Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries

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Abstract

Introduction

Acute stroke unit care, intravenous thrombolysis and endovascular treatment significantly improve the outcome for patients with ischaemic stroke, but data on access and delivery throughout Europe are lacking. We assessed best available data on access and delivery of acute stroke unit care, intravenous thrombolysis and endovascular treatment throughout Europe.

Methods

A survey, drafted by stroke professionals (ESO, ESMINT, EAN) and a patient organisation (SAFE), was sent to national stroke societies and experts in 51 European countries (World Health Organization definition) requesting experts to provide national data on stroke unit, intravenous thrombolysis and endovascular treatment rates. We compared both pooled and individual national data per one million inhabitants and per 1000 annual incident ischaemic strokes with highest country rates. Population estimates were based on United Nations data, stroke incidences on the Global Burden of Disease Report.

Results

We obtained data from 44 European countries. The estimated mean number of stroke units was 2.9 per million inhabitants (95% CI 2.3–3.6) and 1.5 per 1000 annual incident strokes (95% CI 1.1–1.9), highest country rates were 9.2 and 5.8. Intravenous thrombolysis was provided in 42/44 countries. The estimated mean annual number of intravenous thrombolysis was 142.0 per million inhabitants (95% CI 107.4–176.7) and 72.7 per 1000 annual incident strokes (95% CI 54.2–91.2), highest country rates were 412.2 and 205.5. Endovascular treatment was provided in 40/44 countries. The estimated mean annual number of endovascular treatments was 37.1 per million inhabitants (95% CI 26.7–47.5) and 19.3 per 1000 annual incident strokes (95% CI 13.5–25.1), highest country rates were 111.5 and 55.9. Overall, 7.3% of incident ischaemic stroke patients received intravenous thrombolysis (95% CI 5.4–9.1) and 1.9% received endovascular treatment (95% CI 1.3–2.5), highest country rates were 20.6% and 5.6%.

Conclusion

We observed major inequalities in acute stroke treatment between and within 44 European countries. Our data will assist decision makers implementing tailored stroke care programmes for reducing stroke-related morbidity and mortality in Europe.

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Most cited references 15

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Global Burden of Stroke.

Bo Norrving, George Mensah, Valery L. Feigin (2017)

On the basis of the GBD (Global Burden of Disease) 2013 Study, this article provides an overview of the global, regional, and country-specific burden of stroke by sex and age groups, including trends in stroke burden from 1990 to 2013, and outlines recommended measures to reduce stroke burden. It shows that although stroke incidence, prevalence, mortality, and disability-adjusted life-years rates tend to decline from 1990 to 2013, the overall stroke burden in terms of absolute number of people affected by, or who remained disabled from, stroke has increased across the globe in both men and women of all ages. This provides a strong argument that "business as usual" for primary stroke prevention is not sufficiently effective. Although prevention of stroke is a complex medical and political issue, there is strong evidence that substantial prevention of stroke is feasible in practice. The need to scale-up the primary prevention actions is urgent.

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Stroke incidence and prevalence in Europe: a review of available data.

B. Jozwiak, T Truelsen, John Mathers … (2006)

Reliable data on stroke incidence and prevalence are essential for calculating the burden of stroke and the planning of prevention and treatment of stroke patients. In the current study we have reviewed the published data from EU countries, Iceland, Norway, and Switzerland, and provide WHO estimates for stroke incidence and prevalence in these countries. Studies on stroke epidemiology published in peer-reviewed journals during the past 10 years were identified using Medline/PubMed searches, and reviewed using the structure of WHO's stroke component of the WHO InfoBase. WHO estimates for stroke incidence and prevalence for each country were calculated from routine mortality statistics. Rates from studies that met the 'ideal' criteria were compared with WHO's estimates. Forty-four incidence studies and 12 prevalence studies were identified. There were several methodological differences that hampered comparisons of data. WHO stroke estimates were in good agreement with results from 'ideal' stroke population studies. According to the WHO estimates the number of stroke events in these selected countries is likely to increase from 1.1 million per year in 2000 to more than 1.5 million per year in 2025 solely because of the demographic changes. Until better and more stroke studies are available, the WHO stroke estimates may provide the best data for understanding the stroke burden in countries where no stroke data currently exists. A standardized protocol for stroke surveillance is recommended.

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Stroke.

Charles Warlow, Cathie Sudlow, Martin Dennis … (2003)

Stroke is a major public-health burden worldwide. Prevention programmes are essential to reduce the incidence of stroke and to prevent the all but inevitable stroke epidemic, which will hit less developed countries particularly hard as their populations age and adopt lifestyles of the more developed countries. Efficient, effective, and rapid diagnosis of stroke and transient ischaemic attack is crucial. The diagnosis of the exact type and cause of stroke, which requires brain imaging as well as traditional clinical skills, is also important when it will influence management. The treatment of acute stroke, the prevention and management of the many complications of stroke, and the prevention of recurrent stroke and other serious vascular events are all improving rapidly. However, stroke management will only be most effective when delivered in the context of an organised, expert, educated, and enthusiastic stroke service that can react quickly to the needs of patients at all stages from onset to recovery.

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Author and article information

Journal

Journal ID (nlm-ta): Eur Stroke J

Journal ID (iso-abbrev): Eur Stroke J

Journal ID (publisher-id): ESO

Journal ID (hwp): speso

Title: European Stroke Journal

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 2396-9873

ISSN (Electronic): 2396-9881

Publication date (Electronic): 20 July 2018

Publication date (Print): March 2019

Volume: 4

Issue: 1

Pages: 13-28

Affiliations

[1 ]Department of Neurology, University of Lisbon, Hospital de Santa Maria, Lisbon, Portugal

[2 ]Department of Neurology, University of Bern, Inselspital, Bern, Switzerland

[3 ]Stroke Programme, Agency for Health Quality and Assessment of Catalonia, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

[4 ]Department of Neurology, Medical University of Graz, Graz, Austria

[5 ]Interventional Stroke and Cerebrovascular Disease Treatment Centre, Department of Neuroradiology, Institute of Psychiatry and Neurology, Warsaw, Poland

[6 ]Stroke Programme, Health Department of Catalonia, Spain

[7 ]National Institute of Clinical Neurosciences, Budapest, Hungary

[8 ]National Institute for Stroke & Applied Neurosciences, Auckland, New Zealand

[9 ]Stroke Unit, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy

Author notes

[*]

The authors contributed equally.

[†]

Details of the collaborators are given at the end of the article.

[*]Urs Fischer, Department of Neurology, University of Bern, Inselspital, Freiburgstrasse 10, Bern 3010, Switzerland. Email: urs.fischer@ 123456insel.ch

Author information

Diana Aguiar de Sousa https://orcid.org/0000-0002-6702-7924

Sònia Abilleira https://orcid.org/0000-0002-5587-128X

Article

Publisher ID: 10.1177_2396987318786023

DOI: 10.1177/2396987318786023

PMC ID: 6533860

PubMed ID: 31165091

SO-VID: 459e1d3a-c367-4a66-932a-afb7a2e6bdb5

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries

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Abstract

Introduction

Methods

Results

Conclusion

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Stroke MRI

Most cited references 15

Global Burden of Stroke.

Stroke incidence and prevalence in Europe: a review of available data.

Stroke.

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