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Garcia-Tornel A, Millan M, Rubiera M, Bustamante A, Requena M, Dorado L, Olivé-Gadea M, Jiménez X, Soto A, Querol M, Hernández-Pérez M, Gomis M, Cardona P, Urra X, Purroy F, Silva Y, Ustrell X, Esteve P, Salvat-Plana M, Gallofré M, Molina C, Dávalos A, Jovin T, Abilleira S, Ribo M, Pérez de la Ossa N. Workflows and Outcomes in Patients With Suspected Large Vessel Occlusion Stroke Triaged in Urban and Nonurban Areas. Stroke 2022; 53:3728-3740. [PMID: 36259411 DOI: 10.1161/strokeaha.122.040768] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aim to compare the outcome of patients from urban areas, where the referral center is able to perform thrombectomy, with patients from nonurban areas enrolled in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion). METHODS Patients with suspected large vessel occlusion stroke, as evaluated by a Rapid Arterial Occlusion Evaluation score of ≥5, from urban catchment areas of thrombectomy-capable centers during RACECAT trial enrollment period were included in the Stroke Code Registry of Catalonia. Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with an ischemic stroke. Secondary outcomes included mortality at 90 days, rate of thrombolysis and thrombectomy, time from onset to thrombolysis, and thrombectomy initiation. Propensity score matching was used to assemble a cohort of patients with similar characteristics. RESULTS The analysis included 1369 patients from nonurban areas and 2502 patients from urban areas. We matched 920 patients with an ischemic stroke from urban areas and nonurban areas based on their propensity scores. Patients with ischemic stroke from nonurban areas had higher degrees of disability at 90 days (median [interquartle range] modified Rankin Scale score, 3 [2-5] versus 3 [1-5], common odds ratio, 1.25 [95% CI, 1.06-1.48]); the observed average effect was only significant in patients with large vessel stroke (common odds ratio, 1.36 [95% CI, 1.08-1.65]). Mortality rate was similar between groups(odds ratio, 1.02 [95% CI, 0.81-1.28]). Patients from nonurban areas had higher odds of receiving thrombolysis (odds ratio, 1.36 [95% CI, 1.16-1.67]), lower odds of receiving thrombectomy(odds ratio, 0.61 [95% CI, 0.51-0.75]), and longer time from stroke onset to thrombolysis (mean difference 38 minutes [95% CI, 25-52]) and thrombectomy(mean difference 66 minutes [95% CI, 37-95]). CONCLUSIONS In Catalonia, Spain, patients with large vessel occlusion stroke triaged in nonurban areas had worse neurological outcomes than patients from urban areas, where the referral center was able to perform thrombectomy. Interventions aimed at improving organizational practices and the development of thrombectomy capabilities in centers located in remote areas should be pursued. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02795962.
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Affiliation(s)
- Alvaro Garcia-Tornel
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | - Monica Millan
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.)
| | - Marta Rubiera
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | - Alejandro Bustamante
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.)
| | - Manuel Requena
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | - Laura Dorado
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.)
| | - Marta Olivé-Gadea
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | - Xavier Jiménez
- Emergency Medical Services of Catalonia, Barcelona, Spain (X.J., A.S., M.Q.)
| | - Angels Soto
- Emergency Medical Services of Catalonia, Barcelona, Spain (X.J., A.S., M.Q.)
| | - Marisol Querol
- Emergency Medical Services of Catalonia, Barcelona, Spain (X.J., A.S., M.Q.)
| | | | - Meritxell Gomis
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.)
| | - Pere Cardona
- Department of Neurology, Stroke Unit, Hospital Universitari Bellvitge, Barcelona, Spain (P.C.)
| | - Xabier Urra
- Department of Neurology, Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U.)
| | - Francesc Purroy
- Department of Neurology, Stroke Unit, Hospital Arnau de Vilanova de Lleida, Lleida, IRBLleida, UdL, Spain (F.P.)
| | - Yolanda Silva
- Department of Neurology, Stroke Unit, Hospital Josep Trueta, Girona, Spain (Y.S.)
| | - Xavier Ustrell
- Department of Neurology, Stroke Unit, Hospital Joan XXIII, Tarragona, Spain (X.U.)
| | - Patricia Esteve
- Department of Neurology, Stroke Unit, Hospital Verge de la Cinta, Tortosa, Spain (P.E.)
| | - Mercè Salvat-Plana
- Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (M.S.-P., N.P.d.l.O.)
| | | | - Carlos Molina
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | | | - Tudor Jovin
- Neurological Institute, Cooper University Hospital, Camden, New Jersey (T.J.)
| | | | - Marc Ribo
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain (A.G.-T., M. Rubiera, M. Requena, M.O.-G., C.M., M. Ribo)
| | - Natalia Pérez de la Ossa
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.M., A.B., L.D., M.G., D.A., N.P.d.l.O.).,Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (M.S.-P., N.P.d.l.O.)
