Abstract WP203: Stroke Statistics of South Korea in the 1st Decade of the 12th Century

Background: This study aimed to summarize the data of epidemiology, risk factors, characteristics and outcomes of patients, and acute stroke care of South Korea in the first decade of the 21th century Methods: We searched relevant reports of government or related organizations and published articles and summarized the most representative data. Results: Every 5 minutes stroke attacks someone (≈105,000 incidence/year), and every 20 minutes stroke kills someone (≈26,000 stroke death/year) in South Korea. Stroke accounts for ≈1 of every 10 deaths. The estimated nationwide annual disability-adjusted life years lost to stroke was ≈344,000. An estimated prevalence of stroke in people with ≥30 years of age is 795,000. Nationwide total cost for stroke care was estimated to be US$ 3.3 billion in 2005, which must be much greater now. The annual stroke death rate substantially decreased by 28.3% during the first decade of the 21th century (74.2 per 100,000 person-years in 2001 and 53.2 per 100,000 person-years in 2010). The proportion of ischemic stroke has steadily increased and accounted for 76% of all strokes in 2009. According to hospital registry studies, the 90-day mortality rate was 3-7% for ischemic stroke and 17% for intracerebral hemorrhage. For risk factors, one in 3-4 Korean adults has hypertension, one in 10 diabetes mellitus, one in 7 hypercholesterolemia, and one in 3 obesity. Nearly 50% of men are current smokers, whereas less than 10% of women are smokers. Korean hospitals are likely to provide a high quality of acute stroke care as reflected in more than 90% of the average performance rate for most of quality indicators for acute stroke care. Intravenous TPA treatment for acute ischemic stroke has increased from 4.6% in 2005 to 8.7% in 2008 and 7.9% in 2010, and the proportion of IV-TPA treatment within 1 hour after hospital arrival was 58%. Among OECD countries, South Korea had the lowest in-hospital 30-day case-fatality rate for ischemic stroke and ranked third lowest for hemorrhagic stroke in 2009. Conclusion: This report would be a valuable resource for clinicians, researchers, healthcare policy makers, and public to establish health care planning and to guide a future research direction in South Korea and for comparison of stroke statistics among countries.

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Acute Ischemic Stroke in COVID-19: Putative Mechanisms, Clinical Characteristics, and Management

Neurology Research International ◽

10.1155/2020/7397480 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Ademola S. Ojo ◽

Simon A. Balogun ◽

Ahmed O. Idowu

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Disease Transmission ◽

Clinical Characteristics ◽

Severe Disease ◽

Stroke Care ◽

Current Evidence ◽

Future Research ◽

Acute Stroke Care

The emergence and spread of the highly contagious novel coronavirus disease (COVID-19) have triggered the greatest public health challenge of the last century. Aside from being a primary respiratory disease, acute ischemic stroke has emerged as a complication of the disease. While current evidence shows COVID-19 could cause ischemic stroke especially in severe disease, there are similarities in the risk factors for severe COVID-19 as well as ischemic stroke, underscoring the complex relationship between these two conditions. The pandemic has created challenges for acute stroke care. Rapid assessment and time-sensitive interventions required for optimum outcomes in acute stroke care have been complicated by COVID-19 due to the need for disease transmission preventive measures. The purpose of this article is to explore the putative mechanisms of ischemic stroke in COVID-19 and the clinical characteristics of COVID-19 patients who develop ischemic stroke. In addition, we discuss the challenges of managing acute ischemic stroke in the setting of COVID-19 and review current management guidelines. We also highlighted potential areas for future research.

