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24 Lundbeck Magazine 2009
"Unfortunately, there are
still major differences in the
treatment on offer to patients in
different countries in Europe"
Everyone agrees that patients with a
myocardial infarct should be treated by
cardiologists, but the attitude was that anyone
could treat stroke patients,” Markku Kaste says.
When he was able to document on the basis
of a study that stroke patients who had been
treated by neurologists were able to leave
hospital 16 days earlier than those treated in
other wards, and that more were discharged to
their own homes and were also better able to
care for themselves without help, the Helsinki
City Council saw the light. That happened in
1995. The stroke unit at HUCH Meilahti
hospital has since treated all acute stroke
patients in Helsinki. The experience gained in
acute care of stroke has been formulated as
European guidelines. The recommendations,
previously written by a task force of the
European Stroke Initiative (EUSI) and later on
by the European Stroke Organisation (ESO),
both of which Markku Kaste helped found, are
available in multiple languages.
Four out of ten neglected
“Unfortunately, there are still major differences
in the treatment on offer to patients in
different countries in Europe. Recently we
asked 4261 randomly selected hospitals
throughout the EU about their treatment of
stroke, and the results were shocking. Only one
out of seven patients – between 13 and 14 per
cent – were treated as recommended by WHO
i.e. in a stroke unit at a university hospital or
other well equipped hospital, which has
neurologists, cardiologists, neurosurgeons,
vascular surgeons, and a CT scanner that is
manned 24 hours a day. Forty-four per cent
receive acceptable treatment, generally at
large hospital centres. But the remaining 42
per cent are treated in hospitals that lack both
equipment and experience. And this happens
in rich countries as well as in poor. This is not
only appalling for patients, it is also costly for
society,” Markku Kaste says.
Too weak to bang on the table
Stroke is an illness which costs society a lot
of money. “In Finland, caring for a patient in
a nursing home costs EUR 50,000 per year.
As strokes generally occur in persons between
the ages of 60 and 70, their life expectancy is
higher than, for example, persons with
dementia, who are usually older when they
enter a nursing home. Stroke is exceedingly
expensive for society, but those who have
suffered a stroke are too weak to bang on
the table and demand better treatment. This
makes it important to prevent the illness –
also from an economic point of view,”
Professor Kaste continues.
The factors that can cause stroke are the same
as those that can cause cardiovascular
diseases: high blood pressure, high cholesterol,
obesity, smoking, high alcohol consumption
and lack of physical exercise.
Quick treatment makes the difference
“It is therefore possible to do something
oneself, and prevention is of course the best
mode of action. But for those who suffer a
stroke anyway, it is important for society to
invest in stroke units where it is possible to
obtain the best possible treatment, which
increases the likelihood of good recovery. With
the present drugs for dissolving blood clots, we
consider it possible to save many patients up
until four and a half hours of the time of the
symptom onset and in some patients even
after longer time before irreversible damage
occurs. We are currently investigating a new
drug which may give us as much as nine hours,
and thus more time to get patients to
hospitals that can provide the right treatment.
Some patients cannot tolerate drugs that solve
the blood clot, which occludes the brain artery,
for example if they have very high blood
pressure or internal bleeding. But quick arrival
at the hospital and appropriate treatment
benefit all patients. Competent intervention by
a wide spectrum of specialists reduces the risk
of the patient dying or becoming helpless and
requiring care. Quick and correct treatment is
good for the individual patient, and a major
economic benefit for society,” says Professor
Markku Kaste.
PHOTO: Joachim ladefoged