Nationwide “Hospital Emergent Capability Accreditation by Level-Stroke” Improves Stroke Treatment in Taiwan

Abstract

Background and Purpose Recombinant tissue plasminogen activator (rtPA) is one of the proven therapies that improve the outcome of patients with acute ischemic stroke (AIS). In 2009, the Ministry of Health and Welfare, Executive Yuan, Republic of China, launched the project “Hospital Emergent Capability Accreditation by Level-Stroke (HECAL-Stroke)” to improve AIS treatment in Taiwan. The current study was performed to determine whether the project launched by the government was effective in promoting rtPA therapy among AIS patients. Methods All participating hospitals were verified and designated as “heavy duty (HD),” “moderate duty (MoD),” or “medium duty (MeD)” according to the stroke center criteria. Four annual indices (rates of treatment, protocol adherence, in-time treatment, and complications) were recorded from 2009 to 2014 as outcome measures. The data were analyzed using the χ2 test for significance. Results The number of certified hospitals progressively increased from 74 to 112 during the 6-year period and finally consisted of 33 HD, 9 MoD and 70 MeD hospitals in 2014. The annual intravenous rtPA treatment rate increased significantly from 3.0% in 2009 to 4.5% in 2014. The protocol adherence rates were 95.7% in the HD group, 92.4% in the MoD group and 72.8% in the MeD group. The annual in-time treatment rate significantly improved from 26.0% in 2009 to 60.1% in 2014. The overall symptomatic intracranial hemorrhagic rate after rtPA treatment was 8.6%. Conclusions Initiation of the HECAL-Stroke project by the government significantly improved rtPA treatment in Taiwan.

The impact of a comprehensive national policy on improving acute stroke patient care in Lithuania

“…27 However, hospital admission rates for AIS in Lithuania in 2019 were still high despite an obvious downward trend from the highest stroke incidence worldwide in 2010. 2,28 Ample previous studies have shown a continuous increase in IV rtPA 26,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] and EVT rates for AIS [46][47][48] in different countries over different study periods. However, our data show that Lithuania experienced a countrywide breakthrough of IV rtPA use only after the introduction of a comprehensive national policy.…”

The effects of socioeconomic and geographic factors on chronic phase long-term survival after stroke in South Korea

“…These efforts are primarily intended to enhance hyperacute care of patients with stroke, improve patients’ long-term prognosis through early comprehensive rehabilitation, and provide additional education programs for maintenance and secondary prevention. Therefore, these efforts are directly related to the acute phase survival rate 13 , 29 and can reduce chronic phase mortality and improve the long-term quality of life after stroke 30 . Model 1 showed no significant increase in the chronic phase mortality risk at the city or county level.…”

Nationwide temporal trend analysis of reperfusion therapy utilization and mortality in acute ischemic stroke patients in Japan

“…Previous studies have reported on the trends in IV rt-PA use for acute ischemic stroke over specific time periods in various countries: 2003 to 2006, [ 25 ] 2003 to 2010, [ 26 ] and 2007 to 2010 [ 27 ] in Sweden; 2000 to 2012 [ 28 ] and 2003 to 2011 [ 29 , 30 ] in the US; 2007-2009 in Germany [ 31 ] ; 2005 to 2012 in the Netherlands [ 32 ] ; 2009 to 2014 in Taiwan [ 33 ] ; 2014 to 2018 in South Korea [ 34 ] ; and 2006 to 2018 in Austria. [ 35 ] These studies have observed continuous increases in IV rt-PA use over the study periods in their respective countries.…”