Bo Norrving shouldn't be commenting at all, I saw nothing he accomplished when he was president of the WSO.
YOU need to get involved, you can't leave this up to stroke medical professionals, they came up with the inadequate Helsingborg declarations.
Helsingborg 1996
Helsingborg 2006
Status and Perspectives of Acute Stroke Care in Europe
Originally published30 Aug 2018Stroke. 2018;49:2281–2282
Stroke is the second most common single cause of death in Europe and the leading cause of long-term disability.1,2 Every year, up to 1.3 million persons in Europe suffer a first-ever stroke.3 Consequently, the socioeconomic impact of stroke is considerable with an annual cost in Europe of up to €45 billion.1
Projections show that the overall stroke burden in Europe will further
increase by 35% in 2050, mostly because of the aging population.4
However, there is overwhelming evidence that an acute ischemic stroke
is no longer an unavoidable fate because strokes can be prevented and
treated(10% full recovery is not being treated successfully), dramatically reducing the burden of stroke and its long-term
consequences.
Endovascular treatment (EVT) has recently become the standard of care in stroke patients with large vessel occlusions, and it is now, together with stroke unit (SU) treatment and intravenous thrombolysis (IVT), a main pillar of acute stroke management.(But you never tell us its full success rate , so I call that a failure.) However, and despite much discussion on the necessary overhaul of stroke systems of care, information on access and delivery of these acute stroke treatment strategies in Europe was lacking. In a recent publication in the European Stroke Journal, Aguiar de Sousa et al5 surveyed the status of acute stroke treatment in Europe.
The estimated mean number of SUs was 2.9 per 1 million inhabitants and 1.5 per 1000 annual incident strokes; highest country rates were 9.2 and 5.8, respectively. Forty-two countries provided the annual number of IVTs. The estimated mean annual number was 142 IVT per 1 million inhabitants, whereas 4 countries had rates per million above 350. Overall, 7.3% of all patients with an ischemic stroke in Europe received IVT. However, 15 countries had IVT rates <5%, whereas 6 countries reported that at least 15% of their patients received this treatment. The annual number of EVT was provided in 39 countries and was mostly for 2016. The estimated mean annual number of EVTs was 37.1 per 1 million inhabitants. Importantly, the annual number of treatments was estimated to be <10 per 1 million inhabitants in 13 countries, whereas rates for the 3 best-performing countries were 3× higher than the overall mean (up to 111.5). Overall, only 1.9% of incident ischemic stroke patients received EVT, whereas the top 3 countries reported rates above 5%.
These data showed that for most countries access to and delivery of SU care along with both IVT and EVT rates varied significantly, and in most countries, rates were far below best performers. The discrepancy means that 226 662 more patients could have been treated with IVT (339 929 instead of 113 267) and 67 347 with EVT (94 852 instead of 27 505), if best practice would have been followed in all countries. Although these are still rather conservative estimates, this means that two-thirds of patients that would potentially be eligible for IVT and three-quarters of candidates for EVT did not receive these treatments in Europe.
This survey provides a comprehensive snapshot of acute stroke care standards in European countries. These results are valuable for all stakeholders responsible for drawing up and implementing long-term strategies. The major limitation of this investigation was that it relied on surveyed data. Although it was requested that only best available information has to be utilized to compile the survey, in countries lacking organized nationwide registries, data came from variable sources, namely recent health ministerial statistics, service reports, national stroke registries, and estimates made by a consensus of coordinators and experts. In addition, no audit could be performed to assess the quality of the data. A larger prospective survey is planned for 2019.
