Q. Since the start of the Covid pandemic, has there been an increase in the number of stroke cases in India?
Dr Aparna Jaiswal: COVID-19 has taken the world by storm. It had only forced people to stay inside their homes during recurrent lockdowns but has had a huge impact on the overall lifestyle. The drastic lifestyle changes in people have made them prone to hypertension, unchecked diabetes, which are directly linked to stroke. Several research reports have also indicated that COVID-19 may have increased the risk of having a thrombotic vascular event, or thrombosis that led to the number of stroke cases.
Q. What are the latest advancements that have enabled better prevention and treatment of stroke?
Dr Aparna Jaiswal: There have been significant developments in the field of prevention and treatment of stroke. In the area of prevention, there has been an array of diagnostics to identify arrhythmia or Atrial Fibrillation, or irregular heartbeat. Recent advances in mobile health technology and wearable electronic devices allow heart rhythm monitoring to be undertaken in real-time with greater comfort, ease, and engagement. Wearable devices such as smartwatches show great potential for the detection of cardiac arrhythmias. Holter monitors are tools of proven efficacy in diagnosing and monitoring cardiac arrhythmias. New holter monitoring technologies and loop recorders allow prolonged monitoring of heart rhythm for periods from a few days to several months. Further, there are ILRs (Insertable Loop Recorders), which can be inserted into the patient’s skin and have an enhanced battery life of up to three years. These improved diagnostics help in the identification of rhythm disorders, which may potentially put them at risk of stroke.
We have also witnessed tremendous advancements in drugs and devices towards managing patients with Atrial Fibrillation. In drugs, a new class called the Non-Vitamin K Oral Antagonist has made the treatment of atrial fibrillation much simpler that protects the patient from a stroke if found at risk. These non-vitamin K antagonists are as effective in preventing stroke as vitamin K antagonists and also have the added advantage of reduced intra-cerebral bleed contrary to the earlier version of vitamin K antagonists. Moreover, the latest advancements for patients who are contraindicated for the above drugs are also available called Left Atrial Appendage (LAA) closure devices. When suffering from atrial fibrillation, blood clots are most commonly formed in LAA part of the heart. If a blood clot forms, it could dislodge from the heart and travel to the brain where it might block blood flow, causing a stroke. Closing the LAA is an ideal way of reducing stroke risk in people with atrial fibrillation with the help of these devices when they are unable to take Non-vitamin K Antagonist Oral Anticoagulant (NOAC).
Q. What measures can help in reducing the incidence of stroke?
Dr Aparna Jaiswal: Older age and family history of strokes are among the things that make one more likely to have a stroke. While no one can change the family health history, taking required precautions can reduce the risk of stroke. Experts also say that 80% of strokes can be prevented. Several lifestyle factors may increase the risk of stroke including high blood pressure, smoking, diabetes, high blood cholesterol levels, heavy drinking, high salt, and high-fat diet, and lack of exercise. Therefore, controlling these risk factors and leading a healthy life can reduce the incidence of stroke across age groups.
Q. What is your message on World Stroke Day?
Dr Aparna Jaiswal: Stroke is devastating. We must take adequate measures before our patient has a stroke. For patients, who are at risk of rhythm disturbances must attempt rhythm surveillance (look for Atrial Fibrillation). Patients should look after their lifestyle disorders and take necessary preventive measures towards leading a healthier life.