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García‐Tornel Á, Seró L, Urra X, Cardona P, Zaragoza J, Krupinski J, Gómez‐Choco M, Mas Sala N, Catena E, Palomeras E, Serena J, Hernandez‐Perez M, Boned S, Olivé‐Gadea M, Requena M, Muchada M, Tomasello A, Molina CA, Salvat‐Plana M, Escudero M, Jimenez X, Davalos A, Jovin TG, Purroy F, Abilleira S, Ribó M, Perez de la Ossa N, Jacobi MR, Sanjuan E, Santana K, Molina C, Rubiera M, Rodríguez N, Pagola J, Rodriguez‐Luna D, Maisterra O, Santamarina E, Muchada M, Juega J, Boned S, Franco AP, García‐Tornel Á, Gadea MO, Deck M, Requena M, Sala V, de la Ossa NP, Muñoz L, Millán M, Gomis M, López‐Cancio E, Dorado L, Hernández‐Pérez M, Ciurans J, Samaniego D, Canento T, Martin L, Planas A, Broto J, Sorrentino A, Paré M, Zhu N, Garrido A, Grau L, Crespo AM, Presas S, Almendrote M, Ramos A, Lucente G, Ispierto L, Lozano M, Becerra JL, Jiménez M, Rolán DV, Guanyabens N, Sanchez‐Ojanguren J, Martínez‐Piñeiro A, Forcén S, Gea M, Álvarez M, Ramos A, Lizarbe MD, Sara, Guerra R, Bragado I, Arbex A, Rodríguez L, Bustamante A, Portela PC, García HQ, Rodríguez BL, Cayuela N, Miró J, Marzal C, Paipa A, Campoy S, Núñez A, Arroyo P, Besora S, Adell V, Campdelacreu J, Martí MA, González B, Vila LB, Crespo MF, Berbel A, Urbaneja CV, Guillen N, Vidal N, Santamaria PVV, Navarro DH, Simó M, Falip M, Matas E, Ochoa NM, Gifreu A, Muñoz A, Romero L, Portell E, Perez GH, Esteve FR, Teixidor S, Talavera AS, Gómez R, Nuin XU, Vargas M, Chamorro Á, Amaro S, Llull L, Renú A, Rudilosso S, del Valle RS, Ariño H, Solà N, la Puma D, Gil F, Gómez JB, Matos N, Falgàs N, Borrego S, Sánchez A, Balasa M, Montejo C, Guasp M, Reyes D, Cervilla PS, Contador JM, Monge VAV, Ramos O, Manzanera LSR, Rodríguez A, Campello AR, Ballester GR, Trujillano ML, Steinhauer EG, Godia EC, Santiago AJO, Conde JJ, Fábregas JM, Guisado D, Prats L, Camps P, Delgado R, Domeño AM, Marín R, Cànovas D, Estela J, Ros M, Aranceta S, Espinosa J, Rubio M, Lafuente C, Barrachina O, Anguita A, Reverter A, García C, Sansa G, Hervas M, Crosas M, Delgado T, Krupinski J, Folch DSH, Gamito GM, Alvarez JT, Subirana T, Molina J, Besora S, Romero LC, Valls GG, Jover M, Sotova JJ, Sánchez SMG, Valenzuela S, Gómez‐Choco M, Mengual JJ, Font MÀ, Ruiz MIG, Zubizarreta I, González SF, Gubieras L, Cobos CE, Romo LM, Caballol N, Cano L, Leal JS, Blas YS, Izarra MT, Trigo IB, Viturro SB, Albiñana LP, Garrido MR, Cazcarra CM, Uscamaita KE, Márquez F, Coll C, Villlas MIL, Vila BS, Perna BA, Domínguezl DL, de Lera M, Foraster AC, Monge VAV, Bojaryn U, García FP, Benabdelhak I, Capdevila GM, Montesinos JS, Vázquez D, Hervás JV, González C, Quílez A, Pascual MV, Ruiz M, Riba Y, Villar MPG, García C, Roig XU, Mora MB, Guinjoan AP, Borras J, Martínez AM, Marés R, Viñas i Gaya J, Seró L, Flores A, Rodríguez DP, Castilho G, Ortega AM, Reverté S, Zaragoza J, Baiges JJ, Zaragoza J, Ozaeta GM, Escalante S, Belloch PE, Payo I, Salvado JS, Sala NM, Soler Insa JM, Vilamala ET, Navarro JA, Tabuenca HC, Sánchez TC, Ros M, Matos N, Roldán E, Rubiol EP, Franquet E, Fuentes L, Donaire J, Martí E, Giménez L, Vázquez JG, Ambrós ENCG, Rodríguez P, Oletta JF, Mellado PP, Catena, Gómez B, Raileau V, Ruíz EC, Pardina O, Mercadal J, López‐Diéguez M, Pérez P, Gabarró L, Orriols M, Molina JC, Canet JJ, Roca