China's stroke care is improving, but the disease is still No. 1 killer

China has made strides in stroke care over the past decade – but a new report shows the number of strokes each year is rising, and the disease remains the country's leading cause of death.

The report, published Monday in the American Heart Association journal Stroke, is a wide-ranging review of how the world's most populous country is doing when it comes to stroke management, and suggests the need to step up prevention efforts.

The progress China has made in stroke care has paid off in part because the stroke death rate has declined, said Dr. David Wang, a neurologist and co-author of the report.

"Many hospitals have become certified stroke centers, and standardized stroke care is being practiced throughout China," said Wang, an acute stroke specialist with OSF Healthcare System in Peoria, Illinois.

Even so, there's room for improvement, said Wang, vice chair of neurology at the University of Illinois College of Medicine.

For instance, many hospitals don't have enough medical personnel or adequate equipment to treat stroke patients, he said. Antiquated beliefs about patient care among physicians hinder efforts to offer quality care, Wang said, and the country has a long way to go in offering better stroke rehabilitation services.

Stroke killed more than 2 million people in China in 2016. By comparison, the disease kills more than 140,000 Americans each year.

A stroke occurs when a clot forms and cuts off blood supply or ruptures in a main blood vessel in the brain. High blood pressure, high cholesterol and arrhythmias are among the leading risk factors for the condition. Worldwide, stroke is the second leading cause of death and the third leading cause of disability, according to the World Health Organization.

The report suggests China took an important step in improving stroke care when it launched its first national stroke patient registry in 2007. Since 2014, a telemedicine program has allowed at least 300 rural hospitals to treat stroke patients, according to the report.

The country has seen some progress in treating acute stroke patients, the report shows. Physicians are relying more on the gold-standard clot-busting medication that's been used in the U.S. and Europe for more than 20 years. At the same time, China is using some effective therapies that haven't been used in other countries, the report said.

Those gains, however, may not mean much unless prevention efforts ramp up. High blood pressure and high cholesterol rates in China, for instance, are lower than in the U.S., but statistics show those conditions aren't well-controlled.

China's stroke prevention efforts would benefit from focusing, at least in part, on high blood pressure among adults, said Dr. Harlan M. Krumholz, a cardiologist at Yale-New Haven Hospital in Connecticut.

Treatment and access to primary care seem to be the key ingredients. A recent study co-authored by Krumholz showed high blood pressure was more common among Americans, but their Chinese counterparts with the condition were twice as likely to have severe high blood pressure. In addition, Americans are much more likely to be treated for the condition than their Chinese peers. The data also show many people in China with high blood pressure don't know they have it.

"It's not a matter of lack of access to drugs because of their expense," said Krumholz, a professor at Yale School of Medicine. "It's about strengthening the (primary care) system."

Historically, China has not put a premium on improving primary care for non-communicable diseases like stroke and heart disease, in part because public health officials had to focus on slowing the spread of infectious diseases, Krumholz said. More recently, the country has poured resources into specialized medical centers to treat heart disease, cancer and neurological diseases, he said.

Both Wang and Krumholz said public health officials face a considerable challenge because the country is large and has a significant population of aging adults who are at high risk for stroke.

Nonetheless, Krumholz said, "This is a great moment in time for China to recognize this is an opportunity to improve population health."

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