Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020

Diana Aguiar de Sousa; Arlene Wilkie; Bo Norrving; Chris Macey; Claudio Bassetti; Cristina Tiu; Greg Roth; Grethe Lunde; Hanne Christensen; Jens Fiehler; Francesca Romana Pezzella; Martin Dichgans; Melinda B. Roaldsen; Peter Kelly; Robert Mikulik; Simona Sacco; Valeria Caso; Urs Fischer; Entela Basha; Nune Yeghiazaryan; Stefan Kiechl; Rana Shiraliyeva; Peter Vanacker; Marija Bender; Mihael Emilov Tsalta-Mladenov; Hrvoje Budincevic; Ales Tomek; Georgios Kaponides; Helle Klingenberg Iversen; Jürgen Faiss; Janika Kõrv; Tiina Sairanen; Sibon Igor; Alexander Tsiskaridze; George Ntaios; Georgios Tsivgoulis; Laszlo Szapary; Bjorn Logi Thorarinsson; Joe Harbison; Natan M. Bornstein; Danilo Toni; Jashari Fisnik; Kunduz Karbozova; Evija Miglane; Jatužis Dalius; Dirk Droste; Maria Mallia; Erakovic Jevto; Anita Arsovska; Annette Fromm; on behalf of the Steering Committee for the Implementation of the Stroke Action Plan in Europe

doi:10.1177/23969873231186042

Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020

Diana Aguiar de Sousa, Arlene Wilkie, Bo Norrving, Chris Macey, Claudio Bassetti, Cristina Tiu, Greg Roth, Grethe Lunde, Hanne Christensen, Jens Fiehler, Francesca Romana Pezzella, Martin Dichgans, Melinda B. Roaldsen, Peter Kelly, Robert Mikulik, Simona Sacco, Valeria Caso, Urs Fischer^*, Entela Basha, Nune YeghiazaryanStefan Kiechl, Rana Shiraliyeva, Peter Vanacker, Marija Bender, Mihael Emilov Tsalta-Mladenov, Hrvoje Budincevic, Ales Tomek, Georgios Kaponides, Helle Klingenberg Iversen, Jürgen Faiss, Janika Kõrv, Tiina Sairanen, Sibon Igor, Alexander Tsiskaridze, George Ntaios, Georgios Tsivgoulis, Laszlo Szapary, Bjorn Logi Thorarinsson, Joe Harbison, Natan M. Bornstein, Danilo Toni, Jashari Fisnik, Kunduz Karbozova, Evija Miglane, Jatužis Dalius, Dirk Droste, Maria Mallia, Erakovic Jevto, Anita Arsovska, Annette Fromm, on behalf of the Steering Committee for the Implementation of the Stroke Action Plan in Europe

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

Introduction: We assessed best available data on access and delivery of acute stroke unit (SU) care, intravenous thrombolysis (IVT) and endovascular treatment (EVT) in the European region in 2019 and 2020. Patients and methods: We compared national data per number of inhabitants and per 100 annual incident first-ever ischaemic strokes (AIIS) in 46 countries. Population estimates and ischaemic stroke incidence were based on United Nations data and the Global Burden of Disease Report 2019, respectively. Results: The estimated mean number of acute SUs in 2019 was 3.68 (95% CI: 2.90–4.45) per one million inhabitants (MIH) with 7/44 countries having less than one SU per one MIH. The estimated mean annual number of IVTs was 21.03 (95% CI: 15.63–26.43) per 100,000 and 17.14% (95% CI: 12.98–21.30) of the AIIS in 2019, with highest country rates at 79.19 and 52.66%, respectively, and 15 countries delivering less than 10 IVT per 100,000. The estimated mean annual number of EVTs in 2019 was 7.87 (95% CI: 5.96–9.77) per 100,000 and 6.91% (95% CI: 5.15–8.67) of AIIS, with 11 countries delivering less than 1.5 EVT per 100,000. Rates of SUs, IVT and EVT were stable in 2020. There was an increase in mean rates of SUs, IVT and EVT compared to similar data from 2016. Conclusion: Although there was an increase in reperfusion treatment rates in many countries between 2016 and 2019, this was halted in 2020. There are persistent major inequalities in acute stroke treatment in the European region. Tailored strategies directed to the most vulnerable regions should be prioritised.

Original language	English
Journal	European Stroke Journal
Volume	8
Issue number	3
Pages (from-to)	618-628
Number of pages	11
ISSN	2396-9873
DOIs	https://doi.org/10.1177/23969873231186042
Publication status	Published - 2023

Bibliographical note

Publisher Copyright:
© European Stroke Organisation 2023.

