Análisis de recursos asistenciales para el ictus en España en 2012: ¿beneficios de la Estrategia del Ictus del Sistema Nacional de Salud? / Analysis of stroke care resources in Spain in 2012: Have we benefitted from the Spanish Health System’s stroke care strategy?

Introducción: La Estrategia del Ictus del Sistema Nacional de Salud (EISNS) fue un documento de consenso entre las distintas administraciones y sociedades científicas que se desarrolló con el objetivo de mejorar la calidad del proceso asistencial y garantizar la equidad territorial. Nuestro objetivo fue analizar los recursos asistenciales existentes y si se había cumplido el objetivo de la EISNS. Material y métodos: La encuesta sobre los recursos disponibles se realizó por un comité de neurólogos de cada una de las comunidades autónomas (CC.AA), los cuales también realizaron la encuesta de 2008. Los ítems incluidos fueron el número de Unidades de Ictus (UI), su dotación (monitorización, neurólogo 24 h/7 días, ratio enfermería, protocolos), ratio cama UI/100.000 habitantes, recursos diagnósticos (ecografía cardíaca y arterial cerebral, neuroimagen avanzada), realización de trombolisis intravenosa, intervencionismo neurovascular (INV), cirugía del infarto maligno de la arteria cerebral media (ACM) y disponibilidad de la telemedicina. Resultados: Se incluyeron datos de 136 hospitales. Existen 45 UI distribuidas de un modo desigual. La relación cama de UI por habitantes y comunidad autónoma osciló entre 1/74.000 a 1/1.037.000 habitantes, cumpliendo el objetivo solo Cantabria y Navarra. Se realizaron por neurólogos 3.237 trombolisis intravenosas en 83 hospitales, con un porcentaje respecto del total de ictus isquémico entre el 0,3 y el 33,7%. Los hospitales sin UI tenían una disponibilidad variable de recursos. Se realiza INV en todas las CC.AA salvo La Rioja, la disponibilidad del INV 24 h/7 días solo existe en 17 ciudades. Hay 46 centros con cirugía del infarto maligno de la ACM y 5 con telemedicina. Conclusión: La asistencia al ictus ha mejorado en cuanto al incremento de hospitales participantes, la mayor aplicación de trombolisis intravenosa y procedimientos endovasculares, también en la cirugía del infarto maligno de la ACM, pero con insuficiente implantación de UI y de la telemedicina. La disponibilidad de recursos diagnósticos es buena en la mayoría de las UI, e irregular en el resto de hospitales. Las distintas CC.AA deben avanzar para garantizar el mejor tratamiento y equidad territorial, y así conseguir el objetivo de la EISNS

Introduction: The Spanish Health System’s stroke care strategy (EISNS) is a consensus statement that was drawn up by various government bodies and scientific societies with the aim of improving quality throughout the care process and ensuring equality among regions. Our objective is to analyse existing healthcare resources and establish whether they have met EISNS targets. Material and methods: The survey on available resources was conducted by a committee of neurologists representing each of Spain’s regions; the same committee also conducted the survey of 2008. The items included were the number of stroke units (SU), their resources (monitoring, neurologists on call 24 h/7d, nurse ratio, protocols), SU bed ratio/100 000 inhabitants, diagnostic resources (cardiac and cerebral arterial ultrasound, advanced neuroimaging), performing iv thrombolysis, neurovascular interventional radiology (neuro VIR), surgery for malignant middle cerebral artery (MCA) infarctions and telemedicine availability. Results: We included data from 136 hospitals and found 45 Stroke Units distributed unequally among regions. The ratio of SU beds to residents ranged from 1/74,000 to 1/1,037,000 inhabitants; only the regions of Cantabria and Navarre met the target. Neurologists performed 3,237 intravenous thrombolysis procedures in 83 hospitals; thrombolysis procedures compared to the total of ischaemic strokes yielded percentages ranging from 0.3 to 33.7%. Hospitals without SUs showed varying levels of available resources. Neuro VIR is performed in every region except La Rioja, and VIR is only available on a 24 h/7 d basis in 17 cities. Surgery for malignant MCA infarction is performed in 46 hospitals, and 5 have telemedicine. Conclusion: Stroke care has improved in terms of numbers of participating hospitals, the increased use of intravenous thrombolysis and endovascular procedures, and surgery for malignant MCA infarction. Implementation of SUs and telemedicine remain insufficient. The availability of diagnostic resources is good in most SUs and irregular in other hospitals. Regional governments should strive to ensure better care and territorial equality, which would achieve the EISNS objectives

