Healthcare system for patients with stroke in Russia. Results of 10-years implementation of the measures aimed at improvement of medical care for patients with acute cerebrovascular events

Abstract

The implementation of measures aimed to improve medical care for patients with acute cerebrovascular accidents in the Russian Federation has made it possible to establish a unified healthcare system for patients with stroke, to provide regional vascular centers with modern equipment, to train medical personnel, to introduce modern effective methods of treatment of acute cerebrovascular accidents-thrombolytic therapy and thrombus extraction. The extent of operative treatment of brain aneurysms and hemorrhagic stroke increased more than 7 times. A positive experience has been gained in the arrangement of medical care for a patient with acute cerebrovascular accident at the pre-hospital stage. Measures for reduction of mortality from the main causes are being monitored, and a geo-information map embracing the main statistical parameters of each region is uploaded into the healthcare unified state information system. In the period of 2005–2016, the death rate from cerebrovascular diseases decreased by more than 40%, including 41% reduction of the death rate from stroke.

About the authors

Veronika I. Skvortsova

Ministry of Healthcare of the Russian Federation, Moscow

Author for correspondence.
Email: platonova@neurology.ru
Russian Federation

Irma M. Shetova

Ministry of Healthcare of the Russian Federation, Moscow

Email: platonova@neurology.ru
Russian Federation

Ekaterina P. Kakorina

Ministry of Healthcare of the Russian Federation, Moscow

Email: platonova@neurology.ru
Russian Federation

Eugeny G. Kamkin

Ministry of Healthcare of the Russian Federation, Moscow

Email: platonova@neurology.ru
Russian Federation

Elena L. Boyko

Ministry of Healthcare of the Russian Federation, Moscow

Email: platonova@neurology.ru
Russian Federation

Vladimir G. Dashyan

2A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow

Email: platonova@neurology.ru
Russian Federation

Vladimir V. Krylov

2A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow

Email: platonova@neurology.ru
Russian Federation

References

  1. Krishnamurthi R.V., Feigin V.L., Forouzanfar M.H. et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health 2013; 1: e259–281. doi: 10.1016/S2214-109X(13)70089-5. PMID: 25104492.
  2. WHO. Global status report on noncommunicable diseases 2014. Geneva; 2014. URL: http://www.who.int/nmh/publications/ncd-status-report-2014/en
  3. Skvortsova V.I., Stakhovskaya L.V., Ayrian N.Yu. [Stroke epidemiology in Russian]. Consilium Medicum. Systemnye gipertenzii 2005; 7(1): 10–12. (In Russ.)
  4. Stakhovskaya L.V., Kotov S.V. (eds.) Stroke. Guide for physicians. Moscow: MIA; 2014. 400 p. (In Russ.)
  5. Bray B.D., Campbell J., Cloud G.C. et al. Bigger, faster? Associations between hospital thrombolysis volume and speed of thrombolysis administration in acute ischemic stroke. Stroke 2013; 44: 3129–3135. doi: 10.1161/STROKEAHA. 113.001981. PMID: 24052511.
  6. Kunisawa S., Kobayashi D., Lee J. et al. Factors associated with the administration of tissue plasminogen activator for acute ischemic stroke. J Stroke Cerebrovasc Dis 2014; 25: 724–731. doi: 10.1016/j.jstrokecerebrovasdis.2013.06.033. PMID: 23910512.
  7. Katzan I.L., Hammer M.D., Hixson E.D. et al. Utilization of intravenous tissue plasminogen activator for acute ischemic stroke. Arch Neurol 2004; 61: 346–350. DOI: 0.1001/archneur.61.3.346. PMID: 15023810.
  8. van Wijngaarden J.D., Dirks M., Huijsman R. et al. Hospital rates of thrombolysis for acute ischemic stroke: the influence of organizational culture. Stroke 2009; 40: 3390–3392. doi: 10.1161/STROKEAHA.109.559492. PMID: 19713539.
  9. Boode B., Welzen V., Franke C., van Oostenbrugge R. Estimating the number of stroke patients eligible for thrombolytic treatment if delay could be avoided. Cerebrovasc Dis 2007; 23: 294–298. doi: 10.1161/STROKEAHA.109.559492. PMID: 19713539.
  10. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ishemic stroke. N Engl J Med 1995; 333(24): 1581–1587. doi: 10.1056/NEJM199512143332401. PMID: 7477192.
  11. Hacke W., Kaste M., Fieschi C. et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995; 274: 1017–1025. PMID: 7563451.
  12. Hacke W., Kaste M., Fieschi C. et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 1998; 352: 1245–1251. PMID: 9788453.
  13. Clark W.M., Wissman S., Albers G.W. et al. Recombinant tissue-type plasminogen activator (alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA. 1999; 282: 2019–2026. PMID: 10591384.
  14. Hacke W., Kaste M., Bluhmki E. et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359: 1317–1329. doi: 10.1056/NEJMoa0804656. PMID: 18815396.
  15. Berkhemer O.A., Fransen P.S., Beumer D. et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11–20. doi: 10.1056/NEJMoa1411587. PMID: 25517348.
  16. Goyal M., Demchuk A.M., Menon B.K. et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372: 1019–1030. doi: 10.1056/NEJMoa1414905. PMID: 25671798.
  17. Jovin T.G., Chamorro A., Cobo E. et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372: 2296–2306. doi: 10.1056/NEJMoa1503780. PMID: 25882510.
  18. Saver J.L., Goyal M., Bonafe A. et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372: 2285–2295.doi: 10.1056/NEJMoa1415061. PMID: 25882376.
  19. Campbell B.C., Mitchell P.J., Kleinig T.J. et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372: 1009–1018. doi: 10.1056/NEJMoa1414792. PMID: 25671798.
  20. Skvortsova V.I., Golukhov G.., Gubskii L.V. et al. [Systemic thrombolysis in ischemic stroke therapy]. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova 2006, 106(12): 24–31. (In Russ.)
  21. Skvortsova V.I., Golukhov G.N., Volynskiy Yu.D. et al. [High efficiency of intraarterial selective thrombolysis in therapy of patients with large artery occlusion]. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova 2006; 106(12): 32–40. (In Russ.)
  22. Demin T.V., Saykhunov M.V., Khasanova D.R. [Systemic thrombolysis experience in ischemic stroke treatment]. Nevrologiya, neiropsikhiatriya, psikhosomatika 2010; (1): 42–46. (In Russ.)
  23. Skvortsova V.I., Shamalov N.A., Anisimov K.V., Ramazanov G.R. [The results of systemic thrombolysis introduction in ischemic stroke treatment in Russian Federation]. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova 2010; (12-2): 17–22. (In Russ.)
  24. Powers W.J., Derdeyn C.P., Biller J. et al. 2015 American Heart Association/ American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients with Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46: 3020–3035. doi: 10.1161/STR.0000000000000074. PMID: 26123479.
  25. Ministry of Healthcare of the Russian Federation. [Clinical recommendations. Ischemic stroke and transient ischemic attack in adults]; 2015. URL: https://neurologic.ru/wp-content/uploads/2018/06/kr171.pdf (In Russ.)
  26. Nogueira R.G., Lutsep H.L., Gupta R. et al. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 2012; 380: 1231–1240. doi: 10.1016/S0140-6736(12)61299-9. PMID: 22932714.

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Copyright (c) 2018 Skvortsova V.I., Shetova I.M., Kakorina E.P., Kamkin E.G., Boyko E.L., Dashyan V.G., Krylov V.V.

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