The European Stroke Organisation has therefore prepared a European Stroke Action Plan (ESAP) for the years 2018 to 2030, in cooperation with the European patient organisation Stroke Alliance for Europe.7 The ESAP adheres to the format of the Helsingborg Declarations, presenting a review of the state of the art, the state of current services, research and development priorities, and targets for a series of domains in stroke care (organization of stroke services, management of acute stroke, prevention, rehabilitation, evaluation of stroke outcome, and quality assessment). The ESAP includes 2 additional domains, on primary prevention and life after stroke, along with research and development priorities for translational stroke research. The ESAP was prepared in an open, transparent process that involved >100 scientists and patient organization representatives from almost all of the European countries. A live-streamed consensus workshop was held in Munich, March 22 to 23, 2018. The ESAP was launched at the European Stroke Organisation Congress in Gothenburg in May 2018, and the publication of the document is currently being finalized.
ESAP provides 32 specific targets for 7 domains. Four overarching targets were identified:
Clearly, the implementation of the ESAP is a big challenge, which involves financial factors, as well as policy issues. Preventing and treating stroke should be seen as an investment for the society that has a favorable return, both social and economical, rather than just a cost to the healthcare sector. Governmental bodies need to substantially upscale efforts for stroke, along with other noncommunicable diseases, requiring a change of strategy in many of the European countries. National stroke and neurological societies will have a key role in the implementation of the targets. Role models of stroke management have been identified (ie, Austrian Stroke Network, Code Stroke System of Catalonia), as well as national quality registers currently set up in several European countries.
The ESAP is likely the most comprehensive and detailed plan for improvement of prevention and care of stroke in any large geographical region of the world, emphasizing the need to invest in stroke proportionally to the public health impact of the disease. Hopefully, this plan could also become an inspiration for other areas in the world. As Larry Elder said, “A goal without a plan is just a wish”.8
Endovascular treatment (EVT) has recently become the standard of care in stroke patients with large vessel occlusions, and it is now, together with stroke unit (SU) treatment and intravenous thrombolysis (IVT), a main pillar of acute stroke management.(But you never tell us its full success rate , so I call that a failure.) However, and despite much discussion on the necessary overhaul of stroke systems of care, information on access and delivery of these acute stroke treatment strategies in Europe was lacking. In a recent publication in the European Stroke Journal, Aguiar de Sousa et al5 surveyed the status of acute stroke treatment in Europe.
Current Status of Acute Stroke Care in Europe
A survey drafted by stroke professionals from the European Stroke Organisation, the European Society of Minimally Invasive Neurological Therapy, the European Academy of Neurology, and the patient organisation Stroke Alliance for Europe was sent to national stroke societies and experts requesting best available national data on the number of SUs, as well as IVT and EVT rates, per year. Experts from 44 of 51 European countries provided data. Out of the 7 nonparticipating countries, 5 were from Eastern Europe. The authors compared both pooled and individual national data per 1 million inhabitants (United Nations data) and per 1000 annual incident ischemic strokes (Global Burden of Disease Report) with the best-performing countries.(Well fuck, you didn't request surveys from survivors asking how well they recovered because you didn't want to publicize your complete failure in getting them 100% recovered.)The estimated mean number of SUs was 2.9 per 1 million inhabitants and 1.5 per 1000 annual incident strokes; highest country rates were 9.2 and 5.8, respectively. Forty-two countries provided the annual number of IVTs. The estimated mean annual number was 142 IVT per 1 million inhabitants, whereas 4 countries had rates per million above 350. Overall, 7.3% of all patients with an ischemic stroke in Europe received IVT. However, 15 countries had IVT rates <5%, whereas 6 countries reported that at least 15% of their patients received this treatment. The annual number of EVT was provided in 39 countries and was mostly for 2016. The estimated mean annual number of EVTs was 37.1 per 1 million inhabitants. Importantly, the annual number of treatments was estimated to be <10 per 1 million inhabitants in 13 countries, whereas rates for the 3 best-performing countries were 3× higher than the overall mean (up to 111.5). Overall, only 1.9% of incident ischemic stroke patients received EVT, whereas the top 3 countries reported rates above 5%.