Analysis of stroke care resources in Spain in 2012: have we benefitted from the Spanish Health System's stroke care strategy?

INTRODUCTION: The Spanish Health System's stroke care strategy (EISNS) is a consensus statement that was drawn up by various government bodies and scientific societies with the aim of improving quality throughout the care process and ensuring equality among regions. Our objective is to analyse existing healthcare resources and establish whether they have met EISNS targets. MATERIAL AND METHODS: The survey on available resources was conducted by a committee of neurologists representing each of Spain's regions; the same committee also conducted the survey of 2008. The items included were the number of stroke units (SU), their resources (monitoring, neurologists on call 24h/7d, nurse ratio, protocols), SU bed ratio/100,000 inhabitants, diagnostic resources (cardiac and cerebral arterial ultrasound, advanced neuroimaging), performing iv thrombolysis, neurovascular interventional radiology (neuro VIR), surgery for malignant middle cerebral artery (MCA) infarctions and telemedicine availability. RESULTS: We included data from 136 hospitals and found 45 Stroke Units distributed unequally among regions. The ratio of SU beds to residents ranged from 1/74,000 to 1/1,037,000 inhabitants; only the regions of Cantabria and Navarre met the target. Neurologists performed 3,237 intravenous thrombolysis procedures in 83 hospitals; thrombolysis procedures compared to the total of ischaemic strokes yielded percentages ranging from 0.3 to 33.7%. Hospitals without SUs showed varying levels of available resources. Neuro VIR is performed in every region except La Rioja, and VIR is only available on a 24h/7 d basis in 17 cities. Surgery for malignant MCA infarction is performed in 46 hospitals, and 5 have telemedicine. CONCLUSION: Stroke care has improved in terms of numbers of participating hospitals, the increased use of intravenous thrombolysis and endovascular procedures, and surgery for malignant MCA infarction. Implementation of SUs and telemedicine remain insufficient. The availability of diagnostic resources is good in most SUs and irregular in other hospitals. Regional governments should strive to ensure better care and territorial equality, which would achieve the EISNS objectives.

Recursos asistenciales en ictus en España 2010: análisis de una encuesta nacional del Grupo de Estudio de Enfermedades Cerebrovasculares / Health care resources for stroke patients in Spain, 2010: analysis of a national survey by the Cerebrovascular Diseases Study Group

Introduction: Stroke is currently a major social health problem. For this reason, the Spanish Ministry of Health approved the Stroke National Strategy (SNS) in 2008 to improve the prevention, treatment and rehabilitation of stroke patients. This plan intends to guarantee 24-hour, 365-days neurological assistance in the whole country by the end of 2010. Our aim was to analyse the situation of stroke assistance in Spain in 2009. Material and methods: A committee of neurologists practicing in the different autonomous communities (AC), and who had not participated in the preparation of the SNS, was created. A national survey was performed including the number of stroke units (SU) and their characteristics (monitoring, 24-h/7-day on-call neurology service, nursing staff ratio and the use of protocols), bed ratio of SU/100,000 people, availability of intravenous thrombolysis therapy, neurovascular intervention (NI) and telemedicine. Results: We included data from 145 hospitals. There are 39 SU in Spain, unevenly distributed. The ratio between SU bed/number of people/AC varied from 1/75,000 to 1/1,037,000 inhabitants; Navarra and Cantabria met the goal. Intravenous thrombolysis therapy is used in 80 hospitals; the number of treatments per AC was between 7 and 536 in 2008. NI was performed in the 63% of the AC, with a total of 28 qualified hospitals (although only 1 hospital performed it 24h, 7days a week in 2009). There were 3 hospitals offering clinical telemedicine services. Conclusions: Assistance for stroke patients has improved in Spain compared to previous years, but there are still some important differences between the AC that must be eliminated to achieve the objectives of the SNS (AU)

