanity's ability to analyze large amounts of information has increased, and with it the results have begun to be obtained – progress in solving complex complex problems, such as stroke. The developed new methods of treatment had a significant and direct impact, which turned the overall perspective on the problem - from a strategy for preventing accidents (based on primary prevention and control of risk factors) to a strategy for timely treatment aimed at maximizing the relative share of patients who have access to treatment within the established therapeutic window. Reorganizations of the centers for the treatment of the acute phase were introduced, gradually imposing an understanding of the need for specialized, multidisciplinary teams, relying on a set of modern diagnostic tools, organized in the so-called "stroke units". Innovations have also emerged in terms of the relationship between emergency care and specialized stroke units, and the so-called "Stroke Units" have been introduced in a number of major cities in the United States and Europe. Mobile stroke units are mobile teams equipped with everything necessary to apply modern on-site treatment to the patient.
Based on this renewed perspective, the analysis of a group of researchers[1] predicts an 81% increase in stroke cases by 2050, or reaching a global level of 21.43 million per year, or 225 strokes per year per 100,000 inhabitants. At the same time, the ratio of new first strokes to those living after a stroke in 2050 is expected to be 1 in 7. and they will reach an impressive 159.31 million. worldwide. The predicted deaths in the study on an annual basis are for 12.05 million. These values, of course, are too generalized and although they give some clarity about the direction of development, they are far from what is necessary to build a national strategic concept. In this regard, we get more clarity by looking at the forecast for stroke in 2050, interpreted through the three main groups of countries – low, middle and high average income per capita.
In low-income countries, there is expected to be an exponential increase in the number of stroke cases in all age groups. The average survival after a stroke will also decrease. Expectations are based on poor access to modern treatment in these countries, underdeveloped logistics and infrastructure, and the slow pace of innovation in the health sector.
Middle-income countries will also have an increase in the number of strokes, but mainly in the age group 60+, with the highest concentration of cases expected in the age of 85. An example of such a slower process is the difficult digitization of medical data, which underpins evidence-based treatment.
In high-income countries, a concentration of cases over the age of 85 is expected, combined with reduced mortality and increased life expectancy after a stroke incident. In these countries, the level of effectiveness of primary and secondary prevention is expected to peak.
In terms of gender distribution, stroke accidents will continue to be a priority for men, however, by 2050. The roles are expected to be reversed. This prediction is justified by demographic trends, which portend a lasting change in the dominant sex of the human population.
Let's take a look at Bulgaria and try to put our short-term trends in the overall forecast for the development of stroke worldwide until 2050. (58,128 cases or 836 per 100 thousand inhabitants), which gradually decreased to 45,444 cases (664 per 100 thousand inhabitants) in 2021. After this minimum, the data demonstrate continuous growth by an average of 6% per year, and for 2024. is expected to reach around and above 50,500 cases or 790-800 cases per 100 thousand. Residents. For comparison, in Europe, the average current rate of stroke is just over 150 cases per 100 thousand. residents, and the minimum is 38-50 cases per 100 thousand. Residents. This puts us today in the position of lagging behind with nearly 5 times worse results and an upward trend.
Putting in the general context the data of Bulgaria, a quarter of a century before the forecast 2050. with 800 cases per 100 thousand. compared to the expected 225 for the world, we are already 3.5 times behind the forecast norm, and we start from a position 7 times worse compared to the countries in Europe.
What can be done and by whom?
First of all, as a patient organization, we believe that each of us, a constituent unit of Bulgarian society, needs to learn and apply in our lives the knowledge of risk factors, available methods for their control, stroke symptoms and the correct behavior that follows when they are identified. An interesting fact is that nearly 10,000 cases in Bulgaria per year can be directly and positively influenced by our knowledge. This is the approximate number of unrealized potential thrombolysis (a type of modern treatment that applied in the therapeutic window (up to 4.5 hours after the accident) can minimize the disability of stroke. All this means that we, ordinary people, depend on our knowledge and skills to apply what we have learned for the favorable outcome of nearly 1/5 of the cases per year.
Secondly, it is necessary to improve primary and secondary prevention. With the implementation of the new electronic system and the expansion of the scope of data in it, it could be aimed at identifying specific high-risk groups with which to work extremely actively to prevent both primary and secondary incidents. This step needs to be supported by simplifying and facilitating the procedure for receiving prescribed medications, excluding the entire complicated administrative chain, which currently focuses not on seeking the effect of the patient's treatment, but on preventing misuse of public funds. This will help encourage young people to successfully apply their prescribed therapy, which can change the negative trend of continuous growth of high blood pressure. Its control and control are the basis for dealing with a risk factor that is responsible for more than 40% of stroke cases.
Third, but not least, it is necessary to follow the example of all successful countries in the fight against stroke. Experts dealing with the diversity of stroke activities, from primary prevention to life after stroke, need to establish a lasting dialogue at working level. It is necessary for everyone to define the data they need in order to require the Ministry of Health to compile a specific statistical reference book for the purposes of analyzing and creating a policy to combat stroke in the country. This will make it possible to create an evidence-based, clear, achievable national strategic document aimed at addressing specific, defined problems. In this regard, Bulgaria received a clear sign of support from the European Stroke Organization at the recent press conference of the Association for Stroke and Aphasia and the Bulgarian Society of Neurology. It was attended by the President of ESO, Prof. Simona Sacco, who personally advocated for the Bulgarian organizations, recognizing the contribution of their work to the achievement of the common goal of reducing strokes in the country.
In recent days, we have witnessed the inauguration of a new, first regular government in the country after a long break. This gives us hope for a sufficient window of time for intensive work at an expert level. Because the cause of stroke in Bulgaria to be controlled is much bigger than each of us, we believe that in the coming months the common sense and professionalism of everyone involved will prevail and together we will begin to achieve results, but not for ourselves or for our organizations, but for our society as a whole.
[1] Projections of the Stroke Burden at the Global, Regional, and National Levels up to 2050 Based on the Global Burden of Disease Study 2021, available: https://www.ahajournals.org/doi/10.1161/JAHA.124.036142