Initial Establishment of a Stroke Management Model in China: 10 Years (2011–2020) of Stroke Prevention Project Committee, National Health Commission
Introduction
Stroke remains a leading cause of death and disability in China, characterized by high recurrence, disability, and mortality rates. According to the Report on Nutrition and Chronic Disease Status of Chinese Residents (2020), chronic diseases account for 88.5% of total deaths, with stroke ranking as the primary cause. The lifetime risk of stroke for individuals aged 25 and above in China is 39.3%, significantly higher than the global average of 25%. In 2013, China recorded 11 million prevalent stroke cases, 2.4 million new cases, and 1.1 million stroke-related deaths annually. Compounding this burden is the trend of younger stroke onset, with the average age of patients below 60 years, posing profound challenges to public health and socioeconomic stability.
To address these challenges, the Stroke Prevention Project Committee (CSPPC) under the National Health Commission was established in April 2011. Over the subsequent decade, the CSPPC spearheaded nationwide initiatives to develop a structured, multi-tiered stroke prevention and treatment model. This article comprehensively reviews the strategies, achievements, and future directions of China’s stroke management framework during this period.
National Strategy and Policy Integration
The CSPPC introduced a 32-word prevention and control strategy in 2010, emphasizing “prevention first, early intervention, population stratification, comprehensive management of high-risk groups, and hierarchical diagnosis and treatment.” This strategy prioritized risk factor screening, acute care optimization, and post-stroke rehabilitation, aligning with the broader national health agenda. The Chinese government integrated stroke prevention into the Healthy China 2030 initiative, elevating stroke management to a national priority.
Between 2011 and 2020, the CSPPC implemented the Technical Program for Screening and Comprehensive Intervention for High-Risk Stroke Populations across 245 cities in 31 provinces, covering over 2% of the target population. A three-tiered healthcare network was established, comprising 562 tertiary hospitals, 990 secondary hospitals, and over 1,000 primary community clinics. This network facilitated coordinated care across urban and rural regions, ensuring accessibility to stroke prevention and treatment services.
Innovations in Stroke Prevention and Treatment Systems
The CSPPC pioneered a stratified stroke management model, integrating government leadership, medical institutions, and public health agencies. This model emphasized three phases:
- Pre-hospital phase: Screening high-risk populations and providing emergency care for acute stroke.
- In-hospital phase: Multidisciplinary collaboration for diagnosis and treatment.
- Post-hospital phase: Long-term follow-up and rehabilitation.
By 2020, 325 base hospitals and 380 certified stroke centers formed the backbone of this system. These centers adopted a patient-centered approach, reducing interdisciplinary collaboration costs and improving care efficiency. The median door-to-needle time (DNT) for thrombolysis in advanced stroke centers dropped to 41 minutes, comparable to international standards.
Advancements in Treatment Technologies
The decade witnessed exponential growth in stroke intervention technologies:
- Intravenous thrombolysis increased by 36.8 times compared to 2010.
- Carotid endarterectomy (CEA) and carotid artery stenting (CAS) surged by 31.7 times and 32.1 times, respectively.
- Endovascular thrombectomy procedures rose 19.6-fold since 2015.
Hospitals capable of performing CEA expanded by 9.7 times, while stroke centers reported 50% fewer complications and 30% lower 3-month disability rates compared to non-certified facilities. These advancements significantly improved patient outcomes, with thrombolysis rates in stroke centers doubling national averages.
Stroke Emergency Response Systems
In 2017, the CSPPC launched the China Stroke First Aid Map and the “1-1-1” Golden Rescue Circle, aiming to streamline emergency care:
- 1 hour from symptom onset to emergency call.
- 1 hour for pre-hospital transportation.
- 1 hour for in-hospital DNT.
By 2020, over 1,700 medical institutions and emergency centers in 26 provinces participated in this network. The initiative improved acute stroke management, particularly in rural and underserved areas.
Big Data and Economic Impact
The CSPPC established the Bigdata Observatory Platform for Stroke of China (BOSC), aggregating data from 12.23 million individuals screened for stroke risk factors. Key metrics included:
- 2.235 million high-risk individuals identified.
- 3.935 million follow-up records for intervention tracking.
- 1 million clinical records from 1,500 stroke centers, encompassing thrombolysis, thrombectomy, and surgical data.
Economically, the CSPPC’s initiatives averted 59,000 potential strokes between 2011 and 2020, saving 4.72 billion CNY in direct medical costs. With a government investment of 1.38 billion CNY, the program demonstrated a favorable cost-benefit ratio, highlighting its sustainability and scalability.
Future Directions
Despite progress, challenges persist due to population aging, rising chronic disease prevalence, and regional healthcare disparities. The CSPPC outlined strategic priorities for 2021–2030:
- Regional System Enhancement: Expand the “Stroke Recognition Action in Thousands of Counties and Ten Thousand Towns” to improve rural healthcare access.
- Stroke Center Expansion: Certify stroke centers in all counties with populations exceeding 300,000 by 2022, ensuring thrombolysis availability in secondary hospitals.
- Talent Development: Strengthen training programs for stroke specialists and emergency responders, particularly in western China.
- Public Health Integration: Leverage traditional Chinese medicine for preventive care and enhance public awareness of stroke risk factors.
Conclusion
Over the past decade, China’s stroke management model has achieved remarkable progress through policy innovation, technological advancement, and systemic integration. The CSPPC’s efforts reduced stroke incidence, improved treatment outcomes, and alleviated economic burdens. However, sustained success requires addressing demographic shifts, chronic disease management, and healthcare inequities. By advancing regional networks, stroke center certification, and public health education, China is poised to further mitigate the stroke burden and achieve its Healthy China 2030 objectives.
DOI: 10.1097/CM9.0000000000001856
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