These data showed that for most countries access to and delivery of SU care along with both IVT and EVT rates varied significantly, and in most countries, rates were far below best performers. The discrepancy means that 226 662 more patients could have been treated with IVT (339 929 instead of 113 267) and 67 347 with EVT (94 852 instead of 27 505), if best practice would have been followed in all countries. Although these are still rather conservative estimates, this means that two-thirds of patients that would potentially be eligible for IVT and three-quarters of candidates for EVT did not receive these treatments in Europe.
This survey provides a comprehensive snapshot of acute stroke care standards in European countries. These results are valuable for all stakeholders responsible for drawing up and implementing long-term strategies. The major limitation of this investigation was that it relied on surveyed data. Although it was requested that only best available information has to be utilized to compile the survey, in countries lacking organized nationwide registries, data came from variable sources, namely recent health ministerial statistics, service reports, national stroke registries, and estimates made by a consensus of coordinators and experts. In addition, no audit could be performed to assess the quality of the data. A larger prospective survey is planned for 2019.
Perspective of Acute Stroke Care in Europe
The findings of this survey have implications for the future organization of acute stroke care standards throughout Europe. In 2006, the second Helsingborg Declaration, cosponsored by the World Health Organization Regional Office for Europe, set new targets for stroke management and care.6 One specific goal for 2015 was that all patients with acute stroke who were potentially eligible for acute specific treatment should be transferred to hospitals with adequate capacity and expertise to administer treatments—defined as an SU or stroke dedicated area. The current survey suggests that this goal still is far from being reached.The European Stroke Organisation has therefore prepared a European Stroke Action Plan (ESAP) for the years 2018 to 2030, in cooperation with the European patient organisation Stroke Alliance for Europe.7 The ESAP adheres to the format of the Helsingborg Declarations, presenting a review of the state of the art, the state of current services, research and development priorities, and targets for a series of domains in stroke care (organization of stroke services, management of acute stroke, prevention, rehabilitation, evaluation of stroke outcome, and quality assessment). The ESAP includes 2 additional domains, on primary prevention and life after stroke, along with research and development priorities for translational stroke research. The ESAP was prepared in an open, transparent process that involved >100 scientists and patient organization representatives from almost all of the European countries. A live-streamed consensus workshop was held in Munich, March 22 to 23, 2018. The ESAP was launched at the European Stroke Organisation Congress in Gothenburg in May 2018, and the publication of the document is currently being finalized.
ESAP provides 32 specific targets for 7 domains. Four overarching targets were identified:
- To reduce the absolute number of strokes in Europe by 10%.
- To treat 90% or more of all patients with stroke in Europe in a dedicated SU as the first level of care.
- To have national plans for stroke encompassing the entire chain of care from primary prevention to life after stroke.
- To fully implement national strategies for multisector public health interventions to promote and facilitate a healthy lifestyle, and reduce environmental (including air pollution), socioeconomic, and educational factors that increase the risk of stroke.
Where the fuck is the goal for 100% recovery for all survivors? Leaders would tackle such a goal.
Clearly, the implementation of the ESAP is a big challenge, which involves financial factors, as well as policy issues. Preventing and treating stroke should be seen as an investment for the society that has a favorable return, both social and economical, rather than just a cost to the healthcare sector. Governmental bodies need to substantially upscale efforts for stroke, along with other noncommunicable diseases, requiring a change of strategy in many of the European countries. National stroke and neurological societies will have a key role in the implementation of the targets. Role models of stroke management have been identified (ie, Austrian Stroke Network, Code Stroke System of Catalonia), as well as national quality registers currently set up in several European countries.
The ESAP is likely the most comprehensive and detailed plan for improvement of prevention and care of stroke in any large geographical region of the world, emphasizing the need to invest in stroke proportionally to the public health impact of the disease. Hopefully, this plan could also become an inspiration for other areas in the world. As Larry Elder said, “A goal without a plan is just a wish”.8
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