Stakeholder Insight: Acute Stroke
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the Cardiovascular pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Datamonitor insight into the stroke market - page 4
- Stroke is the third leading cause of death in the US and the second leading cause of death in Europe. Incidence of stroke is predicted to increase to 1.5 million by 2012 within the seven major markets. According to the American Stroke Association, the estimated direct and indirect cost of stroke in the US in 2004 will be $53.6 billion. - page 4
- Increasing awareness of the symptoms and urgency of stroke is essential for patient outcomes to improve. Datamonitor research reveals that one of the biggest delays in patients receiving treatment is late presentation to hospital, as patients often perceive symptoms as not serious or do not recognize they are having a stroke. To improve patient outcomes radically for ischemic stroke patients, "time to treatment" needs to be improved so that more eligible patients can receive tPA therapy. - page 5
- Ideally patients should be taken straight to stroke unit/centers by Medical Emergency Services. This would greatly improve treatment times as facilities such as diagnostic machinery are located conveniently and specialists are at hand to differentiate between stroke types and initiate treatment. However, Datamonitor also found that resources available to stroke units vary across countries and this can greatly influence the care that patients receive. Stroke units/centers need to have a standard definition across countries. - page 6
- Datamonitor research shows that no one pharmacological treatment protocol produces better outcomes than another. However, even with the lack of pharmacological therapies, death rates and recurrence figures are better in Japan, so maybe countries should look to Japan for best practice strategies. - page 7
- Datamonitor recommendations - page 8
- CHAPTER 2 INTRODUCTION AND SCOPE - page 16
- 2.1 Coverage of the Stakeholder Insight Survey - page 16
- 2.1.1 Country level 'treatment trees' - page 19
- 2.1.2 Supporting data sets - page 19
- 2.1 Coverage of the Stakeholder Insight Survey - page 16
- CHAPTER 3 COUNTRY TREATMENT TREES - page 20
- Introduction to the treatment trees - page 20
- US - page 21
- Japan - page 23
- France - page 25
- Germany - page 27
- Italy - page 29
- Spain - page 31
- UK - page 33
- Introduction to the treatment trees - page 20
- CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION - page 35
- 4.1 Disease definition and classification - page 35
- Symptoms - page 35
- Ischemic stroke - page 36
- Hemorrhagic stroke - page 37
- Transient ischemic attack - page 39
- Symptoms - page 35
- 4.2 Epidemiology of stroke - page 40
- 4.3 Key patient segmentations - page 41
- Patient gender - page 41
- Patient age - page 44
- 4.4 Comorbidities, complications and risk factors - page 46
- 4.1 Disease definition and classification - page 35
- CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS - page 48
- 5.1 Presentation and diagnosis - page 48
- Time to presentation - page 48
- Diagnosis - page 49
- Healthcare professionals involved in the diagnosis of stroke - page 49
- Tests in emergency diagnosis of stroke - page 50
- Secondary tests performed after initial diagnosis - page 52
- 5.3 Influences on diagnosis and treatment rates - page 55
- The Stroke Association - page 55
- The National Stroke Association - page 55
- STOP Stroke Act - page 56
- 5.5 Treatment guidelines - page 56
- 5.6 Treatment pathways - page 62
- 5.1 Presentation and diagnosis - page 48
- CHAPTER 6 PRESCRIBING TRENDS AND INFLUENCING FACTORS - page 64
- 6.1 Prescribing trends - page 64
- Ischemic stroke treatment - page 64
- Time to treatment - page 64
- Drug therapy - page 65
- Hemorrhagic stroke treatment - page 75
- Ischemic stroke treatment - page 64
- 6.1 Prescribing trends - page 64
- CHAPTER 7 IMPROVING TREATMENT OUTCOMES - page 80
- 7.1 Treatment outcomes - page 80
- Length of stay - page 81
- Mortality - page 82
- Recovery - page 83
- 7.2 Unmet needs - page 88
- Patient awareness - page 88
- Rapid diagnosis - page 89
- Adequately equipped stroke units - page 89
