In France, lack of national stroke plan places heavy burden on survivors and families

There is no plan anywhere in the world for getting stroke survivors 100% recovered! Everything in stroke is a shitshow; NO leadership; NO strategy!

In France, lack of national stroke plan places heavy burden on survivors and families

By Clara Bauer-Babef | Euractiv.com

Clara Bauer-Babef

Reporter; Health

Location: Paris
Languages: French, English
Expertise: Health

Est. 4min

 Nov 15, 2023 (updated:  Nov 21, 2023)

Content-Type:

Every year in France, 150,000 new people suffer a stroke, i.e. one every 4 minutes, and 30,000 will die as a result, according to figures from the Ministry of Health and Prevention.  [Atthapon Raksthaput/Shutterstock]

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This article is part of our special report Navigating care pathways for stroke survivors across the EU.

In France, stroke is the second leading cause of death after cancer. Yet to date, there is no national plan to prevent stroke or address the life after stroke for patients and their families. 

Every year in France, 150,000 new people experience a stroke, meaning one stroke every four minutes, leading to death for 30,000 people, according to figures from the Ministry of Health and Prevention. 

“This often ignored or neglected pathology affects almost 500,000 French people today, two-thirds of whom are left with disabilities,” the Ministry of Health said on its website. 

In France, the last national stroke plan was for 2010-2014. “Since then, nothing new has been proposed,” pointed out Françoise Benon, president of the Fonds de dotation France AVC, a patients’ association. 

Among the countries of the European Union, France is a poor performer, particularly when it comes to caring for patients after a stroke. 

There are no specialised centres in France to receive stroke victims and their families and to support them throughout their care, both physical and mental. 

Given the lack of specialised centres, stroke survivors are often placed in accommodation establishments for dependent elderly people (EHPAD), “whatever their age”, deplored the chairwoman of the France AVC Endowment Fund. 

“We receive dramatic phone calls from families saying ‘I don’t want my son to go to an old people’s home,” she explained. 

Particularly as there are no qualified staff or appropriate care for stroke victims in care homes. “Families are outraged,” added Benon. 

Families find themselves powerless due to a lack of information, support and qualified professionals. “We’re short of doctors, nurses and stroke specialists. Home help is expensive,” continued Benon.  

In the majority of cases, it is the relatives who look after the victims. They become carers “in spite of themselves”, with a considerable impact on their private and professional lives. 

The after-effects of a stroke vary from person to person. Some are invisible, such as fatigue or memory loss. “People find themselves the target of ridicule”, and yet, psychological support is essential. 

“Carers have an essential role to play. They bring well-being and provide emotional support. They are admirable people,” added Benon.

Belgium, European champion

Conversely, Belgium is a model country in Europe when it comes to caring for stroke victims, forcing families to travel to ensure that their loved ones receive proper treatment. 

This is the case for Claudine Belguiral, whose daughter, a stroke victim in 2015, is being looked after by doctors in a specialist neurology centre in Belgium, as she could not find enough help and care in France.  

“In Belgium, as soon as you go to the emergencies for a stroke, there’s immediately re-education and post-stroke care”, such as moving different parts of the patient’s body, she told Euractiv.

“In France, you have to wait ten days.” 

But support is essential. “Stroke is like a hurricane that hits the person and the family. It calls a whole life into question”, said Belguiral.

In her opinion, France lacks a national prevention policy against stroke but also experiences a general lack of knowledge. 

“There is a lack of medical knowledge, not least because they don’t receive enough information about stroke during their training,” she explained.

For example, between 2014 and 2017, the frequency of stroke among the 25% poorest people was 40% higher than among the 25% richest people, according to data from the French Department of Foreign Economic Relations (DREE). 

As a result, “in France, strokes are more frequent, more serious and less often treated in specialised units for people of modest means”, according to the DREE. 

However, a better understanding of strokes is one of the keys to implementing effective public health policies and reducing the number of strokes per year in France. 

Alongside Belgium, other good performers are Sweden, Finland, and Germany, said Belguiral. 

In France, patients’ associations, such as the Fonds de dotation France AVC, are almost the only structures to help victims and their families, doing their best to compensate for the absence of a genuine national health policy. 

“Stroke is the second leading cause of death in France after cancer, yet it is not a national priority,” concluded Benon.

Botulinum toxin use in patients with post-stroke spasticity: a nationwide retrospective study from France

You say nothing on whether any of this cured the spasticity. Survivors want spasticity cured, not managed or treated!  You'll want spasticity cured when you are the

1 in 4 per WHO that has a stroke!