M, Álvaro M, Boneu F, Giménez G, Albà J, Gibert F, Garcia J, Barragan P, Jurado G, Pascual V, Ortega JS, Solano JAM, Fernández V, Torres M, Alvaredo ABM, Parejo LR, Aragonés JM, Bullón A, Loste C, González P, Bejarano N, Sanchez F, Lucchetti G, Pla X, Gimeno J, Reynaga E, Barcons M, Celedón G, Ortiz J, Anastasovski G, Mascaró O, de los Ríos JD, Feliu M, Ribera A, Ruiz C, Corominas G, Nunes DD, Roca C, Latorre N, Yataco L, Cruz M, Blanco N, Castejón S, Calderón DC, Sunyer CP, Garcia JE, Martin RP, de Luis Sanchez A, Vivas DE, Molina JV, Palome GP, Chaume LT, Vilella AV, Bustamante M, Boltes A, Rodríguez F, Arrieta I, Molist JC, Andreu B, Soler EP, Buscà NG, López MD, Farreres JB, Ruiz VC, Batiste DM, Cartagena MPS, de Vega EC, Real JB, Roman HP, Socolich C, Camp JMA, Orgaz ATC, Felip MPF, Morón N, Bacca S, Molina M, Casarramona F, Elias L, Bukaei MZ, Gutierrez JAM, Escuin JL, Olaizola C, Vargas YL, Oyonarte JJ, Soultana R, Golpe ES, Salvador E, Vila G, Serrano M, Claverol MNL, Lamolla M, Amate M, Rodriguez A, Romero R, del Carpio M, Hernandez AI, Martín J, Rosas MC, Nogueroles A, Encarnación S, Robles A, Herrera JA, Gavilán R, Mameghani T, Araujo G, Morales MAG, Segui ERA, Climent EF, Pujol FP, Seira MJG, Pía LG, Nuñez FS, Peñalver CA, Lopes CV, Tasa ER, Vilchez CR, Zambrana MS, Ribas BS, Panés IV, Planavila MV, Lorenzo AV, Guixes MS, Medina J, Sambrano D, Zamarreño J, Pirela C, Vélez P, Cajamarca L, Pérez H, Martínez Y, Gonçalves JA, Regordosa C, Mormeneo C, Griu L, Colina MF, Farik E, Duch DC, Badenas C, Bernal O, Agramunt N, Morales S, Reynoso V, Guerrero M, Cid PR, Folqué M, Pedroza C, Hachem A, Martínez ÍS, García XV, Amorós ML, Subirós XC, Benet MC, Eendenburg CV, Osuna T, Santos DG, Pallisera DM, Oliva LG, Sanchez DG, Basurto X, Vivoda L, Van der Kleyn R, Robles DL, Barranco AC, Almendros MC, Oliveras MP, Álvarez AF, Rybyeva M, Viñas A, Barcons M, Tavera JDA, Burbano P, López C, Cruz D, Bisbe P, Fernández N, Palacio JC, Fraiz E, Aguiló O, Amorodjo R, Velázquez J, Sánchez E, Español J, de Celis JP, Coll A, Díaz G, Vergés i Sala M, Capdevila MÁC, Ferrini YY, Gorriz A, Navarro DC, Velásquez D, Soler JP, González J, Higuera JD, Cuellar L, Miniello LM, Pujol L, Cracan S, Angela MVM, Anabel LL, Molist MG, Anna D, Muñoz SS, Yolanda F, Pujalte C, Marín ET, Casas YF, Luque SH, Sendra JM, Valero FM, Olga CE, Carles GDL, Enric LD, Paramio C, Xavier, Xavier CE, Jaime EM, Jordi CM, Antonio CA, Elena CNM, Lluis CRP, Anna DF, Pere FSJ, Ana FG, Antoni FBJ, Carlos GHJ, Sergio HP, Zulma IT, Rafael MR, Albert OG, Marta OC, Soledad QGM, RodriguezJavier R, Joaquin RS, Ramon RMJ, Pere SV, Jose SAM, Angeles SGM, Francisco TE, José TGP, Isabel VCM, Jose VLJ, Angeles LCM, Isaac LG, Arnulfo MAJ, Olga MF, Teresa SGM, Miquel TM, Mercedes VLM, Manuel PRJ, Marta RF, Dominica RT, Jose SG, Meritxell SG, Sheila AR, Falip AG, Vanessa AO, Stella BP, Miriam CM, Monica CF, Estefani CM, Nuria DM, Laura DM, Margarita FP, Sylvia FC, Georgina GT, del Mar GGA, de Jesus LAD, Pilar LS, Monica LV, Jordi MC, de la Cruz Raquel M, Arantxa MB, Marcos OO, Núria PS, Sergi PM, Carlos RGJ, Virginia RP, Anna SP, Mireia SV, Rossana SL, Judit TR, Anna TC, Maria VA, Teresa AGM, Silvia BV, Maria CGR, Antonio ECJ, Agusti EM, Helena GF, Sar HL, Sonia JD, Angel MGM, Pau OS, Noemi PF, Jesus SF, Carlos