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Abstract MP22: Sex Differences in the Delivery of Acute Telestroke Care

Stroke ◽

10.1161/str.52.suppl_1.mp22 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Johanna L Morton ◽

Suraj Didwania ◽

Eric Anderson ◽

Jason Hallock

Keyword(s):

Sex Differences ◽

Ischemic Stroke ◽

Acute Stroke ◽

Patient Population ◽

Functional Outcomes ◽

Stroke Care ◽

Stroke Severity ◽

Acute Stroke Care ◽

Presenting Symptoms ◽

Suspected Stroke

Background: Sex differences are encountered in many aspects of ischemic stroke, including risk factors, presenting symptoms, stroke mechanism, acute interventions and functional outcomes. As telestroke services continue to expand, many patients utilize telestroke for the evaluation and treatment of suspected stroke symptoms. To date, the existence of such differences between sexes has not been identified in the patient population having utilized telestroke for acute stroke care. Methods: A retrospective observational study of the experience of a single teleneurology practice serving 340 hospitals from April 2018 to June 2020 was performed. Patients seen in the emergency department (ED) with a diagnosis of suspected stroke were included. Data from the acute stroke encounter was reported through the current medical record platform. Results: Within the queried period, there were 11,454 male and 11,794 female patients identified as having received ED telestroke evaluation for suspected acute stroke. Males were younger than females (67 vs 70, P <0.01). Males had higher rates of prior stroke, hypertension, diabetes, hyperlipidemia, and coronary disease than females ( P <0.01), while females had higher rates of atrial fibrillation ( P =0.03) and TIA ( P <0.01). Rates of antiplatelet and anticoagulants were higher in males ( P <0.01) than females. There were no differences in time to ED presentation, time to request consult or make a thrombolysis decision, or length of consult. Females had higher stroke severity ( P <0.01) and door-to-needle times ( P <0.01), but lower alteplase rates ( P =0.02) compared to males. Conclusion: This review of a national heterogeneous telestroke patient population is indicative of sex differences in multiple aspects of acute ischemic stroke, most notably in thrombolysis delivered via telestroke. Further investigation into the etiology of such differences is warranted, as well as a survey of functional outcomes. As telemedicine continues to expand in the era of the COVID-19 pandemic, it is imperative that the reasons behind this disparity are investigated.

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Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions

Neurology ◽

10.1212/wnl.0000000000012781 ◽

2021 ◽

Vol 97 (20 Supplement 2) ◽

pp. S6-S16

Author(s):

Vasu Saini ◽

Luis Guada ◽

Dileep R. Yavagal

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Randomized Clinical Trials ◽

Time Window ◽

Systems Of Care ◽

Stroke Care ◽

Acute Stroke Care ◽

Vessel Occlusion ◽

Global Epidemiology

Purpose of the ReviewTo provide an up-to-date review of the incidence of stroke and large vessel occlusion (LVO) around the globe, as well as the eligibility and access to IV thrombolysis (IVT) and mechanical thrombectomy (MT) worldwide.Recent FindingsRandomized clinical trials have established MT with or without IVT as the usual care for patients with LVO stroke for up to 24 hours from symptom onset. Eligibility for IVT has extended beyond 4.5 hours based on permissible imaging criteria. With these advances in the last 5 years, there has been a notable increase in the population of patients eligible for acute stroke interventions. However, access to acute stroke care and utilization of MT or IVT is lagging in these patients.SummaryStroke is the second leading cause of both disability and death worldwide, with the highest burden of the disease shared by low- and middle-income countries. In 2016, there were 13.7 million new incident strokes globally; ≈87% of these were ischemic strokes and by conservative estimation about 10%–20% of these account for LVO. Fewer than 5% of patients with acute ischemic stroke received IVT globally in the eligible therapeutic time window and fewer than 100,000 MTs were performed worldwide in 2016. This highlights the large gap among eligible patients and the low utilization rates of these advances across the globe. Multiple global initiatives are underway to investigate interventions to improve systems of care and bridge this gap.

