STROKE UNITS IN THE CZECH REPUBLIC – CURRENT

SITUATIONMUDr.Daniel Václavík

Ostrava Vítkovice

Hospital

ISCHEMIC STROKE ( IS )-Disease incidence amounts to 280 strokes people

out of 100,000 yearly.-This ranks us among one of the first places in

Europe.-Stroke is in CZ the most frequent cause of death

and invalidity.-Death rate among people older than 65 years is

double in CZ compared to other EU states.-CZ pledged at Helsingborg Conference together

with other states to decrease mortality till 2005 under 40%.

System Measures

1/ organization of pre-hospital care

2/ establishing stroke units /SU/ and stroke centers /SC/

3/ establishing specialized outpatients' departments to ensure primary and secondary prevention

Advantages of Specialized Care at an Stroke Unit

-Random studies proved that hospitalization and care at SU reduce mortality and no. of independent patients by up to 30% compared to hospitalizations at a standard department

-decreasing total cost of treatment - shorter hospitalization, smaller number of complications

Required Number of SU Beds

• IS incidence 280/100,000• 28,000 IS in the Czech Rep./year• 4 beds per 100,000 inhabitants are needed

when hospitalizing 70% of strokes, with average SU time of 5 days and utilized 70 %

• Approx. 30% strokes – hospitalization at other departments for severe other disease or impossibility to improve patient´s prognosis (recurrent stroke with Rankin score higher than 4)

Minimum Criteria for an SU

• Delivery time max. 90 minutes• Appliances and technical equipment meeting

Czech criteria for intensive care• Therapy and patient´s care by a neurologist,

available 24/7• CT, lab 24/7• Vessels examination (at least one of:

ultrasound,CTA,MRA), minimum surgery hours Mo – Fr, better 24 hrs every day

• Sufficient numbers of minimum 100,000 with the goal to treat at least 280 ÍS/year

General Medical Measures with STROKE

-monitoring vital functions-pulmonary embolism and deep venous

thrombosis prevention-treatment of cardiac disorders, hyperglycemia,

fever,elecrolyte disturbances-prevention and treatment of bronchopneumonia-pressure sores prevention-from the second day of hospitalization active

rehabilitation, possibly logopedics care-after complex stabilization transfer to a standard

department

Cerebrovascular Team - Minimum

Parts of team are the following :

- neurologists

- radiologists

- internists (kardiologist)

- rehabilitation therapist

- speech therapist

- educated medical staff ( nursing care )

Cerebrovascular Team – Stroke Centre

Parts of team are the following: - neurologists- radiologists- internists, cardiologists- interventional neuroradiologist- neurosurgeon- vascular surgeon- rehabilitation therapist- speech therapist- educated medical staff ( nursing care )- psychologist

Goal

1. Identify no. of stroke units ( SU ) in CZ2. Analyze percentage of SU in neurological departments

and general internal depertements and no of trombolysing units

3. Identify no. of stroke beds in individual regions4. Find out how many thrombolysis are carried out in

individual regions out of potential 4 % of patients suitable for thrombolysis

5. Identify stroke beds effectivity in connection with thrombolysis in individual regions – ration of stroke beds and no. of thrombolysis

6. Comparison of years 2006 and 2007

Methodology

• Data sources• Czech Statistic Office – no. of inhabitants in

regions• Stroke questionnaire – sent to all head

physicians of neurological departments• Study by company Boehringer – questionnaires

at departments• Trombolytic SITS register • List of neurological departments• SU questionnaire of Ministry of Health

Results

Neurological departments

STROKE beds – neurologic + general

Thrombolysing SU June 2006 upper chart, June 2007 down chart

SU thrombolysig more than 10 pat/year June 2006 upper chart, June 2007 down chart

No. in 2006 % 2006

Districts 86 ( 10 Prague) 100

Neurological departements

71 82

SU neurological + general

49 ( 52 in 2007 ) 57

SU neurological 33 38

Thrombolysing SU 26 ( 46 in 2007) 30

SU with 10 and more thrombolysis/year

7 ( 18 in 2007) 8 ( 31 % 2007 )