SAA, Giovanna TL, Sandra VH, Marta TG, Ada AV, Sonia AA, Laura AN, Mar AB, Cristina AM, Angels AO, Jeannette AC, Miriam AP, Vanessa ACM, Remedios AGE, Silvia AS, Izaskun AS, Nuria BG, Sergio BB, Teresa BT, Roser BP, Ariadna BP, Isabel BG, Nuria BS, Laia BA, Salvador CC, Arnau CC, Iren CM, Nuria CB, Daniel CF, Marc CS, Teresa CM, Cristina CB, Sandra CC, Borrego AJLC, Orri AC, Vilanova GC, Sole AC, Torres MC, Estepa NC, de Sostoa Graell M, del Rio Lopez L, Sandra BDC, Carmen DB, Lucia DMA, Carme DPM, Javier DCP, Laura DM, Khadija EA, Pau EM, David EC, Daniel FP, Sergi FQ, Sergio FE, Anna FA, del Valle Africa F, del Valle Mª Luisa F, Maria FQS, Teresa FRM, Rut GF, Alicia GG, Laura GC, Marina GR, Gemma C, Manuela GA, Xavier GG, Beatriz GF, Marta GG, Ricardo GG, Flor GL, Maria GO, Marta GB, Susana GR, Albert GE, Gemma HS, Dolça HC, Lluis HA, Marta HR, Paula IB, Alessandro I, Marta IC, Etxetxikia JU, Jordi JG, Rajaa KA, Gustavo LG, Anna LM, de Jesus LAD, Lourdes LMM, Aida LC, Monica LB, Laura LM, Cristian LR, Pedro LR, Tania LM, Ruth LM, Jessica LC, Alexia LN, Antonio MDJ, Morales MTP, Albert MC, Natanael MCD, David MG, Paula MG, Quesada M, Marzà Fusté Mireia CM, Marta ML, Jordi MM, Pastalle MP, Silvia MV, Emma MM, Christian MP, Olga MF, Helena MC, Mireia MV, Guillem MS, Aldara MQ, Natalia NR, Asuncion NIM, Pilar NMM, Judith OM, Roger PR, Xenia PT, Ivana PB, Anna PG, Mireia PO, Alejandra PRM, Raquel PY, Anna PM, Sergi PM, Alba PC, Lourdes QB, Cristina RB, Helena RF, del Carmen RGM, Joaquim RP, Inma RF, Amalia RF, Mariola RF, Raquel RM, Yolanda RN, Alicia RI, Albert RG, Silvia RB, de Eugenio Ramon R, Priscila RBARL, Julia SL, Carolina SJA, Daniel SS, Jordi SS, Marta SS, Enriqueta SP, Maria SB, Ruth SD, Ignacio TM, Cristina TV, Ines TSE, Soledad TT, Lluis TF, Marina TR, Anna TG, Nuria TE, Florenc U, Garazi VB, De la Paz Angel V, Fernando VG, Ingrit VG, Natalia VM, Eva VC, Jose VJM, Angela VF, Carla VG, Elisabeth VV, Jose CJF, Agusti GV, Albert GG, Laura JM, Jose MC, Felix MO, Jose MBM, Manuel ML, Jesus MRM, Carles MG, Ricardo MH, Eva MO, Ramon PP, Camilo PC, Antonio PAJ, Pol QM, Jordi RM, Sonia AA, Celia AA, Lorena AF, Joan BP, Laia BA, Francisco CV, Jaume CH, Gloria CGM, Gonzalo CM, Xavier CE, Enric CG, Montserrat CS, Carlos DS, Javier ER, del Mar ECM, Joaquin FA, Carlos FG, Patricia FP, Laura FE, Cristina FG, Marta GP, Ainhoa GG, Rafael HS, Dolça HC, Marta HR, Sonia JA, Pedro JR, Angeles LCM, Alejandro LL, Aleix LO, Rosa MRM, Daniel MM, Marta MM, Noelia ME, Olga MF, Sandra MJ, Matilde MR, Jessica NR, Maria NIR, Raquel NV, Alba PTM, Montserrat PVC, Alba PC, Angels RM, Alejandro RT, Merce RO, Mariola RF, Baltasar SG, Paola SP, Enriqueta SP, Cristina SB, Angeles SGM, Meritxell TF, Gemma TB, Jose TA, Agusti EM, Purificacion FM, Luis HP, Laura JM, Pedro LF, Alfonso LG, Felix MO, Jose MBM, Carles MG, Eva MO, Ricardo PL, Ramon PP, Joan QA, Miguel VL, Consuelo AD, Jeannette AC, Miguel AM, Anna AC, Raquel BG, Antonio BC, Del Mar CGM, Montserrat CO, Daniel CF, Marc CS, Isabel CMC, Alexander CB, Gloria CGM, Gonzalo CM, Sergio CC, Alexandre CO, Lidia CP, Rita CO, Carles DE, Javier DCP, del Mar ECM, Raquel FM, Luis GLP, Marta GP, Vallve GA, Manuela GA, Xavier GG, Carlos GM, Elena HV, Dolça HC, Cristina HG, Rafael MR, Marta MM, Daniel MM, Sergi MB, Xavier