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A cross-sectional study of awareness regarding dog bite and its management in rural community of Maharashtra, India

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20203593 ◽

2020 ◽

Vol 7 (9) ◽

pp. 1307

Author(s):

Mohammed Alqwaifly

Keyword(s):

Saudi Arabia ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Stroke Care ◽

Cross Sectional Study ◽

Sectional Study ◽

Acute Stroke Care ◽

Cross Sectional ◽

Stroke Treatment

Background: Stroke is a major cause of morbidity and disability worldwide. However, its outcomes have improved in the last few years with advancement in acute stroke treatment, including the use of tissue plasminogen activator (t-PA) within 4.5 hours of onset, which led several international guidelines to adopt it as the standard of care. In this study, authors sought to assess the knowledge, practices, and attitudes of emergency and medicine staff in Qassim, Saudi Arabia toward acute ischemic stroke care.Methods: A quantitative observational cross-sectional study involving 148 physicians from emergency and medicine departments (only three neurologists) was conducted in three main hospitals of the Qassim region, Saudi Arabia. Information was obtained from a self-administered questionnaire. A logistic regression model was used to control for potential confounding factors.Results: Ninety-two percent of participants were aware of t-PA. Eighty-seven percent of participants thought that t-PA was an effective treatment for acute ischemic stroke. Only 20% of participants had given t-PA or participated in the use of t-PA in acute ischemic stroke. Moreover, 64% of participants believed that allowing blood pressure to remain high was the most appropriate action in the first 24 hours in acute ischemic stroke patients who presented outside the t-PA window.Conclusion: Most of the emergency and medicine staff are well informed about t-PA, but the majority of these physicians have never given t-PA or participated in the administration of t-PA to a stroke patient. The main finding here is the positive outlook among emergency and medicine physicians in Qassim toward training in acute stroke care and administering t-PA for stroke, which will positively impact patient outcomes.

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Maintenance of Acute Stroke Care Service During the COVID-19 Pandemic Lockdown

Stroke ◽

10.1161/strokeaha.120.032176 ◽

2021 ◽

Vol 52 (5) ◽

pp. 1693-1701

Author(s):

Valerian L. Altersberger ◽

Lotte J. Stolze ◽

Mirjam R. Heldner ◽

Hilde Henon ◽

Nicolas Martinez-Majander ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Performance Measures ◽

Care Service ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

National Institutes Of Health ◽

Reference Period ◽

Acute Stroke Care ◽

Symptomatic Intracranial Hemorrhage

Background and Purpose: Timely reperfusion is an important goal in treatment of eligible patients with acute ischemic stroke. However, during the coronavirus disease 2019 (COVID-19) pandemic, prehospital and in-hospital emergency procedures faced unprecedented challenges, which might have caused a decline in the number of acute reperfusion therapy applied and led to a worsening of key quality measures for this treatment during lockdown. Methods: This prospective multicenter cohort study used data from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry of patients with acute ischemic stroke treated with reperfusion therapies, that is, intravenous thrombolysis or endovascular therapy. We compared prehospital and in-hospital time-based performance measures (stroke-onset-to-admission, admission-to-treatment, admission-to-image, and image-to-treatment time) during the first 6 weeks after announcement of lockdown (lockdown period) with the same period in 2019 (reference period). Secondary outcomes included stroke severity (National Institutes of Health Stroke Scale) after 24 hours and occurrence of symptomatic intracranial hemorrhage (following the ECASS [European-Australasian Acute Stroke Study]-II criteria). Results: Across 20 stroke centers, 540 patients were treated with intravenous thrombolysis/endovascular therapy during lockdown period compared with 578 patients during reference period (−7% [95% CI, 5%–9%]). Performance measures did not change significantly during the lockdown period (2020/2019 minutes median: onset-to-admission 133/145; admission-to-treatment 51/48). Same was true for admission-to-image (20/19) and image-to-treatment (31/30) time in patients with available time of first image (n=871, 77.9%). Median National Institutes of Health Stroke Scale on admission (2020/2019: 11/11) and after 24 hours (2020/2019: 6/5) and percentage of symptomatic intracranial hemorrhage (2020/2019: 6.2/5.7) did not differ significantly between both periods. Conclusions: The COVID-19 pandemic lockdown resulted in a mild decline in the number of patients with stroke treated with acute reperfusion therapies. More importantly, the solid stability of key quality performance measures between the 2020 and 2019 period may indicate resilience of acute stroke care service during the lockdown, at least in well-established European stroke centers.

