Abstract W P219: Enhancing Delivery of Reperfusion Therapies for Ischemic Stroke: Towards Equity Through Organization
Introduction: Delays in hospital arrival are the most relevant impediment to effective dissemination of thrombolysis. Organization is crucial to overcome such difficulties. Objective: to report on the achievements of a region-wide organized stroke network in terms of numbers of acute stroke patients assessed by stroke experts, numbers of patients treated with any reperfusion therapy and their geographical distribution, and clinical outcomes. Methods: In mid 2006 the government-based Stroke Program (SP) of Catalonia (7.5 millions) established a regionalized system of acute stroke care (Stroke Code System, SCS) that involves professionals and health administrators. Any acute stroke patient must be referred to the nearest referral hospitals, currently including 14 PSC and 11 community hospitals connected to the telestroke network covered by a centralized, 24-hour, on-call service made up with vascular neurologists. As for stroke admissions, the Hospital Discharge Database is used. Telestroke-based assessments are included in the TICat registry and reperfusion therapies are notified to the government-mandated SONIIA registry. In both registries completeness is guaranteed by SP. Results: Since dissemination of the SCS, numbers of stroke patients undergoing timely expert assessment have gradually increased: from 2,000 in 2006 to 4,800 assessments in 2013 (20% and 44% of all stroke admissions, respectively). Similarly, numbers of IV thrombolysis have risen from 329 in 2006 to 1,106 in 2013. In the areas primarily covered by telestroke hospitals, the population thrombolysis rate reached 13*100,000 in 2013. Overall, the population reperfusion treatment rate increased from 4.6*100,000 in 2006 to 14.5*100,000 in 2013, with some hospitals and their catchment areas achieving rates over 20*100,000. As for clinical outcomes, reperfusion therapies are safe and effective and metrics improve over time. IV thrombolysis has been mapped out to show a clear territorial dissemination (2005 on). Conclusion: Regionalization and organization of the SCS has had a quantifiable and favorable effect in terms of numbers of acute stroke patients receiving early diagnosis and specific reperfusion therapies, as well as clinical outcomes.
Author Disclosures: M. Gallofre: None. S. Abilleira: None. J. Argimon: None. C. Constante: None.
- © 2015 by American Heart Association, Inc.