1
|
Ramos-Pachón A, Rodríguez-Luna D, Martí-Fàbregas J, Millán M, Bustamante A, Martínez-Sánchez M, Serena J, Terceño M, Vera-Cáceres C, Camps-Renom P, Prats-Sánchez L, Rodríguez-Villatoro N, Cardona-Portela P, Urra X, Solà S, del Mar Escudero M, Salvat-Plana M, Ribó M, Abilleira S, Pérez de la Ossa N, Silva Y. Effect of Bypassing the Closest Stroke Center in Patients with Intracerebral Hemorrhage: A Secondary Analysis of the RACECAT Randomized Clinical Trial. JAMA Neurol 2023; 80:1028-1036. [PMID: 37603325 PMCID: PMC10442788 DOI: 10.1001/jamaneurol.2023.2754] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/05/2023] [Indexed: 08/22/2023]
Abstract
Importance Prehospital transfer protocols are based on rapid access to reperfusion therapies for patients with ischemic stroke. The effect of different protocols among patients receiving a final diagnosis of intracerebral hemorrhage (ICH) is unknown. Objective To determine the effect of direct transport to an endovascular treatment (EVT)-capable stroke center vs transport to the nearest local stroke center. Design, Setting, and Participants This was a prespecified secondary analysis of RACECAT, a multicenter, population-based, cluster-randomized clinical trial conducted from March 2017 to June 2020 in Catalonia, Spain. Patients were evaluated by a blinded end point assessment. All consecutive patients suspected of experiencing a large vessel occlusion stroke (Rapid Arterial Occlusion Evaluation Scale [RACE] score in the field >4 on a scale of 0 to 9, with lower to higher stroke severity) with final diagnosis of ICH were included. A total of 1401 patients were enrolled in RACECAT with suspicion of large vessel occlusion stroke. The current analysis was conducted in October 2022. Intervention Direct transport to an EVT-capable stroke center (n = 137) or to the closest local stroke center (n = 165). Main Outcomes and Measures The primary outcome was tested using cumulative ordinal logistic regression to estimate the common odds ratio (OR) and 95% CI of the shift analysis of disability at 90 days as assessed by the modified Rankin Scale (mRS) score (range, 0 [no symptoms] to 6 [death]) in the intention-to-treat population. Secondary outcomes, included 90-day mortality, death or severe functional dependency, early neurological deterioration, early mortality, ICH volume and enlargement, rate of neurosurgical treatment, rate of clinical complications during initial transport, and rate of adverse events until day 5. Results Of 1401 patients enrolled, 1099 were excluded from this analysis (32 rejected informed consent, 920 had ischemic stroke, 29 had transient ischemic attack, 12 had subarachnoid hemorrhage, and 106 had stroke mimic). Thus, 302 patients were included (204 [67.5%] men; mean [SD] age 71.7 [12.8] years; and median [IQR] RACE score, 7 [6-8]). For the primary outcome, direct transfer to an EVT-capable stroke center (mean [SD] mRS score, 4.93 [1.38]) resulted in worse functional outcome at 90 days compared with transfer to the nearest local stroke center (mean [SD] mRS score, 4.66 [1.39]; adjusted common OR, 0.63; 95% CI, 0.41-0.96). Direct transfer to an EVT-capable stroke center also suggested potentially higher 90-day mortality compared with transfer to the nearest local stroke center (67 of 137 [48.9%] vs 62 of 165 [37.6%]; adjusted hazard ratio, 1.40; 95% CI, 0.99-1.99). The rates of medical complications during the initial transfer (30 of 137 [22.6%] vs 9 of 165 patients [5.6%]; adjusted OR, 5.29; 95% CI, 2.38-11.73) and in-hospital pneumonia (49 of 137 patients [35.8%] vs 29 of 165 patients [17.6%]; OR, 2.61; 95% CI, 1.53-4.44) were higher in the EVT-capable stroke center group. Conclusions and Relevance In this secondary analysis of the RACECAT randomized clinical trial, bypassing the closest stroke center resulted in reduced chances of functional independence at 90 days for patients who received a final diagnosis of ICH. Trial Registration ClinicalTrials.gov Identifier: NCT02795962.
Collapse
Affiliation(s)
- Anna Ramos-Pachón
- Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | | | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Mònica Millán
- Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
| | - Alejandro Bustamante
- Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
| | - Marina Martínez-Sánchez
- Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
| | - Joaquín Serena
- Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain
| | - Mikel Terceño
- Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain
| | | | - Pol Camps-Renom
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Luis Prats-Sánchez
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | | | - Pere Cardona-Portela
- Stroke Unit, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain
| | - Xabier Urra
- Stroke Unit, Hospital Clínic, and August Pi i Sunyer Biomedical Research Institute Barcelona, Barcelona, Spain
| | - Silvia Solà
- Sistema d’Emergències Mèdiques, Barcelona, Spain
| | | | - Mercè Salvat-Plana
- Catalan Stroke Program, Agency for Health Quality and Assessment of Catalonia, and CIBER Epidemiology and Public Health, Barcelona, Spain
| | - Marc Ribó
- Stroke Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Sònia Abilleira
- Catalan Stroke Program, Agency for Health Quality and Assessment of Catalonia, and CIBER Epidemiology and Public Health, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
| | - Yolanda Silva
- Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain
| |
Collapse
|
2
|
Valero-Bover D, Monterde D, Carot-Sans G, Cainzos-Achirica M, Comin-Colet J, Vela E, Clèries M, Folguera J, Abilleira S, Arrufat M, Lejardi Y, Solans Ò, Dedeu T, Coca M, Pérez-Sust P, Pontes C, Piera-Jiménez J. Is Age the Most Important Risk Factor in COVID-19 Patients? The Relevance of Comorbidity Burden: A Retrospective Analysis of 10,551 Hospitalizations. Clin Epidemiol 2023; 15:811-825. [PMID: 37408865 PMCID: PMC10319286 DOI: 10.2147/clep.s408510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/26/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose To assess the contribution of age and comorbidity to the risk of critical illness in hospitalized COVID-19 patients using increasingly exhaustive tools for measuring comorbidity burden. Patients and Methods We assessed the effect of age and comorbidity burden in a retrospective, multicenter cohort of patients hospitalized due to COVID-19 in Catalonia (North-East Spain) between March 1, 2020, and January 31, 2022. Vaccinated individuals and those admitted within the first of the six COVID-19 epidemic waves were excluded from the primary analysis but were included in secondary analyses. The primary outcome was critical illness, defined as the need for invasive mechanical ventilation, transfer to the intensive care unit (ICU), or in-hospital death. Explanatory variables included age, sex, and four summary measures of comorbidity burden on admission extracted from three indices: the Charlson index (17 diagnostic group codes), the Elixhauser index and count (31 diagnostic group codes), and the Queralt DxS index (3145 diagnostic group codes). All models were adjusted by wave and center. The proportion of the effect of age attributable to comorbidity burden was assessed using a causal mediation analysis. Results The primary analysis included 10,551 hospitalizations due to COVID-19; of them, 3632 (34.4%) experienced critical illness. The frequency of critical illness increased with age and comorbidity burden on admission, irrespective of the measure used. In multivariate analyses, the effect size of age decreased with the number of diagnoses considered to estimate comorbidity burden. When adjusting for the Queralt DxS index, age showed a minimal contribution to critical illness; according to the causal mediation analysis, comorbidity burden on admission explained the 98.2% (95% CI 84.1-117.1%) of the observed effect of age on critical illness. Conclusion Comorbidity burden (when measured exhaustively) explains better than chronological age the increased risk of critical illness observed in patients hospitalized with COVID-19.
Collapse
Affiliation(s)
- Damià Valero-Bover
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | - David Monterde
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
- Catalan Institute of Health, Barcelona, Spain
| | - Gerard Carot-Sans
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Josep Comin-Colet
- Cardiology Department, Bellvitge University Hospital (IDIBELL), Barcelona, Spain
- Department of Medicine, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
- CIBER Cardiovascular (CIBERCV), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Emili Vela
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | - Montse Clèries
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | - Júlia Folguera
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | - Sònia Abilleira
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | | | - Òscar Solans
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
- Health Department, eHealth Unit, Barcelona, Spain
| | - Toni Dedeu
- WHO European Centre for Primary Health Care, Almaty, Kazakhstan
| | - Marc Coca
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | | | - Caridad Pontes
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
- Department of Pharmacology, Autonomous University of Barcelona, Barcelona, Spain
| | - Jordi Piera-Jiménez
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
- Faculty of Informatics, Telecommunications and Multimedia, Universitat Oberta de Catalunya, Barcelona, Spain
| |
Collapse
|
3
|
Silva Y, Sánchez-Cirera L, Terceño M, Dorado L, Valls A, Martínez M, Abilleira S, Rubiera M, Quesada H, Llull L, Rodríguez-Campello A, Martí-Fàbregas J, Seró L, Purroy F, Payo I, García S, Cánovas D, Krupinski J, Mas N, Palomeras E, Cocho D, Font MÀ, Catena E, Puiggròs E, Pedroza C, Marín G, Carrión D, Costa X, Almendros MC, Torres I, Colom C, Velasquez JA, Diaz G, Jiménez X, Subirats T, Deulofeu A, Hidalgo V, Salvat-Plana M, Pérez de la Ossa N. Sex and gender differences in acute stroke care: metrics, access to treatment and outcome. A territorial analysis of the Stroke Code System of Catalonia. Eur Stroke J 2023; 8:557-565. [PMID: 37231687 PMCID: PMC10334164 DOI: 10.1177/23969873231156260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/23/2023] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Previous studies have reported differences in the management and outcome of women stroke patients in comparison with men. We aim to analyze sex and gender differences in the medical assistance, access to treatment and outcome of acute stroke patients in Catalonia. PATIENTS AND METHODS Data were obtained from a prospective population-based registry of stroke code activations in Catalonia (CICAT) from January/2016 to December/2019. The registry includes demographic data, stroke severity, stroke subtype, reperfusion therapy, and time workflow. Centralized clinical outcome at 90 days was assessed in patients receiving reperfusion therapy. RESULTS A total of 23,371 stroke code activations were registered (54% men, 46% women). No differences in prehospital time metrics were observed. Women more frequently had a final diagnosis of stroke mimic, were older and had a previous worse functional situation. Among ischemic stroke patients, women had higher stroke severity and more frequently presented proximal large vessel occlusion. Women received more frequently reperfusion therapy (48.2% vs 43.1%, p < 0.001). Women tended to present a worse outcome at 90 days, especially for the group receiving only IVT (good outcome 56.7% vs 63.8%; p < 0.001), but not for the group of patients treated with IVT + MT or MT alone, although sex was not independently associated with clinical outcome in logistic regression analysis (OR 1.07; 95% CI, 0.94-1.23; p = 0.27) nor in the analysis after matching using the propensity score (OR 1.09; 95% CI, 0.97-1.22). DISCUSSION AND CONCLUSION We found some differences by sex in that acute stroke was more frequent in older women and the stroke severity was higher. We found no differences in medical assistance times, access to reperfusion treatment and early complications. Worse clinical outcome at 90 days in women was conditioned by stroke severity and older age, but not by sex itself.
Collapse
Affiliation(s)
| | | | | | - Laura Dorado
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Adrián Valls
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marina Martínez
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Marta Rubiera
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Helena Quesada
- Hospital Universitari de Bellvitge, L’Hospitalet de llobregat, Spain
| | - Laura Llull
- Hospital Clínic of Barcelona, Barcelona, Spain
| | | | | | - Laia Seró
- Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | - Iago Payo
- Hospital Verge de la Cinta, Tortosa, Spain
| | - Sònia García
- Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | | | | | | | | | | | | | - Esther Catena
- Consorci Sanitari Alt Penedès-Garraf, Vilafranca del Penedès, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mercè Salvat-Plana
- Pla Director de les Malalties Vasculars Cerebrals. Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS) CIBER en Epidemiolgia i Salut Pública (CBERESP), Departament de Salut, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Pla Director de les Malalties Vasculars Cerebrals. Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS) CIBER en Epidemiolgia i Salut Pública (CBERESP), Departament de Salut, Barcelona, Spain
| |
Collapse
|
4
|
Pérez de la Ossa N, Abilleira S, Jovin TG, García-Tornel Á, Jimenez X, Urra X, Cardona P, Cocho D, Purroy F, Serena J, San Román Manzanera L, Vivanco-Hidalgo RM, Salvat-Plana M, Chamorro A, Gallofré M, Molina CA, Cobo E, Davalos A, Ribo M. Effect of Direct Transportation to Thrombectomy-Capable Center vs Local Stroke Center on Neurological Outcomes in Patients With Suspected Large-Vessel Occlusion Stroke in Nonurban Areas: The RACECAT Randomized Clinical Trial. JAMA 2022; 327:1782-1794. [PMID: 35510397 PMCID: PMC9073661 DOI: 10.1001/jama.2022.4404] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE In nonurban areas with limited access to thrombectomy-capable centers, optimal prehospital transport strategies in patients with suspected large-vessel occlusion stroke are unknown. OBJECTIVE To determine whether, in nonurban areas, direct transport to a thrombectomy-capable center is beneficial compared with transport to the closest local stroke center. DESIGN, SETTING, AND PARTICIPANTS Multicenter, population-based, cluster-randomized trial including 1401 patients with suspected acute large-vessel occlusion stroke attended by emergency medical services in areas where the closest local stroke center was not capable of performing thrombectomy in Catalonia, Spain, between March 2017 and June 2020. The date of final follow-up was September 2020. INTERVENTIONS Transportation to a thrombectomy-capable center (n = 688) or the closest local stroke center (n = 713). MAIN OUTCOMES AND MEASURES The primary outcome was disability at 90 days based on the modified Rankin Scale (mRS; scores range from 0 [no symptoms] to 6 [death]) in the target population of patients with ischemic stroke. There were 11 secondary outcomes, including rate of intravenous tissue plasminogen activator administration and thrombectomy in the target population and 90-day mortality in the safety population of all randomized patients. RESULTS Enrollment was halted for futility following a second interim analysis. The 1401 enrolled patients were included in the safety analysis, of whom 1369 (98%) consented to participate and were included in the as-randomized analysis (56% men; median age, 75 [IQR, 65-83] years; median National Institutes of Health Stroke Scale score, 17 [IQR, 11-21]); 949 (69%) comprised the target ischemic stroke population included in the primary analysis. For the primary outcome in the target population, median mRS score was 3 (IQR, 2-5) vs 3 (IQR, 2-5) (adjusted common odds ratio [OR], 1.03; 95% CI, 0.82-1.29). Of 11 reported secondary outcomes, 8 showed no significant difference. Compared with patients first transported to local stroke centers, patients directly transported to thrombectomy-capable centers had significantly lower odds of receiving intravenous tissue plasminogen activator (in the target population, 229/482 [47.5%] vs 282/467 [60.4%]; OR, 0.59; 95% CI, 0.45-0.76) and significantly higher odds of receiving thrombectomy (in the target population, 235/482 [48.8%] vs 184/467 [39.4%]; OR, 1.46; 95% CI, 1.13-1.89). Mortality at 90 days in the safety population was not significantly different between groups (188/688 [27.3%] vs 194/713 [27.2%]; adjusted hazard ratio, 0.97; 95% CI, 0.79-1.18). CONCLUSIONS AND RELEVANCE In nonurban areas in Catalonia, Spain, there was no significant difference in 90-day neurological outcomes between transportation to a local stroke center vs a thrombectomy-capable referral center in patients with suspected large-vessel occlusion stroke. These findings require replication in other settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02795962.
