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Eurohope conference call 25.02.2012

Are stroke patients equally
treated in Europe?
Antti Malmivaara, MD, PhD, Chief Physician
On behalf of the EuroHOPE group
National Institute for Health and Welfare, Finland
Policy Brief - EuroHOPE, 25th of September, Brussels
Definition of stroke
ƒ WHO definition: “Rapidly developed clinical signs of focal (or global in case of subarachnoid haemorrhage) disturbance of cerebral function, lasting more than 24 hours or leading to death before that, with no apparent cause other than of vascular origin.” ƒ International stroke classification (used by EuroHOPE): ƒ Ischaemic stroke due to a thrombosis in cerebral artery –
this presentation
ƒ Intracerebral haemorrhageƒ Subarachnoid haemorrhageƒ Ill-defined stroke Policy Brief - EuroHOPE, 25th of September, Brussels
Numbers and incidence of ischaemic
stroke in the database (year 2007)

Ischaemic
Ischaemic stroke
population
stroke (N)
(N/105 inhabitants)
Policy Brief - EuroHOPE, 25th of September, Brussels
Demographics of the ischaemic stroke
patients

< 65yr (%)
Female (%)
Policy Brief - EuroHOPE, 25th of September, Brussels
Antithrombotic medication one year
prior and after ischaemic stroke

Policy Brief - EuroHOPE, 25th of September, Brussels
Mean hospital days of ischaemic stroke patients
during first hospital episode and the first year by
country, adjusted for age and sex

Policy Brief - EuroHOPE, 25th of September, Brussels
Mean length of first hospital episode of ischaemic
stroke patients per region by country, adjusted for
age and sex, with confidence intervals

Policy Brief - EuroHOPE, 25th of September, Brussels
Mean length of stay of ischaemic stroke patients
in one year per region by country, adjusted for
age and sex, with confidence intervals

Policy Brief - EuroHOPE, 25th of September, Brussels
Mean mortality (30-, 90-day and one-year (%)) of
ischaemic stroke patients by country, adjusted for
age and sex

Policy Brief - EuroHOPE, 25th of September, Brussels
Mean one-year mortality of ischaemic stroke
patients per region by country, adjusted for age
and sex, with confidence intervals

Policy Brief - EuroHOPE, 25th of September, Brussels
Summary of findings
ƒ The patients are youngest and the incidence of stroke ƒ Data of thrombolysis and stroke centre care is at ƒ Antithrombotic treatment is most common in Finland ƒ Length of stay at hospital is longest in Finlandƒ Mortality is similar in Finland, Sweden, and Policy Brief - EuroHOPE, 25th of September, Brussels
Conclusions: Are ischaemic stroke
patients equally treated in Europe?

ƒ No, the patients are not treated equally.
ƒ There are large differences in the quality and – both between countries and between regions. – The country differences are somewhat dependent on the risk adjustment (will be elaborated further).
Policy Brief - EuroHOPE, 25th of September, Brussels
Conclusions: What could be done?
ƒ Better data of thrombolysis and stroke center treatment is needed to ensure appropriate acute care.
ƒ There is need to promote antithrombotic treatment both in primary and secondary prevention of stroke.
ƒ Starting of benchmarking => evaluation of what the best practice regions (e.g. mortality under 20 % of mean: three regions in Finland and two in Sweden) do differently and how to use this information to improve treatment quality. Policy Brief - EuroHOPE, 25th of September, Brussels
Thank you!
Policy Brief - EuroHOPE, 25th of September, Brussels

Source: http://www.eurohope.info/doc/stroke.pdf

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