- Physician education - page 90
- Safe acute treatment options with greater therapeutic window - page 90
- 7.3 New product development - page 92
- Ancrod - page 92
- Desmoteplase - page 93
- Novoseven - page 93
- 7.1 Treatment outcomes - page 80
- APPENDIX A BIBLIOGRAPHY - page 95
- Epidemiology methodology - page 95
- Epidemiology - page 95
- Clinical trial data - page 96
- Bibliography - page 97
- General and clinical trial data - page 97
- Key associations and conferences - page 97
- APPENDIX B - page 99
- Physician research methodology - page 99
- Physician sample breakdown - page 99
- US - page 99
- Japan - page 100
- France - page 100
- Germany - page 101
- Italy - page 101
- Spain - page 102
- UK - page 102
- Physician research methodology - page 99
- APPENDIX C - page 103
- The survey questionnaire - page 103
- 1. Epidemiology and patient segmentation - page 103
- 2. Diagnosis of stroke - page 107
- 3. Treatment of acute stroke - page 112
- Treatment of Ischemic stroke - page 117
- 4. Surgical procedures - page 126
- 5. Patient outcomes - page 128
- Glossary - page 130
- Key Opinion Leader discussion guide - page 131
- Epidemiology and patient segmentation - page 131
- Diagnosis and treatment options - page 133
- Prescribing trends and influencing factors - page 138
- Improving treatment outcomes - page 147
- Unmet needs - page 151
- New product awareness - page 152
- Regulatory issues - page 153
- Disclaimer - page 154
- List of Tables
- Table 1: Current and future estimated incidence of stroke in the seven major markets, 2004-12 - page 41
- Table 2: Estimated proportion of all stroke patients with comorbid conditions and risk factors in the seven major markets, 2004 - page 46
- Table 3: Causes of hemorrhagic stroke experienced by patients - page 47
- Table 4: Type of medical professional diagnosing stroke, 2004 - page 50
- Table 5: Emergency diagnosis tests carried out in stroke patients, 2004 - page 50
- Table 6: Secondary diagnostic tests carried out in stroke patients, 2004 - page 52
- Table 7: Percentage of patients undergoing each test following initial diagnosis, 2004 - page 53
- Table 8: Percentage of ischemic stroke patients treated by each healthcare professional, 2004 - page 64
- Table 9: Anti-platelets given to ischemic stroke patients in the acute phase, 2004 - page 67
- Table 10: Antiplatelets given to ischemic stroke patients in the post-acute phase, 2004 - page 68
- Table 11: Anticoagulants given to ischemic stroke patients in the acute phase, 2004 - page 69
- Table 12: Anticoagulants given to ischemic stroke patients in the post-acute phase, 2004 - page 71
- Table 13: Percentage of ischemic stroke patients receiving the following types of therapy to prevent recurrence, 2004 - page 73
- Table 14: Late stage drugs in development for stroke, 2005 - page 92
- US physician sample breakdown, 2004 - page 99
- Japan physician sample breakdown, 2002 - page 100
- France physician sample breakdown, 2002 - page 100
- Germany physician sample breakdown, 2002 - page 101
- Italy physician sample breakdown, 2002 - page 101
- Spain physician sample breakdown, 2002 - page 102
- UK physician sample breakdown, 2002 - page 102
- Type of medical professional diagnosing stroke, 2004 - page 135
- Anti-platelets given to ischemic stroke patients in the acute phase - page 139
- Phase III drugs for stroke - page 152
- List of Figures
- Figure 1: Diagrammatic overview of the coverage of the Stakeholder Insight: Stroke survey, 2004 - page 18
- Figure 2: Summary flow of stroke treatment in the US, 2004 - page 21
- Figure 3: Summary flow of treatment of stroke in the US, 2004 - page 22
- Figure 4: Summary flow of stroke treatment in the Japan, 2004 - page 23
- Figure 5: Summary flow of treatment of stroke in the Japan, 2004 - page 24
- Figure 6: Summary flow of stroke treatment in the France, 2004 - page 25
- Figure 7: Summary flow of treatment of stroke in the France, 2004 - page 26
- Figure 8: Summary flow of stroke treatment in the Germany, 2004 - page 27
- Figure 9: Summary flow of treatment of stroke in the Germany, 2004 - page 28
- Figure 10: Summary flow of stroke treatment in the Italy, 2004 - page 29