Collapse
Affiliation(s)
- Natalia Pérez de la Ossa
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Sònia Abilleira
- Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Tudor G. Jovin
- Neurological Institute, Cooper University Hospital, Camden, New Jersey
| | - Álvaro García-Tornel
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d’Hebrón, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Xavier Jimenez
- Emergency Medical Services of Catalonia, Barcelona, Spain
| | - Xabier Urra
- Department of Neurology, Stroke Unit, Hospital Clínic, Barcelona, Spain
| | - Pere Cardona
- Department of Neurology, Stroke Unit, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Dolores Cocho
- Neurology Department, Hospital Granollers, Granollers, Spain
| | - Francisco Purroy
- Department of Neurology, Stroke Unit, Hospital Arnau de Vilanova, Lleida, Spain
| | - Joaquin Serena
- Department of Neurology, Stroke Unit, Hospital Josep Trueta, Girona, Spain
| | | | - Rosa Maria Vivanco-Hidalgo
- Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Mercè Salvat-Plana
- Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Angel Chamorro
- Department of Neurology, Stroke Unit, Hospital Clínic, Barcelona, Spain
| | - Miquel Gallofré
- Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Carlos A. Molina
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d’Hebrón, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Erik Cobo
- Statistics and Operational Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Antoni Davalos
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marc Ribo
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d’Hebrón, Universitat Autonoma de Barcelona, Barcelona, Spain
| |
Collapse
|
5
|
Ribera A, Vela E, García-Altés A, Clèries M, Abilleira S. Trends in healthcare resource use and expenditure before and after ischaemic stroke. A population-based study. Neurologia 2022; 37:21-30. [PMID: 30902459 DOI: 10.1016/j.nrl.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/13/2018] [Accepted: 11/17/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. METHODS The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. RESULTS We identified 36,044 patients with ischaemic stroke (mean age, 74.7±13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was €3,230 the year before stroke, €11,060 for year one after stroke, €4,104 for year 2, and €3,878 for year 3. The greatest determinants of cost in year one were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. CONCLUSION After ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services.
Collapse
Affiliation(s)
- A Ribera
- Unidad de Epidemiología Cardiovascular, Hospital Universitario Vall d'Hebron, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Pla Director de la Malaltia Vascular Cerebral, Departament de Salut, Generalitat de Catalunya.
| | - E Vela
- Unitat d'Informació i Coneixement, Servei Català de la Salut, Barcelona, España
| | - A García-Altés
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència per la Qualitat i l'Avaluació Sanitària de Catalunya, Departament de Salut, Barcelona, España; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, España
| | - M Clèries
- Unitat d'Informació i Coneixement, Servei Català de la Salut, Barcelona, España
| | - S Abilleira
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Pla Director de la Malaltia Vascular Cerebral, Departament de Salut, Generalitat de Catalunya; Agència per la Qualitat i l'Avaluació Sanitària de Catalunya, Departament de Salut, Barcelona, España
| |
Collapse
|
6
|
Monterde D, Carot-Sans G, Cainzos-Achirica M, Abilleira S, Coca M, Vela E, Clèries M, Valero-Bover D, Comin-Colet J, García-Eroles L, Pérez-Sust P, Arrufat M, Lejardi Y, Piera-Jiménez J. Performance of Three Measures of Comorbidity in Predicting Critical COVID-19: A Retrospective Analysis of 4607 Hospitalized Patients. Risk Manag Healthc Policy 2021; 14:4729-4737. [PMID: 34849041 PMCID: PMC8627311 DOI: 10.2147/rmhp.s326132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/14/2021] [Indexed: 12/24/2022] Open
Abstract
Background Comorbidity burden has been identified as a relevant predictor of critical illness in patients hospitalized with coronavirus disease 2019 (COVID-19). However, comorbidity burden is often represented by a simple count of few conditions that may not fully capture patients' complexity. Purpose To evaluate the performance of a comprehensive index of the comorbidity burden (Queralt DxS), which includes all chronic conditions present on admission, as an adjustment variable in models for predicting critical illness in hospitalized COVID-19 patients and compare it with two broadly used measures of comorbidity. Materials and Methods We analyzed data from all COVID-19 hospitalizations reported in eight public hospitals in Catalonia (North-East Spain) between June 15 and December 8 2020. The primary outcome was a composite of critical illness that included the need for invasive mechanical ventilation, transfer to ICU, or in-hospital death. Predictors including age, sex, and comorbidities present on admission measured using three indices: the Charlson index, the Elixhauser index, and the Queralt DxS index for comorbidities on admission. The performance of different fitted models was compared using various indicators, including the area under the receiver operating characteristics curve (AUROCC). Results Our analysis included 4607 hospitalized COVID-19 patients. Of them, 1315 experienced critical illness. Comorbidities significantly contributed to predicting the outcome in all summary indices used. AUC (95% CI) for prediction of critical illness was 0.641 (0.624-0.660) for the Charlson index, 0.665 (0.645-0.681) for the Elixhauser index, and 0.787 (0.773-0.801) for the Queralt DxS index. Other metrics of model performance also showed Queralt DxS being consistently superior to the other indices. Conclusion In our analysis, the ability of comorbidity indices to predict critical illness in hospitalized COVID-19 patients increased with their exhaustivity. The comprehensive Queralt DxS index may improve the accuracy of predictive models for resource allocation and clinical decision-making in the hospital setting.
Collapse
Affiliation(s)
- David Monterde
- Catalan Institute of Health, Barcelona, Spain.,Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain
| | - Gerard Carot-Sans
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain.,Servei Català de la Salut, Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA.,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Sònia Abilleira
- Catalan Institute of Health, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Marc Coca
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain.,Servei Català de la Salut, Barcelona, Spain
| | - Emili Vela
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain.,Servei Català de la Salut, Barcelona, Spain
| | - Montse Clèries
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain.,Servei Català de la Salut, Barcelona, Spain
| | - Damià Valero-Bover
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain.,Servei Català de la Salut, Barcelona, Spain
| | - Josep Comin-Colet
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.,Bioheart-Cardiovascular Diseases Research Group (Idibell), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universität de Barcelona - UB, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luis García-Eroles
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain.,Servei Català de la Salut, Barcelona, Spain
| | | | | | | | - Jordi Piera-Jiménez
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain.,Servei Català de la Salut, Barcelona, Spain.,Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
| |
Collapse
|
7
|
Ribera A, Vela E, García-Altés A, Clèries M, Abilleira S. Trends in healthcare resource use and expenditure before and after ischaemic stroke. A population-based study. Neurologia (Engl Ed) 2021; 37:21-30. [PMID: 34538775 DOI: 10.1016/j.nrleng.2018.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/17/2018] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Despite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. METHODS The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. RESULTS We identified 36 044 patients with ischaemic stroke (mean age, 74.7 ± 13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was €3230 the year before stroke, €11 060 for year 1 after stroke, €4104 for year 2, and €3878 for year 3. The greatest determinants of cost in year 1 were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. CONCLUSION After ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services.
Collapse
Affiliation(s)
- A Ribera
- Unidad de Epidemiología Cardiovascular, Hospital Universitario Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Pla Director de la Malaltia Vascular Cerebral, Departament de Salut, Generalitat de Catalunya, Spain.
| | - E Vela
- Unitat d'Informació i Coneixement, Servei Català de la Salut, Barcelona, Spain
| | - A García-Altés
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Agència per la Qualitat i l'Avaluació Sanitària de Catalunya, Departament de Salut, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - M Clèries
- Unitat d'Informació i Coneixement, Servei Català de la Salut, Barcelona, Spain
| | - S Abilleira
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Pla Director de la Malaltia Vascular Cerebral, Departament de Salut, Generalitat de Catalunya, Spain; Agència per la Qualitat i l'Avaluació Sanitària de Catalunya, Departament de Salut, Barcelona, Spain
| |
Collapse
|
8
|
Guisado-Alonso D, Martínez-Domeño A, Prats-Sánchez L, Delgado-Mederos R, Camps-Renom P, Abilleira S, de la Ossa NP, Ramos-Pachón A, Cardona P, Rodríguez-Campello A, Molina CA, Rudilosso S, Martí-Fàbregas J. Reasons for Not Performing Mechanical Thrombectomy: A Population-Based Study of Stroke Codes. Stroke 2021; 52:2746-2753. [PMID: 34289711 DOI: 10.1161/strokeaha.120.032648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Daniel Guisado-Alonso
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Spain (D.G.-A., A.M.-D., L.P.-S., R.D.-M., P.C.-R., J.M.-F.)
| | - Alejandro Martínez-Domeño
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Spain (D.G.-A., A.M.-D., L.P.-S., R.D.-M., P.C.-R., J.M.-F.)
| | - Luis Prats-Sánchez
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Spain (D.G.-A., A.M.-D., L.P.-S., R.D.-M., P.C.-R., J.M.-F.)
| | - Raquel Delgado-Mederos
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Spain (D.G.-A., A.M.-D., L.P.-S., R.D.-M., P.C.-R., J.M.-F.)
| | - Pol Camps-Renom
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Spain (D.G.-A., A.M.-D., L.P.-S., R.D.-M., P.C.-R., J.M.-F.)
| | - Sònia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., N.P.d.l.O.)
| | - Natalia Pérez de la Ossa
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., N.P.d.l.O.)
| | - Anna Ramos-Pachón
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P)
| | - Pere Cardona
- Department of Neurology, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.)
| | | | - Carlos A Molina
- Department of Neurology, Hospital Vall d'Hebrón, Barcelona, Spain (C.A.M.)
| | | | - Joan Martí-Fàbregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Spain (D.G.-A., A.M.-D., L.P.-S., R.D.-M., P.C.-R., J.M.-F.)
| | | |
Collapse
|
9
|
Guasch-Jiménez M, Prats-Sánchez L, Martínez-Domeño A, Delgado-Mederos R, Camps-Renom P, Guisado-Alonso D, Abilleira S, Martí-Fàbregas J. Patterns of Admission and Outcomes for Patients with Intracranial Hemorrhage in Catalonia, Spain. World Neurosurg 2021; 149:e1123-e1127. [PMID: 33412328 DOI: 10.1016/j.wneu.2020.12.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Limited information is available about the hospital types to which patients with intracerebral hemorrhage (ICH) are admitted and treated. This could be important because some effective therapeutic measures can only be administered at comprehensive stroke centers (CSCs). METHODS Using the Acute Hospitals Discharge database, which provides population-based information, we identified ICH patients admitted to 7 CSCs and 53 non-CSCs (from January 2015 to December 2016) in Catalonia. CSCs were defined as centers with an emergency department ready to assess and treat code stroke patients around the clock, 24-hour availability of neurology, neurosurgery, and neuroradiology services, and admission to the stroke unit and/or intensive care unit. The database provided the demographics, admitting hospital, and interhospital transfers. Vital status was retrieved from the Central Registry of the Catalan Public Health Insurance. RESULTS A total of 3339 ICH patients were identified (mean age, 72.2 ± 14.6 years; 56.8% men). Of the 3339 patients, 45.7% were admitted to a CSC and 54.3% to a non-CSC. Transfer from a non-CSC to a CSC occurred for 1.97% of the patients. In-hospital mortality was similar between the CSCs and non-CSCs (30.2% vs. 27.5%; P = 0.09). The long-term mortality was also comparable between the CSC and non-CSC groups (45.4% vs. 47%; P = 0.34). CONCLUSIONS Despite a considerable proportion of ICH patients remaining at a non-CSC for their entire hospitalization, the short- and long-term mortality were comparable between the 2 hospital types. More studies are required to determine whether outcomes other than mortality might be related to the admitting hospital type and whether the routing protocols for ICH patients should be modified.
Collapse
Affiliation(s)
- Marina Guasch-Jiménez
- Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Luis Prats-Sánchez
- Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alejandro Martínez-Domeño
- Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Raquel Delgado-Mederos
- Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pol Camps-Renom
- Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Daniel Guisado-Alonso
- Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sònia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Centro de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid, Spain
| | - Joan Martí-Fàbregas
- Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| |
Collapse
|
10
|
Purroy F, Arque G, Mauri G, García-Vázquez C, Vicente-Pascual M, Pereira C, Vazquez-Justes D, Torres-Querol C, Vena A, Abilleira S, Cardona P, Forné C, Jiménez-Fàbrega X, Pagola J, Portero-Otin M, Rodríguez-Campello A, Rovira À, Martí-Fàbregas J. REMOTE Ischemic Perconditioning Among Acute Ischemic Stroke Patients in Catalonia: REMOTE-CAT PROJECT. Front Neurol 2020; 11:569696. [PMID: 33101178 PMCID: PMC7546310 DOI: 10.3389/fneur.2020.569696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/27/2020] [Indexed: 01/24/2023] Open
Abstract
Rationale: Remote ischemic perconditioning during cerebral ischemia (RIPerC) refers to the application of brief episodes of transient limb ischemia commonly to a limb, it represents a new safe, simple and low-cost paradigm in neuroprotection. Aim and/or Hypothesis: To evaluate the effects of RIPerC on acute ischemic stroke (AIS) patients, applied in the ambulance, to improve functional outcomes compared with standard of care. Sample Size Estimates: A sample size of 286 patients in each arm achieves 80% power to detect treatment differences of 14% in the outcome, using a two-sided binomial test at significance level of 0.05, assuming that 40% of the control patients will experience good outcome and an initial misdiagnosis rate of 29%. Methods and Design: We aim to conduct a multicentre study of pre-hospital RIPerC application in AIS patients. A total of 572 adult patients diagnosed of suspected clinical stroke within 8 h of symptom onset and clinical deficit >0 according to prehospital rapid arterial occlusion evaluation (RACE) scale score will be randomized, in blocks of size 4, to RIPerC or sham. Patients will be stratified by RACE score scale. RIPerC will be started in the ambulance before hospital admission and continued in the hospital if necessary. It will consist of five cycles of electronic tourniquet inflation and deflation (5 min each). The cuff pressure for RIPerC will be 200 mmHg during inflation. Sham will only simulate vibration of the device. Study Outcome(s): The primary outcome will be the difference in the proportion of patients with good outcomes as defined by a mRS score of 2 or less at 90 days. Secondary outcomes to be monitored will include early neurological improvement rate, treatment related serious adverse event rates, size of the infarct volume, symptomatic intracranial hemorrhage, metabolomic and lipidomic response to RIPerC and Neuropsychological evaluation at 90 days. Discussion: Neuroprotective therapies could not only increase the benefits of available reperfusion therapies among AIS patients but also provide an option for patients who are not candidates for these treatments. REMOTE-CAT will investigate the clinical benefit of RIC as a new neuroprotective strategy in AIS. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03375762.