Introducción: El ictus constituye un importante problema sociosanitario. Por ese motivo, el Ministerio de Sanidad aprobó en 2008 la Estrategia Nacional en Ictus (ENI) con el objetivo de mejorar la prevención, tratamiento y rehabilitación del paciente con ictus. Se pretende garantizar una atención neurológica en todo el país y a cualquier hora del día para final del 2010. Nuestro objetivo fue analizar la situación de la atención al ictus en España en el año 2009. Material y métodos: Se constituyó un comité de neurólogos de las diferentes CC. AA. que no hubieran participado en la ENI. Se elaboró una encuesta nacional que recogió el número de unidades de ictus (UI) y la dotación (monitorización, guardia de neurología 24h/7 días, ratio de enfermería y existencia de protocolos), ratio cama UI/100.000 habitantes, presencia de trombólisis iv, intervencionismo neurovascular (INV) y telemedicina. Resultados: Se incluyeron datos de 145 hospitales. Existen 39 UI distribuidas de un modo desigual. La relación cama de UI/número de habitantes/comunidad autónoma osciló entre 1/75.000 a 1/1.037.000 habitantes, cumpliendo el objetivo Navarra y Cantabria. Se realiza trombólisis iv en 80 hospitales, el número osciló entre 7-536 tratamientos/CC. AA. durante el año 2008. Se realiza INV en el 63% de las CC. AA., teniendo 28 centros capacitados, aunque sólo 1 la realizaba en 2009 las 24h/7 día. Existen 3 centros con telemedicina. Conclusiones: La asistencia al ictus ha mejorado en España respecto a unos años atrás, pero todavía existen importantes desigualdades por CC. AA. que deberían superarse si se quiere cumplir el objetivo de la ENI (AU)

Health care resources for stroke patients in Spain, 2010: analysis of a national survey by the Cerebrovascular Diseases Study Group.

INTRODUCTION: Stroke is currently a major social health problem. For this reason, the Spanish Ministry of Health approved the Stroke National Strategy (SNS) in 2008 to improve the prevention, treatment and rehabilitation of stroke patients. This plan intends to guarantee 24-hour, 365-days neurological assistance in the whole country by the end of 2010. Our aim was to analyse the situation of stroke assistance in Spain in 2009. MATERIAL AND METHODS: A committee of neurologists practicing in the different autonomous communities (AC), and who had not participated in the preparation of the SNS, was created. A national survey was performed including the number of stroke units (SU) and their characteristics (monitoring, 24-h/7-day on-call neurology service, nursing staff ratio and the use of protocols), bed ratio of SU/100,000 people, availability of intravenous thrombolysis therapy, neurovascular intervention (NI) and telemedicine. RESULTS: We included data from 145 hospitals. There are 39 SU in Spain, unevenly distributed. The ratio between SU bed/number of people/AC varied from 1/75,000 to 1/1,037,000 inhabitants; Navarra and Cantabria met the goal. Intravenous thrombolysis therapy is used in 80 hospitals; the number of treatments per AC was between 7 and 536 in 2008. NI was performed in the 63% of the AC, with a total of 28 qualified hospitals (although only 1 hospital performed it 24h, 7 days a week in 2009). There were 3 hospitals offering clinical telemedicine services. CONCLUSIONS: Assistance for stroke patients has improved in Spain compared to previous years, but there are still some important differences between the AC that must be eliminated to achieve the objectives of the SNS.

