In an interview with BioPharma APAC, Prof Jeyaraj Pandian, President-Elect of the World Stroke Organization, provides an in-depth overview of the current stroke burden in Southeast Asia. He elaborates on the contributing risk factors, the challenges posed by limited access to stroke care, and the significant impact these issues have on mortality and disability rates in the region. Prof Pandian also sheds light on the initiatives and programs spearheaded by the World Stroke Organization aimed at addressing these challenges, including collaborative efforts with patient organizations, healthcare providers, and pharmaceutical companies to improve stroke care outcomes.

Can you provide an overview of the current stroke burden in Southeast Asia and how it compares to other regions globally?

The World Health Organization estimates that the Southeast Asia region accounts for over 40% of the global stroke mortality. 

Southeast Asia faces a particularly high incidence of stroke, and affects on average, 1,300 people in every 100,000. The burden of stroke is a growing threat to Southeast Asia. The region, which includes three of the most highly populated countries in the world, is experiencing an increase in non-communicable diseases, including stroke and other cardiovascular diseases. This is caused by the alarming rise in risk factors due to unhealthy lifestyle and other non-communicable diseases.

What are the key risk factors contributing to the high incidence of stroke in Southeast Asia, and how can they be effectively mitigated?

The increased prevalence of risk factors in Southeast Asia is due to an aging population, hypertension, diabetes mellitus, tobacco and alcohol consumption, lack of physical activity, high ambient pollution, heat, and humidity.  Moreover, major barriers to monitoring of stroke onset, prevention, acute care, and rehabilitation also result in poor awareness of stroke and its management. 

Therefore, reducing the burden of stroke requires a multifaceted approach across the stroke care continuum. As a prominent patient advocacy organization, the World Stroke Organization (WSO), together with our partners have a part to play in advocating and building capacity for stroke care and research and championing universal health coverage that can facilitate population-wide access to stroke care.

How does limited access to stroke care in the region impact mortality and disability rates, and what are the most significant barriers to providing adequate stroke care?

Despite the significant stroke burden, the access for patients in the region to acute stroke care is limited, with access varying across different countries. This highlights a substantial gap in the availability of stroke care services. This is driven by the wide disparity in stroke care resource allocation across the region due to socioeconomic development and geographical local. Lack of awareness, poor structure of pre-hospital services, and lack of established Emergency Medical Services (EMS) contribute to delays in accessing stroke-ready centers.

High stroke death rates in Southeast Asia countries could also be due to variations in stroke incidence, severity, and quality of stroke care services. In fact, in every 30 minutes, a stroke patient who could have been saved dies or is permanently disabled, because they were treated in the wrong hospital. Most stroke patients do not receive treatment because they are too late in arriving at the hospital.

This highlights that urgent measures are needed to reduce the burden of stroke worldwide and in Southeast Asia. With optimal acute stroke care, more lives can be saved, and thousands of patients can return to the life they knew.

What specific initiatives and programs is the World Stroke Organization (WSO) implementing to address the growing stroke burden in Southeast Asia?

As the only global body solely focused on stroke, the WSO plays an active role in improving the standards of stroke care worldwide by creating a platform to unite the stroke community, enhance education and research, build capacity across Stroke Support Organizations (SSOs) and creating awareness and advocating for the cause. 

An example of an initiative in the region that leverages the collaborative efforts of multiple stakeholders would be the Angels Initiative – a non-profit, non-promotional, global healthcare initiative, dedicated to improving stroke patients’ chances of survival and a disability-free life. The goals include increasing the number of stroke-ready hospitals and optimizing treatment quality in all existing stroke centers.

Launched in 2016, the initiative is run by Boehringer Ingelheim in partnership with the European Stroke Organization (ESO), the WSO, the Stroke Alliance for Europe (SAFE), and over 50 national stroke societies, companies, and health institutions. The Angels Initiative has been actively supporting hospitals globally and the Asia region, through various programs, including simulation exercises, best practices exchanges, and targeted capacity-building initiatives. Across Asia, more than one million patients have been treated at the Angels initiative’s 1,100 stroke-ready hospitals. Additionally, WSO also works with the World Health Organization Southeast Asia region (SEAR) to develop stroke care in six countries, including Bhutan, Myanmar, Timor Leste, Maldives, Nepal and Sri Lanka through capacity building.

Beyond building stroke-ready hospitals, we are also building the capacity of stroke delivery through training and education for healthcare professionals in the region. In July 2024, we signed a Memorandum of Understanding (MoU) with SingHealth to launch clinical service development, research, education, and advocacy initiatives focused on training and sharing best practices with hospitals in Southeast Asia, thereby improving the number and quality of stroke centers in the region. It is our goal that the program can aid in the efforts to reduce death and disability from stroke as well as improve the stroke care journey for patients.

How can patient organizations, healthcare providers, and pharmaceutical companies collaborate to improve stroke care and outcomes in the region?

The coordination and collaboration between diverse healthcare professionals, patients’ organizations, and pharmaceutical companies are essential for providing comprehensive, high-quality stroke care and optimizing outcomes for stroke. The community’s partnership is crucial at each stage of the development and implementation throughout the continuum of stroke care, ensuring that the capabilities and systems best meet the needs of the stroke community locally.

One such example is the recent Angels Preceptorship program held in collaboration with WSO and SingHealth. The program brought over 40 stroke care professionals and hospital staff in the region to exchange and compare best practices, collaborate, and identify critical aspects of stroke management and services for improvement. Such training and sharing of best practices are critical in building capacity and elevating stroke care across the region.

Moreover, patient organizations, hospitals, and pharmaceutical companies can also work together to create public awareness campaigns to elevate the health literacy of the population. Increasing social literacy on stroke symptoms, risk factors, and the importance of timely treatment, can correct wrong perceptions of stroke and help with the underutilization of stroke care services.

The concerted collaborative efforts can be made more impactful with the support of a government committed to supporting the delivery of safe and effective care of stroke patients through the promotion of changes to public health and system policies to improve the delivery of care and ultimately, patient outcomes.

What are the most promising advancements or strategies in stroke prevention and treatment that could be particularly beneficial for Southeast Asia?

Improving the capabilities of physicians is also key in addressing the stroke burden. Many countries in the Southeast Asia region rely on physicians to manage stroke as the availability of specialist neurologists is low. Therefore, this often leads to delays in diagnosis and referral to stroke-ready centers due to the lack of timely access to neuroimaging. 

Managing the stroke burden in the dynamic region can be complex and challenging, therefore requires a multi-faceted approach and collaboration of stakeholders to address the issue. 

For example, WSO in partnership with Angels Initiative established the WSO Angels Award to drive improvement of stroke treatment across the world and honor organizations who go above and beyond for their stroke patients. This program consolidates our respective efforts to improve stroke outcomes worldwide and complements the WSO roadmap to delivering quality stroke care. In 2023, 515 WSO Angels awards were given to ASKAN hospitals to acknowledge excellent stroke care. 

However, more can be done to improve treatment for stroke care. This includes access to stroke care through the establishment of pre-hospital services such as the EMS. This can contribute to the prioritization of suspected stroke patients and transportation to appropriate stroke centers. Timely treatment at stroke centers can reduce the mortality and disability rates of stroke patients.