MP, Isabel MD, Maria MC, Pastalle MP, de la Cruz Raquel M, Olga MF, Javier MSF, Roger PR, Alba PTM, Feliciano PB, Monica PA, Cristina RB, Obed RP, Javier RPF, Mar RT, Sandra RP, Laura SS, Yolanda SM, Sheila SM, Eduardo SC, Soledad TT, Lluis TF, José TGP, Ricard TT, Narcis VD, Olga VE, Nuria VP, Andres BG, Marc BP, Cristina BS, Victor BA, Gemma BB, Estel BC, Alejandro CG, Esther CC, Sanchez CF, Toledo EJF, Roger ER, Xavier ERF, Mireia FS, Jordi GL, Daniel GL, Jorge HL, Alicia JLS, Joel LO, Samuel LY, Marta LV, Soto LS, Nicolas MC, Jesus MCD, Arich MP, Susana MS, Raul MM, Isabel MHM, Jose OFM, Bàrbara PB, Pedro PS, Judith RC, Marc RL, Verònica RL, Silvina RL, Gerard SC, Marc SL, Manel SR, Meritxell SG, Albert SC, Noemí SD, Gabriel SMG, Miquel TM, Maria VPA, Silvia VM, Salvat‐Plana M, Roig J, Hidalgo V, Vivanco‐Hidalgo RM, Gallofré M, Cobo E. Workflow times and outcomes in patients triaged for a suspected severe stroke. Ann Neurol 2022; 92:931-942. [DOI: 10.1002/ana.26489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/21/2022] [Accepted: 08/18/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Álvaro García‐Tornel
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Laia Seró
- Department of Neurology Hospital Universitari Joan XXIII Tarragona Spain
| | | | - Pere Cardona
- Stroke Unit Hospital Universitari Bellvitge, L'Hospitalet de Llobregat Spain
| | - Josep Zaragoza
- Department of Neurology Hospital Verge de la Cinta Tortosa Spain
| | | | - Manuel Gómez‐Choco
- Department of Neurology Complex Hospitalari Hospital Moisés Broggi Sant Joan Despí Spain
| | - Natalia Mas Sala
- Department of Neurology Hospital Sant Joan de Déu ‐ Fundació Althaia Manresa Spain
| | - Esther Catena
- Department of Neurology Consorci Sanitari Alt Penedès‐Garraf Spain
| | | | - Joaquin Serena
- Stroke Unit Hospital Universitari Josep Trueta Girona Spain
| | | | - Sandra Boned
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Marta Olivé‐Gadea
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Manuel Requena
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
- Department of Interventional Neurorradiology. Hospital Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Marian Muchada
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Alejandro Tomasello
- Department of Interventional Neurorradiology. Hospital Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Carlos A. Molina
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Mercè Salvat‐Plana
- Stroke Program, Catalan Health Department, Agency for Health Quality and Assesment of Catalonia (AQuAS) CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | | | | | - Antoni Davalos
- Stroke Unit Hospital Germans Trias i Pujol Badalona Barcelona Spain
| | - Tudor G Jovin
- Neurological Institute Cooper University Hospital Camden New Jersey
| | - Francesc Purroy
- Stroke Unit. Department of Neurology Hospital Universitari Arnau de Vilanova de Lleida Lleida Spain
| | - Sonia Abilleira
- Stroke Program, Catalan Health Department, Agency for Health Quality and Assesment of Catalonia (AQuAS) CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Marc Ribó
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
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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.