Atención y tratamiento del paciente con un ataque isquémico transitorio / Attending and treating patients who have suffered a transient ischemic attack

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Factores clínicos predictores de la aparición de episodios vasculares tras un ataque isquémico transitorio / Clinical factors predicting the appearance of vascular events following a transient ischemic attack

Introducción. Los pacientes que han sufrido un ataque isquémico transitorio (AIT) tienen un elevado riesgo de sufrir un episodio vascular grave. La mayoría de ellos no se atienden de forma precoz y no se pueden beneficiar de un diagnóstico y tratamiento adecuados. Objetivo. Identificar los factores clínicos que predicen la aparición de un nuevo episodio vascular en estos pacientes. Pacientes y métodos. Estudiamos de forma prospectiva 104 pacientes con un AIT, atendidos en las primeras 24 horas tras el inicio de los síntomas, durante una mediana de seguimiento de 12,6 meses. Resultados. La incidencia de ictus, cardiopatía isquémica, arteriopatía periférica y muerte fue del 13, el 6, el 3 y el 8 por ciento, respectivamente. El análisis multivariante identificó, como predictores independientes de nuevos ictus, la edad mayor de 73 años (odds ratio -OR-, 4,46; IC 95 por ciento, 1,15-17,38) y la etiología aterotrombótica (OR, 4,36; IC 95 por ciento, 1,4413,18); de episodios de cardiopatía isquémica, el antecedente de padecer dicha cardiopatía (OR, 30,65; IC 95 por ciento, 2,94-319,17) y la toma de antidiabéticos orales (OR, 31,23; IC 95 por ciento, 2,65-368,74). La leucocitosis (OR 11,21; IC 95 por ciento, 1,25-100,39) se relacionó con las muertes de causa vascular, mientras que, nuevamente, la etiología aterotrombótica (OR, 3,83; IC 95 por ciento, 1,31-11,20) y el sexo masculino (OR 3,44; IC 95 por ciento, 1,02-11,60) se mostraron como predictores de la aparición de cualquier episodio vascular. Conclusiones. Nuestros resultados demuestran que el riesgo de sufrir episodios vasculares graves tras un AIT es elevado. Existen variables clínicas útiles (edad mayor de 73 años, etiología aterotrombótica, sexo masculino, toma de antidiabéticos orales y leucocitosis) para identificar los pacientes de mayor riesgo (AU)

[Clinical factors predicting the appearance of vascular events following a transient ischemic attack]. / Factores clinicos predictores de la aparicion de episodios vasculares tras un ataque isquemico transitorio.

INTRODUCTION: Patients who have suffered a transient ischemic attack (TIA) have a high risk of undergoing a severe vascular event. Most of them do not receive early attention and cannot benefit from an adequate diagnosis and treatment. AIMS: The aim of this study is to identify the clinical factors that predict the appearance of a new vascular event in these patients. PATIENTS AND METHODS: We conducted a prospective study of 104 TIA patients, who had been given attention during the first 24 hours after the onset of symptoms, for a mean follow up time of 12.6 months. RESULTS: The incidence rates of strokes, ischemic heart disease, peripheral arteriopathy and death were 13, 6, 3 and 8%, respectively. Multivariate analysis identified the following aspects as independent predictors of new strokes: an age above 73 odds ratio (OR) 4.46 (CI 95%, 1.15 17.38) and an atherothrombotic aetiology OR 4.36 (CI 95%, 1.4413.18); and episodes of ischemic heart disease, a history of suffering from such heart disease OR 30.65 (CI 95%, 2.94319.17) and taking oral antidiabetic drugs OR 31.23 (CI 95%, 2.65368.74). Leukocytosis OR 11.21 (CI 95%, 1.25100.39) is linked to the deaths caused by vascular disorders, whereas an atherothrombotic aetiology OR 3.83 (CI 95%, 1.31 11.20) and being male OR 3.44 (CI 95%, 1.02 11.60) were seen to be predictors of the appearance of any vascular event. CONCLUSIONS: Our findings showed that the risk of suffering severe vascular events after a TIA becomes higher. There are a number of useful clinical variables (age above 73, atherothrombotic aetiology, being male, taking oral antidiabetic drugs and leukocytosis) for identifying the patients at the highest risk.

