“China now is among one of the nations with the highest incidence rates of stroke. At present, there are over 12 million stroke patients in China who are at particularly high risk for recurrence.”
On October 13th, at "Stroke Prevention & Control" session in the 8th U.S.-China Health Summit, experts appealed to neurologists, sonographers and doctors in other departments to actively involve themselves into Chinese Stroke Centre construction and quality improvements to welcome an early remarkable decline in stroke mortality.
CHAO Baohua, Secretary-General, Stroke prevention committee, China National Health Commission
"Establishing a Stroke Center and Application ProcessCHAO Baohua, Secretary-General, Stroke prevention committee, China National Health Commission"
Cerebrovascular diseases are the leading cause of death and disability in China. At present, all sectors of society haven’t attached enough importance to cerebrovascular diseases prevention and treatment.
Chao Baohua, Director of the Office of the Secretary, Office of the Stroke Prevention and Control, the National Health Commission of China, believes that neurologists should take great responsibilities to shoulder. “Thanks to continuous advocacy of doctors in relevant areas, tumor and cardiovascular diseases has gained great attention from the society.”
In recent years, the National Health Commission of China has made active efforts in construction and quality improvements of the system for stroke prevention and treatment. The model for hierarchical region-based medical system is under the way to be developed and comprehensive. And we have witnessed obvious improvements in diagnosis capability and prevention and treatment outcomes. In January 2018, five centers including Stroke Center and Chest Pain Center were decided to be set up at work conference of National Health Commission. In June, as Construction Promotion Conference of National Stroke Centers was held in Tianjin, active efforts have also been made across the country in stroke centers enhancement. ”
"Why must stroke centers be set? Because stroke is the leading cause of death and disability in our country." Treatment within four-and-a-half hours of the onset of the stroke, the golden time for stroke cure, is of great significance. Therefore, under the guidance of regional health administrative departments, with hospital directors’ careful organizing and active participation that involves experts and medical workers, stroke centers are gradually set up and improved.” said Chao Baohua. Chao also introduced that specific plans for stroke centers evaluation have been released. There are first-level indicators and second-level indicators that can be quantified for evaluation. A 1000 points grading system will be taken to grade stroke centers from management, department settings, requirements for staff in the bedside, development of medical technology and other respects.
It’s very important for directors to pay enough attention to these assessment criterias. “Stroke centers construction is hard to be carried out without directors’ attention and their overall arrangements.” Chao considers that stroke center is a platform for multidisciplinary cooperation, the weakest link in China where various departments and wards are managed respectively. Therefore, a model for sound cooperation among multidisciplinary teams depends on leaders’ management and implementation of institutional processes.
For stroke centers construction, Chao believes that a good system is not enough, implementation is another key point. Stroke centers hold monthly multidisciplinary conferences, weekly meetings, daily ward rounds, and quarterly multidisciplinary team meetings. “Discussion on hard problems and quality control should be taken at least once per week. Chao also added some specific requirements. For example, multidisciplinary team should analyze reasons of some problems and summarize them in PPT before weekly discussions. Chao also asked them to take advantage of information technology to save time as every minute a stroke goes untreated, 1.9 million brain cells die.
Finally, Chao summed up ten points that need to be paid attention to in stroke center construction: 1) organizing and management; 2) leaders’ attention and system’s implementation; 3) public recognition, 120 first aid and emergency green channel; 4) multidisciplinary team approach; 5) stroke diagnosis and treatment technology, process and time control; 6) informationization; 7) secondary prevention and follow-up care; 8) publicity and education; 9) formalized technical training; and 10) region-based collaboration and hierarchical diagnosis and treatment.
HUA Yang, Deputy Director of The Management Steering Committee, Stroke Center of Stroke Prevention Committee, China National Health Commission
"Screening and Accurate Assessment of Stroke Patients at High Risk"
China Cardiovascular Disease Report 2018 shows that cardiovascular and cerebrovascular diseases rank first among all causes of death in China. Cardiovascular and cerebrovascular diseases are big risk factors to our people.
Targeted ultrasound screening is of great help in stroke prevention and treatment. Hua Yang, Director of Vascular Ultrasound Diagnosis Department, Xuanwu Hospital, Capital Medical University; Director of the Beijing Vascular Ultrasound Diagnosis Center, Deputy Director of Expert Committee, National Committee on Stroke Prevention and Treatment, National Health Commission, analyzed that: “There are atherosclerosis and non-atherosclerosis among the causes of stroke. As our examination deepened and we found that not only arterial stroke sources but many venous ones can be detected by screening at an early stage.”
“Thrombosis, aortic atherosclerosis and other risk factors of stroke can be detected by vascular ultrasound screening. Therefore, once the cause is found, stroke patients can be treated promptly.” said Hua.
Then what are the risk factors of stroke? “In 2010, 10 risk factors for stroke were analyzed in an article. Among them, high blood pressure was the leading one accounting for 34.6% of stroke risk.” Hua pointed out that antihypertensive therapy can reduce the risk of stroke by 35%-40%. Therefore, cardiovascular and cerebrovascular diseases treatment should focus on prevention and relevant risks control.
How can stroke patients avoid a recurrence? What can they do to deal with long-term outcome of embolism? Hua recommended them to take ultrasound screening. Vascular ultrasound plays a critical role in the clinical work-up by providing objective information. Therefore, vascular ultrasound brings great value to stroke prevention.