Collapse
Affiliation(s)
- Francisco Purroy
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Gloria Arque
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Gerard Mauri
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Cristina García-Vázquez
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Mikel Vicente-Pascual
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Cristina Pereira
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Daniel Vazquez-Justes
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Coral Torres-Querol
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Ana Vena
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Sònia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Pere Cardona
- Stroke Unit, Hospital de Bellvitge, Hospitalet de Llobregat, Spain
| | - Carles Forné
- Department of Basic Medical Sciences, Universitat de Lleida, Lleida, Spain
| | | | - Jorge Pagola
- Stroke Unit, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Manuel Portero-Otin
- Department of Experimental Medicine, NUTREN-Nutrigenomics, Biomedical Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Ana Rodríguez-Campello
- Neurovascular Research Group, Neurology Department, Institut Hospital del Mar d'Investigacions Mèdiques-Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology and MRI Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | |
Collapse
|
11
|
Rudilosso S, Laredo C, Amaro S, Renú A, Llull L, Obach V, Moreno J, Ribó M, Abilleira S, Cardona P, Martí-Fàbregas J, Pérez de la Ossa N, Ramos A, Roquer J, Serena J, Purroy F, Urra X, Chamorro Á. Clinical improvement within 24 hours from mechanical thrombectomy as a predictor of long-term functional outcome in a multicenter population-based cohort of patients with ischemic stroke. J Neurointerv Surg 2020; 13:119-123. [PMID: 32461229 DOI: 10.1136/neurintsurg-2020-015934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/04/2020] [Accepted: 04/10/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Single-center studies have suggested that the early clinical course after mechanical thrombectomy (MT) in patients with ischemic stroke is a clinical predictor of long-term outcome. OBJECTIVE To analyze the prognostic value of clinical improvement within 24 hours in a population-based multicenter cohort. METHODS From a total of 3792 patients with acute ischemic stroke in Catalonia (CICAT registry), 1951 patients were treated with MT. The National Institutes of Health Stroke Scale (NIHSS) score within 24 hours, and follow-up was available in 1666 patients. Percentage variation in the NIHSS score was calculated in relation to a baseline assessment. Good outcome was defined as a modified Rankin Scale score ≤2 at 90 days. Predictive values of clinical improvement and adjusted OR to predict good outcomes were assessed in the whole cohort and the subgroup of patients with posterior circulation stroke (n=166). RESULTS Good outcome was achieved in 656/1666 patients (39%) overall. Percentage improvements both at the end of MT and at 24 hours predicted good outcome, with higher predictive capacity at 24 hours (C-statistic, 0.85 vs 0.73, p<0.001). Positive and negative predictive values were 70% and 74% for the >30% cut-off point at the end of MT, and 69% and 84% for the >50% cut-off point at 24 hours, respectively. The adjusted OR for good outcome was 5.8 (95% CI 4.2 to 8.1) and 12.9 (95% CI 9.7 to 17.1), respectively. In patients with posterior circulation stroke, the predictive value of the improvement at 24 hours was similar (C-statistic 0.90). CONCLUSION Clinical improvement of patients within 24 hours of MT is a reliable and robust predictor of long-term prognosis, including patients with posterior circulation occlusions.
Collapse
Affiliation(s)
- Salvatore Rudilosso
- Comprehensive Stroke Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Carlos Laredo
- Comprehensive Stroke Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Sergio Amaro
- Comprehensive Stroke Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Arturo Renú
- Comprehensive Stroke Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Laura Llull
- Comprehensive Stroke Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Víctor Obach
- Comprehensive Stroke Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Javier Moreno
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Marc Ribó
- Stroke Unit. Neurology, Hospital Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Sònia Abilleira
- Health Department of Catalonia, Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Pedro Cardona
- Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalonia, Spain
| | - Joan Martí-Fàbregas
- Department of Neurology, Hospital de Sant Pau I Santa Creu, Barcelona, Catalonia, Spain
| | - Natalia Pérez de la Ossa
- Stroke Unit, Department of Neurology, Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Anna Ramos
- Stroke Unit, Department of Neurology, Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Jaume Roquer
- Department of Neurology, Hospital del Mar, Barcelona, Catalonia, Spain
| | - Joaquín Serena
- Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Catalonia, Spain
| | - Francisco Purroy
- Department of Neurology, Hospital Arnau de Vilanova, Lleida, Catalonia, Spain
| | - Xabier Urra
- Comprehensive Stroke Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Ángel Chamorro
- Comprehensive Stroke Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| |
Collapse
|
12
|
Abilleira S, de Sousa DA, Gattringer T, Kobayashi A, Fazekas F, Szikora I, Feigin V, Caso V, Gallofré M, Fischer U. Planning of stroke care and urgent prehospital care across Europe: Results of the ESO/ESMINT/EAN/SAFE Survey. Eur Stroke J 2020; 4:329-336. [PMID: 31903431 DOI: 10.1177/2396987319837106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/20/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Adequate planning and implementation of stroke systems of care is key to guarantee a rapid healthcare response and delivery of specific reperfusion therapies among candidates. We assessed the availability of stroke care plans in Europe, and evaluated their impact on rates of reperfusion therapies for stroke. Patients Based on the European Stroke Organisation (ESO), the European Society of Minimally Invasive Neurological Therapy (ESMINT), the European Academy of Neurology (EAN), and the Stroke Alliance for Europe (SAFE) survey, we analysed specific prespecified items in the questionnaire regarding availability and adequacy of stroke care plans, organised prehospital care and their potential impact on rates of delivery of reperfusion therapies for stroke at the country level. Results Of 44 participating European countries, 37 have stroke care plans that operate at national and/or regional levels. Most stroke care plans take responsibility for the organisation/implementation of stroke systems of care (86%), quality of care assessment (77%), and act as a liaison between emergency medical systems and stroke physicians (79%). As for stroke systems of care, the focus is mainly on prehospital and in-hospital acute stroke care (Code Stroke systems available in 37/44 countries). Preferred urgent transport is via non-medicalised ambulances (70%). Presence of stroke care plans, stroke registry data, transport of urgent stroke patients via non-medicalised ambulances, and drip-and-ship routing of acute patients showed higher reperfusion treatment rates. Discussion Availability of stroke care plans, still absent in some European countries, as well as some features of the stroke systems of care are associated with higher reperfusion treatment rates. Conclusion Stroke is not yet a priority everywhere in Europe, which is a barrier to the spread of reperfusion therapies for stroke.
Collapse
Affiliation(s)
- Sònia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia. CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Diana Aguiar de Sousa
- Department of Neurology, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | | | - Adam Kobayashi
- Faculty of Medical Sciences and Physical Education, Kazimierz Pulaski University of Technology and Humanities, Radom, Poland
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Istvan Szikora
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Valery Feigin
- National Institute for Stroke & Applied Neurosciences, Auckland, New Zealand
| | - Valeria Caso
- Stroke Unit, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Miquel Gallofré
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia. CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Urs Fischer
- Department of Neurology, University Hospital Bern and University of Bern, Inselspital, Bern, Switzerland
| | | |
Collapse
|
13
|
Alasheev AM, Hubert GJ, Santo GC, Vanhooren GT, Zvan B, Campos ST, Abilleira S, Corea F. Recommendations on telestroke in Europe. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:33-41. [DOI: 10.17116/jnevro202012003233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
14
|
Gomis M, Dávalos A, Purroy F, Cardona P, Rodríguez-Campello A, Martí-Fábregas J, Pagola J, Pardo L, Muñoz-Narbona L, Benabdelhak I, Lara-Rodríguez B, Cuadrado-Godia E, Martínez-Domeño A, Juega JM, Serena J, Alvarez-Ballano J, Paipa A, Roquer J, Abilleira S, Neeter R, van de Groep A, Molina C. Stroke Risk Analysis, a System With a High Detection Rate of Atrial Fibrillation in Stroke and Transient Ischemic Attack. Stroke 2019; 51:262-267. [PMID: 31842722 DOI: 10.1161/strokeaha.119.026354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Stroke Risk Analysis (SRA) comprises an algorithm for automated analysis of ECG monitoring, enabling the detection of paroxysmal atrial fibrillation (pxAF) and identifying patterns indicating a high risk of atrial fibrillation (R_AF). We compared Holter-enabled continuous ECG monitoring in combination with SRA (hSRA) with standard continuous ECG monitoring for pxAF detection in patients with acute ischemic stroke. Also, we sought to identify whether the detection of R_AF patterns during the first cycle (first 2 hours) of hSRA recording was associated with the detection of pxAF during the Stroke Unit stay. Methods- We enrolled 524 consecutive patients admitted in the Stroke Unit with acute ischemic stroke or transient ischemic attack with neither history of AF nor AF at admission into a prospective multicentric observational analytic clinical study with intrapatient comparison, who received both continuous ECG monitoring as well as hSRA up to 7 days. Investigators were blinded to hSRA results unless pxAF was detected on SRA. Results- Of the 524 consecutive acute stroke patients (median age, 70.0 years; 60% male; acute ischemic stroke 93%, transient ischemic attack 7%), 462 were eligible and included in the study. Among 462 patients with hSRA available for 66 hours, AF was documented by hSRA in 79 patients (17.1%). From this group, 45 AF cases (9.7%) were confirmed after review by an independent and blinded cardiologist. continuous ECG monitoring detected 21 AF cases (4.3%; P<0.0001). hSRA detected R_AF patterns in 92 patients. 35 out of the 92 R_AF patients showed an episode of AF during the Stroke Unit stay. Predictive values of R_AF patterns within the first cycle of hSRA were: sensitivity 71%, specificity 86%, positive predictive value 38%, and negative predictive value 96%. Conclusions- Automated analysis using SRA technology strongly improves pxAF detection in acute ischemic stroke patients compared with continuous ECG monitoring. The predictive value of a R_AF pattern, as detected by hSRA during the first few hours after admission, deserves further investigation.
Collapse
Affiliation(s)
- Meritxell Gomis
- From the Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Neurosciences, Badalona-Barcelona, Spain (M.G., A.D., L.M.-N., J.A.-B.)
| | - Antoni Dávalos
- From the Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Neurosciences, Badalona-Barcelona, Spain (M.G., A.D., L.M.-N., J.A.-B.)
| | - Francisco Purroy
- Department of Neurology, Hospital Arnau de Vilanova, Lleida, Spain (F.P., I.B.)
| | - Pere Cardona
- Department of Neurology, Hospital de Bellvitge, Hospitalet de Llobregat-Barcelona, Spain (P.C., B.L.-R., A.P)
| | | | - Joan Martí-Fábregas
- Department of Neurology, Hospital de Sant Pau, Barcelona, Spain (J.M.-F., A.M.-D.)
| | - Jorge Pagola
- Department of Neurology, Hospital Vall d'Hebrón, Barcelona, Spain (J.P., J.M.J., C.M.)
| | - Laura Pardo
- Department of Neurology, Hospital Doctor Josep Trueta, Girona, Spain (L.P., J.S.)
| | - Lucía Muñoz-Narbona
- From the Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Neurosciences, Badalona-Barcelona, Spain (M.G., A.D., L.M.-N., J.A.-B.)
| | - Ikram Benabdelhak
- Department of Neurology, Hospital Arnau de Vilanova, Lleida, Spain (F.P., I.B.)
| | - Blanca Lara-Rodríguez
- Department of Neurology, Hospital de Bellvitge, Hospitalet de Llobregat-Barcelona, Spain (P.C., B.L.-R., A.P)
| | - Elisa Cuadrado-Godia
- Department of Neurology, Hospital de Mar, Barcelona, Spain (A.R.-C., E.C.-G., J.R.)
| | | | - Jesús Maria Juega
- Department of Neurology, Hospital Vall d'Hebrón, Barcelona, Spain (J.P., J.M.J., C.M.)
| | - Joaquin Serena
- Department of Neurology, Hospital Doctor Josep Trueta, Girona, Spain (L.P., J.S.)
| | - Jesús Alvarez-Ballano
- From the Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Neurosciences, Badalona-Barcelona, Spain (M.G., A.D., L.M.-N., J.A.-B.)
| | - Andrés Paipa
- Department of Neurology, Hospital de Bellvitge, Hospitalet de Llobregat-Barcelona, Spain (P.C., B.L.-R., A.P)
| | - Jaume Roquer
- Department of Neurology, Hospital de Mar, Barcelona, Spain (A.R.-C., E.C.-G., J.R.)
| | - Sònia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.)
| | - Rob Neeter
- Evina Health Solutions, the Netherlands (R.N., A.v.d.G.)
| | | | - Carlos Molina
- Department of Neurology, Hospital Vall d'Hebrón, Barcelona, Spain (J.P., J.M.J., C.M.)
| |
Collapse
|
15
|
Abstract
Background and Purpose- The aim of the study was to determine the impact of individuals' socioeconomic status and their Primary Care Service Area Socioeconomic Index on survival after ischemic stroke. Methods- We conducted a nationwide population-based cohort study in Catalonia, Spain. We included all patients with first ischemic stroke admitted to a public hospital between January 1, 2015, and December 31, 2016. We measured both individual socioeconomic status (categorized as exempts, <€18 000 [$US 20 468] income per year, and >€18 000 income per year) and Primary Care Service Area Socioeconomic Index (from 0 to 100 categorized in quartiles). We used mixed-effects logistic and survival models to estimate odds ratios and hazard ratios for the short- (30 days) and the long-term (3 years) all-cause case fatality rates by individuals' socioeconomic status groups. Results- The cohort consisted of 16 344 ischemic stroke patients with 24 638 person-years of follow-up. We did not find an association between the lowest socioeconomic individual status and short-term survival (odds ratio, 1.03; 95% CI, 0.76-1.40), although we found it in patients with <€18 000 income/year (odds ratio, 1.26; 95% CI, 1.10-1.45). At long-term, after adjustment, we observed a gradient in mortality risk with decreasing individual socioeconomic status (hazard ratio, 1.52; 95% CI, 1.30-1.77). The Primary Care Service Area Socioeconomic Index had only an influence on short-term survival (odds ratio, 1.19; 95% CI, 1.03-1.37). Conclusions- Individuals' socioeconomic status was associated with short- and long-term survival in patients with ischemic stroke. Conversely, Primary Care Service Area Socioeconomic Index measures had an influence only in short-term survival. A small fraction of this association is due to differences in comorbidity and cardiovascular risk factors. Interventions addressing both individuals' and primary care service socioeconomic aspects might eventually affect differently short- and long-term survival.
Collapse
Affiliation(s)
| | - Aida Ribera
- Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d'Hebron, Barcelona, Spain (A.R.).,CIBER Epidemiología y Salud Pública, Barcelona, Spain (A.R.)
| | - Sònia Abilleira
- Stroke Program, Agency for Health Quality and Assessment of Catalonia CIBER Epidemiología y Salud Pública, Barcelona, Spain (S.A.)
| |
Collapse
|
16
|
Abilleira S, Pérez de la Ossa N, Jiménez X, Cardona P, Cocho D, Purroy F, Serena J, Román LS, Urra X, Vilaró M, Cortés J, González JA, Chamorro Á, Gallofré M, Jovin T, Molina C, Cobo E, Dávalos A, Ribó M. 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. Int J Stroke 2019; 14:734-744. [PMID: 31142219 DOI: 10.1177/1747493019852176] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
RATIONALE Optimal pre-hospital delivery pathways for acute stroke patients suspected to harbor a large vessel occlusion have not been assessed in randomized trials. AIM To establish whether stroke subjects with rapid arterial occlusion evaluation scale based suspicion of large vessel occlusion evaluated by emergency medical services in the field have higher rates of favorable outcome when transferred directly to an endovascular center (endovascular treatment stroke center), as compared to the standard transfer to the closest local stroke center (local-SC). DESIGN Multicenter, superiority, cluster randomized within a cohort trial with blinded endpoint assessment. PROCEDURE Eligible patients must be 18 or older, have acute stroke symptoms and not have an immediate life threatening condition requiring emergent medical intervention. They must be suspected to have intracranial large vessel occlusion based on a pre-hospital rapid arterial occlusion evaluation scale of ≥5, be located in geographical areas where the default health authority assigned referral stroke center is a non-thrombectomy capable hospital, and estimated arrival at a thrombectomy capable stroke hospital in less than 7 h from time last seen well. Cluster randomization is performed according to a pre-established temporal sequence (temporal cluster design) with three strata: day/night, distance to the endovascular treatment stroke center, and week/week-end day. STUDY OUTCOME The primary endpoint is the modified Rankin Scale score at 90 days. The primary safety outcome is mortality at 90 days. ANALYSIS The primary endpoint based on the modified intention-to-treat population is the distribution of modified Rankin Scale scores at 90 days analyzed under a sequential triangular design. The maximum sample size is 1754 patients, with two planned interim analyses when 701 (40%) and 1227 patients have completed follow-up. Hypothesized common odds ratio is 1.35.