Factores clínicos predictores de la aparición de episodios vasculares tras un ataque isquémico transitorio / Clinical factors predicting the appearance of vascular events following a transient ischemic attack

Introducción. Los pacientes que han sufrido un ataque isquémico transitorio (AIT) tienen un elevado riesgo de sufrir un episodio vascular grave. La mayoría de ellos no se atienden de forma precoz y no se pueden beneficiar de un diagnóstico y tratamiento adecuados. Objetivo. Identificar los factores clínicos que predicen la aparición de un nuevo episodio vascular en estos pacientes. Pacientes y métodos. Estudiamos de forma prospectiva 104 pacientes con un AIT, atendidos en las primeras 24 horas tras el inicio de los síntomas, durante una mediana de seguimiento de 12,6 meses. Resultados. La incidencia de ictus, cardiopatía isquémica, arteriopatía periférica y muerte fue del 13, el 6, el 3 y el 8 por ciento, respectivamente. El análisis multivariante identificó, como predictores independientes de nuevos ictus, la edad mayor de 73 años (odds ratio -OR-, 4,46; IC 95 por ciento, 1,15-17,38) y la etiología aterotrombótica (OR, 4,36; IC 95 por ciento, 1,44-13,18); de episodios de cardiopatía isquémica, el antecedente de padecer dicha cardiopatía (OR, 30,65; IC 95 por ciento, 2,94-319,17) y la toma de antidiabéticos orales (OR, 31,23; IC 95 por ciento, 2,65-368,74). La leucocitosis (OR 11,21; IC 95 por ciento, 1,25-100,39) se relacionó con las muertes de causa vascular, mientras que, nuevamente, la etiología aterotrombótica (OR, 3,83; IC 95 por ciento, 1,31-11,20) y el sexo masculino (OR 3,44; IC 95 por ciento, 1,02-11,60) se mostraron como predictores de la aparición de cualquier episodio vascular. Conclusiones. Nuestros resultados demuestran que el riesgo de sufrir episodios vasculares graves tras un AIT es elevado. Existen variables clínicas útiles (edad mayor de 73 años, etiología aterotrombótica, sexo masculino, toma de antidiabéticos orales y leucocitosis) para identificar los pacientes de mayor riesgo (AU)

Introduction. Patients who have suffered a transient ischemic attack (TIA) have a high risk of undergoing a severe vascular event. Most of them do not receive early attention and cannot benefit from an adequate diagnosis and treatment. Aims. The aim of this study is to identify the clinical factors that predict the appearance of a new vascular event in these patients. Patients and methods. We conducted a prospective study of 104 TIA patients, who had been given attention during the first 24 hours after the onset of symptoms, for a median follow-up time of 12.6 months. Results. The incidence rates of strokes, ischemic heart disease, peripheral arteriopathy and death were 13, 6, 3 and 8%, respectively. Multivariate analysis identified the following aspects as independent predictors of new strokes: an age above 73 odds ratio (OR) 4.46 (CI 95%, 1.15-17.38) and an atherothrombotic aetiology OR 4.36 (CI 95%, 1.44-13.18); and episodes of ischemic heart disease, a history of suffering from such heart disease OR 30.65 (CI 95%, 2.94-319.17) and taking oral antidiabetic drugs OR 31.23 (CI 95%, 2.65-368.74). Leukocytosis OR 11.21 (CI 95%, 1.25-100.39) is linked to the deaths caused by vascular disorders, whereas an atherothrombotic aetiology OR 3.83 (CI 95%, 1.31- 11.20) and being male OR 3.44 (CI 95%, 1.02-11.60) were seen to be predictors of the appearance of any vascular event. Conclusions. Our findings showed that the risk of suffering severe vascular events after a TIA becomes higher. There are a number of useful clinical variables (age above 73, atherothrombotic aetiology, being male, taking oral antidiabetic drugs and leukocytosis) for identifying the patients at the highest risk (AU)