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Ongoing Improvement in Acute Ischemic Stroke Therapy Per Concurrent Guidelines and Easily Implementable Quality Improvement Protocol

Neuroscience and Neurological Surgery ◽

10.31579/2578-8868/184 ◽

2021 ◽

Vol 8 (6) ◽

pp. 01-09

Author(s):

Wengui Yu

Keyword(s):

Quality Improvement ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Stroke Care ◽

Linear Regression Models ◽

Stroke Therapy ◽

Acute Stroke Care ◽

Stroke Registry ◽

Intravenous Tissue Plasminogen Activator

Background: Despite proven efficacy of intravenous tissue plasminogen activator (tPA) and endovascular thrombectomy (EVT) in acute ischemic stroke, there has been slow administration of these therapies in the real world practice. We examined the ongoing quality improvement in acute stroke care at our comprehensive stroke center. Methods: Consecutive patients with acute ischemic stroke from 2013 to 2018 were studied. Patients were managed using Code Stroke algorithm per concurrent AHA guidelines and a simple quality improvement protocol implemented in 2015. Demographics and clinical data were collected from Get-With-The-Guideline-Stroke registry and electronic medical records. Patients were divided into 3 groups per admission and implementation date of quality improvement initiatives. Quality measures, including rates of intravenous tPA and EVT, door-to-needle (DTN) time, and door-to-puncture (DTP) time, were analyzed with general mean linear regression models and Jonckheere-Terpstra test. Results: Of the 1,369 eligible patients presenting within 24 hours of symptom onset or wakeup stroke, the rate of intravenous tPA was 20%, 30% and 22%, respectively, in 2013-2014, 2015-2016, and 2017-2018. In contrast, EVT rate was 9%, 14% and 15%, respectively. Based on Jonckheere-Terpstra test, there was significant ongoing improvement in the median DTN time (57, 45, 39 minutes; p < 0.001) and DTP time (172, 130, 114 minutes; p =0.009) during the 3 time periods, with DTN time ≤ 60 and ≤45 minutes in 80% and 63% patients, respectively, in 2017-2018. Conclusions: Getting with the guidelines and simple quality improvement initiatives are associated with satisfactory rates of acute stroke therapy and ongoing improvement in door to treatment times.

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Abstract T P37: Routine CT Angiography in Acute Stroke Does Not Delay Acute Stroke Care

Stroke ◽

10.1161/str.46.suppl_1.tp37 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Gisele S Silva ◽

Renata C Miranda ◽

Rodrigo M Massaud ◽

Andreia M Vacari ◽

Miguel Cendoroglo Neto

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Tertiary Hospital ◽

Acute Stroke Care ◽

Time Intervals ◽

Radiology Report ◽

Group 2

Introduction: Vascular imaging is increasingly used for diagnosis of arterial occlusions in acute ischemic stroke. Hypothesis:We hypothesized that time intervals using a CTA based acute ischemic stroke protocol are not increased when compared to an earlier non-CTA based protocol. Methods: We evaluated a database of consecutive patients admitted to a Brazilian tertiary hospital with acute ischemic stroke from February 2009 to March 2014 and reviewed our stroke quality measures data to determine if the time required to obtain CTA prolonged door-to-neuroimaging, door to radiology report and door-to-needle times. Patients were categorized into: Group 1 (February 2009 to October 2013) (Non-contrast CT Scan based acute stroke protocol) and Group 2 (November 2013 to August 2014) (CTA based acute stroke protocol). Time intervals were compared between the two groups.Results: We evaluated 415 consecutive patients, 20 of whom (4.8%) had a CTA in the acute phase (Group 2). Patients in groups 1 and 2 had similar onset-to-door times (1.86 [0.75-3.58] versus 2.75 hours [1.0-8.49], p=0.09); door to neuroimaging times (27.6 [18.6-46.8] versus 37.8 minutes [23.4-46.2], p=0.28 ) and door to radiology report intervals (39 [27-60.6] versus 53.4 minutes[35.4-61.2], p=0.09). The frequency of treatment with recanalization therapies ( either intravenous thrombolysis or endovascular procedures) was similar between groups 1 (30%) and 2 (21%), p=0.33, as well as door to needle times (p=0.09). Conclusions: CTA based acute stroke care does not significantly delay time to neuroimaging or thrombolysis in routine clinical practice.

