Stakeholder Insight: Acute Stroke - TPA spurs infrastructure changes for the better
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 4
- Scope of the analysis - page 4
- Contributing experts - page 4
- Experts interviewed for this report (interviewed in October 2007) - page 4
- Experts interviewed for Stakeholder Insight 2005: Acute Stroke, DMHC2058 (interviewed in 2005) - page 5
- Experts interviewed for Pipeline Insight 2005: Antithrombotics, DMHC2084 (interviewed in 2005) - page 5
- Experts interviewed for Pipeline Insight 2006: Acute Stroke, DMHC2167 (interviewed in February 2006) - page 5
- Datamonitor insight into the stroke market - page 6
- Related reports - page 7
- CHAPTER 2 INTRODUCTION AND SCOPE - page 9
- Coverage of the Stakeholder Insight survey - page 9
- Country level "treatment trees" - page 12
- Supporting data sets - page 12
- Coverage of the Stakeholder Insight survey - page 9
- CHAPTER 3 COUNTRY TREATMENT TREES - page 13
- Introduction to the treatment trees - page 13
- United States - page 14
- Japan - page 19
- France - page 24
- Germany - page 29
- Italy - page 34
- Spain - page 39
- United Kingdom - page 44
- Introduction to the treatment trees - page 13
- CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION - page 49
- Disease definition and classification - page 49
- Symptoms - page 49
- Ischemic stroke - page 50
- Hemorrhagic stroke - page 52
- Transient ischemic attack - page 55
- Symptoms - page 49
- Epidemiology of stroke - page 56
- Epidemiology methodology - page 58
- US - page 58
- Japan - page 58
- Europe - page 59
- Epidemiology methodology - page 58
- Key patient segmentations - page 60
- Patient age - page 60
- Comorbidities, complications and risk factors - page 61
- Disease definition and classification - page 49
- CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS - page 64
- Presentation and diagnosis - page 64
- Time to presentation - page 64
- Diagnosis - page 67
- Healthcare professionals involved in the diagnosis of stroke - page 67
- Tests in emergency diagnosis of stroke - page 68
- Secondary tests performed after initial diagnosis - page 73
- Influences on diagnosis and treatment rates - page 75
- The National Stroke Association - page 75
- STOP Stroke Act - page 75
- The Stroke Association - page 76
- Treatment guidelines - page 77
- Treatment of acute ischemic stroke - page 78
- Treatment of hemorrhagic stroke - page 81
- Stroke units - page 83
- Treatment pathways - page 90
- Presentation and diagnosis - page 64
- CHAPTER 6 PRESCRIBING TRENDS AND INFLUENCING FACTORS - page 92
- Ischemic stroke treatment - page 92
- Antiplatelets - page 100
- Anticoagulants - page 102
- Thrombolytics - page 104
- Hemorrhagic stroke treatment - page 107
- Ischemic stroke treatment - page 92
- CHAPTER 7 IMPROVING TREATMENT OUTCOMES - page 111
- Treatment outcomes - page 111
- Length of stay - page 111
- Mortality - page 113
- Recovery - page 115
- Recurrence of stroke - page 117
- Unmet needs - page 119
- Physician education: tackling physician competence and attitude - page 121
- Patient education: raising stroke-symptom awareness - page 128
- Infrastructural unmet needs: establishing, maintaining and expanding the network of dedicated stroke units. - page 131
- Unmet clinical needs - page 135
- Procoagulation - page 135
- Neuroprotection - page 135
- Revascularization - page 136
- Safety - page 139
- Efficacy - page 139
- Extended time window of treatment - page 141
- Ease of use - page 142
- New product development - page 145
- Prolyse - page 148
- Clinical trials - page 148
- Ancrod - page 148
- Clinical trials - page 149
