Concentrating stroke care provision in the Czech Republic: The establishment of Stroke Centres in 2011 has led to improved outcomes

Bryndová, Lucie; Bar, Michal; Herzig, Roman; Mikulík, Robert; Neumann, Jiří; Šaňák, Daniel; Škoda, Ondřej; Školoudík, David; Václavík, Daniel; Tomek, Aleš

doi:10.1016/j.healthpol.2021.01.011

Cited by 14 publications

(13 citation statements)

References 16 publications

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“…In 2005, results from a third population-based stroke registry in Estonia indicated a decline in stroke incidence and 28-day case fatality rates starting from the preceding decade [12]. The Czech Republic was also very consistent in the development of a national stroke plan [14,15], stroke prevention [15,16], case registering [17,18], and effective stroke management [19][20][21][22][23][24]. A noticeable stroke burden decline was also found in Slovenia and Hungary [25,26].…”

Section: Discussionmentioning

confidence: 99%

Trends in Stroke Burden in Central and Eastern Europe from 1990–2019

Докова

Feigin

2022

Neuroepidemiology

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Introduction: There has been wide recognition of the health divide between Western Europe and the former socialist countries from Central and Eastern Europe. However, these have not been assessed in terms of burden of disease, and the effect of stroke has not been fully elucidated, especially in terms of time trends. Methods: The West-Eastern European stroke burden was analysed using data from the Global Burden of Stroke (GBD) Study 2019 in terms of disability-adjusted life years lost (DALYs) and years of life lost (YLL) over the period 1990–2019 by gender. Data were extracted on a regional (West, Central, and East Europe) and country level for the twenty former socialist countries from Central and East Europe according to GBD regional definitions. We focused on the trends of age-standardized stroke DALY rates across the three decades and compared them with the average rates for West Europe. Main Findings: All Central and East European countries experienced a decline in all-cause disease burden between 1990 and 2019, and a gap was confirmed between the East, the Central, and the West European region for men but not for women. The age-standardized stroke DALY rates declined in the three European regions and in all twenty Central and East European countries but at a different pace. The stroke DALY rates among women exhibited the greatest decline in the West −59% (95% UI [−60; −57]) followed by the Central European region −48% (95% UI [−53; −42]) and lowest among women in East Europe −37% (95% UI [−43; −29]). The decline in men was even higher than among women −61% (95% UI [−63; −60]), while in Central Europe it was −43% (95% UI [−50; −37]) and in the East −25% (95% UI [−34; −14]), leading to widening of the gap between East, Central, and West Europe in relation to stroke burden. YLL represented more than 70% of stroke DALYs and more than 90% of DALYs for men in East European countries. Conclusions: The burden of stroke contributes to the European health gap through preventable premature stroke deaths. There are some very successful countries in stroke burden management from both Central (Slovenia, Czech Republic, and Hungary) and East Europe (Estonia), suggesting that closing the health gap between East and West is a realistic aim.

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Section: Discussionmentioning

confidence: 99%

Trends in Stroke Burden in Central and Eastern Europe from 1990–2019

Докова

Feigin

2022

Neuroepidemiology

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“…Collection of all information on patients treated with thrombolysis and thrombectomy became standard practice in 2004 and was further reinforced by certification of stroke centers in 2011 by the Ministry of Health, which demanded collection of stroke cases in a registry as part of service assessment. 9 Because there are no competing registries, all cases have always been collected in a single registry. A detailed description of the development of national stroke services in the Czech Republic, interventions to shorten DNT and time trends of DNT, and yearly thrombolytic rates were published.…”