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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
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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.
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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
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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.
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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
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Mas MÀ, Closa C, Gámez S, Inzitari M, Ribera A, Santaeugènia SJ, Gallofré M. Home as a Place for Care of the Oldest Stroke Patients: A Pilot from the Catalan Stroke Program. J Am Geriatr Soc 2019; 67:1979-1981. [PMID: 31018014 DOI: 10.1111/jgs.15944] [Citation(s) in RCA: 2] [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: 12/31/2018] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Miquel À Mas
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain.,RE-FIT BCN Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | | | - Sara Gámez
- Badalona Serveis Assistencials, Badalona, Spain
| | - Marco Inzitari
- RE-FIT BCN Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.,Parc Sanitari Pere Virgili, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aida Ribera
- Cardiovascular Epidemiology Unit, Cardiology Department, CIBERESP, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Miquel Gallofré
- Stroke Program, Ministry of Health of Catalonia, Barcelona, Spain
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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.
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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
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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).
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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
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Closa C, Mas MÀ, Santaeugènia SJ, Inzitari M, Ribera A, Gallofré M. Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care. J Am Med Dir Assoc 2017; 18:780-784. [DOI: 10.1016/j.jamda.2017.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 10/19/2022]
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Purroy F, Vena A, Cánovas D, Cardona P, Cocho D, Cuadrado-Godia E, Chamorro A, Dávalos A, Garcés M, Gomis M, Krupinski J, Palomeras E, Ribó M, Roquer J, Rubiera M, Sanahuja J, Saura J, Serena J, Ustrell X, Vargas M, Benabdelhak I, Abilleira S, Gallofré M. Influence of Hospital Type on Outcomes of Individuals Aged 80 and Older with Stroke Treated Using Intravenous Thrombolysis. J Am Geriatr Soc 2017; 65:E117-E122. [DOI: 10.1111/jgs.14935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Ana Vena
- Hospital Universitari Arnau de Vilanova de Lleida; Lleida Spain
| | | | - Pere Cardona
- Hospital de Bellvitge; Hospitalet del Llobregat Spain
| | | | | | | | | | | | | | | | | | - Marc Ribó
- Vall d'Hebrón Hospital; Barcelona Spain
| | | | | | - Jordi Sanahuja
- Hospital Universitari Arnau de Vilanova de Lleida; Lleida Spain
| | | | | | | | | | | | - Sonia Abilleira
- Agency for Health Quality and Assessment of Catalonia; Barcelona Spain
| | - Miquel Gallofré
- Agency for Health Quality and Assessment of Catalonia; Barcelona Spain
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11
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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.
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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
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12
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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.
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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
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Pérez LM, Inzitari M, Quinn TJ, Montaner J, Gavaldà R, Duarte E, Coll-Planas L, Cerdà M, Santaeugenia S, Closa C, Gallofré M. Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study. PLoS One 2016; 11:e0166304. [PMID: 27829011 PMCID: PMC5102428 DOI: 10.1371/journal.pone.0166304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/26/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stroke is a major cause of disability in older adults, but the evidence around post-acute treatment is limited and heterogeneous. We aimed to identify profiles of older adult stroke survivors admitted to intermediate care geriatric rehabilitation units. METHODS We performed a cohort study, enrolling stroke survivors aged 65 years or older, admitted to 9 intermediate care units in Catalonia-Spain. To identify potential profiles, we included age, caregiver presence, comorbidity, pre-stroke and post-stroke disability, cognitive impairment and stroke severity in a cluster analysis. We also proposed a practical decision tree for patient's classification in clinical practice. We analyzed differences between profiles in functional improvement (Barthel index), relative functional gain (Montebello index), length of hospital stay (LOS), rehabilitation efficiency (functional improvement by LOS), and new institutionalization using multivariable regression models (for continuous and dichotomous outcomes). RESULTS Among 384 patients (79.1±7.9 years, 50.8% women), we identified 3 complexity profiles: a) Lower Complexity with Caregiver (LCC), b) Moderate Complexity without Caregiver (MCN), and c) Higher Complexity with Caregiver (HCC). The decision tree showed high agreement with cluster analysis (96.6%). Using either linear (continuous outcomes) or logistic regression, both LCC and MCN, compared to HCC, showed statistically significant higher chances of functional improvement (OR = 4.68, 95%CI = 2.54-8.63 and OR = 3.0, 95%CI = 1.52-5.87, respectively, for Barthel index improvement ≥20), relative functional gain (OR = 4.41, 95%CI = 1.81-10.75 and OR = 3.45, 95%CI = 1.31-9.04, respectively, for top Vs lower tertiles), and rehabilitation efficiency (OR = 7.88, 95%CI = 3.65-17.03 and OR = 3.87, 95%CI = 1.69-8.89, respectively, for top Vs lower tertiles). In relation to LOS, MCN cluster had lower chance of shorter LOS than LCC (OR = 0.41, 95%CI = 0.23-0.75) and HCC (OR = 0.37, 95%CI = 0.19-0.73), for LOS lower Vs higher tertiles. CONCLUSION Our data suggest that post-stroke rehabilitation profiles could be identified using routine assessment tools and showed differential recovery. If confirmed, these findings might help to develop tailored interventions to optimize recovery of older stroke patients.