- Danaparoid sodium - page 150
- Clinical trials - page 150
- Dabigatran etexilate - page 151
- Clinical trials - page 152
- Clazosentan - page 152
- Clinical trials - page 152
- Rivaroxaban - page 153
- Clinical trials - page 153
- Desmoteplase - page 154
- Clinical trials - page 154
- Conclusion - page 154
- Prolyse - page 148
- Treatment outcomes - page 111
- APPENDIX A BIBLIOGRAPHY - page 156
- Epidemiology - page 156
- General and clinical trial data - page 158
- APPENDIX B - page 164
- Physician research methodology - page 164
- Physician sample breakdown - page 164
- US - page 164
- Japan - page 165
- France - page 165
- Germany - page 166
- Italy - page 166
- Spain - page 167
- UK - page 167
- Physician research methodology - page 164
- APPENDIX C - page 168
- The survey questionnaire - page 168
- 1. Patient Segmentation - page 168
- 2. Presentation And Referral - page 170
- 3. Diagnosis - page 173
- 4. Treatment - page 177
- Treatment of ischemic stroke - page 179
- Treatment of hemorrhagic stroke - page 187
- 5. Treatment Outcomes - page 190
- Glossary - page 191
- The survey questionnaire - page 168
- DISCLAIMER - page 193
- List of Tables
- Table 1: Incidence of first-ever stroke, 2007 - page 57
- Table 2: All stroke patients with comorbidities and risk factors in the seven major markets, 2007 - page 61
- Table 3: Causes of hemorrhagic stroke experienced by patients, 2007 - page 63
- Table 4: Type of medical professional diagnosing stroke, 2007 - page 67
- Table 5: Emergency diagnosis tests carried out in stroke patients, 2007 - page 68
- Table 6: Percentage of patients undergoing each test following initial diagnosis, 2007 - page 74
- Table 7: Antiplatelets given to ischemic stroke patients in the acute phase, 2007 - page 100
- Table 8: Antiplatelets given to ischemic stroke patients in the post-acute phase, 2007 - page 101
- Table 9: Anticoagulants given to ischemic stroke patients in the acute phase, 2007 - page 102
- Table 10: Anticoagulants given to ischemic stroke patients in the post-acute phase, 2007 - page 103
- Table 11: Types of therapy received by Ischemic stroke patients to prevent recurrence, 2007 - page 105
- Table 12: Late-stage drugs in development for stroke, 2007 - page 147
- US physician sample breakdown, 2007 - page 164
- Japan physician sample breakdown, 2007 - page 165
- France physician sample breakdown, 2007 - page 165
- Germany physician sample breakdown, 2007 - page 166
- Italy physician sample breakdown, 2007 - page 166
- Spain physician sample breakdown, 2007 - page 167
- UK physician sample breakdown, 2007 - page 167
- List of Figures
- Figure 1: Diagrammatic overview of the coverage of the Stakeholder Insight: Stroke survey, 2007 - page 11
- Figure 2: Summary of stroke treatment in the US, 2007 - page 14
- Figure 3: Ischemic stroke treatment in the US (I), 2007 - page 15
- Figure 4: Ischemic stroke treatment in the US (II), 2007 - page 16
- Figure 5: Ischemic stroke treatment in the US (III), 2007 - page 17
- Figure 6: Hemorrhagic stroke treatment in the US, 2007 - page 18
- Figure 7: Summary of stroke treatment in Japan, 2007 - page 19
- Figure 8: Ischemic stroke treatment in Japan (I), 2007 - page 20
- Figure 9: Ischemic stroke treatment in Japan (II), 2007 - page 21
- Figure 10: Ischemic stroke treatment in Japan (III), 2007 - page 22
- Figure 11: Hemorrhagic stroke treatment in Japan, 2007 - page 23
- Figure 12: Summary of stroke treatment in France, 2007 - page 24
- Figure 13: Ischemic stroke treatment in France (I), 2007 - page 25
- Figure 14: Ischemic stroke treatment in France (II), 2007 - page 26
- Figure 15: Ischemic stroke treatment in France (III), 2007 - page 27
