Measuring and reducing stroke burden In New Zealand

ARCOS V

Contact: Balakrishnan Nair (Research Programme Manager): balakrishnan.nair@aut.ac.nz

Aim: Stroke and TIA are associated with a major economic burden, including emergency service use, hospitalisations, residential care, and other associated costs. Understanding the costs strokes and TIAs impose on the healthcare system and the people of New Zealand is critical for helping to identify and implement cost effective strategies that can reduce this burden.

The ARCOS V Programme is structured around four interlinked studies addressing the following aims: (Study 1) determining population-based estimates of stroke and TIA mortality and functional outcomes at 12 months and analysing 40-year trends in stroke burden, including healthcare use, and economic impact in the Auckland Region; (Study 2) determining the impact of pre-hospital pathways of stroke/TIA on their outcomes over the last 10 years (2011-2021); (Study 3) estimating the national burden of acute stroke, and (Study 4) determining the effectiveness of health and wellness coaching (HWC) in improving lifestyle behaviour to reduce the risk of stroke after a minor stroke or TIA.

Programme Coordinator: Rita Krishnamurthi, AUT

Principal Investigators:

  • Professor Valery Feigin, AUT
  • Associate Professor Rita Krishnamurthi, AUT

Project Collaborators:

  • Professor Suzanne Barker-Collo, University of Auckland
  • Dr Braden Te Ao, University of Auckland
  • Professor Peter Barber, University of Auckland
  • Professor Bruce Arroll, University of Auckland
  • Associate Professor Daniel Exeter, University of Auckland
  • Dr Yogini Ratnasabapathy, Waitemata District health Board
  • Professor Jeroen Douwes, Massey University
  • Associate Professor Annemarei Ranta, Otago University
  • Dr Hinemoa Elder,
  • Associate Professor Andrew Swain, AUT
  • Dr Bronwyn Tunnage, AUT
  • Associate Professor El-Shadan Tautolo, AUT
  • Professor Craig Anderson, The George Institute
  • Professor Amanda Thrift,  Monash University
  • Dr Derrick Bennett, Oxford University
  • Professor Dominique Cadilhac, Monash University
  • Professor Paul Brown, University of California, Merced

Timeline: March 2021 - February 2026

Funded by: Health Research Council of New Zealand

Budget: $4.9million


Study 2: Mapping the pre-hospital pathway of stroke

Contact: Dr. Bronwyn Tunnage

Principal Investigators: Prof. Valery Feigin (AUT); Dr. Bronwyn Tunnage (AUT); Assoc. Prof. Andrew Swain (Wellington Free Ambulance)

Aim/Summary: To determine the impact of pre-hospital pathways of stroke/TIA on their outcomes over the last 10 years (2011-2021). This study will determine how patients with stroke and TIA accessed the healthcare system, and the impact of the quality of their healthcare on the access to time-critical treatments in hospital. Cases for the study will be from the ARCOS V cohort. The five main objectives are to: (1) identify the referral pathway from the community; (2) establish the sensitivity and specificity of stroke/TIA recognition by paramedics; (3) evaluate the efficacy of the a New Zealand -developed paramedic acute assessment tool (PASTA) in identifying stroke-related large vessel occlusions; (4) determine the time to thrombolysis and endovascular clot retrieval associated with a paramedic-initiated bypass protocol policy; and (5) quantify the association between paramedic pre-arrival notification and in-hospital processes, treatment and outcome. These findings will inform EMS practice guidelines to improve outcomes of stroke/TIA.


Study 3: Determining national and regional (for all NZ DHBs) stroke incidence and mortality, and their determinants

Contact: Professor Jeroen Douwes (Massey)

Principal Investigators: Prof. Jeroen Douwes (Massey), Assoc. Prof. Anna Ranta (Otago University Wellington)

Aim/summary: This study will use robust and in-depth population-based data from ARCOS V and routinely collected national health and social data held in NZ’s IDI to determine national stroke incidence and mortality, and the impact of socio-economic status (SES) on stroke (with data for all DHBs).


Study 4: Trial of an Individualised Intervention for the Prevention of Stroke (TIIPS)

Contact: Dr. Devaki De Silva

Principal Investigators: Assoc. Prof. Rita Krishnamurthi (AUT); Prof. Suzanne Barker-Collo (Auckland); Prof. Valery Feigin (AUT)

Study manager: Dr Devaki De Silva / Jesse Dyer

Aim/Summary: To determine the effectiveness of health and wellness coaching (HWC) in improving lifestyle behaviour to reduce the risk of stroke after a minor stroke or TIA. This is a phase III, prospective, single blind, 2-arm randomised controlled trial to test the effectiveness of HWC for secondary prevention of stroke following TIA or minor stroke. The intervention will combine educational material and intensive HWC coaching.