Region No. of inhabitants

No. Of Stroke beds 06, 07

Required no. No. of thrombolysis

6/05-6/06

11/06-11/07

No of required thrombolysis ( 4 % of all strokes )

Moravsko

slezský

1269467 38 ( 74%)

51 ( 100% )

51 63 ( 44%)

99 ( 69 % )

142

Olomoucký 639369 18 ( 69%)

14 ( 54 % )

26 35 ( 48%)

46 ( 63 % )

72

Zlínský 595010 12 ( 50%)

13 ( 54 % )

24 19 ( 28%)

16 ( 23 %)

67

Jihomoravský

1127718 35 ( 77%)

35 ( 77%)

45 29 ( 23%)

86 ( 69 %)

125

Vysočina 519211 16 ( 76%)

19 ( 90 % )

21 2( 3%)

9( 15%)

58

Pardubický 508281 9 ( 45%)

11 ( 55 % )

20 8 (14%)

8 (14 %)

56

Královehradecký

550724 18 ( 81%)

20 ( 90 % )

22 17 (27%)

27(43 %)

62

Region No. of inhabitants

No. Of Stroke beds 06, 07

Required no. No. of thrombolysis

6/05-6/06

11/06-11/07

No of required thrombolysis ( 4 % of all strokes )

Praha 1165581 49 (106%)

62 (134 % )

46 32 ( 24%)

108(83%)

130

Středo

český

1122473 13 ( 28%)

24 ( 53 % )

45 0

15( 12%)

125

Jiho

český

625267 14 ( 56%)

16 ( 64 % )

25 15 (21%)

22( 31%)

70

Liberecký 428184 14 ( 82%)

17 ( 100 %)

17 13 (27%)

17(36%)

47

Ústecký 820219 29 ( 87%)

18 ( 54 % )

33 14 (15%)

35(38 %)

92

Karlo

varský

304343 4 (33%)

11 ( 91%)

12 4 ( 11%)

5(14 %)

34

Plzeňský 550688 6 (27%)

6 ( 27 % )

22 4 (6%)

35(56 %)

62

Total 275 (67%)

287 ( 70 %)

409 255 (22%)

526(46 %)

1142

Required numbers of stroke beds as per regions, in %, 2006

106

87 82 81 77 76 74 6956 50 45

33 28 27

0

20

40

60

80

100

120

Required numbers of stroke beds as per regions, in %, in 2007

134

54

82 9077

90100

5464

54 55

94

53

27

020406080

100120140160

Thrombolysis percentage 2006

4844

28 27 27 24 23 2115 14 11

6 3 00

10

20

30

40

50

60

Thrombolysis percentage 2007

6369

23

4336

83

69

3138

14 14

56

15 12

0102030405060708090

Beds effectivity coefficient

% thrombolysis / % stroke beds 2006

0,690,59 0,56

0,37 0,33 0,33 0,32 0,31 0,290,22 0,22

0,17

0,04 00

0,10,20,30,40,50,60,70,8

Beds effectivity coefficient

% thrombolysis / % stroke beds 2007

1,16

0,690,42 0,48 0,47

0,150,36 0,25

0,890,61

2,07

0,7

0,16 0,22

0

0,5

1

1,5

2

2,5

Conclusion

• In 2006 at least 33% stroke beds missing (reported data include also beds with patients having other than IS diagnosis)

• 2007 increased the number of stroke beds by 3%

• Generally low percentage of thrombolysed patients , 0.88 % of all IS in 2006 – more than doubled to 1.88 % of all IS in 2007

• In 8% of districts more than 10 throbolysis were done in 2006, in 2007 already 31 % of all SU

Conclusion

• Huge unevenness among no. of stroke beds in individual regions

• Huge unevenness among numbers of thrombolysed patients as well as in stroke units effectivity

• Increase of thrombolysed patients(2.13 times) and functiong stroke units with thrombolysis higher than 10 pacients per year (3.87 times)

THANK YOU FOR YOUR ATTENTION