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
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.”
International stroke classification (used by EuroHOPE):
Ischaemic stroke due to a thrombosis in cerebral artery – this presentation
Intracerebral haemorrhage Subarachnoid haemorrhage 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
The patients are youngest and the incidence of stroke
Data of thrombolysis and stroke centre care is at
Antithrombotic treatment is most common in Finland
Length of stay at hospital is longest in Finland Mortality is similar in Finland, Sweden, and
Policy Brief - EuroHOPE, 25th of September, Brussels Conclusions: Are ischaemic stroke patients equally treated in Europe?
No, the patients are not treated equally.
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?
Better data of thrombolysis and stroke center
treatment is needed to ensure appropriate acute care.
There is need to promote antithrombotic treatment
both in primary and secondary prevention of stroke.
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
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Are stroke patients equally 
Definition of stroke 
Numbers and incidence of ischaemic 
Demographics of the ischaemic stroke 
Antithrombotic medication one year 
Mean hospital days of ischaemic stroke patients 
Mean length of first hospital episode of ischaemic 
Mean length of stay of ischaemic stroke patients 
Mean mortality (30-, 90-day and one-year (%)) of 
Mean one-year mortality of ischaemic stroke 
Summary of findings
Conclusions: Are ischaemic stroke 
Conclusions: What could be done?
Thank you!