Keywords

acute stroke treatment
endovascular treatment
Europe
health care resources
intravenous thrombolysis
stroke care implementation
stroke unit

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10.1177/23969873231186042

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Aguiar de Sousa, D., Wilkie, A., Norrving, B., Macey, C., Bassetti, C., Tiu, C., Roth, G., Lunde, G., Christensen, H., Fiehler, J., Pezzella, F. R., Dichgans, M., Roaldsen, M. B., Kelly, P., Mikulik, R., Sacco, S., Caso, V., Fischer, U., Basha, E., ... on behalf of the Steering Committee for the Implementation of the Stroke Action Plan in Europe (2023). Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020. European Stroke Journal, 8(3), 618-628. https://doi.org/10.1177/23969873231186042

Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020. / Aguiar de Sousa, Diana; Wilkie, Arlene; Norrving, Bo; Macey, Chris; Bassetti, Claudio; Tiu, Cristina; Roth, Greg; Lunde, Grethe; Christensen, Hanne; Fiehler, Jens; Pezzella, Francesca Romana; Dichgans, Martin; Roaldsen, Melinda B.; Kelly, Peter; Mikulik, Robert; Sacco, Simona; Caso, Valeria; Fischer, Urs; Basha, Entela; Yeghiazaryan, Nune; Kiechl, Stefan; Shiraliyeva, Rana; Vanacker, Peter; Bender, Marija; Emilov Tsalta-Mladenov, Mihael; Budincevic, Hrvoje; Tomek, Ales; Kaponides, Georgios; Klingenberg Iversen, Helle; Faiss, Jürgen; Kõrv, Janika; Sairanen, Tiina; Igor, Sibon; Tsiskaridze, Alexander; Ntaios, George; Tsivgoulis, Georgios; Szapary, Laszlo; Logi Thorarinsson, Bjorn; Harbison, Joe; Bornstein, Natan M.; Toni, Danilo; Fisnik, Jashari; Karbozova, Kunduz; Miglane, Evija; Dalius, Jatužis; Droste, Dirk; Mallia, Maria; Jevto, Erakovic; Arsovska, Anita; Fromm, Annette; on behalf of the Steering Committee for the Implementation of the Stroke Action Plan in Europe.

In: European Stroke Journal, Vol. 8, No. 3, 2023, p. 618-628.

Research output: Contribution to journal › Journal article › Research › peer-review

Aguiar de Sousa, D, Wilkie, A, Norrving, B, Macey, C, Bassetti, C, Tiu, C, Roth, G, Lunde, G, Christensen, H, Fiehler, J, Pezzella, FR, Dichgans, M, Roaldsen, MB, Kelly, P, Mikulik, R, Sacco, S, Caso, V, Fischer, U, Basha, E, Yeghiazaryan, N, Kiechl, S, Shiraliyeva, R, Vanacker, P, Bender, M, Emilov Tsalta-Mladenov, M, Budincevic, H, Tomek, A, Kaponides, G, Klingenberg Iversen, H, Faiss, J, Kõrv, J, Sairanen, T, Igor, S, Tsiskaridze, A, Ntaios, G, Tsivgoulis, G, Szapary, L, Logi Thorarinsson, B, Harbison, J, Bornstein, NM, Toni, D, Fisnik, J, Karbozova, K, Miglane, E, Dalius, J, Droste, D, Mallia, M, Jevto, E, Arsovska, A, Fromm, A & on behalf of the Steering Committee for the Implementation of the Stroke Action Plan in Europe 2023, 'Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020', European Stroke Journal, vol. 8, no. 3, pp. 618-628. https://doi.org/10.1177/23969873231186042

Aguiar de Sousa, Diana ; Wilkie, Arlene ; Norrving, Bo ; Macey, Chris ; Bassetti, Claudio ; Tiu, Cristina ; Roth, Greg ; Lunde, Grethe ; Christensen, Hanne ; Fiehler, Jens ; Pezzella, Francesca Romana ; Dichgans, Martin ; Roaldsen, Melinda B. ; Kelly, Peter ; Mikulik, Robert ; Sacco, Simona ; Caso, Valeria ; Fischer, Urs ; Basha, Entela ; Yeghiazaryan, Nune ; Kiechl, Stefan ; Shiraliyeva, Rana ; Vanacker, Peter ; Bender, Marija ; Emilov Tsalta-Mladenov, Mihael ; Budincevic, Hrvoje ; Tomek, Ales ; Kaponides, Georgios ; Klingenberg Iversen, Helle ; Faiss, Jürgen ; Kõrv, Janika ; Sairanen, Tiina ; Igor, Sibon ; Tsiskaridze, Alexander ; Ntaios, George ; Tsivgoulis, Georgios ; Szapary, Laszlo ; Logi Thorarinsson, Bjorn ; Harbison, Joe ; Bornstein, Natan M. ; Toni, Danilo ; Fisnik, Jashari ; Karbozova, Kunduz ; Miglane, Evija ; Dalius, Jatužis ; Droste, Dirk ; Mallia, Maria ; Jevto, Erakovic ; Arsovska, Anita ; Fromm, Annette ; on behalf of the Steering Committee for the Implementation of the Stroke Action Plan in Europe. / Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020. In: European Stroke Journal. 2023 ; Vol. 8, No. 3. pp. 618-628.