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Abstract P470: Annual Endovascular Treatment Procedural Volume and One Year Mortality in Acute Ischemic Stroke

Stroke ◽

10.1161/str.52.suppl_1.p470 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Jun Yup Kim ◽

Keon-Joo Lee ◽

Jihoon Kang ◽

Beom Joon Kim ◽

Seong-Eun Kim ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Stroke ◽

Stroke Care ◽

Emergency Rooms ◽

Acute Stroke Care ◽

Survey Period ◽

Case Volume ◽

Procedural Volume ◽

One Year

Background: In-hospital and 30-day mortality, 3-month functional outcome were reported as associated with endovascular treatment (EVT) case volume per hospital, but one-year mortality was unknown. Furthermore, the hospital EVT volume threshold based on one-year mortality was not reported. We aimed to investigate whether there was a correlation between annual EVT case volume per hospital and one-year mortality and suggest volume threshold. Methods: Data from Korean national survey for assessing quality of acute stroke care were used. The survey was conducted since 2005 and the subject was patients with acute stroke who were admitted via emergency rooms within 7 days of onset at hospitals treating 10 or more stroke cases during the three (2013, 2014) or six (2016) month survey period. Ischemic stroke cases treated with EVT during the last available three assessments (2013, 2014, and 2016) were selected for the analysis. Results: A total of 1,746 ischemic stroke cases (age, 69.2 ± 12.4years; male, 56.6%) treated in 120 hospitals with EVT were analyzed. The median annual EVT case volume was 12.0 cases per hospital (interquartile range, 6.0-22.9) and the mortality at one-month, three-month, and one-year were 12.7%, 16.6%, and 23.3%, respectively. When divided into quartiles according to the annual EVT case volume, the lowest quartile group was found to have the highest one-year mortality (odds ratio [95% confidence intervals], 1.49 [1.04-2.13]), adjusted for age, sex, NIHSS, onset to arrival time. Restricted cubic splines performed on the annual EVT case volume per hospital revealed that cut-off value for the probability of one-year mortality was 15 cases per year ( p <0.02) (Figure). Conclusions: There was an association between annual EVT case volume and one-year mortality, and the volume threshold per hospital based on the one-year mortality was found to be 15 EVT cases per year.

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Abstract P37: A Novel Emergency Stroke Alert System Reduces Door-to-CT And Door-to-Needle Time in Patients With Acute Ischemic Stroke

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap37 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Muhammad A Pervez ◽

