Hospital service for ischemic stroke patients in Brazilian countryside: are we still in the ‘80s?

Abstract

Background Stroke is one of the most common causes of death and incapacity in the world. The benefits of reperfusion therapies and hospitalization in neurologic intensive care units (ICUs) are undeniable. However, these treatments are not widely available in a continental-sized country like Brazil. Objective To describe the treatment for ischemic stroke and the functional outcome 90 days after the hospitalization of patients in the Brazilian countryside. Methods Observational, prospective case series study design. The data collected refer to randomly selected patients hospitalized in 3 hospitals in the south region of the state of Bahia between December 2018 and December 2019. Results The population consisted of 61 consecutive patients. They were elderly (median age: 62 years old); with a predominance of hypertension (82%); and were light to moderate stroke cases (National Institute of Health Stroke Scale [NIHSS] median: 7). A total of 37.7% of the cases arrived at the hospital in a < 4.5-hour window but received no reperfusion therapy. Of these, 94.3% were discharged from the hospital with a prescription for antiplatelets or anticoagulant. A total of 64.1% of the patients received a statin prescription. At the end of the follow-up period, the general mortality was 21%. Almost half of the population (47.9%) evolved to an unfavored outcome (modified Rankin scale [mRs]: 3 to 6). Conclusion Our population presented sociodemographic and comorbidities characteristics similar to those of other national samples. No reperfusion therapy was used and the treatment was basically secondary and prophylaxis-oriented, and almost half of the population evolved with incapacities and a high mortality rate, despite the initial low clinical gravity.

Length of Hospitalization and Mortality among Stroke Patients before and after the Implementation of a Specialized Unit: A Retrospective Cohort Study Using Real-World Data from One Reference Hospital in Southern Brazil

“…Research consistently shows that providing rehabilitation plans upon hospital discharge for stroke patients significantly enhances their quality of life, reduces the likelihood of sequelae, and decreases readmission rates, along with in-hospital and late clinical complications [30,32,36,37]. A study conducted in Bahia highlighted the limited availability of comprehensive stroke care in most Brazilian hospitals, with only secondary and prophylactic treatments provided due to the unavailability of thrombolysis and thrombectomy, despite their regulation by the SUS [38]. Additionally, patients admitted for AIS to HNSC in pre-and post-SU implementation differed regarding various comorbidities and sex distribution.…”

Mortalidade hospitalar por AVC isquêmico no município de Bacabal - MA entre 2010 e 2021: Estudo epidemiológico

“…O acidente vascular cerebral (AVC) é uma condição médica grave e uma das principais causas de morte e incapacidade em todo o mundo. Estima-se que até 30% dos indivíduos afetados evoluam para óbito nos primeiros 30 dias após o evento, e mais da metade dos sobreviventes enfrentem algum tipo de sequela (Junior et al, 2022;Lopes et al, 2023;Scavasine et al, 2023). No contexto do município de Bacabal -MA, a mortalidade hospitalar por AVC isquêmico tem sido uma preocupação devido à gravidade e às consequências debilitantes dessa condição.…”