Características de las unidades de ictus y equipos de ictus en España en el año 2018. Proyecto Pre2Ictus

Leciñana, María Alonso de; Morales, A.; Martínez-Zabaleta, Maite; Ayo-Martín, Óscar; Lizán, Luís; Ictus, Geecv-Sen en representación de los investigadores del Proyecto

doi:10.1016/j.nrl.2020.06.012

Cited by 10 publications

(5 citation statements)

References 20 publications

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“…All communities have developed organisational models for stroke care according to their particular characteristics and needs, aiming to provide optimal treatment to each patient and equity in terms of access to the best diagnostic and therapeutic resources, including management in SUs. 10 Although the number of available SUs and the population-adjusted rate of SU beds differ by community, most patients with acute stroke are treated in these facilities and, therefore, data from these units during the first pandemic peak could reflect the impact of COVID-19 on stroke care in Spain. The number of inhabitants and population density vary by community, which might account for the differences in the pandemic's impact among regions.…”

Section: Settingmentioning

confidence: 99%

Stroke care during the COVID-19 outbreak in Spain: the experience of Spanish stroke units

2020

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Background and purposeSpain has been heavily affected by COVID-19. Reallocation of resources for managing the outbreak might have caused a disruption in stroke care. This study analyses the impact on stroke care of reorganising the healthcare system in response to the first COVID-19 outbreak peak in Spain and the strategies adopted by Spanish stroke units to deal with this impact.Materials and methodsWe obtained data from a structured survey sent to the responsible of stroke units across the country. We recorded the number of strokes, stroke code activations, intravenous thrombolysis treatments and mechanical thrombectomies during February and March 2019 and 2020. We also collected information on the impact on workflow metrics and on the availability of specialised neurological care and rehabilitation treatments, the characteristics of stroke care for patients with SARS-CoV-2 infection and the impact on human resources. We compared the activity data between 2019 and 2020 and the information on activity and impact on stroke care between regions classified according to the disease incidence rate.ResultsFifty-seven (75%) of all stroke units in Spain responded to the survey. There was an overall reduction in admissions for all stroke types during the outbreak’s peak and in the number of stroke code activations and intravenous thrombolysis treatments, results that were independent of the COVID-19 incidence rate. Participants reported a delay in workflow metrics and a reduction of admissions to stroke units, outpatient clinics and rehabilitation therapies. Specific pathways and protocols for managing stroke patients with SARS-CoV-2 infection have been established.ConclusionThe COVID-19 outbreak has jeopardised all phases of stroke care. As a consequence, some patients with stroke did not receive adequate treatment.

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Section: Settingmentioning

confidence: 99%

Stroke care during the COVID-19 outbreak in Spain: the experience of Spanish stroke units

2020

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“…6 For example, although significant improvements have been made in the amount of resource allocation for stroke unit creation in Spain, stroke units tend to be concentrated in highly populated areas, so that autonomous regions like Madrid, Catalunya, and the Vasque Country have significantly more stroke units, while poorer but more extensive areas, such as Andalucia have less stroke units, making access for the population in this area more difficult. 26 French data indicate that only 50% of stroke patients are treated in stroke units, 27 while 73% of patients with Finnish who live within a specific catchment area of a stroke unit are treated in stroke units, compared with only 9% of patients treated in stroke units when they live outside a catchment area. 28 These findings suggest large within-country and national variations in the quality and accessibility of stroke treatment.…”

Section: Discussionmentioning

confidence: 99%

Burden of Stroke in Europe: An Analysis of the Global Burden of Disease Study Findings From 2010 to 2019