Collapse
Affiliation(s)
- Sònia Abilleira
- Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Xavier Jiménez
- Emergency Medical Services of Catalonia, Barcelona, Spain
| | - Pere Cardona
- Department of Neurology, Stroke Unit, Hospital Universitari Bellvitge, Barcelona, Spain
| | | | - Francisco Purroy
- Department of Neurology, Stroke Unit, Hospital Arnau de Vilanova, Lleida, Spain
| | - Joaquín Serena
- Department of Neurology, Stroke Unit, Hospital Josep Trueta, Girona, Spain
| | - Luis San Román
- Department of Neuroradiology, Hospital Clínic, Barcelona, Spain
| | - Xabier Urra
- Department of Neurology, Stroke Unit, Hospital Clínic, Barcelona, Spain
| | - Marta Vilaró
- Statistics and Operational Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Jordi Cortés
- Statistics and Operational Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - José Antonio González
- Statistics and Operational Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Ángel Chamorro
- Department of Neurology, Stroke Unit, Hospital Clínic, Barcelona, Spain
| | - Miquel Gallofré
- Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Tudor Jovin
- Department of Neurological Surgery, Pierre and Marie Curie University, Pittsburgh, PA, USA
| | - Carlos Molina
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain Sònia Abilleira, Natalia Pérez de la Ossa and Marc Ribó contributed equally to this article
| | - Erik Cobo
- Statistics and Operational Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Antoni Dávalos
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marc Ribó
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain Sònia Abilleira, Natalia Pérez de la Ossa and Marc Ribó contributed equally to this article
| |
Collapse
|
17
|
Carrera D, Gorchs M, Querol M, Abilleira S, Ribó M, Millán M, Ramos A, Cardona P, Urra X, Rodríguez-Campello A, Prats-Sánchez L, Purroy F, Serena J, Cánovas D, Zaragoza-Brunet J, Krupinski JA, Ustrell X, Saura J, García S, Mora MÀ, Jiménez X, Dávalos A, Pérez de la Ossa N. Revalidation of the RACE scale after its regional implementation in Catalonia: a triage tool for large vessel occlusion. J Neurointerv Surg 2018; 11:751-756. [PMID: 30580284 DOI: 10.1136/neurintsurg-2018-014519] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 11/04/2022]
Abstract
Background and purposeOur aim was to revalidate the RACE scale, a prehospital tool that aims to identify patients with large vessel occlusion (LVO), after its region-wide implementation in Catalonia, and to analyze geographical differences in access to endovascular treatment (EVT).MethodsWe used data from the prospective CICAT registry (Stroke Code Catalan registry) that includes all stroke code activations. The RACE score evaluated by emergency medical services, time metrics, final diagnosis, presence of LVO, and type of revascularization treatment were registered. Sensitivity, specificity, and area under the curve (AUC) for the RACE cut-off value ≥5 for identification of both LVO and eligibility for EVT were calculated. We compared the rate of EVT and time to EVT of patients transferred from referral centers compared with those directly presenting to comprehensive stroke centers (CSC).ResultsThe RACE scale was evaluated in the field in 1822 patients, showing a strong correlation with the subsequent in-hospital evaluation of the National Institute of Health Stroke Scale evaluated at hospital (r=0.74, P<0.001). A RACE score ≥5 detected LVO with a sensitivity 0.84 and specificity 0.60 (AUC 0.77). Patients with RACE ≥5 harbored a LVO and received EVT more frequently than RACE <5 patients (LVO 35% vs 6%; EVT 20% vs 6%; all P<0.001). Direct admission at a CSC was independently associated with higher odds of receiving EVT compared with admission at a referral center (OR 2.40; 95% CI 1.66 to 3.46), and symtoms onset to groin puncture was 133 min shorter.ConclusionsThis large validation study confirms RACE accuracy to identify stroke patients eligible for EVT, and provides evidence of geographical imbalances in the access to EVT to the detriment of patients located in remote areas.
Collapse
Affiliation(s)
- David Carrera
- Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Montse Gorchs
- Emergency Medical Services of Catalonia, Barcelona, Spain
| | | | - Sònia Abilleira
- Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Marc Ribó
- Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Anna Ramos
- Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Xabier Urra
- Hospital Clínic, Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Xavier Jiménez
- Emergency Medical Services of Catalonia, Barcelona, Spain
| | | | | |
Collapse
|
18
|
Hubert GJ, Santo G, Vanhooren G, Zvan B, Tur Campos S, Alasheev A, Abilleira S, Corea F. Recommendations on telestroke in Europe. Eur Stroke J 2018; 4:101-109. [PMID: 31259258 DOI: 10.1177/2396987318806718] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/20/2018] [Indexed: 11/17/2022] Open
Abstract
Lack of stroke specialists determines that many European rural areas remain underserved. Use of telemedicine in stroke care has shown to be safe, increase use of evidence-based therapy and enable coverage of large areas of low population density. The aim of this article is to summarise the following recommendations of the Telestroke Committee of the European Stroke Organisation on the setup of telestroke networks in Europe: Hospitals participating in telestroke networks should be chosen according to criteria that include population density, transportation distance, geographic specifics and in-hospital infrastructure and professional resources. Three hospital categories are identified to be part of a hub-and-spoke network: (1) the Telemedicine Stroke Centre (an European Stroke Organisation stroke centre or equivalent with specific infrastructure and setup for network and telemedicine support), (2) the telemedicine-assisted stroke Unit (equivalent to an European Stroke Organisation stroke unit but without 24 h onsite stroke expertise) and (3) the telemedicine-assisted stroke ready hospital (only covering hyperacute treatment in the emergency department and transferring all patients for further treatment).
Collapse
Affiliation(s)
- Gordian J Hubert
- Department of Neurology, TEMPiS network, Munich Clinic, Munich, Germany
| | - Gustavo Santo
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Geert Vanhooren
- Department of Neurology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Bojana Zvan
- TeleKap network, Ljubljana University Medical Center, Ljubljana, Slovenia
| | | | - Andrey Alasheev
- Sverdlovsk Regional Clinical Hospital #1, Yekaterinburg, Russia
| | - Sònia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Francesco Corea
- Stroke and Neurology Clinic, San Giovanni Battista Hospital, Foligno, Italy
| |
Collapse
|
19
|
López-Cancio E, Ribó M, Cardona P, Serena J, Purroy F, Palomeras E, Aragonès J, Cocho D, Garcés M, Puiggròs E, Soteras I, Cabanelas A, Villagrasa D, Catena E, Sanjurjo E, López Claverol N, Carrión D, López M, Abilleira S, Dávalos A, Pérez de la Ossa N. Telestroke in Catalonia: Increasing Thrombolysis Rate and Avoiding Interhospital Transfers. Cerebrovasc Dis 2018; 46:66-71. [DOI: 10.1159/000492124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/14/2018] [Indexed: 11/19/2022] Open
Abstract
Objectives: The study aimed to evaluate the impact of a telestroke network on acute stroke care in Catalonia, by measuring thrombolysis rates, access to endovascular treatment, and clinical outcome of telestroke patients in a population-based study. Methods: Telestroke network was implemented on March 2013 and consists of 12 community hospitals and 1 expert stroke neurologist 24 h/7 day, covering a population of 1.3 million inhabitants. Rest of the population (6.2 million) of Catalonia is covered by 8 primary stroke centers (PSC) and 6 comprehensive stroke centers (CSC). After a 2-way videoconference and visualization of neuroimaging on a web platform, the stroke neurologist decides the therapeutic approach and/or to transfer the patient to another facility, entering these data in a mandatory registry. Simultaneously, all patients treated with reperfusion therapies in all centers of Catalonia are prospectively recorded in a mandatory and audited registry. Results: From March 2013 to December 2015, 1,206 patients were assessed by telestroke videoconference, of whom 322 received intravenous thrombolysis (IVT; 33.8% of ischemic strokes). Baseline and 24 h NIHSS, rate of symptomatic hemorrhage, mortality, and good outcome at 3 months were similar compared to those who received IVT in PSC or CSC (2,897 patients in the same period). The door-to-needle time was longer in patients treated through telestroke, but was progressively reduced from 2013 to 2015. Percentage of patients receiving thrombectomy after IVT was similar in patients treated through telestroke circuit, compared to those treated in PSC or CSC (conventional circuit). Population rates of IVT*100,000 inhabitants in Catalonia increased from 2011 to 2015, especially in areas affected by the implementation of telestroke network, achieving rates as high as 16 per 100,000 inhabitants. Transfers to another facility were avoided after telestroke consultation in 46.8% of ischemic, 76.5% of transient ischemic attacks, and 23.5% of hemorrhages. Conclusions: Telestroke favors safe and effective thrombolysis, helps to increase the population rate of IVT, and avoids a large number of interhospital transfers.
Collapse
|
20
|
Aguiar de Sousa D, von Martial R, Abilleira S, Gattringer T, Kobayashi A, Gallofré M, Fazekas F, Szikora I, Feigin V, Caso V, Fischer U. Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries. Eur Stroke J 2018; 4:13-28. [PMID: 31165091 PMCID: PMC6533860 DOI: 10.1177/2396987318786023] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 05/24/2018] [Indexed: 12/19/2022] Open
Abstract
Introduction Acute stroke unit care, intravenous thrombolysis and endovascular treatment significantly improve the outcome for patients with ischaemic stroke, but data on access and delivery throughout Europe are lacking. We assessed best available data on access and delivery of acute stroke unit care, intravenous thrombolysis and endovascular treatment throughout Europe. Methods A survey, drafted by stroke professionals (ESO, ESMINT, EAN) and a patient organisation (SAFE), was sent to national stroke societies and experts in 51 European countries (World Health Organization definition) requesting experts to provide national data on stroke unit, intravenous thrombolysis and endovascular treatment rates. We compared both pooled and individual national data per one million inhabitants and per 1000 annual incident ischaemic strokes with highest country rates. Population estimates were based on United Nations data, stroke incidences on the Global Burden of Disease Report. Results We obtained data from 44 European countries. The estimated mean number of stroke units was 2.9 per million inhabitants (95% CI 2.3-3.6) and 1.5 per 1000 annual incident strokes (95% CI 1.1-1.9), highest country rates were 9.2 and 5.8. Intravenous thrombolysis was provided in 42/44 countries. The estimated mean annual number of intravenous thrombolysis was 142.0 per million inhabitants (95% CI 107.4-176.7) and 72.7 per 1000 annual incident strokes (95% CI 54.2-91.2), highest country rates were 412.2 and 205.5. Endovascular treatment was provided in 40/44 countries. The estimated mean annual number of endovascular treatments was 37.1 per million inhabitants (95% CI 26.7-47.5) and 19.3 per 1000 annual incident strokes (95% CI 13.5-25.1), highest country rates were 111.5 and 55.9. Overall, 7.3% of incident ischaemic stroke patients received intravenous thrombolysis (95% CI 5.4-9.1) and 1.9% received endovascular treatment (95% CI 1.3-2.5), highest country rates were 20.6% and 5.6%. Conclusion We observed major inequalities in acute stroke treatment between and within 44 European countries. Our data will assist decision makers implementing tailored stroke care programmes for reducing stroke-related morbidity and mortality in Europe.
Collapse
Affiliation(s)
- Diana Aguiar de Sousa
- Department of Neurology, University of Lisbon, Hospital de Santa Maria, Lisbon, Portugal
| | - Rascha von Martial
- Department of Neurology, University of Bern, Inselspital, Bern, Switzerland
| | - Sònia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Adam Kobayashi
- Interventional Stroke and Cerebrovascular Disease Treatment Centre, Department of Neuroradiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Istvan Szikora
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Valery Feigin
- National Institute for Stroke & Applied Neurosciences, Auckland, New Zealand
| | - Valeria Caso
- Stroke Unit, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Urs Fischer
- Department of Neurology, University of Bern, Inselspital, Bern, Switzerland
| |
Collapse
|
21
|
Vivanco-Hidalgo RM, Abilleira S, Salvat-Plana M, Ribera A, Gallofré G, Gallofré M. Innovation in Systems of Care in Acute Phase of Ischemic Stroke. The Experience of the Catalan Stroke Programme. Front Neurol 2018; 9:427. [PMID: 29928257 PMCID: PMC5997815 DOI: 10.3389/fneur.2018.00427] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 05/22/2018] [Indexed: 11/13/2022] Open
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).
Collapse
Affiliation(s)
| | - Sònia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | | | - Aida Ribera
- Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | |
Collapse
|
22
|
Corea F, Hubert G, Abilleira S. Letter by Corea et al Regarding Article, "Telemedicine Quality and Outcomes in Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke 2017; 48:e139. [PMID: 28465459 DOI: 10.1161/strokeaha.117.016724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Francesco Corea
- Department of Neurology, Ospedale San Giovanni USL-Umbria2, Foligno, Italy
| | - Gordian Hubert
- Department of Neurology, TEMPiS, Städtisches Klinikum München, Germany
| | - Sònia Abilleira
- Stroke Program/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| |
Collapse
|
23
|
Abilleira S, Tebé C, de la Ossa NP, Ribó M, Cardona P, Urra X, Giralt-Steinhauer E, Cánovas D, Camps-Renom P, Gallofré M. Geographic dissemination of endovascular stroke thrombectomy in Catalonia within the 2011-2015 period. Eur Stroke J 2017; 2:163-170. [PMID: 31008311 DOI: 10.1177/2396987317696376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/03/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction Endovascular thrombectomy was recently established as a new standard of care in acute ischemic stroke patients with large artery occlusions. Using small area health statistics, we sought to assess dissemination of endovascular thrombectomy in Catalonia throughout the period 2011-2015. Patients and methods We used registry data to identify all endovascular thrombectomies for acute ischemic stroke performed in Catalonia within the study period. The SONIIA registry is a government-mandated, population-based and externally audited data base that includes all reperfusion therapies for acute ischemic stroke. We linked endovascular thrombectomy cases identified in the registry with the Central Registry of the Catalan Public Health Insurance to obtain the primary care service area of residence for each treated patient, age and sex. We calculated age-sex standardized endovascular thrombectomy rates over time according to different territorial segmentation patterns (metropolitan/provincial rings and primary care service areas). Results Region-wide age-sex standardized endovascular thrombectomy rates increased significantly from 3.9 × 100,000 (95% confidence interval: 3.4-4.4) in 2011 to 6.8 × 100,000 (95% confidence interval: 6.2-7.6) in 2015. Such increase occurred in inner and outer metropolitan rings as well as provinces although highest endovascular thrombectomy rates were persistently seen in the inner metropolitan area. Changes in endovascular thrombectomy access across primary care service areas over time were more subtle, but there was a rather generalized increase of standardized endovascular thrombectomy rates. Discussion This study demonstrates temporal and territorial dissemination of access to endovascular thrombectomy in Catalonia over a 5-year period although variation remains at the completion of the study. Conclusion Mapping of endovascular thrombectomy is essential to assess equity and propose actions for access dissemination.