 You won't like Dr. William M. Landau's uninformed 'expert' opinion after your stroke.  Survivors would immediately disabuse him of that notion. When schadenfreude hits him with his stroke he'll regret his ideas on the matter. 

His statement from here:

Spasticity After Stroke: Why Bother? Aug. 2004

Botulinum toxin use in patients with post-stroke spasticity: a nationwide retrospective study from France

Jonathan Levy^1,2* Pierre Karam³ Anne Forestier⁴ Jean-Yves Loze⁴ Djamel Bensmail^1,2

• ¹Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Teaching Hospital, AP-HP, Université Paris-Saclay, Garches, France
• ²Unité INSERM 1179, University of Versailles Saint-Quentin-en-Yvelines, Montigny-Le-Bretonneux, France
• ³PKCS, Ecully, France
• ⁴Ipsen, Boulogne-Billancourt, France

Background: Current guidelines recommend intramuscular botulinum toxin type A (BoNT-A) injection as first-line treatment for spasticity, a frequent and impairing feature of various central nervous system (CNS) lesions such as stroke. Patients with spasticity commonly require BoNT-A injections once every 3 to 4 months. We conducted a nationwide, population-based, retrospective cohort study, using the French National Hospital Discharge Database (PMSI), to describe BoNT-A use for spasticity in clinical practice in France between 2014 and 2020. The PMSI database covers the whole French population, corresponding to over 66 million persons.

Methods: We first searched the PMSI database for healthcare facility discharge of patients who received BoNT-A injections between 2014 and 2020, corresponding to the first set. For each BoNT-A-treated patient, we identified the medical condition for which BoNT-A may have been indicated. Another search of the PMSI database focused on patients admitted for acute stroke between 2014 and 2016 and their spasticity-related care pathway (second set). Overall, two subpopulations were analysed: 138,481 patients who received BoNT-A injections between 2014 and 2020, and 318,025 patients who survived a stroke event between 2014 and 2016 and were followed up until 2020.

Results: Among the 138,481 BoNT-A-treated patients, 53.5% received only one or two BoNT-A injections. Most of these patients (N = 85,900; 62.0%) received BoNT-A because they had CNS lesions. The number of patients with CNS lesions who received ≥1 BoNT-A injection increased by a mean of 7.5% per year from 2014 to 2019, but decreased by 0.2% between 2019 and 2020, corresponding to the COVID-19 outbreak. In stroke survivors (N = 318,025), 10.7% were coded with post-stroke spasticity, 2.3% received ≥1 BoNT-A injection between 2014 and 2020, and only 0.8% received ≥3 injections within the 12 months following BoNT-A treatment initiation, i.e., once every 3 to 4 months.

Conclusion: Our analysis of the exhaustive PMSI database showed a suboptimal implementation of BoNT-A treatment recommendations in France. BoNT-A treatment initiation and re-administration are low, particularly in patients with post-stroke spasticity. Further investigations may help explain this observation, and may target specific actions to improve spasticity-related care pathway.

Mechanical thrombectomy practices in France: exhaustive survey of centers and individual operators

There is absolutely nothing impressive about this. You are lying by omission of the survivors that got 100% recovered and the death rate. Your bar of excellence is so low it is buried underground. Seeing the questions would tell us how biased the survey was.

Mechanical thrombectomy practices in France: exhaustive survey of centers and individual operators

Author links open overlay panelGéraudForestier^a

BasileKerleroux^bKévinJanot^cFrançoisZhu^dVictorDumas^eJean-FrançoisHak^fEimadShotar^gWagihBenHassen^bRomainBourcier^hSébastienSoizeⁱJéromeBerge^jOlivierNaggara^bHubertDesal^hGrégoireBoulouis^b1AymericRouchaud^ak1JENI Research collaboration

https://doi.org/10.1016/j.neurad.2020.05.001Get rights and content

Abstract

Background and purpose: 

Mechanical thrombectomy (MT) has dramatically changed the landscape of stroke care as well as stroke care organization. Public health institutions are faced with the challenge of swiftly providing equal access to this high technical level procedure with rapidly broadening indications, and constantly developing techniques. The aim of this study was to present a current nationwide overview of technical MT practices in France as well as local organizations. (Survivors don't fucking care about practices, they want to know your results, this told us nothing.)

