Innovation in Systems of Care in Acute Phase of Ischemic Stroke. The Experience of the Catalan Stroke Programme

Abstract

Stroke, and mainly ischemic stroke, is the second cause of death and disability. To confront the huge burden of this disease, innovative stroke systems of care are mandatory. This requires the development of national stroke plans to offer the best treatment to all patients eligible for reperfusion therapies. Key elements for success include a high level of organization, close cooperation with emergency medical services for prehospital assessment, an understanding of stroke singularity, the development of preassessment tools, a high level of commitment of all stroke teams at Stroke Centres, the availability of a disease-specific registry, and local government involvement to establish stroke care as a priority. In this mini review, we discuss recent evidence concerning different aspects of stroke systems of care and describe the success of the Catalan Stroke Programme as an example of innovation. In Catalonia, reperfusion treatment rates have increased in recent years and currently are among the highest in Europe (17.3% overall, 14.3% for IVT, and 6% for EVT in 2016).

A Visual Task Management Application for Acute Ischemic Stroke Care

“…In line with previous reports (5–10), this study confirms that the most effective factor that leads to a reduction in certain processing times in AIS care is the use of a CS algorithm itself. However, we show that the use of TCS in combination with a CS system has an additional time-saving effect.…”

“…In a stroke center, many tasks need to be performed across multiple departments in order to quickly decide on the therapeutic indication for IV-tPA or EVT (3, 4). The key concept in fast treatment is the paradigm of parallel (rather than serial) diagnostic evaluation, assessment, and treatment (7–9), which requires a high commitment among all stroke team members in the organizational structure (10).…”

Real-World Treatment Trends in Endovascular Stroke Therapy

“…Stroke systems of care across the globe are currently faced with the challenge of developing the best methods to triage patients with large vessel occlusions to ensure that eligible patients have access to EST [19][20][21] . A wide range of solutions have been proposed, with some supporting a massive expansion in the number of EST-capable hospitals and providers to increase the number of local and community centers that can provide these services 22 .…”

Transfer to the Local Stroke Center versus Direct Transfer to Endovascular Center of Acute Stroke Patients with Suspected Large Vessel Occlusion in the Catalan Territory (RACECAT): Study protocol of a cluster randomized within a cohort trial

“…The RACECAT study is being performed in the autonomous region of Catalonia, with the participation of EMS and all the stroke centers: six EVT-SC and 19 local stroke centers (local-SC), seven of them primary stroke centers and 12 telestroke centers. 9…”

“… Stroke patients with suspected LVO identified by a RACE scale 9 score > 4 evaluated by EMS professionals previous to the transfer to a stroke center: at the pre-hospital setting, in non-stroke ready centers or primary healthcare centers. Patients located in geographical areas where the reference stroke center is a hospital not capable to offer EVT (primary stroke center or telestroke center). Estimated arrival time to an EVT-SC < 7 h from symptom onset. Symptom onset is defined as the time in which the patient was last seen well. No significant pre-stroke functional disability (modified Rankin scale (mRS) 0–2). Age ≥ 18. Deferred informed consent obtained from patient or acceptable patient surrogate (after the acute phase, as permission to use clinical data within a clinical registry was approved by the ethics committee). Exclusion criteria: Patients in a coma (National Institutes of Health Stroke Scale (NIHSS) item of consciousness > 1). Patients with unstable clinical status who require emergent life support care. Serious, advanced, or terminal illness with anticipated life expectancy of less than six months. Acute stroke patients with suspected LVO identified at the Emergency Department of a stroke center. Subjects participating in a study involving an investigational drug or device if it is believed that participation in such a study would impact the results of this study. Patients with a pre-existing neurological or psychiatric disease that would impair the neurological or functional evaluation. Unlikely to be available for 90-day follow-up (e.g.…”