Strategies for stroke management

Abstract

The publication of the second consensus of the Helsingborg Declaration on Nov 30 has once again directed interest towards the management of stroke in Europe. The original Helsingborg Declaration, published in 1995, aimed to improve stroke management in all European member states by 2005. Sadly, many of the aims were frustratingly vague and no attention was given to vital primary prevention strategies. Despite this, the guidelines were welcomed by the stroke community as a step in the right direction, and the management of acute stroke in Europe has improved over the past 10 years—partly due to increased numbers of specialist stroke units.As a result, the publication of the second Helsingborg Declaration has been eagerly awaited. The second consensus conference in March of this year met to determine the primary goals for 2015, covering five main areas of stroke management: organisation of stroke services, management of acute stroke, prevention, rehabilitation, and evaluation of stroke outcome and quality assessment. The new guidelines do have some benefits over the 1995 declaration; they are certainly more detailed, giving specific targets such as calling for further development of recombinant factor VII for the treatment of acute haemorrhagic stroke. They also include updated drug treatment information and targets for primary prevention strategies. Yet despite these improvements, many of the 2015 targets are worryingly similar to those previously set to be achieved by 2005.Evidently, it would be easy to bemoan the publication of yet more guidelines with vague and lofty targets set for some unthinkable time in the future, but our responsibilities surely run deeper than that. Without first directing additional resources towards stroke research, so that more can be learnt about what interventions would genuinely improve clinical outcomes, how can we expect anyone to foster realistic guidelines or, more importantly, to improve patient care? The most useful part of this second Helsingborg Declaration is the detailed research and development priorities. This is where the stroke community and the funding bodies should aim their efforts over the coming 9 years. Perhaps, then, the third draft will be more useful. The publication of the second consensus of the Helsingborg Declaration on Nov 30 has once again directed interest towards the management of stroke in Europe. The original Helsingborg Declaration, published in 1995, aimed to improve stroke management in all European member states by 2005. Sadly, many of the aims were frustratingly vague and no attention was given to vital primary prevention strategies. Despite this, the guidelines were welcomed by the stroke community as a step in the right direction, and the management of acute stroke in Europe has improved over the past 10 years—partly due to increased numbers of specialist stroke units. As a result, the publication of the second Helsingborg Declaration has been eagerly awaited. The second consensus conference in March of this year met to determine the primary goals for 2015, covering five main areas of stroke management: organisation of stroke services, management of acute stroke, prevention, rehabilitation, and evaluation of stroke outcome and quality assessment. The new guidelines do have some benefits over the 1995 declaration; they are certainly more detailed, giving specific targets such as calling for further development of recombinant factor VII for the treatment of acute haemorrhagic stroke. They also include updated drug treatment information and targets for primary prevention strategies. Yet despite these improvements, many of the 2015 targets are worryingly similar to those previously set to be achieved by 2005. Evidently, it would be easy to bemoan the publication of yet more guidelines with vague and lofty targets set for some unthinkable time in the future, but our responsibilities surely run deeper than that. Without first directing additional resources towards stroke research, so that more can be learnt about what interventions would genuinely improve clinical outcomes, how can we expect anyone to foster realistic guidelines or, more importantly, to improve patient care? The most useful part of this second Helsingborg Declaration is the detailed research and development priorities. This is where the stroke community and the funding bodies should aim their efforts over the coming 9 years. Perhaps, then, the third draft will be more useful.