Stroke is clearly one of the most major health issues in our time. It is the second most common cause of death worldwide and a leading cause of adult disability in developed countries. Stroke is of particular concern in New Zealand (NZ), where the overall rate of decline is about four times slower than that in other developed countries [1, 2]. Further, the incidence for Māori and Pacific Islanders is similar to that in developing countries . Reasons for these differences remain unclear but are a matter of great importance as stroke is a leading cause of disability in our community, and older people (the most stroke-prone age group) constitute the fastest-growing segment of the NZ population. In addition, stroke recurrence rate in NZ is high and has not changed over the last 30 years , indicating the urgent need for the clinical testing and implementation of improved secondary stroke prevention strategies in the community.
In this issue of the International Journal of Stroke, the methodologies of three interrelated studies currently being undertaken in NZ as parts of the Health Research Council of New Zealand funded 5-year research Programme ‘ARCOS IV: Measuring and Reducing Stroke Burden in New Zealand’ are presented in detail. The program will provide clinicians and policy makers with: (a) the most reliable population-based data on the current and future burden of stroke in NZ; (b) accurate population-based data regarding how best to reduce its burden through secondary stroke prevention; and (c) novel data on recovery and adaptation given our inclusion of a qualitative sub-study exploring strategies people find most helpful in living well after stroke.
This unique population-based approach will allow the examination of trends in stroke incidence, prevalence and outcomes in NZ for a fourth consecutive decade; analysis of the effectiveness of primary and secondary prevention strategies adopted over the last 30 years; and the evaluation of a novel, potentially widely applicable behavioral intervention to reduce stroke recurrence. This 5-year program (2010–2015) with the five inter-linked objectives was built on our three previous HRC-funded Auckland Regional Community Stroke (ARCOS 1981–2003) studies and other stroke-related research carried out by our team. It utilizes three distinct study designs to provide a multi-perspective evidence-base to measure and reduce stroke burden in NZ: (a) quantitative non-experimental component ; (b) qualitative non-experimental component ; and (c) clinical experimental component . All these studies are population-based, and share the same logistics for participant recruitment as well as many common outcome measures, thus enabling substantial synergies and ‘added value’ from the data. Although the papers here present three separate program components, data from each component will inform the interpretation of the overall program.
While published guidelines and protocols for ideal stroke incidence and outcomes studies and clinical trials are well established, in this issue our goal is to provide the reader with practical input about the day-to-day application of these guidelines. Looking at the program as a whole we hope to provide a context from which to view how epidemiological, outcomes, or trials work might fit within a larger and more integrated framework. Within each individual study, our intention is to provide a more detailed account to the reader of how the existing guidelines have been applied. This is by providing more detailed information on how processes such as recruitment and data management were conducted, and identifying issues which became apparent during the day-to-day running of each component and how these were addressed. We are aware of the need for, and hopeful our program will point towards, new opportunities for evaluating etiological causes of ethnic disparities in the risk of stroke occurrence and reducing these disparities with clinical testing of best, culturally appropriate strategies for primary stroke prevention, and management, in NZ.