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title = "Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020",

abstract = "Introduction: We assessed best available data on access and delivery of acute stroke unit (SU) care, intravenous thrombolysis (IVT) and endovascular treatment (EVT) in the European region in 2019 and 2020. Patients and methods: We compared national data per number of inhabitants and per 100 annual incident first-ever ischaemic strokes (AIIS) in 46 countries. Population estimates and ischaemic stroke incidence were based on United Nations data and the Global Burden of Disease Report 2019, respectively. Results: The estimated mean number of acute SUs in 2019 was 3.68 (95% CI: 2.90–4.45) per one million inhabitants (MIH) with 7/44 countries having less than one SU per one MIH. The estimated mean annual number of IVTs was 21.03 (95% CI: 15.63–26.43) per 100,000 and 17.14% (95% CI: 12.98–21.30) of the AIIS in 2019, with highest country rates at 79.19 and 52.66%, respectively, and 15 countries delivering less than 10 IVT per 100,000. The estimated mean annual number of EVTs in 2019 was 7.87 (95% CI: 5.96–9.77) per 100,000 and 6.91% (95% CI: 5.15–8.67) of AIIS, with 11 countries delivering less than 1.5 EVT per 100,000. Rates of SUs, IVT and EVT were stable in 2020. There was an increase in mean rates of SUs, IVT and EVT compared to similar data from 2016. Conclusion: Although there was an increase in reperfusion treatment rates in many countries between 2016 and 2019, this was halted in 2020. There are persistent major inequalities in acute stroke treatment in the European region. Tailored strategies directed to the most vulnerable regions should be prioritised.",

keywords = "acute stroke treatment, endovascular treatment, Europe, health care resources, intravenous thrombolysis, stroke care implementation, stroke unit",

author = "{Aguiar de Sousa}, Diana and Arlene Wilkie and Bo Norrving and Chris Macey and Claudio Bassetti and Cristina Tiu and Greg Roth and Grethe Lunde and Hanne Christensen and Jens Fiehler and Pezzella, {Francesca Romana} and Martin Dichgans and Roaldsen, {Melinda B.} and Peter Kelly and Robert Mikulik and Simona Sacco and Valeria Caso and Urs Fischer and Entela Basha and Nune Yeghiazaryan and Stefan Kiechl and Rana Shiraliyeva and Peter Vanacker and Marija Bender and {Emilov Tsalta-Mladenov}, Mihael and Hrvoje Budincevic and Ales Tomek and Georgios Kaponides and {Klingenberg Iversen}, Helle and J{\"u}rgen Faiss and Janika K{\~o}rv and Tiina Sairanen and Sibon Igor and Alexander Tsiskaridze and George Ntaios and Georgios Tsivgoulis and Laszlo Szapary and {Logi Thorarinsson}, Bjorn and Joe Harbison and Bornstein, {Natan M.} and Danilo Toni and Jashari Fisnik and Kunduz Karbozova and Evija Miglane and Jatu{\v z}is Dalius and Dirk Droste and Maria Mallia and Erakovic Jevto and Anita Arsovska and Annette Fromm and {on behalf of the Steering Committee for the Implementation of the Stroke Action Plan in Europe}",

note = "Publisher Copyright: {\textcopyright} European Stroke Organisation 2023.",

year = "2023",

doi = "10.1177/23969873231186042",

language = "English",

volume = "8",

pages = "618--628",

journal = "European Stroke Journal",

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TY - JOUR

T1 - Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020

AU - Aguiar de Sousa, Diana

AU - Wilkie, Arlene

AU - Norrving, Bo

AU - Macey, Chris

AU - Bassetti, Claudio

AU - Tiu, Cristina

AU - Roth, Greg

AU - Lunde, Grethe

AU - Christensen, Hanne

AU - Fiehler, Jens

AU - Pezzella, Francesca Romana

AU - Dichgans, Martin

AU - Roaldsen, Melinda B.