Section: Methodsmentioning

confidence: 99%

Ultrashort Door‐to‐Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019

Mikulík

Bar

Bělašková

et al. 2022

JAHA

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Background The benefit of intravenous thrombolysis is time dependent. It remains unclear, however, whether dramatic shortening of door‐to‐needle time (DNT) among different types of hospitals nationwide does not compromise safety and still improves outcome. Methods and Results Multifaceted intervention to shorten DNT was introduced at a national level, and prospectively collected data from a registry between 2004 and 2019 were analyzed. Generalized estimating equation was used to identify the association between DNT and outcomes independently from prespecified baseline variables. The primary outcome was modified Rankin score 0 to 1 at 3 months, and secondary outcomes were parenchymal hemorrhage/intracerebral hemorrhage (ICH), any ICH, and death. Of 31 316 patients treated with intravenous thrombolysis alone, 18 861 (60%) had available data: age 70±13 years, National Institutes of Health Stroke Scale at baseline (median, 8; interquartile range, 5–14), and 45% men. DNT groups 0 to 20 minutes, 21 to 40 minutes, 41 to 60 minutes, and >60 minutes had 3536 (19%), 5333 (28%), 4856 (26%), and 5136 (27%) patients. National median DNT dropped from 74 minutes in 2004 to 22 minutes in 2019. Shorter DNT had proportional benefit: it increased the odds of achieving modified Rankin score 0 to 1 and decreased the odds of parenchymal hemorrhage/ICH, any ICH, and mortality. Patients with DNT ≤20 minutes, 21 to 40 minutes, and 41 to 60 minutes as compared with DNT >60 minutes had adjusted odds ratios for modified Rankin score 0 to 1 of the following: 1.30 (95% CI, 1.12–1.51), 1.33 (95% CI, 1.15–1.54), and 1.15 (95% CI, 1.02–1.29), and for parenchymal hemorrhage/ICH: 0.57 (95% CI, 0.45–0.71), 0.76 (95% CI, 0.61–0.94), 0.83 (95% CI, 0.70–0.99), respectively. Conclusions Ultrashort initiation of thrombolysis is feasible, improves outcome, and makes treatments safer because of fewer intracerebral hemorrhages. Stroke management should be optimized to initiate thrombolysis as soon as possible optimally within 20 minutes from arrival to a hospital.

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“…Similarly to Poland, Czechia has also sought to concentrate provision of highly specialized care. Between 2008 and 2011, dedicated care networks for cancer, stroke, and cardiovascular disease patients were established, mainly covering specialist inpatient care ( 24 , 25 ), and these have been further improved over the past decade. For example, Regional Oncology Groups were set up in 2017 to improve provision of cancer care, and the previously established Comprehensive Oncology Centers were charged with coordinating the full spectrum of cancer care within their regional group, including palliative care and home care services.…”

Section: Efforts To Strengthen Primary Carementioning

confidence: 99%

What is being done to respond to the rise of chronic diseases and multi-morbidity in Czechia, Hungary, Poland, and Slovakia?

Sagan

Kowalska-Bobko

Bryndová

et al. 2023

Front. Public Health

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Although countries in central and eastern Europe (CEE) have relatively younger populations compared to the West, their populations are often affected by higher prevalence of chronic conditions and multi-morbidity and this burden will likely increase as their populations age. Relatively little is known about how these countries cater to the needs of complex patients. This Perspective piece identifies key initiatives to improve coordination of care in Czechia, Hungary, Poland, and Slovakia, including some pioneering and far-reaching approaches. Unfortunately, some of them have failed to be implemented, but a recent strategic commitment to care coordination in some of these countries and the dedication to rebuilding stronger health systems after the COVID-19 pandemic offer an opportunity to take stock of these past and ongoing experiences and push for more progress in this area.

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Concentrating stroke care provision in the Czech Republic: The establishment of Stroke Centres in 2011 has led to improved outcomes

Cited by 14 publications

References 16 publications

Trends in Stroke Burden in Central and Eastern Europe from 1990–2019

Trends in Stroke Burden in Central and Eastern Europe from 1990–2019

Ultrashort Door‐to‐Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019

What is being done to respond to the rise of chronic diseases and multi-morbidity in Czechia, Hungary, Poland, and Slovakia?

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