Collapse
Affiliation(s)
- Sònia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Cristian Tebé
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain.,Faculty of Medicine and Health Sciences, Rovira i Virgili University, Spain
| | | | - Marc Ribó
- Stroke Unit, Hospital Vall d'Hebron, Spain
| | - Pere Cardona
- Department of Neurology, Hospital de Bellvitge, Hospitalet de Llobregat, Spain
| | - Xabier Urra
- Department of Neuroscience, Hospital Clínic, Spain
| | | | - David Cánovas
- Department of Neurology, Hospital del Parc Taulí, Spain
| | | | - Miquel Gallofré
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | | |
Collapse
|
24
|
Abilleira S, Ribera A, Cardona P, Rubiera M, López-Cancio E, Amaro S, Rodríguez-Campello A, Camps-Renom P, Cánovas D, de Miquel MA, Tomasello A, Remollo S, López-Rueda A, Vivas E, Perendreu J, Gallofré M, Martí-Fàbregas J, Delgado-Mederos R, Martínez-Domeño A, Marín R, Roquer J, Ois Á, Jiménez-Conde J, Guimaraens L, Chamorro Á, Obach V, Urra X, Macho J, Blasco J, San Roman L, Martínez-Yélamos A, Quesada H, Lara B, Cayuela N, Aja L, Mora P, Molina C, Ribó M, Pagola J, Rodríguez-Luna D, Muchada M, Coscojuela P, Dávalos A, Millán M, Pérez de la Ossa N, Gomis M, Dorado L, Castaño C, Garcia M, Estela J, Krupinski J, Huertas-Folch S, Nicolás-Herrerias M, Gómez-Choco M, García S, Martínez R, Sanahuja J, Purroy F, Serena J, Castellanos M, Silva Y, Marés R, Pellisé A, Ustrell X, Baiges J, Garcés M, Saura J, Soler-Insa J, Aragonés J, Cocho D, Palomeras E. Outcomes After Direct Thrombectomy or Combined Intravenous and Endovascular Treatment Are Not Different. Stroke 2017; 48:375-378. [DOI: 10.1161/strokeaha.116.015857] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 10/24/2016] [Accepted: 11/15/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Whether intravenous thrombolysis adds a further benefit when given before endovascular thrombectomy (EVT) is unknown. Furthermore, intravenous thrombolysis delays time to groin puncture, mainly among drip and ship patients.
Methods—
Using region-wide registry data, we selected cases that received direct EVT or combined intravenous thrombolysis+EVT for anterior circulation strokes between January 2011 and October 2015. Treatment effect was estimated by stratification on a propensity score. The average odds ratios for the association of treatment with good outcome and death at 3 months and symptomatic bleedings at 24 hours were calculated with the Mantel–Haenszel test statistic.
Results—
We included 599 direct EVT patients and 567 patients with combined treatment. Stratification through propensity score achieved balance of baseline characteristics across treatment groups. There was no association between treatment modality and good outcome (odds ratio, 0.97; 95% confidence interval, 0.74–1.27), death (odds ratio, 1.07; 95% confidence interval, 0.74–1.54), or symptomatic bleedings (odds ratio, 0.56; 95% confidence interval, 0.25–1.27).
Conclusions—
This observational study suggests that outcomes after direct EVT or combined intravenous thrombolysis+EVT are not different. If confirmed by a randomized controlled trial, it may have a significant impact on organization of stroke systems of care.
Collapse
Affiliation(s)
- Sònia Abilleira
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Aida Ribera
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Pedro Cardona
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Marta Rubiera
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Elena López-Cancio
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Sergi Amaro
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Ana Rodríguez-Campello
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Pol Camps-Renom
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - David Cánovas
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Maria Angels de Miquel
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Alejandro Tomasello
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Sebastian Remollo
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Antonio López-Rueda
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Elio Vivas
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Joan Perendreu
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Miquel Gallofré
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Giralt-Steinhauer E, Ois A, Abilleira S, Urra X, Cardona-Portela P, Gomis M, Castellanos M, Molina C, Martí-Fàbregas J, Pellisé A, Cànovas D, Gómez-Choco M, Kuprinski J, Cocho D, Roquer J. Frequency and outcome of total anterior circulation strokes without intracranial large-vessel occlusion. Eur J Neurol 2016; 24:11-17. [DOI: 10.1111/ene.13187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/16/2016] [Indexed: 11/30/2022]
Affiliation(s)
- E. Giralt-Steinhauer
- Neurovascular Research Group; Neurology Department; Hospital del Mar; Barcelona Spain
| | - A. Ois
- Neurovascular Research Group; Neurology Department; Hospital del Mar; Barcelona Spain
| | - S. Abilleira
- Stroke Programme; Catalan Agency for Health Information, Assessment and Quality (CAHIAQ); Barcelona Spain
| | - X. Urra
- Hospital Clínic; Barcelona Spain
| | | | - M. Gomis
- Hospital GermansTrias i Pujol de Badalona; Badalona Spain
| | - M. Castellanos
- Hospital Universitari JosepTrueta de Girona; Girona Spain
| | - C. Molina
- Hospital Universitari de la Valld'Hebron; Barcelona Spain
| | | | - A. Pellisé
- Hospital Universitari Joan XXIII de Tarragona; Tarragona Spain
| | - D. Cànovas
- Hospital Parc Taulí de Sabadell; Barcelona Spain
| | | | - J. Kuprinski
- Hospital Universitari Mútua Terrassa; Barcelona Spain
- Healthcare Sciences; MMU; Manchester UK
| | - D. Cocho
- Hospital de Granollers; Granollers Spain
| | - J. Roquer
- Neurovascular Research Group; Neurology Department; Hospital del Mar; Barcelona Spain
| | | |
Collapse
|
26
|
Pérez de la Ossa N, Ribó M, Jiménez X, Abilleira S. Prehospital Scales to Identify Patients With Large Vessel Occlusion. Stroke 2016; 47:2877-2878. [DOI: 10.1161/strokeaha.116.014911] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/06/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Natalia Pérez de la Ossa
- From the Department of Neurology, Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O.); Department of Neurology, Stroke Unit, Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Department of Innovation and Development, Emergency Medical Services of Catalonia, Spain (X.J.); and Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain (S.A.)
| | - Marc Ribó
- From the Department of Neurology, Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O.); Department of Neurology, Stroke Unit, Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Department of Innovation and Development, Emergency Medical Services of Catalonia, Spain (X.J.); and Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain (S.A.)
| | - Xavier Jiménez
- From the Department of Neurology, Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O.); Department of Neurology, Stroke Unit, Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Department of Innovation and Development, Emergency Medical Services of Catalonia, Spain (X.J.); and Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain (S.A.)
| | - Sònia Abilleira
- From the Department of Neurology, Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O.); Department of Neurology, Stroke Unit, Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Department of Innovation and Development, Emergency Medical Services of Catalonia, Spain (X.J.); and Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain (S.A.)
| |
Collapse
|
27
|
Abilleira S, Ribera A, Quesada H, Rubiera M, Castellanos M, Vargas M, Gomis M, Krupinski J, Delgado-Mederos R, Gómez-Choco M, Giralt-Steinhauer E, Garcia M, Pellisé A, Purroy F, Garcés M, Gallofré M. Applicability of the SPAN-100 index in a prospective and contemporary cohort of patients treated with intravenous rtPA in Catalonia. Neurología (English Edition) 2016. [DOI: 10.1016/j.nrleng.2014.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
28
|
Pérez de la Ossa N, Abilleira S, Dorado L, Urra X, Ribó M, Cardona P, Giralt E, Martí-Fàbregas J, Purroy F, Serena J, Cánovas D, Garcés M, Krupinski J, Pellisé A, Saura J, Molina C, Dávalos A, Gallofré M, Delgado Mederos R, Martínez Domeño A, Marín Bueno R, Roquer J, Rodríguez-Campello A, Ois Á, Jiménez-Conde J, Cuadrado-Godia E, Guimaraens L, Chamorro A, Obach V, Amaro S, Macho JM, Blasco J, San Roman Manzanera L, López A, Martínez-Yélamos A, Quesada H, Lara B, Cayuela N, Aja L, de Miquel MA, Mora P, Rubiera M, Pagola J, Rodríguez-Luna D, Muchada M, Tomasello A, Coscojuela P, Millán M, Gomis M, López-Cancio E, Castaño C, Remollo S, Del Carmen Garcia M, Estela J, Perendreu J, Huertas S, Nicolás MC, Gómez-Choco M, García S, Martínez R, Sanahuja J, Castellanos M, Silva Y, van Eendenburg C, Marés R, Ustrell X, Baiges J, Soler Insa JM, Aragonés JM, Cocho Calderón L, Otermin P, Palomeras E. Access to Endovascular Treatment in Remote Areas. Stroke 2016; 47:1381-4. [DOI: 10.1161/strokeaha.116.013069] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 02/24/2016] [Indexed: 01/19/2023]
Abstract
Background and Purpose—
Since demonstration of the benefit of endovascular treatment (EVT) in acute ischemic stroke patients with proximal arterial occlusion, stroke care systems need to be reorganized to deliver EVT in a timely and equitable way. We analyzed differences in the access to EVT by geographical areas in Catalonia, a territory with a highly decentralized stroke model.
Methods—
We studied 965 patients treated with EVT from a prospective multicenter population-based registry of stroke patients treated with reperfusion therapies in Catalonia, Spain (SONIIA). Three different areas were defined: (A) health areas primarily covered by Comprehensive Stroke Centers, (B) areas primarily covered by local stroke centers located less than hour away from a Comprehensive Stroke Center, and (C) areas primarily covered by local stroke centers located more than hour away from a Comprehensive Stroke Center. We compared the number of EVT×100 000 inhabitants/year and time from stroke onset to groin puncture between groups.
Results—
Baseline characteristics were similar between groups. Throughout the study period, there were significant differences in the population rates of EVT across geographical areas. EVT rates by 100 000 in 2015 were 10.5 in A area, 3.7 in B, and 2.7 in C. Time from symptom onset to groin puncture was 82 minutes longer in group B (312 minutes [245–435]) and 120 minutes longer in group C (350 minutes [284–408]) compared with group A (230 minutes [160–407];
P
<0.001).
Conclusions—
Accessibility to EVT from remote areas is hampered by lower rate and longer time to treatment compared with areas covered directly by Comprehensive Stroke Centers.
Collapse
Affiliation(s)
- Natalia Pérez de la Ossa
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Sònia Abilleira
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Laura Dorado
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Xabier Urra
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Marc Ribó
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Pere Cardona
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Eva Giralt
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Joan Martí-Fàbregas
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Francisco Purroy
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Joaquín Serena
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - David Cánovas
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Moisés Garcés
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Jurek Krupinski
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Anna Pellisé
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Júlia Saura
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Carlos Molina
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Antoni Dávalos
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Miquel Gallofré
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Urra X, Abilleira S, Dorado L, Ribó M, Cardona P, Millán M, Chamorro A, Molina C, Cobo E, Dávalos A, Jovin TG, Gallofré M, Delgado Mederos R, Martínez Domeño A, Marín Bueno R, Roquer J, Rodríguez-Campello A, Ois Á, Cuadrado-Godia E, Giralt E, Vivas E, Guimaraens L, Obach V, Amaro S, Macho JM, Blasco J, San Roman Manzanera L, López A, Martínez-Yélamos A, Quesada H, Cano L, Aja L, de Miquel MA, Mora P, Molina C, Rubiera M, Pagola J, Santamarina E, Álvarez-Sabín J, Tomasello A, Coscojuela P, Pérez de la Ossa N, Gomis M, López-Cancio E, Castaño C, Cánovas D, del Carmen Garcia M, Estela J, Perendreu J, Krupinski J, Huertas Folch S, Herrerias MCN, Gómez-Choco M, García S, Martínez R, Purroy F, Sanahuja J, Serena J, Castellanos M, Silva Y, van Eendenburg C, Marés R, Pellisé A, Ustrell X, Baiges J, Garcés M, Saura J, Soler Insa JM, Aragonés JM, Cocho Calderón L, Otermin Vallejo P, Palomeras E. Mechanical Thrombectomy in and Outside the REVASCAT Trial: Insights From a Concurrent Population-Based Stroke Registry. Stroke 2015; 46:3437-42. [PMID: 26508752 DOI: 10.1161/strokeaha.115.011050] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/17/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Recent trials have shown the superiority of endovascular thrombectomy (EVT) over medical therapy alone in certain stroke patients with proximal arterial occlusion. Using data from the Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke due to Anterior Circulation Large Vessel Occlusion Presenting Within 8-Hours of Symptom Onset (REVASCAT) and a parallel reperfusion treatment registry, we sought to assess the utilization of EVT in a defined patient population, comparing the outcomes of patients treated in and outside the REVASCAT trial. METHODS SONIIA [Sistema Online d'Informació de l'Ictus Agut], a population-based, government-mandated, prospective registry of reperfusion therapies for stroke encompassing the entire population of Catalonia, was used as data source. The registry documents 5 key inclusion criteria of the REVASCAT trial: age, stroke severity, time to treatment, baseline functional status, and occlusion site. We compared procedural, safety, and functional outcomes in patients treated inside and outside the trial. RESULTS From November 2012 to December 2014, out of 17596 ischemic stroke patients in Catalonia (population 7.5 million), 2576 patients received reperfusion therapies (17/100000 inhabitants-year), mainly intravenous thrombolysis only (2036). From the remaining 540 treated with EVT, 103 patients (out of 206 randomized) were treated within REVASCAT and 437 outside the trial. Of these, 399 did not fulfill some of the study criteria, and 38 were trial candidates (8 treated at REVASCAT centers and 30 at 2 non-REVASCAT centers). The majority of procedural, safety, and functional outcomes were similar in patients treated with EVT within and outside REVASCAT. CONCLUSIONS REVASCAT enrolled nearly all eligible patients representing one third of all patients treated with EVT. Patients treated with EVT within and outside REVASCAT had similar outcomes, reinforcing the therapeutic value of EVT. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01692379.