- Figure 11: Summary flow of treatment of stroke in the Italy, 2004 - page 30
- Figure 12: Summary flow of stroke treatment in the Spain, 2004 - page 31
- Figure 13: Summary flow of treatment of stroke in the Spain, 2004 - page 32
- Figure 14: Summary flow of stroke treatment in the UK, 2004 - page 33
- Figure 15: Summary flow of treatment of stroke in the UK, 2004 - page 34
- Figure 16: Percentage of male and female ischemic stroke patients, 2004 - page 42
- Figure 17: Percentage of male and female hemorrhagic stroke patients, 2004 - page 43
- Figure 18: Average age of ischemic stroke patients, 2004 - page 44
- Figure 19: Average age of hemorrhagic stroke patients, 2004 - page 45
- Figure 20: Time to presentation after the onset of symptoms, 2004 - page 48
- Figure 21: Time taken to obtain emergency test results, 2004 - page 52
- Figure 22: Overview of treatment guidelines for acute ischemic stroke - page 57
- Figure 23: Organization of an acute neurological stroke unit - page 58
- Figure 24: Percentage of respondents with acute stroke units across the seven major markets, 2004 - page 59
- Figure 25: Overview of treatment guidelines for hemorrhagic stroke - page 60
- Figure 26: Treatment pathways, 2004 - page 62
- Figure 27: Percentage of patients that are referred from other hospitals or admitted as emergencies to stroke units, 2004 - page 63
- Figure 28: Time to treatment from onset of symptoms for patients with acute ischemic stroke, 2004 - page 65
- Figure 29: Percentage of ischemic stroke patients treated with acute drug therapy, 2004 - page 66
- Figure 30: Percentage of ischemic stroke patients receiving antiplatelets, 2004 - page 66
- Figure 31: Percentage of ischemic stroke patients receiving anticoagulants, 2004 - page 69
- Figure 32: Percentage of patients receiving thrombolytics, 2004 - page 72
- Figure 33: Percentage of ischemic stroke patients receiving specified thrombolytic, 2004 - page 73
- Figure 34: Percentage of hemorrhagic stroke patients receiving each specified therapy, 2004 - page 75
- Figure 35: Percentage of hemorrhagic stroke patients undergoing surgery, 2004 - page 77
- Figure 36: Percentage of hemorrhagic stroke patients undergoing the specified surgical procedures, 2004 - page 77
- Figure 37: Length of stay, 2004 - page 81
- Figure 38: Percentage of stroke patients that die before receiving medical attention, 2004 - page 82
- Figure 39: Percentage of stroke patients that die in hospital, 2004 - page 83
- Figure 40: Percentage of ischemic stroke patients making each type of recovery, 2004 - page 84
- Figure 41: Percentage of hemorrhagic stroke patients making each type of recovery, 2004 - page 85
- Figure 42: Percentage of stroke patients referred for rehabilitation, 2004 - page 86
- Figure 43: The percentage of stroke patients that go on to have recurrent stroke, 2004 - page 87
- Figure 44: Unmet needs in stroke therapy, 2004 - page 88
- Percentage of ischemic stroke patients that have suffered from a prior TIA across the seven major markets, 2004 - page 131
- Percentage of respondents with acute stroke units/centers across the seven major markets, 2004 - page 133
- Time to presentation after the onset of symptoms - page 134
- Time taken to obtain emergency test results - page 137
- Time to treatment with drug therapy from onset of symptoms for patients with acute ischemic stroke, 2004 - page 138
- Percentage of ischemic stroke patients receiving anticoagulants - page 140
- Percentage of patients receiving thrombolytics - page 142
- Percentage of hemorrhagic stroke patients receiving each specified therapy - page 143
- Percentage of hemorrhagic stroke patients undergoing surgery - page 144
- Percentage of hemorrhagic stroke patients undergoing the specified surgical procedures - page 145
- Most common patient treatment pathways - page 146
- The percentage of stroke patients that go on to have recurrent stroke - page 147
- Length of hospital stay, 2004 - page 148
- Percentage of stroke patients that die before receiving medical attention - page 149
- Percentage of ischemic stroke patients making each type of recovery - page 150
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