Joinvasc: Organizing the Full Cycle of Stroke Care with Universal Coverage

Diegoli, Henrique; Magalhães, Pedro; Makdisse, Márcia; Moro, Carla Heloísa Cabral; França, Paulo Henrique Condeixa de; Longo, Alexandre Luiz

doi:10.1056/cat.22.0283

Cited by 1 publication

(1 citation statement)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Joinville has a privileged position as the first city in Brazil with a Public Stroke Unit, founded in 1997, that served as a great stimulus for improving local stroke care through to the current date. The ongoing efforts made the JOINVASC initiative recently recognized as the best Community Stroke Program in the world, winning the VBHC (Value Based Healthcare) 2021 prize and considered a model for other similar initiatives inside the country and abroad ( 44 , 45 ). In other words, it is questionable whether the Joinville setting is indicative of most Brazilian contexts.…”

Section: Discussionmentioning

confidence: 99%

Stroke profile and care during the COVID-19 pandemic: What changed and what did not? A prospective cohort from Joinville, Brazil

Reis

Magalhães²,

Diegoli³

et al. 2023

Front. Neurol.

Self Cite

View full text Add to dashboard Cite

IntroductionThe COVID-19 pandemic has wrought negative consequences concerning quality of care for stroke patients since its onset. Prospective population-based data about stroke care in the pandemic are limited. This study aims to investigate the impact of COVID-19 pandemic on stroke profile and care in Joinville, Brazil.MethodsA prospective population-based cohort enrolled the first-ever cerebrovascular events in Joinville, Brazil, and a comparative analyzes was conducted between the first 12 months following COVID-19 restrictions (starting March 2020) and the 12 months just before. Patients with transient ischemic attack (TIA) or stroke had their profiles, incidences, subtypes, severity, access to reperfusion therapy, in-hospital stay, complementary investigation, and mortality compared.ResultsThe profiles of TIA/stroke patients in both periods were similar, with no differences in gender, age, severity, or comorbidities. There was a reduction in incidence of TIA (32.8%; p = 0.003). In both periods, intravenous thrombolysis (IV) and mechanical thrombectomy (MT) rates and intervals from door to IV/MT were similar. Patients with cardioembolic stroke and atrial fibrillation had their in-hospital stay abbreviated. The etiologic investigation was similar before and during the pandemic, but there were increases in cranial tomographies (p = 0.02), transthoracic echocardiograms (p = 0.001), chest X-rays (p < 0.001) and transcranial Doppler ultrasounds (p < 0.001). The number of cranial magnetic resonance imaging decreased in the pandemic. In-hospital mortality did not change.DiscussionThe COVID-19 pandemic is associated with a reduction in TIA, without any influence on stroke profile, the quality of stroke care, in-hospital investigation or mortality. Our findings show an effective response by the local stroke care system and offer convincing evidence that interdisciplinary efforts are the ideal approach to avoiding the COVID-19 pandemic's negative effects, even with scarce resources.

show abstract

Section: Discussionmentioning

confidence: 99%