Collapse
Affiliation(s)
- Xabier Urra
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.).
| | - Sònia Abilleira
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Laura Dorado
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Marc Ribó
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Pere Cardona
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Mònica Millán
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Angel Chamorro
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Carlos Molina
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Erik Cobo
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Antoni Dávalos
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Tudor G Jovin
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Miquel Gallofré
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Flores A, Tomasello A, Cardona P, de Miquel MA, Gomis M, Garcia Bermejo P, Obach V, Urra X, Martí-Fàbregas J, Cánovas D, Roquer J, Abilleira S, Ribó M. Endovascular treatment for M2 occlusions in the era of stentrievers: a descriptive multicenter experience. J Neurointerv Surg 2015; 7:234-7. [PMID: 24578483 DOI: 10.1136/neurintsurg-2014-011100] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients with M2 middle cerebral artery (MCA) occlusions are not always considered for endovascular treatment. OBJECTIVE To study outcomes in patients with M2 occlusion treated with endovascular procedures in the era of stentrievers. METHODS We studied patients prospectively included in the SONIIA registry (years 2011-2012)-a mandatory, externally audited registry that monitors the quality of reperfusion therapies in Catalonia in routine practice. Good recanalization was defined as postprocedure Thrombolysis in Cerebral Infarction (TICI) score 2b-3; dramatic recovery as drop in National Institutes of Health Stroke Scale (NIHSS) score >10 points or NIHSS score <2 at 24-36 h; and good outcome as modified Rankin score (mRS) 0-2 at 3months. A 24 h CT scan determined symptomatic intracranial hemorrhage (SICH) and infarct volume. RESULTS Of 571 patients who received endovascular treatment, 65 (11.4%) presented an M2 occlusion on initial angiogram, preprocedure NIHSS 16 (IQR 6). Mean time from symptom onset to groin puncture was 289 ± 195 min. According to interventionalist preferences 86.2% (n=56) were treated with stentrievers (n=7 in combination with intra-arterial tissue plasminogen activator (tPA), 4.6% (n=3) received intra-arterial tPA only, and 9.2% (n=6) diagnostic angiography only. Good recanalization (78.5%) was associated with dramatic improvement (48% vs 14.8%; p=0.02), smaller infarct volumes (8 vs 82 cc; p=0.01) and better outcome (mRS 0-2: 66.3% vs 30%; p=0.03). SICH (9%) was not associated with treatment modality or device used. After adjusting for age and preprocedure NIHSS, good recanalization emerged as an independent predictor of dramatic improvement (OR=5.9 (95% CI 1.2 to 29.2), p=0.03). Independent predictors of good outcome at 3 months were age ( OR=1.067 (95% CI 1.005 to 1132), p=0.03) and baseline NIHSS ( OR=1.162 (95% CI 1.041 to 1.297), p<0.01). CONCLUSIONS Endovascular treatment of M2 MCA occlusion with stentrievers seems safe. Induced recanalization may double the chances of achieving a favorable outcome, especially for patients with moderate or severe deficit.
Collapse
Affiliation(s)
- Alan Flores
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Tomasello
- Department of Radiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Cardona
- Department of Neurology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - M Angeles de Miquel
- Department of Neurology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Meritxell Gomis
- Department of Neurology, Hospital Universitari Germans Trias I Pujo, Badalona, Spain
| | - Pablo Garcia Bermejo
- Department of Neurology, Hospital Universitari Germans Trias I Pujo, Badalona, Spain
| | - Victor Obach
- Department of Neurology, Hospital Clínic I Provincial, Barcelona, Spain
| | - Xabi Urra
- Department of Neurology, Hospital Clínic I Provincial, Barcelona, Spain
| | | | - David Cánovas
- Department of Neurology, Consorci Sanitari Parc Taulí, Barcelona, Spain
| | - Jaume Roquer
- Department of Neurology, Hospital del Mar, Barcelona, Spain
| | - Sònia Abilleira
- Stroke Programme, Catalan Agency for Health Information, Assessment, and Quality, Barcelona, Spain
| | - Marc Ribó
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | |
Collapse
|
31
|
Gallofre M, Abilleira S, Argimon J, Constante C. Abstract W P219: Enhancing Delivery of Reperfusion Therapies for Ischemic Stroke: Towards Equity Through Organization. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.wp219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Delays in hospital arrival are the most relevant impediment to effective dissemination of thrombolysis. Organization is crucial to overcome such difficulties. Objective: to report on the achievements of a region-wide organized stroke network in terms of numbers of acute stroke patients assessed by stroke experts, numbers of patients treated with any reperfusion therapy and their geographical distribution, and clinical outcomes.
Methods:
In mid 2006 the government-based Stroke Program (SP) of Catalonia (7.5 millions) established a regionalized system of acute stroke care (Stroke Code System, SCS) that involves professionals and health administrators. Any acute stroke patient must be referred to the nearest referral hospitals, currently including 14 PSC and 11 community hospitals connected to the telestroke network covered by a centralized, 24-hour, on-call service made up with vascular neurologists. As for stroke admissions, the Hospital Discharge Database is used. Telestroke-based assessments are included in the TICat registry and reperfusion therapies are notified to the government-mandated SONIIA registry. In both registries completeness is guaranteed by SP.
Results:
Since dissemination of the SCS, numbers of stroke patients undergoing timely expert assessment have gradually increased: from 2,000 in 2006 to 4,800 assessments in 2013 (20% and 44% of all stroke admissions, respectively). Similarly, numbers of IV thrombolysis have risen from 329 in 2006 to 1,106 in 2013. In the areas primarily covered by telestroke hospitals, the population thrombolysis rate reached 13*100,000 in 2013. Overall, the population reperfusion treatment rate increased from 4.6*100,000 in 2006 to 14.5*100,000 in 2013, with some hospitals and their catchment areas achieving rates over 20*100,000. As for clinical outcomes, reperfusion therapies are safe and effective and metrics improve over time. IV thrombolysis has been mapped out to show a clear territorial dissemination (2005 on).
Conclusion:
Regionalization and organization of the SCS has had a quantifiable and favorable effect in terms of numbers of acute stroke patients receiving early diagnosis and specific reperfusion therapies, as well as clinical outcomes.
Collapse
Affiliation(s)
| | - Sònia Abilleira
- Stroke Program, Health Dept, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Josep Argimon
- CATALAN HEALTH DEPARTMENT, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | | |
Collapse
|
32
|
Wiedmann S, Hillmann S, Abilleira S, Dennis M, Hermanek P, Niewada M, Norrving B, Asplund K, Rudd AG, Wolfe CDA, Heuschmann PU. Variations in acute hospital stroke care and factors influencing adherence to quality indicators in 6 European audits. Stroke 2014; 46:579-81. [PMID: 25550369 DOI: 10.1161/strokeaha.114.007504] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We compared compliance with standards of acute stroke care between 6 European audits and identified factors associated with delivery of appropriate care. METHODS Data were derived from stroke audits in Germany, Poland, Scotland, Catalonia, Sweden, and England/Wales/Northern-Ireland participating within the European Implementation Score (EIS) collaboration. Associations between demographic and clinical characteristics with adherence to predefined quality indicators were investigated by hierarchical logistic regression analyses. RESULTS In 2007/2008 data from 329 122 patients with stroke were documented. Substantial variations in adherence to quality indicators were found; older age was associated with a lower probability of receiving thrombolytic therapy, anticoagulant therapy, or stroke unit treatment and a higher probability of being tested for dysphagia. Women were less likely to receive anticoagulant or antiplatelet therapy or stroke unit treatment. No major weekend effect was found. CONCLUSIONS Detected variations in performance of acute stroke services were found. Differences in adherence to quality indicators might indicate population subgroups with specific needs for improving care delivery.
Collapse
Affiliation(s)
- Silke Wiedmann
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom.
| | - Steffi Hillmann
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Sònia Abilleira
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Martin Dennis
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Peter Hermanek
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Maciej Niewada
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Bo Norrving
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Kjell Asplund
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Anthony G Rudd
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Charles D A Wolfe
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | - Peter U Heuschmann
- From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom
| | | |
Collapse
|
33
|
Urra X, San Román L, Gil F, Millán M, Cánovas D, Roquer J, Cardona P, Ribó M, Martí-Fàbregas J, Abilleira S, Chamorro Á. Medical and endovascular treatment of patients with large vessel occlusion presenting with mild symptoms: an observational multicenter study. Cerebrovasc Dis 2014; 38:418-24. [PMID: 25472576 DOI: 10.1159/000369121] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/15/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A significant proportion of stroke patients presenting with mild symptoms does not have a successful recovery, especially when a large vessel is occluded. IV thrombolysis is safe and may benefit patients presenting with mild symptoms. In this study, we tested whether endovascular therapy (ET) is superior to medical therapy in these patients. METHODS Observational, prospectively collected, multicenter study of 78 consecutive patients admitted from 2009 to 2012 within 6 h of stroke, with NIHSS≤5 at presentation or during initial diagnostic work-up and large vessel occlusion. Data for patients undergoing ET and/or IV thrombolysis were taken from the SONIIA registry of reperfusion therapies in Catalonia, or from our local stroke registry if no reperfusion therapy was delivered. We compared risk factors, clinical course, collateral circulation, revascularization rates, hemorrhagic complications, infarct volume, and the functional outcome at 3 months of patients treated with ET and those not receiving ET. Ordinal regression was used to assess the independent effect of ET on functional outcome. RESULTS Baseline characteristics were similar for ET (n=34) and medically (n=44) treated patients, except for older age in the latter. The occlusions were located in the terminal internal carotid artery (1%), M1 segment of the middle cerebral artery (33%), M2 segment (30%), posterior circulation (31%), and 5% of the patients had tandem lesions, with no significant differences between groups. Most patients in both treatment groups had good collateral flow. The rate of successful revascularization (91.2 vs. 63.4%; p=0.006) and the risk of symptomatic intracranial hemorrhage (11.8 vs. 0%; p=0.033) were higher in the ET group. The NIHSS scores were similar at hospital arrival, after initial neuroimaging, and at 24 h in both treatment groups and there were no significant differences in the infarct volume in a follow-up MRI. At 3 months, 35.9% of the patients had some disability. The functional outcome was similar in both treatment groups in univariate analysis and also in models adjusted for age and initial NIHSS or for variables associated to functional outcome on univariate comparison. Conversely, IV thrombolysis was associated with significantly greater chances of full recovery after adjusting for baseline differences (OR 3.70, p=0.015). CONCLUSIONS One third of stroke patients with mild symptoms and large vessel occlusions do not have a successful recovery. ET is effective to recanalize the occluded vessel but increases the risk of serious bleeding significantly without improving the functional outcome, and is therefore not justified routinely in these patients.
Collapse
Affiliation(s)
- Xabier Urra
- Functional Unit of Cerebrovascular Diseases, Hospital Clínic, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Abilleira S, Ribera A, Dávalos A, Ribó M, Chamorro A, Cardona P, Molina CA, Martínez-Yélamos A, Urra X, Dorado L, Roquer J, Martí-Fàbregas J, Aja L, Tomasello A, Castaño C, Blasco J, Cánovas D, Castellanos M, Krupinski J, Guimaraens L, Perendreu J, Ustrell X, Purroy F, Gómez-Choco M, Baiges JJ, Cocho D, Saura J, Gallofré M. Functional outcome after primary endovascular therapy or IV thrombolysis alone for stroke. An observational, comparative effectiveness study. Cerebrovasc Dis 2014; 38:328-36. [PMID: 25428822 DOI: 10.1159/000368433] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Among the acute ischemic stroke patients with large vessel occlusions and contraindications for the use of IV thrombolysis, mainly on oral anticoagulation or presenting too late, primary endovascular therapy is often performed as an alternative to the standard therapy even though evidence supporting the use of endovascular reperfusion therapies is not yet established. Using different statistical approaches, we compared the functional independence rates at 3 months among patients undergoing primary endovascular therapy and patients treated only with IV thrombolysis. METHODS We used data from a prospective, government-mandated and externally audited registry of reperfusion therapies for ischemic stroke (January 2011 to November 2012). Patients were selected if treated with either IV thrombolysis alone (n = 1,582) or primary endovascular thrombectomy (n = 250). A series of exclusions were made to homogenize the clinical characteristics among the two groups. We then carried out multivariate logistic regression and propensity score matching analyses on the final study sample (n = 1,179) to compare functional independence at 3 months, as measured by the modified Rankin scale scores 0-2, between the two groups. RESULTS The unadjusted likelihood of good outcome was poorer among the endovascular group (OR: 0.69; 95% CI: 0.47-1.0). After adjustment, no differences by treatment modality were seen (OR: 1.51; 95% CI: 0.93-2.43 for primary endovascular therapy). Patients undergoing endovascular thrombectomy within 180-270 min (OR: 2.89; 95% CI: 1.17-7.15) and patients with severe strokes (OR: 1.84; 95% CI: 1.02-3.35) did better than their intravenous thrombolysis counterparts. The propensity score-matched analyses with and without adjustment by additional covariates showed that endovascular thrombectomy was as effective as intravenous thrombolysis alone in achieving functional independence (OR for unadjusted propensity score matched: 1.35; 95% CI: 0.9-2.02, OR for adjusted propensity score matched: 1.45; 95% CI: 0.91-2.32). CONCLUSION This comparative effectiveness study shows that in ischemic stroke patients with contraindications for IV thrombolysis, primary endovascular treatment might be an alternative therapy at least as effective as IV thrombolysis alone. Randomized controlled trials are urgently needed.
Collapse
Affiliation(s)
- Sònia Abilleira
- Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Abilleira S, Cardona P, Ribó M, Millán M, Obach V, Roquer J, Cánovas D, Martí-Fàbregas J, Rubio F, Alvarez-Sabín J, Dávalos A, Chamorro A, de Miquel MA, Tomasello A, Castaño C, Macho JM, Ribera A, Gallofré M. Outcomes of a contemporary cohort of 536 consecutive patients with acute ischemic stroke treated with endovascular therapy. Stroke 2014; 45:1046-52. [PMID: 24595590 DOI: 10.1161/strokeaha.113.003489] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We sought to assess outcomes after endovascular treatment/therapy of acute ischemic stroke, overall and by subgroups, and looked for predictors of outcome. METHODS We used data from a mandatory, population-based registry that includes external monitoring of completeness, which assesses reperfusion therapies for consecutive patients with acute ischemic stroke since 2011. We described outcomes overall and by subgroups (age ≤ or >80 years; onset-to-groin puncture ≤ or >6 hours; anterior or posterior strokes; previous IV recombinant tissue-type plasminogen activator or isolated endovascular treatment/therapy; revascularization or no revascularization), and determined independent predictors of good outcome (modified Rankin Scale score ≤2) and mortality at 3 months by multivariate modeling. RESULTS We analyzed 536 patients, of whom 285 received previous IV recombinant tissue-type plasminogen activator. Overall, revascularization (modified Thrombolysis In Cerebral Infarction scores, 2b and 3) occurred in 73.9%, 5.6% developed symptomatic intracerebral hemorrhages, 43.3% achieved good functional outcome, and 22.2% were dead at 90 days. Adjusted comparisons by subgroups systematically favored revascularization (lower proportion of symptomatic intracerebral hemorrhages and death rates and higher proportion of good outcome). Multivariate analyses confirmed the independent protective effect of revascularization. Additionally, age >80 years, stroke severity, hypertension (deleterious), atrial fibrillation, and onset-to-groin puncture ≤6 hours (protective) also predicted good outcome, whereas lack of previous disability and anterior circulation strokes (protective) as well as and hypertension (deleterious) independently predicted mortality. CONCLUSIONS This study reinforces the role of revascularization and time to treatment to achieve enhanced functional outcomes and identifies other clinical features that independently predict good/fatal outcome after endovascular treatment/therapy.
