Impact of prevention strategies and improvements in stroke healthcare

Coinciding with National Stroke Week in Australia (19 - 25 September 2005) is the release of results from two recent stroke studies from the George Institute for International Health that investigate both the causative factors as well as a little studied outcome of stroke, that of depression.

The studies are part of a larger project to determine the impact of prevention strategies and improvements in stroke healthcare.

A study of trends in stroke incidence, led by The George Institute researchers Craig Anderson and Kristie Carter and to be published in Stroke, reviewed data accumulated over 20 years in the Auckland, New Zealand population, to determine if significant changes in stroke incidence could be related to life-style changes or other factors. The study found that there was an 11% relative decline in stroke over the 20 years, which can be related to positive changes such as a decreased incidence of smoking in the population. However, opposing this positive trend were adverse changes in the health of the Auckland population over the same period, including increased incidence of obesity, diabetes and overall age, all of which increase the likelihood of stroke.

"Clearly more research is needed to identify those at risk of stroke and to implement effective strategies to reduce the burden of this illness", noted Prof. Anderson

Similar analyses are now being conducted on data provided by an investigation of stroke incidence in Perth, Western Australia. These analyses will determine the impact of prevention strategies and improvements in stroke healthcare services on the incidence and outcome of this major illness within the region over recent decades.

Both the Auckland and Perth studies meet the stringent criteria for an 'ideal' stroke incidence study providing the most reliable data on the incidence and outcome from stroke in a population. Data from these studies will be pooled with similar work from the University of Queensland and the University of Oxford, to better understand risk factors for various stroke subtypes and to organize management strategies.

A further stroke study led by The George Institute's Maree Hackett, and also to be published in Stroke, examined predictors of depression after stroke. Depression in stroke victims has been an often neglected area of recovery from stroke, and with past studies focusing primarily on the physical outcomes of stroke, health systems have not been properly configured to deal with the depression aspects.

The key finding of this study was that depression is more often associated with severe stroke, but the available evidence presently does not allow the identification of patients who are most at risk of depression.

Ms Hackett noted that "Current models of depression after stroke are not accurate, have not been rigorously developed and validated, are not well described, and are not clinically useful for predicting the occurrence of depression after stroke. Additional research in this area would be of considerable importance not only in terms of increasing our understanding of depression risk factors but also in advancing health care delivery to enhance stroke rehabilitation.

"The data suggests that clinicians should be particularly vigilant to the detection of depression among patients with severe strokes and stroke-related disability."