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Affiliation(s)
- Laura M. Pérez
- Convalescence and Rehabilitation Unit, Hospital Parc Sanitari Pere Virgili, Barcelona, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
- * E-mail:
| | - Marco Inzitari
- Convalescence and Rehabilitation Unit, Hospital Parc Sanitari Pere Virgili, Barcelona, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Terence J. Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Joan Montaner
- Neurology Department, Neurovascular Research Laboratory (VHIR), Vall D´Hebrón Hospital, Barcelona, Spain
| | - Ricard Gavaldà
- Department of Computer Science, Universitat Politécnica de Catalunya, Barcelona, Spain
| | - Esther Duarte
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar, Barcelona, Spain
| | - Laura Coll-Planas
- Fundació Salut i Envillement, Universitàt Autónoma de Barcelona, Barcelona, Spain
| | - Mercè Cerdà
- Catalan Healthcare Service, Government of Catalonia, Barcelona, Spain
| | - Sebastià Santaeugenia
- Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
- Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Spain
| | - Conxita Closa
- Rehabilitation Department, Corporación Fisiogestión, Barcelona, Spain
| | - Miquel Gallofré
- Pla Director Malaltia Vascular Cerebral, Department of Health, Government of Catalonia, Barcelona, Spain
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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
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Mas MÀ, Closa C, Santaeugènia SJ, Inzitari M, Ribera A, Gallofré M. Hospital-at-home integrated care programme for older patients with orthopaedic conditions: Early community reintegration maximising physical function. Maturitas 2016; 88:65-9. [DOI: 10.1016/j.maturitas.2016.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/22/2016] [Accepted: 03/03/2016] [Indexed: 12/29/2022]
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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.
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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
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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.
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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.)
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Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Román L, Serena J, Abilleira S, Ribó M, Millán M, Urra X, Cardona P, López-Cancio E, Tomasello A, Castaño C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Pérez M, Goyal M, Demchuk AM, von Kummer R, Gallofré M, Dávalos A. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372:2296-306. [PMID: 25882510 DOI: 10.1056/nejmoa1503780] [Citation(s) in RCA: 3381] [Impact Index Per Article: 375.7] [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: 11/19/2022]
Abstract
BACKGROUND We aimed to assess the safety and efficacy of thrombectomy for the treatment of stroke in a trial embedded within a population-based stroke reperfusion registry. METHODS During a 2-year period at four centers in Catalonia, Spain, we randomly assigned 206 patients who could be treated within 8 hours after the onset of symptoms of acute ischemic stroke to receive either medical therapy (including intravenous alteplase when eligible) and endovascular therapy with the Solitaire stent retriever (thrombectomy group) or medical therapy alone (control group). All patients had confirmed proximal anterior circulation occlusion and the absence of a large infarct on neuroimaging. In all study patients, the use of alteplase either did not achieve revascularization or was contraindicated. The primary outcome was the severity of global disability at 90 days, as measured on the modified Rankin scale (ranging from 0 [no symptoms] to 6 [death]). Although the maximum planned sample size was 690, enrollment was halted early because of loss of equipoise after positive results for thrombectomy were reported from other similar trials. RESULTS Thrombectomy reduced the severity of disability over the range of the modified Rankin scale (adjusted odds ratio for improvement of 1 point, 1.7; 95% confidence interval [CI], 1.05 to 2.8) and led to higher rates of functional independence (a score of 0 to 2) at 90 days (43.7% vs. 28.2%; adjusted odds ratio, 2.1; 95% CI, 1.1 to 4.0). At 90 days, the rates of symptomatic intracranial hemorrhage were 1.9% in both the thrombectomy group and the control group (P=1.00), and rates of death were 18.4% and 15.5%, respectively (P=0.60). Registry data indicated that only eight patients who met the eligibility criteria were treated outside the trial at participating hospitals. CONCLUSIONS Among patients with anterior circulation stroke who could be treated within 8 hours after symptom onset, stent retriever thrombectomy reduced the severity of post-stroke disability and increased the rate of functional independence. (Funded by Fundació Ictus Malaltia Vascular through an unrestricted grant from Covidien and others; REVASCAT ClinicalTrials.gov number, NCT01692379.).