Collapse
Affiliation(s)
- Sònia Abilleira
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain (S.A., A.R., M.G.); Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C., F.R., M.A.d.M.); Hospital Vall d'Hebron, Barcelona, Spain (M.R., J.A.-S., A.T.); Hospital Germans Trias i Pujol, Badalona, Spain (M.M., A.D., C.C.); Hospital Clínic i Provincial, Barcelona, Spain (V.O., A.C., J.M.M.); Hospital del Mar, Barcelona, Spain (J.R.); Hospital de Sabadell, Sabadell, Spain (D.C.); and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (J.M.-F.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Abilleira S, Dávalos A, Chamorro Á, Ribó M, Cardona P, Serena J, Krupinski J, Martí-Fàbregas J, Roquer J, Martínez-Yélamos A, Álvarez-Sabín J, Cánovas D, Ustrell X, Purroy F, Gómez-Choco M, Garcés M, de Miquel MA, Tomasello A, Macho JM, Ribera A, Gallofré M. Abstract 185: Risk-adjusted Comparison of Good Functional Outcome at 3 Months after Primary Endovascular Therapy or Intravenous Thrombolysis Alone. Results from an Observational, Population-based Study. Stroke 2014. [DOI: 10.1161/str.45.suppl_1.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Evidence clearly supports intravenous thrombolysis (IVT) as first-line therapy for AIS. Yet, endovascular treatment (EVT) might be an alternative for patients with IVT contraindications. Our aim was to study whether patients treated with primary EVT in daily practice did as well as those treated with IVT alone in terms of functional outcome.
Methods:
Observational, population-based study of consecutive AIS patients treated with either isolated EVT or IVT within 2011 and 2012 in Catalonia. Patients were prospectively included in a health-administration based registry with external monitoring of completeness. Inclusion criteria: EVT or IVT delivered under routine conditions. Exclusion criteria: combined IVT+EVT therapy, pre-stroke mRS >2, lacunar stroke subtype, unusual stroke etiology, baseline NIHSS >25 and onset-to-treatment (OTT) > 400 minutes. We determined the risk-adjusted probability [adjustment variables: age, NIHSS, OTT, pre-morbid mRS, hypertension, dyslipidemia, diabetes, AF, OCSP classification and etiology] of achieving functional independence at 3 months (mRS <=2) and performed subgroup analyses.
Results:
1149 patients underwent IVT and 129 (10.1%) EVT. Patients in the EVT arm were younger (71.2+/-11.5 vs. 74.3+/-11.9), had higher NIHSS scores (18 [12-20] vs. 11 [7-18]), were treated later (198 [150-270] vs. 140 [105-190]) and more frequently had concomitant AF (55% vs. 21.9%), heart failure (12.4% vs. 4.9%), and were on anticoagulants (49.6% vs. 5.4%). Dyslipidemia (45.4% vs. 36.4%) and antiplatelets (42.7% vs. 26.4%) were more frequent in the IVT arm. Overall, the risk-adjusted likelihood of good functional outcome was better for EVT (OR: 1.56; 95% CI: 0.97-2.52). Subgroup analyses showed that patients with NIHSS =>14 (OR: 1.92; 95% CI: 1.10-3.46) and those treated within 180-270 minutes post-stroke (OR: 3.44; 95% CI: 1.41-8.39) benefited more from EVT.
Conclusions:
In a population-based study of reperfusion therapies for AIS, patients undergoing isolated EVT were more likely to achieve functional independence at 3 months as compared to patients treated with IVT, particularly those with severe strokes or those treated within 3-4.5 hours post-stroke. These findings need to be confirmed in a RCT.
Collapse
Affiliation(s)
- Sònia Abilleira
- Stroke Program, Agency for Health Quality and Assessment of Catalonia (AHQAC), Barcelona, Spain
| | | | | | - Marc Ribó
- Hosp Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Miquel Gallofré
- Stroke Program, Agency for Health Quality and Assessment of Catalonia (AHQAC), Barcelona, Spain
| | | |
Collapse
|
37
|
Abilleira S, Ribera A, Permanyer-Miralda G, Tresserras R, Gallofré M. Noncompliance With Certain Quality Indicators Is Associated With Risk-Adjusted Mortality After Stroke. Stroke 2012; 43:1094-100. [DOI: 10.1161/strokeaha.111.633578] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sònia Abilleira
- From the Stroke Programme (S.A.), Catalan Agency for Health Information, Assessment and Quality (CAHIAQ), Barcelona; CIBER Epidemiología y Salud Pública (CIBERESP); (S.A., A.R., G.P.-M., M.G.); Cardiovascular Epidemiology Unit (A.R., G.P.-M.), Hospital Vall d'Hebron, Barcelona; Stroke Programme (R.T., M.G.), Department of Health, Autonomous Government of Catalonia
| | - Aida Ribera
- From the Stroke Programme (S.A.), Catalan Agency for Health Information, Assessment and Quality (CAHIAQ), Barcelona; CIBER Epidemiología y Salud Pública (CIBERESP); (S.A., A.R., G.P.-M., M.G.); Cardiovascular Epidemiology Unit (A.R., G.P.-M.), Hospital Vall d'Hebron, Barcelona; Stroke Programme (R.T., M.G.), Department of Health, Autonomous Government of Catalonia
| | - Gaietà Permanyer-Miralda
- From the Stroke Programme (S.A.), Catalan Agency for Health Information, Assessment and Quality (CAHIAQ), Barcelona; CIBER Epidemiología y Salud Pública (CIBERESP); (S.A., A.R., G.P.-M., M.G.); Cardiovascular Epidemiology Unit (A.R., G.P.-M.), Hospital Vall d'Hebron, Barcelona; Stroke Programme (R.T., M.G.), Department of Health, Autonomous Government of Catalonia
| | - Ricard Tresserras
- From the Stroke Programme (S.A.), Catalan Agency for Health Information, Assessment and Quality (CAHIAQ), Barcelona; CIBER Epidemiología y Salud Pública (CIBERESP); (S.A., A.R., G.P.-M., M.G.); Cardiovascular Epidemiology Unit (A.R., G.P.-M.), Hospital Vall d'Hebron, Barcelona; Stroke Programme (R.T., M.G.), Department of Health, Autonomous Government of Catalonia
| | - Miquel Gallofré
- From the Stroke Programme (S.A.), Catalan Agency for Health Information, Assessment and Quality (CAHIAQ), Barcelona; CIBER Epidemiología y Salud Pública (CIBERESP); (S.A., A.R., G.P.-M., M.G.); Cardiovascular Epidemiology Unit (A.R., G.P.-M.), Hospital Vall d'Hebron, Barcelona; Stroke Programme (R.T., M.G.), Department of Health, Autonomous Government of Catalonia
| |
Collapse
|
38
|
Wiedmann S, Norrving B, Nowe T, Abilleira S, Asplund K, Dennis M, Hermanek P, Rudd A, Thijs V, Wolfe CD, Heuschmann PU. Variations in Quality Indicators of Acute Stroke Care in 6 European Countries. Stroke 2012; 43:458-63. [DOI: 10.1161/strokeaha.111.628396] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Silke Wiedmann
- From the Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.), University of Würzburg, Germany; Department of Clinical Sciences (B.N.), Section of Neurology, Lund University, Sweden; Center for Stroke Research Berlin (T.N.), Charité–Universitätsmedizin Berlin, Germany; Stroke Programme/Catalan Agency for Health Information, Assessment and Quality (S.A.), Barcelona, Spain, Department of Public Health and Clinical Medicine (K.A.), Umeå University, Sweden; Department of Clinical Neurosciences
| | - Bo Norrving
- From the Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.), University of Würzburg, Germany; Department of Clinical Sciences (B.N.), Section of Neurology, Lund University, Sweden; Center for Stroke Research Berlin (T.N.), Charité–Universitätsmedizin Berlin, Germany; Stroke Programme/Catalan Agency for Health Information, Assessment and Quality (S.A.), Barcelona, Spain, Department of Public Health and Clinical Medicine (K.A.), Umeå University, Sweden; Department of Clinical Neurosciences
| | - Tim Nowe
- From the Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.), University of Würzburg, Germany; Department of Clinical Sciences (B.N.), Section of Neurology, Lund University, Sweden; Center for Stroke Research Berlin (T.N.), Charité–Universitätsmedizin Berlin, Germany; Stroke Programme/Catalan Agency for Health Information, Assessment and Quality (S.A.), Barcelona, Spain, Department of Public Health and Clinical Medicine (K.A.), Umeå University, Sweden; Department of Clinical Neurosciences
| | - Sònia Abilleira
- From the Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.), University of Würzburg, Germany; Department of Clinical Sciences (B.N.), Section of Neurology, Lund University, Sweden; Center for Stroke Research Berlin (T.N.), Charité–Universitätsmedizin Berlin, Germany; Stroke Programme/Catalan Agency for Health Information, Assessment and Quality (S.A.), Barcelona, Spain, Department of Public Health and Clinical Medicine (K.A.), Umeå University, Sweden; Department of Clinical Neurosciences
| | - Kjell Asplund
- From the Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.), University of Würzburg, Germany; Department of Clinical Sciences (B.N.), Section of Neurology, Lund University, Sweden; Center for Stroke Research Berlin (T.N.), Charité–Universitätsmedizin Berlin, Germany; Stroke Programme/Catalan Agency for Health Information, Assessment and Quality (S.A.), Barcelona, Spain, Department of Public Health and Clinical Medicine (K.A.), Umeå University, Sweden; Department of Clinical Neurosciences
| | - Martin Dennis
- From the Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.), University of Würzburg, Germany; Department of Clinical Sciences (B.N.), Section of Neurology, Lund University, Sweden; Center for Stroke Research Berlin (T.N.), Charité–Universitätsmedizin Berlin, Germany; Stroke Programme/Catalan Agency for Health Information, Assessment and Quality (S.A.), Barcelona, Spain, Department of Public Health and Clinical Medicine (K.A.), Umeå University, Sweden; Department of Clinical Neurosciences
| | - Peter Hermanek
- From the Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.), University of Würzburg, Germany; Department of Clinical Sciences (B.N.), Section of Neurology, Lund University, Sweden; Center for Stroke Research Berlin (T.N.), Charité–Universitätsmedizin Berlin, Germany; Stroke Programme/Catalan Agency for Health Information, Assessment and Quality (S.A.), Barcelona, Spain, Department of Public Health and Clinical Medicine (K.A.), Umeå University, Sweden; Department of Clinical Neurosciences
| | - Anthony Rudd
- From the Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.), University of Würzburg, Germany; Department of Clinical Sciences (B.N.), Section of Neurology, Lund University, Sweden; Center for Stroke Research Berlin (T.N.), Charité–Universitätsmedizin Berlin, Germany; Stroke Programme/Catalan Agency for Health Information, Assessment and Quality (S.A.), Barcelona, Spain, Department of Public Health and Clinical Medicine (K.A.), Umeå University, Sweden; Department of Clinical Neurosciences
| | - Vincent Thijs
- From the Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.), University of Würzburg, Germany; Department of Clinical Sciences (B.N.), Section of Neurology, Lund University, Sweden; Center for Stroke Research Berlin (T.N.), Charité–Universitätsmedizin Berlin, Germany; Stroke Programme/Catalan Agency for Health Information, Assessment and Quality (S.A.), Barcelona, Spain, Department of Public Health and Clinical Medicine (K.A.), Umeå University, Sweden; Department of Clinical Neurosciences
| | - Charles D.A. Wolfe
- From the Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.), University of Würzburg, Germany; Department of Clinical Sciences (B.N.), Section of Neurology, Lund University, Sweden; Center for Stroke Research Berlin (T.N.), Charité–Universitätsmedizin Berlin, Germany; Stroke Programme/Catalan Agency for Health Information, Assessment and Quality (S.A.), Barcelona, Spain, Department of Public Health and Clinical Medicine (K.A.), Umeå University, Sweden; Department of Clinical Neurosciences
| | - Peter U. Heuschmann
- From the Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.), University of Würzburg, Germany; Department of Clinical Sciences (B.N.), Section of Neurology, Lund University, Sweden; Center for Stroke Research Berlin (T.N.), Charité–Universitätsmedizin Berlin, Germany; Stroke Programme/Catalan Agency for Health Information, Assessment and Quality (S.A.), Barcelona, Spain, Department of Public Health and Clinical Medicine (K.A.), Umeå University, Sweden; Department of Clinical Neurosciences
| |
Collapse
|
39
|
Abilleira S, Ribera A, Sánchez E, Tresserras R, Gallofré M. The Second Stroke Audit of Catalonia shows improvements in many, but not all quality indicators. Int J Stroke 2011; 7:19-24. [PMID: 21967542 DOI: 10.1111/j.1747-4949.2011.00638.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Periodic audits allow monitoring of healthcare quality by comparing performances at different time points. Aims To assess quality of in-hospital stroke care in Catalonia in 2007 and compare it with 2005 (post-/preguidelines delivery, respectively). METHODS Data on 13 evidence-based performance measures were collected by a retrospective review of medical records of consecutive stroke admissions (January-December 2007) to 47 acute hospitals in Catalonia. Adherence was calculated according to the ratio (patients with documented performance measures' compliance) (valid cases for that measure). Sampling weights were applied to produce estimates of compliance. The proportions of compliance with performance measures in both audits were compared using random-effects logistic regressions, with each performance measure as the dependent variable and audit edition as the explanatory variable to determine whether changes in stroke care quality occurred along time. RESULTS We analyzed 1767 events distributed among 47 hospitals. In 2007, there was an increase in tissue plasminogen activator administrations (2·8% vs. 5·9%) and stroke unit admissions (16·6% vs. 22·6%) and a reduction in seven-day mortality (9·5% vs. 6·8%). Logistic regression models provided evidence of improved adherences to seven performance measures (screening of dysphagia, management of hyperthermia, baseline computed tomography scan, baseline glycemia, rehabilitation needs, early mobilization, and anticoagulants for atrial fibrillation), but worsening of management of hypertension, dyslipidemia, and antithrombotics at discharge. The remaining three performance measures showed no changes. CONCLUSIONS The Second Stroke Audit showed improvements in most dimensions of care, although unexpectedly a few but relevant performance measures became worse. Therefore, periodic stroke audits are needed to check changes in quality of care over time.
Collapse
Affiliation(s)
- Sònia Abilleira
- Stroke Programme, Catalan Agency for Health Information, Assessment and Quality (CAHIAQ), Barcelona, Spain.
| | | | | | | | | |
Collapse
|
40
|
Abilleira S, Dávalos A, Chamorro A, Alvarez-Sabín J, Ribera A, Gallofré M. Outcomes of intravenous thrombolysis after dissemination of the stroke code and designation of new referral hospitals in Catalonia: the Catalan Stroke Code and Thrombolysis (Cat-SCT) Monitored Study. Stroke 2011; 42:2001-6. [PMID: 21566237 DOI: 10.1161/strokeaha.110.605030] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE From 2006, the Stroke Code system operates throughout Catalonia with full coverage. The objective of this study was to determine safety and effectiveness of intravenous thrombolysis in routine practice through a monitored study (Catalan Stroke Code and Thrombolysis [Cat-SCT]) and to assess outcomes according to hospitals' previous experience. METHODS We conducted a prospective, multicenter, observational, monitored study of recombinant tissue plasminogen activator-treated patients declared to the Cat-SCT by all treating hospitals in Catalonia (n=13, of which 6 were newly designated) over a 12-month period. Consecutive recruitment and quality of data were assured through comprehensive quality control. We estimated rates of outcome measures for the potential final sample (after inclusion of undeclared cases) and compared them with those reported for the actual sample. Symptomatic intracranial hemorrhage, mortality, and favorable outcome (modified Rankin Scale score 0 to 1) at 3 months were also evaluated according to hospitals' previous experience using multilevel logistic regression. RESULTS We analyzed 488 patients with a median age of 72 years (interquartile range: 63, 77), 57.2% males, with a baseline National Institutes of Health Stroke Scale score of 13 (interquartile range: 8, 19), and stroke to treatment time of 150 minutes (interquartile range: 120, 180 minutes). Symptomatic intracranial hemorrhage (Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy definition) was observed in 3.3% patients. Ninety-day mortality was 16.6% and 38.5% showed a favorable outcome at 3 months. External monitoring set inclusion losses at <5%. A sensitivity analysis including undeclared cases did not show significant changes in main outcomes. Inexperienced hospitals achieved similar outcomes, except for a higher rate of favorable outcome at 3 months. CONCLUSIONS Health planning applied to acute stroke care and based on dissemination of the Stroke Code system and designation of new referral hospitals showed intravenous thrombolysis safe and effective in routine practice, even among inexperienced hospitals.