- Figure 16: Hemorrhagic stroke treatment in France, 2007 - page 28
- Figure 17: Summary of stroke treatment in Germany, 2007 - page 29
- Figure 18: Ischemic stroke treatment in Germany (I), 2007 - page 30
- Figure 19: Ischemic stroke treatment in Germany (II), 2007 - page 31
- Figure 20: Ischemic stroke treatment in Germany (III), 2007 - page 32
- Figure 21: Hemorrhagic stroke treatment in Germany, 2007 - page 33
- Figure 22: Summary of stroke treatment in Italy, 2007 - page 34
- Figure 23: Ischemic stroke treatment in Italy (I), 2007 - page 35
- Figure 24: Ischemic stroke treatment in Italy (II), 2007 - page 36
- Figure 25: Ischemic stroke treatment in Italy (III), 2007 - page 37
- Figure 26: Hemorrhagic stroke treatment in Italy, 2007 - page 38
- Figure 27: Summary of stroke treatment in Spain, 2007 - page 39
- Figure 28: Ischemic stroke treatment in Spain (I), 2007 - page 40
- Figure 29: Ischemic stroke treatment in Spain (II), 2007 - page 41
- Figure 30: Ischemic stroke treatment in Spain (III), 2007 - page 42
- Figure 31: Hemorrhagic stroke treatment in Spain, 2007 - page 43
- Figure 32: Summary of stroke treatment in the UK, 2007 - page 44
- Figure 33: Ischemic stroke treatment in the UK (I), 2007 - page 45
- Figure 34: Ischemic stroke treatment in the UK (II), 2007 - page 46
- Figure 35: Ischemic stroke treatment in the UK (III), 2007 - page 47
- Figure 36: Hemorrhagic stroke treatment in the UK, 2007 - page 48
- Figure 37: Average age of stroke patients, 2007 - page 60
- Figure 38: Time to presentation after the onset of symptoms, 2007 - page 65
- Figure 39: Time taken to obtain emergency test results, 2007 - page 71
- Figure 40: Secondary diagnostic tests carried out in stroke patients, 2007 - page 73
- Figure 41: Overview of treatment guidelines for acute ischemic stroke - page 78
- Figure 42: Overview of treatment guidelines for ICH - page 81
- Figure 43: Organization of an acute neurological stroke unit - page 83
- Figure 44: Share of respondents whose hospital has an acute stroke unit, seven major markets, 2007 - page 85
- Figure 45: Treatment Pathways, 2007 - page 90
- Figure 46: Percentage of patients that are referred from other hospitals or admitted as emergencies to stroke units, 2007 - page 91
- Figure 47: Percentage of ischemic stroke patients treated by each healthcare professional, 2007 - page 93
- Figure 48: Stroke patients receiving initial drug therapy in the ambulance or emergency room, 2007 - page 95
- Figure 49: Ischemic stroke patients treated with acute drug therapy, 2007 - page 98
- Figure 50: Ischemic stroke patients treated in the post-acute phase, 2007 - page 99
- Figure 51: Ischemic stroke patients receiving specified thrombolytic (%), 2007 - page 104
- Figure 52: Hemorrhagic stroke patients receiving each specified therapy, 2007 - page 107
- Figure 53: Hemorrhagic stroke patients undergoing surgery, 2007 - page 108
- Figure 54: Hemorrhagic stroke patients undergoing the specified surgical procedures, 2007 - page 109
- Figure 55: Average length of hospital stay, 2007 - page 112
- Figure 56: Stroke patients who die before receiving medical attention, 2007 - page 113
- Figure 57: Stroke patients who die in hospital, 2007 - page 114
- Figure 58: Level of recovery achieved by ischemic stroke patients, 2007 - page 115
- Figure 59: Hemorrhagic stroke patients making each type of recovery (%), 2007 - page 116
- Figure 60: Stroke patients referred for rehabilitation, 2007 - page 117
- Figure 61: Stroke patients that go on to have recurrent stroke (%), 2007 - page 118
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