AU - Kelly, Peter

AU - Mikulik, Robert

AU - Sacco, Simona

AU - Caso, Valeria

AU - Fischer, Urs

AU - Basha, Entela

AU - Yeghiazaryan, Nune

AU - Kiechl, Stefan

AU - Shiraliyeva, Rana

AU - Vanacker, Peter

AU - Bender, Marija

AU - Emilov Tsalta-Mladenov, Mihael

AU - Budincevic, Hrvoje

AU - Tomek, Ales

AU - Kaponides, Georgios

AU - Klingenberg Iversen, Helle

AU - Faiss, Jürgen

AU - Kõrv, Janika

AU - Sairanen, Tiina

AU - Igor, Sibon

AU - Tsiskaridze, Alexander

AU - Ntaios, George

AU - Tsivgoulis, Georgios

AU - Szapary, Laszlo

AU - Logi Thorarinsson, Bjorn

AU - Harbison, Joe

AU - Bornstein, Natan M.

AU - Toni, Danilo

AU - Fisnik, Jashari

AU - Karbozova, Kunduz

AU - Miglane, Evija

AU - Dalius, Jatužis

AU - Droste, Dirk

AU - Mallia, Maria

AU - Jevto, Erakovic

AU - Arsovska, Anita

AU - Fromm, Annette

AU - on behalf of the Steering Committee for the Implementation of the Stroke Action Plan in Europe

PY - 2023

Y1 - 2023

N2 - Introduction: We assessed best available data on access and delivery of acute stroke unit (SU) care, intravenous thrombolysis (IVT) and endovascular treatment (EVT) in the European region in 2019 and 2020. Patients and methods: We compared national data per number of inhabitants and per 100 annual incident first-ever ischaemic strokes (AIIS) in 46 countries. Population estimates and ischaemic stroke incidence were based on United Nations data and the Global Burden of Disease Report 2019, respectively. Results: The estimated mean number of acute SUs in 2019 was 3.68 (95% CI: 2.90–4.45) per one million inhabitants (MIH) with 7/44 countries having less than one SU per one MIH. The estimated mean annual number of IVTs was 21.03 (95% CI: 15.63–26.43) per 100,000 and 17.14% (95% CI: 12.98–21.30) of the AIIS in 2019, with highest country rates at 79.19 and 52.66%, respectively, and 15 countries delivering less than 10 IVT per 100,000. The estimated mean annual number of EVTs in 2019 was 7.87 (95% CI: 5.96–9.77) per 100,000 and 6.91% (95% CI: 5.15–8.67) of AIIS, with 11 countries delivering less than 1.5 EVT per 100,000. Rates of SUs, IVT and EVT were stable in 2020. There was an increase in mean rates of SUs, IVT and EVT compared to similar data from 2016. Conclusion: Although there was an increase in reperfusion treatment rates in many countries between 2016 and 2019, this was halted in 2020. There are persistent major inequalities in acute stroke treatment in the European region. Tailored strategies directed to the most vulnerable regions should be prioritised.

AB - Introduction: We assessed best available data on access and delivery of acute stroke unit (SU) care, intravenous thrombolysis (IVT) and endovascular treatment (EVT) in the European region in 2019 and 2020. Patients and methods: We compared national data per number of inhabitants and per 100 annual incident first-ever ischaemic strokes (AIIS) in 46 countries. Population estimates and ischaemic stroke incidence were based on United Nations data and the Global Burden of Disease Report 2019, respectively. Results: The estimated mean number of acute SUs in 2019 was 3.68 (95% CI: 2.90–4.45) per one million inhabitants (MIH) with 7/44 countries having less than one SU per one MIH. The estimated mean annual number of IVTs was 21.03 (95% CI: 15.63–26.43) per 100,000 and 17.14% (95% CI: 12.98–21.30) of the AIIS in 2019, with highest country rates at 79.19 and 52.66%, respectively, and 15 countries delivering less than 10 IVT per 100,000. The estimated mean annual number of EVTs in 2019 was 7.87 (95% CI: 5.96–9.77) per 100,000 and 6.91% (95% CI: 5.15–8.67) of AIIS, with 11 countries delivering less than 1.5 EVT per 100,000. Rates of SUs, IVT and EVT were stable in 2020. There was an increase in mean rates of SUs, IVT and EVT compared to similar data from 2016. Conclusion: Although there was an increase in reperfusion treatment rates in many countries between 2016 and 2019, this was halted in 2020. There are persistent major inequalities in acute stroke treatment in the European region. Tailored strategies directed to the most vulnerable regions should be prioritised.

KW - acute stroke treatment

KW - endovascular treatment

KW - Europe

KW - health care resources

KW - intravenous thrombolysis

KW - stroke care implementation

KW - stroke unit

U2 - 10.1177/23969873231186042

DO - 10.1177/23969873231186042

M3 - Journal article

C2 - 37431768

AN - SCOPUS:85165559753

VL - 8

SP - 618

EP - 628

JO - European Stroke Journal

JF - European Stroke Journal

SN - 2396-9873

IS - 3

ER -