Materials and methods: 

Thrombectomy capable French stroke centers, and physicians performing MT were invited to participate to a nationwide survey, disseminated through an existing trainee-led research network (the JENI-RC) under the aegis of the French Society of Neuroradiology. The survey was composed of 64 questions to collect both individual practices and general center-based information.

Results: 

All French centers (100 %) answered the survey, and 74% (110/148) of active interventional neuroradiologists (INR) performing MT completed individual questionnaires. The mean number of INR per center performing MT was 3.7±1.85, and 85% of the centers were organized for 24/7 continuity of care. MRI was the most commonly used imaging modality for stroke diagnosis and patients’ selection, and perfusion imaging was routinely available in 85% of the centers. Half of centers performed yearly between 100 and 200 MT. Anesthesiologic, and technical considerations are also developed in the manuscript.

Conclusions: 

This nationwide survey highlights the impressive response to the challenge of reorganization of stroke care with regards to mechanical thrombectomy in France. Technical and management disparities remain. Most centers remain understaffed to properly function in the long term, but the inflow of INT trainees is substantial.

A comparison of two LDL cholesterol targets after ischemic stroke

Will this change your doctors protocol post stroke?  Do you prefer your doctor's incompetence in NOT KNOWING or NOT DOING?

A comparison of two LDL cholesterol targets after ischemic stroke

New England Journal of Medicine — Amarenco P, Kim JS, Labreuche J, et al. | November 22, 2019

In this parallel-group trial carried out in France and South Korea, researchers randomized 2,860 individuals with ischemic stroke in the former 3 months or a transient ischemic attack (TIA) within the former 15 days to a target LDL cholesterol level of less than 70 mg per deciliter (lower-target group, n = 1,430) or to a target range of 90 mg to 110 mg per deciliter (higher-target group, n = 1,430) in order to examine the target level for LDL cholesterol to decrease cardiovascular events following stroke. It was concluded that following an ischemic stroke or TIA with evidence of atherosclerosis, compared with those who had a target range of 90 mg to 110 mg per deciliter, individuals who had a target LDL cholesterol level of less than 70 mg per deciliter had a lower risk of succeeding cardiovascular events.

Read the full article on New England Journal of Medicine

Determinants of Case Fatality After Hospitalization for Stroke in France 2010 to 2015

My god, this is so simple. Your stroke leaders just have to write up exactly the cause of these deaths, write RFPs to researchers to solve them, write protocols based on the research, distribute those protocols to all stroke hospitals, likely get the Nobel prize in medicine.  If your stroke leaders can't see and implement these steps, replace them with stroke survivors. And look, an email address for your leaders to communicate to.

Determinants of Case Fatality After Hospitalization for Stroke in France 2010 to 2015

Amélie Gabet

,

Olivier Grimaud

,

Christine de Peretti

,

Yannick Béjot

,

Valérie Olié

Originally published9 Jan 2019https://doi.org/10.1161/STROKEAHA.118.023495Stroke. 2019;0:STROKEAHA.118.023495

Abstract

Background and Purpose—

The aims of this study were to (1) describe early and late case fatality rates after stroke in France, (2) evaluate whether their determinants differed, and (3) analyze time trends between 2010 and 2015.

Methods—

Data were extracted from the Système National des données de santé database. Patients hospitalized for stroke each year from 2010 to 2015, aged ≥18 years, and affiliated to the general insurance scheme were selected. Cox regressions were used to separately analyze determinants of 30-day and 31- to 365-day case fatality rates for each stroke type (ischemic, intracerebral hemorrhage, and subarachnoid hemorrhage).

Results—

In 2015, of the 73 124 persons hospitalized for stroke, 26.8% died in the following year, with the majority of deaths occurring within the first 30 days (56.9%). Nonadmission to a stroke unit, older age, and having comorbidities were all associated with a poorer 30-day and 31- to 365-day prognosis. Female sex was associated with a lower 31- to 365-day case fatality rate for all patients with stroke. Living in an area with a high deprivation index was associated with both higher 30-day and 31- to 365-day case fatality rates for all stroke types. Between 2010 and 2015, significant decreases in both 30-day and 31- to 365-day case fatality rates for ischemic patients were observed.

Conclusions—

Case fatality rates after stroke remained high in 2015 in France, despite major improvements in stroke care and organization. Improvement in stroke awareness and preparedness, particularly in the most deprived areas, together with better follow-up after the acute phase are urgently needed.(Fuck no, you don't need awareness, you need to address and solve why your 30 day deaths remain high.)