Collapse
Affiliation(s)
- Sònia Abilleira
- Stroke Programme, Catalan Agency for Health Information, Assessment and Quality, Roc Boronat 81-95, 2a planta, 08005 Barcelona, Spain.
| | | | | | | | | | | | | |
Collapse
|
41
|
Salvat-Plana M, Abilleira S, Jiménez C, Marta J, Gallofré M. Priorización de indicadores de calidad de la atención al paciente con ictus a partir de un método de consenso. ACTA ACUST UNITED AC 2011; 26:174-83. [DOI: 10.1016/j.cali.2010.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 11/17/2010] [Accepted: 12/15/2010] [Indexed: 11/26/2022]
|
42
|
Abstract
BACKGROUND Different factors may weight on time from stroke onset to hospital arrival, and patients' alert certainly contributes to it. We sought to identify clinical and sociodemographic factors associated with a delayed alert and to delineate the profile of the potential latecomer in Catalonia (Spain). METHODS We used data from the Stroke Code (SC) registry that prospectively recruited consecutive patients with acute stroke, in whom SC was activated (SCA) or not (SCNA), admitted to all Catalan hospitals. Additionally, SCNA patients underwent a structured interview to explore additional beliefs and attitudes related to a delayed alert. We applied a 6-h cut-off to define alert delay according to the time limit for SC activation in Catalonia. We determined independent predictors of delay amongst clinical and sociodemographic data by multivariate logistic regression and applied sample weighting because of different study periods in the SCA and SCNA arms. RESULTS Of the patients, 37.2% delayed alert beyond 6 h. Compared to non-delayers, latecomers were more likely diabetics, illiterates, belonged to an unfavored social class, and were living alone. Fewer had concomitant atrial fibrillation and alerted through emergency medical service (EMS)/112 whilst suffering a mild or moderate stroke. Amongst patients interviewed, being unaware of stroke's vascular nature and erroneously self-perceiving stroke as a reversible or irrelevant condition independently predicted a longer delay. CONCLUSIONS Delaying alert after stroke shows a multifactorial background with implication of pre-stroke health status, socioeconomic factors, stroke-related features and patients' beliefs and attitudes toward the disease. In planning future educational campaigns, all these features should be considered.
Collapse
Affiliation(s)
- S Abilleira
- Stroke Programme, Catalan Agency for Health Technology Assessment and Research, Barcelona, Spain.
| | | | | | | | | |
Collapse
|
43
|
Gallofré M, Abilleira S, Tresserras R, de la Puente ML. El Plan Director para la atención de la enfermedad cerebrovascular en Cataluña. Med Clin (Barc) 2009; 133:589-93. [DOI: 10.1016/j.medcli.2008.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 11/26/2008] [Indexed: 11/30/2022]
|
44
|
Abilleira S, Ribera A, Sánchez E, Roquer J, Duarte E, Tresserras R, Gallofré M. [In-hospital stroke care in Catalonia [Spain]. Results of the "First Clinical Audit of Stroke. Catalonia, 2005/2006"]. Gac Sanit 2009; 22:565-73. [PMID: 19080933 DOI: 10.1016/s0213-9111(08)75355-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the quality of in-hospital stroke care in public acute care hospitals in Catalonia before the implementation of a clinical practice guideline (CPG) on stroke by determining adherence to specific recommendations of the CPG. METHODS We retrospectively reviewed the case notes of consecutive patients with stroke (defined with ICD-9 codes: 431, 433.x1, 434.x1, and 436) admitted to 48 Catalan hospitals within the first half of 2005. Data were collected on indicators of the healthcare process selected on the basis of their scientific evidence and/or clinical relevance. The participating hospitals included 20, 40 or 60 stroke cases according to their annual stroke caseload. After random selection, up to 9.3% of all cases recruited at each study center were externally monitored to assess the quality of the data gathered. Indicators were grouped into six different dimensions related to distinct aspects of clinical practice. RESULTS We analyzed data from 1,791 stroke cases (53.9% men, mean age: 75.6 [12.4] years). Overall inter-observer agreement was 0.7. Compliance with the six dimensions was as follows (mean percentage [95%CI]): quality of medical records, 78.5% (77.5-79.4); initial interventions, 92.4% (91.5-93.2); neurological assessment, 38.3% (37.3-39.3); assessment of rehabilitation needs, 44.9% (43.2-46.7); prevention and management of medical complications, 68.4% (66.9-70), and initial preventive measures, 78.9% (77.3-80.4). CONCLUSIONS In the first half of 2005, in-hospital stroke care in Catalonia showed room for improvement particularly in aspects related to the neurological assessment and follow-up of patients and their rehabilitation process.
Collapse
Affiliation(s)
- Sònia Abilleira
- Departament de Salut, Generalitat de Catalunya, Barcelona, España.
| | | | | | | | | | | | | |
Collapse
|
45
|
Díaz-Guzmán J, Egido-Herrero JA, Fuentes B, Fernández-Pérez C, Gabriel-Sánchez R, Barberà G, Abilleira S. [Incidence of strokes in Spain: the Iberictus study. Data from the pilot study]. Rev Neurol 2009; 48:61-65. [PMID: 19173202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION In a population-based study of the incidence of stroke conducted on a broad denominator, it is wise first to carry out a pilot study. AIM To present the results of the pilot phase of the study on stroke incidence in Spain, entitled Iberictus. PATIENTS AND METHODS Population of the study: all cases involving the first episode of acute cerebrovascular disease (stroke or transient ischaemic attack) diagnosed among residents over 17 years of age with their habitual place of abode registered in the areas of study between 15th and 31st October 2005 (total denominator: 1,440,997 inhabitants). SOURCE OF DATA prospective, hospital records (basic minimum data set, discharge abstracts) and casualty department registers. Standardised definitions: diagnostic categorisation and pathological, topographical and aetiological classification. Inter-observer agreement analysis among researchers (kappa). RESULTS A total of 128 cases were identified. Age range, 37-103 years; mean age, 75.7 +/- 13.4 years; 54% were females. In all, 71.1% of the cases were collected by means of a basic minimum data set. There were 91 ischaemic events (29.7% atherothrombotic and 29.7% cardioembolic). Of the 15 haemorrhagic strokes, 40% due to arterial hypertension, six were lobar hemispheric, six were deep basal ganglia, and there were three cerebellar haemorrhages. The incidence of stroke was seen to increase exponentially with age. Inter-observer agreement was good for the classifications that were employed (range of kappa indices, 0.57-0.78). Several problems were detected and corrected in the fieldwork. CONCLUSIONS The Iberictus pilot study yielded data that were consistent with the literature and provided us with the opportunity to detect and correct issues that would hinder us from conducting the main study.
Collapse
Affiliation(s)
- J Díaz-Guzmán
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España.
| | | | | | | | | | | | | |
Collapse
|
46
|
Díaz-Guzmán J, Egido-Herrero JA, Gabriel-Sánchez R, Barberà G, Fuentes B, Fernández-Pérez C, Abilleira S. [Incidence of strokes in Spain. Methodological foundations of the Iberictus study]. Rev Neurol 2008. [PMID: 19085876 DOI: 10.33588/rn.4712.2008576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Epidemiological data on the incidence of cerebrovascular diseases in our country are scarce. A representative population-based study with a large denominator is required. AIM To present the design of the study on stroke incidence in Spain, entitled Iberictus. SUBJECTS AND METHODS We conducted a prospective, population-based study on the incidence of strokes and transient ischemic attacks, in which it is possible to distinguish: 1) population with a steady risk, which was well defined and had a broad denominator. We included all the cases in which the first episode of acute cerebrovascular disease was diagnosed among those over the age of 17 years (with no upper age limit) with their habitual residence in the areas of study between the 1st January and 31st December 2006: Lugo, Segovia, Talavera de la Reina, Mallorca and Almeria (total denominator, 1,440,997 inhabitants; minimum denominator per area, 100,000 inhabitants); 2) source of multiple and complementary data: hospital records (minimum basic data set, discharge abstracts), emergency and primary care records for the area with diagnostic codes 430-39 and 674.0 (International Classification of Diseases-9), population-based mortality records; 3) standardised definitions: diagnostic categorisation (MONICA-World Health Organisation, 1987), pathological classification (ischaemia, haemorrhagic), topography and aetiology; 4) presentation of data in suitable age groups, by sex and overall; 5) pilot study and analysis of inter-observer agreement among researchers. CONCLUSIONS With this design, the Iberictus study satisfies the methodological criteria as an 'ideal' study of the incidence of acute cerebrovascular diseases proposed by Malgrem, Sudlow and Warlow, and represents a unique opportunity to further our knowledge of the epidemiology of strokes in our country.
Collapse
Affiliation(s)
- J Díaz-Guzmán
- Hospital Universitario 12 de Octubre, Madrid, España.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
de la Ossa NP, Sanchez-Ojanguren J, Palomeras E, Millan M, Arenillas JF, Dorado L, Guerrero C, Abilleira S, Davalos A. Influence of the stroke code activation source on the outcome of acute ischemic stroke patients. Neurology 2008; 70:1238-43. [DOI: 10.1212/01.wnl.0000291008.63002.a5] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
48
|
Delgado P, Alvarez-Sabín J, Abilleira S, Santamarina E, Purroy F, Arenillas JF, Molina CA, Fernández-Cadenas I, Rosell A, Montaner J. Plasma d-dimer predicts poor outcome after acute intracerebral hemorrhage. Neurology 2006; 67:94-8. [PMID: 16832084 DOI: 10.1212/01.wnl.0000223349.97278.e0] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate if systemic d-dimer activation occurs after acute intracerebral hemorrhage (ICH) and to study its influence on clinical outcome. METHODS The authors determined plasma baseline d-dimer in 98 consecutive acute (<24 hours) ICH patients. Glasgow Coma Scale and NIH Stroke Scale scores were recorded to assess neurologic status on baseline and follow-up visits (24 hours, 48 hours, 7th day, and 3rd month). They also determined the d-dimer temporal profile at follow-up visits in a subgroup of 21 patients. ICH volume was measured on baseline and follow-up CT scans. Early neurologic deterioration (END) and mortality during the 1st week were recorded. RESULTS ICH patients showed higher plasma d-dimer level than reference laboratory values at baseline (1,780 vs 360 ng/mL; p = 0.013) and 3 months after ICH onset (1,530 vs 470 ng/mL; p = 0.013). The d-dimer level was related to baseline ICH volume (r = 0.23, p = 0.049) and to the presence of intraventricular (2,370 vs 1,360 ng/mL; p = 0.019) or subarachnoid (4,180 vs 1,520 ng/mL; p = 0.001) extension. Nearly one-fourth of patients presented END, and 20% died as a result of ICH. As predictors of END, the authors identified d-dimer level >1,900 ng/mL (odds ratio [OR] 4.5, 95% CI 1.03 to 20.26, p = 0.045) and systolic blood pressure >182 mm Hg (OR 6.8, 95% CI 1.25 to 36.9, p = 0.026). Moreover, ICH volume >30 mL (OR 19.13, 95% CI 2.06 to 177, p = 0.009) and d-dimer levels >1,900 ng/mL (OR 8.75, 95% CI 1.41 to 54.16, p = 0.020) emerged as independent predictors of mortality. CONCLUSION Increased plasma d-dimer level following acute intracerebral hemorrhage is associated with early neurologic deterioration and poor outcome.
Collapse
Affiliation(s)
- P Delgado
- Neurovascular Research Laboratory and the Stroke Unit, Departament de Medicina, Universitat Autònoma de Barcelona, Hospital General Vall d'Hebron, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
We describe a 70-year-old woman with a 2-month history of a numb chin and gradually increasing bilateral headache and malaise. Neurological examination disclosed chin hypoesthesia while investigations showed a normocytic anemia, ESR of 100, and CRP of 72. A CT brain scan, chest X-ray, and bone scan showed no evidence of malignancy. Temporal arteritis was suspected and prednisolone started with prompt resolution of the headache, chin hypoesthesia, ESR, and CRP. This case illustrates an unusual etiology of the numb chin syndrome, which in most occasions is associated with malignancy. Temporal arteritis should be borne in mind as a possible explanation for this as it is a treatable condition with potentially serious, life-threatening complications.
Collapse
Affiliation(s)
- Sònia Abilleira
- Department of Neurology, The North Middlesex University Hospital, London, UK
| | | |
Collapse
|
50
|
Alvarez-Sabín J, Delgado P, Abilleira S, Molina CA, Arenillas J, Ribó M, Santamarina E, Quintana M, Monasterio J, Montaner J. Temporal profile of matrix metalloproteinases and their inhibitors after spontaneous intracerebral hemorrhage: relationship to clinical and radiological outcome. Stroke 2004; 35:1316-22. [PMID: 15087562 DOI: 10.1161/01.str.0000126827.69286.90] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Matrix metalloproteinases (MMPs) are related to blood-brain barrier disruption, and some members of this family have been recently involved in brain bleedings. We aimed to investigate the temporal profile of MMPs and their natural inhibitors (TIMPs) after acute intracerebral hemorrhage (ICH) and to study its influence on neuroimaging and clinical outcome. METHODS MMP-2, MMP-9, and MMP-3, as well as TIMP-1 and TIMP-2, were serially determined by enzyme-linked immunosorbent assay on admission (<12 hours), and at 24 hours, 48 hours, 7 days, and 3 months in 21 ICH patients. ICH and perihematomal edema (PE) volumes were serially measured on baseline and follow-up computed tomography (48 hours, 7 days, and 3 months), just at the time of neurological assessment. RESULTS Deep ICH was found in 62% patients. Baseline ICH volume did not influence MMP-TIMP level. Highest levels of MMP-2 and TIMP-2 were found at baseline, for MMP-9 and TIMP-1 at 24 hours, and for MMP-3 at 24 to 48 hours. Baseline MMP-9 was positively correlated to PE volume (r=0.67, P=0.004) and, conversely, its inhibitor TIMP-1 was negatively correlated to PE (r=-0.51, P=0.04). Mortality reached 35% and MMP-3 was the only MMP/TIMP related to mortality (7.5 versus 2.4 ng/mL; P=0.035) and its most powerful baseline predictor (odds ratio = 22, confidence interval: 1.5 to 314.2). Both MMP-9 and MMP-3 correlated to the residual scar volume at 3 months (r=0.68, P=0.01 for baseline MMP-9, and r=0.86, P<0.001 for 24-hour MMP-3). CONCLUSIONS A characteristic temporal profile of MMP/TIMP release exists in ICH. Increased MMP-9 is associated with PE, and increased MMP-3 is associated with mortality. Both molecules are related to residual cavity volume.
Collapse
Affiliation(s)
- José Alvarez-Sabín
- Neurovascular Research Laboratory and the Stroke Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|