Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries

Diana Aguiar de Sousa; Rascha von Martial; Sònia Abilleira; Thomas Gattringer; Adam Kobayashi; Miquel Gallofré; Franz Fazekas; Istvan Szikora; Valery Feigin; Valeria Caso; Urs Fischer

doi:10.1177/2396987318786023

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. 2019 Mar;4(1):13-28. doi: 10.1177/2396987318786023. Epub 2018 Jul 20.

Authors

Affiliations

¹ Department of Neurology, University of Lisbon, Hospital de Santa Maria, Lisbon, Portugal.
² Department of Neurology, University of Bern, Inselspital, Bern, Switzerland.
³ Stroke Programme, Agency for Health Quality and Assessment of Catalonia, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
⁴ Department of Neurology, Medical University of Graz, Graz, Austria.
⁵ Interventional Stroke and Cerebrovascular Disease Treatment Centre, Department of Neuroradiology, Institute of Psychiatry and Neurology, Warsaw, Poland.
⁶ Stroke Programme, Health Department of Catalonia, Spain.
⁷ National Institute of Clinical Neurosciences, Budapest, Hungary.
⁸ National Institute for Stroke & Applied Neurosciences, Auckland, New Zealand.
⁹ Stroke Unit, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy.

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.

Keywords: Europe; Survey; acute stroke treatment; endovascular treatment; health care resources; intravenous thrombolysis; stroke unit.