Footnotes

The online-only Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.118.023495.

Correspondence to Amélie Gabet, MS, 14 rue du Val d’Osne, 94410 St Maurice, France. Email: amelie.gabet@santepubliquefrance.fr

National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014

But NO mention made of disability rates from stroke dropping due to better stroke interventions and rehab protocols.  You will have to ask if the National Stroke Action Plan contains ANYTHING AT ALL about stroke rehabilitation and 100% recovery.
http://stroke.ahajournals.org/content/48/11/2939?etoc=

Camille Lecoffre, Christine de Peretti, Amélie Gabet, Olivier Grimaud, France Woimant, Maurice Giroud, Yannick Béjot, Valérie Olié

https://doi.org/10.1161/STROKEAHA.117.017640

Stroke. 2017;48:2939-2945

Originally published September 29, 2017

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Abstract

Background and Purpose—Stroke is the leading cause of death in women and the third leading cause in men in France. In young adults (ie, <65 years old), an increase in the incidence of ischemic stroke was observed at a local scale between 1985 and 2011. After the implementation of the 2010 to 2014 National Stroke Action Plan, this study investigates national trends in patients hospitalized by stroke subtypes, in-hospital mortality, and stroke mortality between 2008 and 2014.

Methods—Hospitalization data were extracted from the French national hospital discharge databases and mortality data from the French national medical causes of death database. Time trends were tested using a Poisson regression model.

Results—From 2008 to 2014, the age-standardized rates of patients hospitalized for ischemic stroke increased by 14.3% in patients <65 years old and decreased by 1.5% in those aged ≥65 years. The rate of patients hospitalized for hemorrhagic stroke was stable (+2.0%), irrespective of age and sex. The proportion of patients hospitalized in stroke units substantially increased. In-hospital mortality decreased by 17.1% in patients with ischemic stroke. From 2008 to 2013, stroke mortality decreased, except for women between 45 and 64 years old and for people aged ≥85 years.

Conclusions—An increase in cardiovascular risk factors and improved stroke management may explain the increase in the rates of patients hospitalized for ischemic stroke. The decrease observed for in-hospital stroke mortality may be because of recent improvements in acute-phase management.

Walking,walking, walking

On the last day in France with only 12,000 steps and walking uphill with a toe crest under my left toes. I  still managed to have enough spasticity  in my toes to be walking on the tips of my toes. What the hell is it going to take to get rid of that fucking toe spasticity?
My God in the last 2.9 years I've  walked 4,036,206 steps.
What the hell is it going to take to release that spasticity?

Who in the world knows what to do to relieve spasticity?

French Drug Trial Details Murky, Should Not Influence Future Cannabinoid Research

I bet alarmists will still use this to stop medical marijuana.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=160210&CultureCode=en
Contrary to initial reports, the drug tested on paid volunteers in a French study, which resulted in one death and five hospitalizations, did not contain cannabis or cannabinoids. The drug, an FAAH inhibitor manufactured by the Portuguese company Bial, was instead designed to act upon the human endocannabinoid system as a potential painkiller and treatment for anxiety. Beyond that, very little information is publicly known and as such, no conclusions can be drawn about the safety or efficacy related to future cannabis and cannabinoid research.

"Without adequate information it is impossible to advance any realistic theory about causes of toxicity," says Daniele Piomelli, PhD, Louise Turner Arnold Chair in Neurosciences and Professor, Anatomy & Neurobiology University of California-Irvine, School of Medicine, and Editor-in-Chief of Cannabis and Cannabinoid Research. "Several structurally different FAAH inhibitors have been previously tested for human safety in rigorous Phase 1 clinical trials. These include compounds from Sanofi, Pfizer, Merck, Johnson and Johnson, and others. All these FAAH inhibitors were shown to be safe in humans."

The human safety of multiple FAAH inhibitors suggests that toxicity of the Bial compound is unlikely to be a 'class effect'-in other words, it is unlikely to be due to the interaction of the Bial compound with FAAH.

"It is more probable that the Bial compound interacts with another, as yet unknown protein that is responsible for the observed toxicity, or that a toxic impurity was present in the test drug," continues Dr. Piomelli. "Of course, while we can tentatively exclude a class effect at this point, we cannot pin-point which other target might be responsible for the toxicity of the Bial compound."
http://www.liebertpub.com/can