Boehringer Ingelheim

Abstract 

Stroke is a major cardiovascular and cerebrovascular disease with a high morbidity rate in China. Epidemiologically, it is characterized by high incidence, mortality, and disability rates, with a noticeable trend toward younger onset. Pathologically, it is closely related to chronic cardio-renal-metabolic (CRM) diseases such as hypertension, diabetes, and hyperlipidemia. The progression of stroke not only results in physical, cognitive, and linguistic impairments but also necessitates longterm treatment and rehabilitation. This imposes a heavy caregiving and economic burden on families while exacerbating pressures on the healthcare system and public health expenditures. Therefore, stroke prevention and control are key issues affecting national health levels and the progress of public health initiatives.

Although China has been strengthening stroke prevention and treatment policies since 2011, the situation remains challenging due to an aging population and widespread exposure to chronic disease risk factors. Stroke continues to be a key issue in major chronic diseases management for Healthy China 2030 development. In recent years, China wrote stroke into the Outline of the Healthy China 2030 Plan and the Healthy China Initiative (2019–2030). A series of policy documents have been issued, including the Healthy China Initiatives: Implementation Plan for Cardiovascular and Cerebrovascular Disease Prevention and Treatment (2023– 2030). The policies laid a solid foundation, integrating stroke into national chronic disease management framework and making arrangements for full-chain prevention and treatment and system development. The Outline of the 15th Five-Year Plan (2026-2030) identifies “strengthening the comprehensive prevention and control of chronic diseases, developing full-chain services for prevention, treatment, rehabilitation and management, and improving systems for early screening, diagnosis and treatment” as some of the key priorities for the next five years, with further emphasis on the comprehensiveness of prevention and control efforts.

To enhance the implementation of national policies and address current challenges – such as insufficient synergy in chronic disease management, limited reach of public education, inconsistencies in emergency care systems, regional disparities in resources, and inadequate primary care capabilities – this paper suggests five key areas of improvement to build an integrated management system for stroke and CRM diseases:

● Integrate CRM disease co-management into the national chronic disease strategy to improve stroke prevention and treatment. Promote a shift from siloed prevention and control toward integrated management of stroke and CRM diseases. First, expand multi-disease joint screenings by leveraging existing initiatives to achieve full coverage of high‑risk populations across age groups and include core metabolic and early renal function tests in basic physical exams under the Basic Public Health Services. Second, establish a linked assessment mechanism, align risk assessment standards, and achieve early identification and early intervention for high-risk groups. Third, strengthen primary-level management, improve training for primary-level healthcare institutions, promote contract signing with family doctors, standardize treatment and management of CRM diseases, and control risk factors. The goal is to stop the chain of events leading to stroke and severe cardio-renal diseases at its root, achieve coordinated prevention and control of stroke and CRM diseases, and address their root causes together. 

● Strengthen public education and improve stroke awareness. Implement long-term and targeted education tailored to different ages, occupations, and health conditions. Use all media channels effectively and integrate medical expertise with media dissemination to improve public awareness of disease prevention and treatment, symptom recognition for emergency care and chronic disease management, and to enhance self-rescue/mutual aid capabilities for emergency. 

● Improve the coordination and standardization of emergency services. Improve standardized emergency care systems and foster coordinated stroke prevention and control services. Accelerate the development of unified national standards for the entire stroke emergency process, enhance regional Stroke Center networks, and create an integrated pathway connecting pre-hospital and in-hospital care. Improve primary-level stroke care capabilities by strengthening the “Stroke Emergency Map”, combining community physical maps and digital maps, precisely addressing gaps in primary-level emergency care capabilities, and improving equipment and professional training. 

● Implement the tiered medical system across the stroke care process. Integrate stroke prevention into the primary-level chronic disease management system and implement tiered medical system. Establish a cerebrovascular disease alliance led by advanced stroke centers and base hospitals and participated by primary-level healthcare institutions to deliver tiered medical care across the full chain of screening, emergency care, diagnosis, treatment, and rehabilitation. 

● Encourage local pilot programs and promote pilot experience to improve stroke care at the city and county levels. Based on the sixth batch of National Demonstration Zones for Comprehensive Chronic Disease Prevention and Control, select cities and counties with strong foundations, high digitalization and strong reform willingness to pilot integrated stroke and chronic disease management. Make bold explorations and innovative breakthroughs in key stroke care areas to establish successful models. The central government should provide policy guidance, funding and technical support for pilot areas, establish regular tracking and evaluation mechanisms, and summarize replicable experience and standard practices. Pilot programs can then be promoted nationwide to enhance the overall prevention and control at city and county levels and to lay a foundation for improving national policies.

Download the full report：Advance Stroke Prevention and Treatment Policies & Explore a New Pathway for Integrated Chronic Disease Co-Management