Prendes,

Rantner,

Hamwi

et al. 2024

Stroke

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BACKGROUND: While most European Regions perform well in global comparisons, large discrepancies within stroke epidemiological parameters exist across Europe. The objective of this analysis was to evaluate the stroke burden across European regions and countries in 2019 and its difference to 2010. METHODS: The GBD 2019 analytical tools were used to evaluate regional and country-specific estimates of incidence, prevalence, deaths, and disability-adjusted life years of stroke for the European Region as defined by the World Health Organization, with its 53 member countries (EU-53) and for European Union as defined in 2019, with its 28 member countries (EU-28), between 2010 and 2019. Results were analyzed at a regional, subregional, and country level. RESULTS: In EU-53, the absolute number of incident and prevalent strokes increased by 2% (uncertainty interval [UI], 0%–4%), from 1 767 280 to 1 802 559 new cases, and by 4% (UI, 3%–5%) between 2010 and 2019, respectively. In EU-28, the absolute number of prevalent strokes and stroke-related deaths increased by 4% (UI, 2%–5%) and by 6% (UI, 1%–10%), respectively. All-stroke age-standardized mortality rates, however, decreased by 18% (UI, −22% to −14%), from 82 to 67 per 100 000 people in the EU-53, and by 15% (UI, −18% to −11%), from 49.3 to 42.0 per 100 000 people in EU-28. Despite most countries presenting reductions in age-adjusted incidence, prevalence, mortality, and disability-adjusted life year rates, these rates remained 1.4×, 1.2×, 1.6×, and 1.7× higher in EU-53 in comparison to the EU-28. CONCLUSIONS: EU-53 showed a 2% increase in incident strokes, while they remained stable in EU-28. Age-standardized rates were consistently lower for all-stroke burden parameters in EU-28 in comparison to EU-53, and huge discrepancies in incidence, prevalence, mortality, and disability-adjusted life-year rates were observed between individual countries.

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“…Research on the impact of the National Stroke Care Strategy has primarily focused on monitoring healthcare processes, 9 case studies, 10 narrative descriptions of clinicians’ responses within care guidance and epidemiological studies on the evolution of the health determinants of stroke. 11 Still, there has yet to be an assessment of variations in hospitals’ outcomes in a period that has witnessed substantial policy and organisational changes in treating AIS.…”

Section: Introductionmentioning

confidence: 99%

Differences in acute ischaemic stroke in-hospital mortality across referral stroke hospitals in Spain: a retrospective, longitudinal observational study

2023

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ObjectiveTo assess differences in acute ischaemic stroke (AIS) in-hospital mortality between referral stroke hospitals and provide evidence on the association of those differences with the overtime adoption of effective reperfusion therapies.DesignRetrospective, longitudinal observational study using administrative data for virtually all hospital admissions from 2003 to 2015.SettingThirty-seven referral stroke hospitals in the Spanish National Health System.ParticipantsPatients aged 18 years and older with a hospital episode with an admission diagnosis of AIS in any referral stroke hospital (196 099 admissions).Main endpoints(1) Hospital variation in 30-day in-hospital mortality measured in terms of the intraclass correlation coefficient (ICC); and (2) the difference in mortality between the hospital of treatment and the trend of utilisation of reperfusion therapies (including intravenous fibrinolysis and endovascular mechanical thrombectomy) in terms of median OR (MOR).ResultsAdjusted 30-day AIS in-hospital mortality decreased over the study period. Adjusted in-hospital mortality after AIS rates varied from 6.66% to 16.01% between hospitals. Beyond differences in patient characteristics, the relative contribution of the hospital of treatment was higher in the case of patients undergoing reperfusion therapies (ICC=0.031 (95% Bayesian credible interval (BCI)=0.017 to 0.057)) than in the case of those who did not (ICC=0.016 (95% BCI=0.010 to 0.026)). Using the MOR, the difference in risk of death was as high as 46% between the hospital with the highest risk and the hospital with the lowest risk of patients undergoing reperfusion therapy (MOR 1.46 (95% BCI 1.32 to 1.68)); in patients not undergoing any reperfusion therapy, the risk was 31% higher (MOR 1.31 (95% BCI 1.24 to 1.41)).ConclusionsIn the referral stroke hospitals of the Spanish National Health System, the overall adjusted in-hospital mortality decreased between 2003 and 2015. However, between-hospital variations in mortality persisted.

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Características de las unidades de ictus y equipos de ictus en España en el año 2018. Proyecto Pre2Ictus

Cited by 10 publications

References 20 publications

Stroke care during the COVID-19 outbreak in Spain: the experience of Spanish stroke units

Stroke care during the COVID-19 outbreak in Spain: the experience of Spanish stroke units

Burden of Stroke in Europe: An Analysis of the Global Burden of Disease Study Findings From 2010 to 2019

Differences in acute ischaemic stroke in-hospital mortality across referral stroke hospitals in Spain: a retrospective, longitudinal observational study

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