Every year, 120,000 people suffer a stroke in France. Among them, 30,000 die. In a report published this Tuesday, October 28, the eve of World Stroke Day, the Court of Auditors warned of deficiencies in stroke management.
Firstly, prevention is too neglected and is not the subject of a specific policy. “The prevention of stroke is linked to that of cardiovascular diseases, with which it shares the associated behavioral (tobacco, alcohol, diet, sedentary lifestyle) and metabolic (high blood pressure, diabetes, cholesterol) risk factors,” notes the Court of Auditors.
Little-known risk factors
If hypertension is the main risk factor for stroke, its “detection and treatment stagnate, or even decrease, for women, and are far from those achieved in other developed countries,” warns the report, which specifies that “the fight against hypertension should be a more important priority in prevention policy.”
Other risk factors for stroke remain unknown in society, such as “sleep apnea, drug consumption or even the association among young women between chemical contraceptives and tobacco,” explains the Court of Auditors.
People with comorbidities, those over 60 years of age or those who have suffered a transient ischemic attack are especially exposed to the risk of suffering a stroke. However, “the prevention of this pathology seems insufficiently oriented towards screening and monitoring of populations” at risk, warns the Court of Auditors, for whom it is necessary to “define a national communication strategy on the population’s knowledge about stroke”, among other things.
Less care provision than needs
In 2010, a stroke plan provided for the creation of 140 neurovascular units (NVUs), which provide emergency care to patients suffering a stroke. If the objective has been achieved, the number of UNV is today lower than the needs identified by the regional health agencies (ARS), and “the supply of specialized care continues to be distributed unequally throughout the territory.”
The report also questions the care for stroke victims. Only 50% of them were able to benefit from a stay in a neurovascular unit in 2023. Far from the target of 90%. “Faced with difficulties in recruiting doctors and paramedics,” UNVs are sometimes forced to turn away patients or close beds.
Interviewed by BFMTV, Margot Turcat, a stroke victim at the age of 30, explains that she received very poor care. “Samu didn’t believe me and referred me to SOS Médicos, who didn’t believe me either. The doctor thought I had a migraine with aura.” In total, Margot Turcat waited four hours before being admitted to the neurovascular unit. A very long delay. Especially since during a stroke, two million neurons die every minute.
What support after a stroke?
Support for people who have suffered a stroke can also be improved. Of the more than 75,000 people affected by this pathology in 2022, 17,000 have serious disabilities when they return home, “without having been able to access rehabilitative medical care (SMR),” the Court notes. “Therefore, certain returns home occur without the essential provision of rehabilitation or rehabilitative care.”
“Resumption of professional activity is difficult after a stroke, and nearly 10% of the 24,000 victims between 40 and 59 years old receive a disability pension,” indicates the Court of Auditors report.
Worse still, in 2022, some 20,000 stroke victims with a long-term disease (ALD) “did not have a treating doctor.” This lack of medical follow-up does not “contribute to helping patients modify their lifestyle habits after a stroke to avoid its recurrence,” warns the Court of Auditors.
The institution’s report continues: “Care in the neurovascular unit, but also, subsequently, in rehabilitation medical care, is decisive for the survival of patients and the limitation of sequelae.” However, “almost a third of hemorrhagic stroke victims who have severe disabilities after their stroke do not benefit from hospitalization in a UNV program,” regrets the Court of Auditors.
According to her, “better patient orientation, better coordination of healthcare agents and a reduction in the length of stay could generate savings of 200 million euros.”
Source: BFM TV