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Affiliation(s)
- Tudor G Jovin
- The authors' affiliations are listed in the Appendix
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Pérez LM, Inzitari M, Roqué M, Duarte E, Vallés E, Rodó M, Gallofré M. Change in cognitive performance is associated with functional recovery during post-acute stroke rehabilitation: a multi-centric study from intermediate care geriatric rehabilitation units of Catalonia. Neurol Sci 2015; 36:1875-80. [DOI: 10.1007/s10072-015-2273-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/28/2015] [Indexed: 11/29/2022]
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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.
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Affiliation(s)
- Sònia Abilleira
- Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain
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Pérez L, Cerda M, Gallofré M, Coll L, Inzitari M. O3.25: Rehabilitation phenotypes in geriatric patients after stroke. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70153-6] [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: 10/24/2022]
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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.
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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.)
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23
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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.
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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
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- Stroke Program, Agency for Health Quality and Assessment of Catalonia (AHQAC), Barcelona, Spain
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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
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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.
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Affiliation(s)
- Sònia Abilleira
- Stroke Programme, Catalan Agency for Health Information, Assessment and Quality (CAHIAQ), Barcelona, Spain.
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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.
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Affiliation(s)
- Sònia Abilleira
- Stroke Programme, Catalan Agency for Health Information, Assessment and Quality, Roc Boronat 81-95, 2a planta, 08005 Barcelona, Spain.
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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]
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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.
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Affiliation(s)
- S Abilleira
- Stroke Programme, Catalan Agency for Health Technology Assessment and Research, Barcelona, Spain.
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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]
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30
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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.
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Affiliation(s)
- Sònia Abilleira
- Departament de Salut, Generalitat de Catalunya, Barcelona, España.
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Fernández-Viladrich P, Buenaventura I, Gudiol F, Gallofré M, Rufí G, Butí M, Pallarés R, Ariza J. [Pneumococcal meningitis in adults. A study of 141 episodes]. Med Clin (Barc) 1986; 87:569-74. [PMID: 3784675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
To shed some light on the potential value of rifampicin in the treatment of tuberculous meningitis (TBM) in adults, a retrospective analysis has been made of 143 medical records from 4 hospitals for the period 1967-80. Treatment of TBM with rifampicin and other antituberculous drugs in combination (Group B) was compared to other regimes which did not include rifampicin (Group A). There were 64 patients in Group B and 79 in Group A. The two groups of patients did not differ significantly in their prognostic characteristics. The total mortality was 14.7%: it was higher among patients not treated with rifampicin (24%; Group A) than amongst those given rifampicin (3.1%; Group B; chi 2 = 10.74; p less than 0.005). The difference was also statistically significant (chi 2 = 6.88; p less than 0.01) if patients who died during the first 48 h after the institution of treatment were excluded. No significant difference in mortality rate was found when patients treated with rifampicin plus isoniazid (INH) 8-10 mg/kg (1 death out of 41 patients) were compared to patients treated with INH 15 mg/kg (2 deaths out of 20 patients). Neurological sequelae recorded during a 6 month follow-up period were more severe among patients not treated with rifampicin.
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Butí M, Gallofré M, Cervera C, Codina Puiggrós A. [Salmonella typhi meningoencephalitis]. Med Clin (Barc) 1983; 81:234-5. [PMID: 6621172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Artaza A, Gallofré M, Arboix M, Laporte JR. [Rifampicin levels in cerebrospinal fluid in meningeal inflammation]. Arch Farmacol Toxicol 1983; 9:121-4. [PMID: 6625672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Massons J, Gallofré M, López Vivancos J, Urrutia A, Dávalos A. [Diagnostic methods for herpetic encephalitis]. Med Clin (Barc) 1982; 79:243-4. [PMID: 6292592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Matías-Guíu J, Ramió R, Miquel F, Lu Cortez L, Gallofré M, Galdós L. [Sarcoidosis with a diencephalic and meningeal onset]. Med Clin (Barc) 1982; 79:47-8. [PMID: 7121108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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