Joshua N Goldstein ◽

Natalia S Rost ◽

Joyce Mclntyre ◽

Joseph Fay ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Stroke Care ◽

National Guidelines ◽

Alert System ◽

Acute Stroke Care ◽

Post Intervention ◽

Symptomatic Intracerebral Hemorrhage ◽

Increased Risk ◽

Iv Tpa

Background: National guidelines recommend eligible acute stroke patients undergo neuroimaging within 25 min and IV tPA within 60 min. In order to reduce door-to-needle time, we implemented an “ED2CT” virtual group pager which allows ED staff to simultaneously activate the Stroke Team, neuroradiologists, CT technologists, nursing supervisors and pharmacists. Methods: We performed an IRB approved retrospective review of a prospectively acquired cohort of consecutive patients with ischemic stroke presenting to a single tertiary stroke center using our Get With the Guidelines Stroke (GWTG-S) database. We compared patients who received IV tPA within 3 hours of symptom onset pre- (March 2006-April 2008) to post-intervention (September 2008-December 2009) by Wilcoxon or Fisher's exact as appropriate. Results: Overall, there were 56 patients in the pre-intervention and 53 in the post-intervention groups. Patients were 50.5% male, median age was 76 [IQR 63, 85] years, median time to presentation was 50 [IQR 33, 87] min, and median initial NIHSS was 14 [IQR 8, 20]. None of these variables were significantly different between the pre- and post-intervention groups. Implementation of the ED2CT alert was associated with a reduction of 31% in door-to-CT time (29 [22, 40] vs. 20 [16, 29] min; p=<0.001) and 13.5% in door-to needle time (59 [42, 78] vs. 51 [35, 62] min; p=0.02). In addition, there was an increase of 55% in the proportion of patients undergoing CT within 25 min (42.9% vs.66.7 % p=0.01) and 39% in door-to needle within 60 min (51.8% vs. 72.0% p=0.03). Symptomatic intracerebral hemorrhage (sICH) was infrequent among patients receiving IV tPA with or without rescue IA reperfusion (n=109, 8.3%) and those with IV tPA only (n=83, 6.0%); there was a trend in reduced sICH rate post intervention (11.6% vs. 0%; p=0.06). Conclusions: A novel emergency alert system with which the ED attending directly activates multiple members of the acute stroke clinical and imaging team was associated with an improved door-CT time and improved door-tPA time without an increased risk of sICH. This approach aligns acute stroke care activation with trauma and emergency cardiac care and suggests that team-based approaches may be better than specialty -specific responses.

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Cost burden and cost-effective analysis of the nationwide implementation of the Quality in Acute Stroke Care protocol in Australia

European Heart Journal ◽

10.1093/eurheartj/ehab724.3157 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

C M Marquina ◽

Z A Ademi ◽

E Z Zomer ◽

R O A Ofori-Asenso ◽

R T Tate ◽

...

Keyword(s):

Acute Stroke ◽

Societal Perspective ◽

Stroke Care ◽

Decision Analytic Model ◽

Stroke Severity ◽

Acute Stroke Care ◽

Stroke Incidence ◽

Care Protocol ◽

Life Years ◽

The Cost

Abstract Background The Quality in Acute Stroke Care (QASC) protocol is a multidisciplinary approach to implement evidence-based treatment after acute stroke that reduces death and disability. Aim This study sought to evaluate the cost-effectiveness of implementing the QASC protocol across Australia, from a healthcare and a societal perspective. Methods A decision-analytic model was constructed to reflect one-year outcomes post-stroke, aligned with the stroke severity categories of the modified Rankin scale (mRS). Decision analysis compared outcomes following implementation of the QASC protocol versus no implementation. Population data were extracted from Australian databases and data inputs regarding stroke incidence, costs, and utilities were drawn from published sources. The analysis assumed a progressive uptake and efficacy of the QASC protocol over five years. Health benefits and costs were discounted by 5% annually. The cost of each year lived by an Australian, from a societal perspective, was based on the Australian Government's “value of statistical life year” (AUD 213,000). Results Over five years, the model predicted 263,722 strokes among the Australian population. The implementation of the QASC protocol was predicted to prevent 1,154 deaths and yield a gain of 876 years of life (0.003 per stroke), and 3,180 quality-adjusted life years (QALYs) (0.012 per stroke). There was an estimated net saving of AUD 65.2 million in healthcare costs (AUD 247 per stroke) and AUD 251.7 million in societal costs (AUD 955 per stroke). Conclusions Implementation of the QASC protocol in Australia represents both a dominant (cost-saving) strategy, from a healthcare and a societal perspective. FUNDunding Acknowledgement Type of funding sources: None. Decision tree PSA

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