1. STROKE UNITS IN THE CZECH REPUBLIC – CURRENT SITUATION MUDr.Daniel Václavík Ostrava Vítkovice Hospital

2. 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%.

3. 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

4. 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

5. 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)

6. 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

7. 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

8. Cerebrovascular Team - Minimum Parts of team are the following : - neurologists - radiologists - internists (kardiologist) - rehabilitation therapist - speech therapist - educated medical staff ( nursing care )

9. 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

10. Goal 1. Identify no. of stroke units ( SU ) in CZ 2. Analyze percentage of SU in neurological departments and general internal depertements and no of trombolysing units 3. Identify no. of stroke beds in individual regions 4. 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

11. 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

12. Results

13. Neurological departments

14. STROKE beds – neurologic + general

15. Thrombolysing SU June 2006 upper chart, June 2007 down chart

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

17. No. in 2006% 2006 Districts86 ( 10 Prague)100 Neurological departements 7182 SU neurological + general 49 ( 52 in 2007 )57 SU neurological3338 Thrombolysing SU26 ( 46 in 2007)30 SU with 10 and more thrombolysis/year 7 ( 18 in 2007)8 ( 31 % 2007 )

18. RegionNo. of inhabitants No. Of Stroke beds 06, 07 Required no.No. of thrombolysis 6/05-6/06 11/06-11/07 No of required thrombolysi s ( 4 % of all strokes ) Moravsko slezský 126946738 ( 74%) 51 ( 100% ) 5163 ( 44%) 99 ( 69 % ) 142 Olomoucký63936918 ( 69%) 14 ( 54 % ) 2635 ( 48%) 46 ( 63 % ) 72 Zlínský59501012 ( 50%) 13 ( 54 % ) 2419 ( 28%) 16 ( 23 %) 67 Jihomoravs ký 112771835 ( 77%) 4529 ( 23%) 86 ( 69 %) 125 Vysočina51921116 ( 76%) 19 ( 90 % ) 212( 3%) 9( 15%) 58 Pardubický5082819 ( 45%) 11 ( 55 % ) 208 (14%) 56 Královehra decký 55072418 ( 81%) 20 ( 90 % ) 2217 (27%) 27(43 %) 62

19. RegionNo. 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 ) Praha116558149 (106%) 62 (134 % ) 4632 ( 24%) 108(83%) 130 Středo český 112247313 ( 28%) 24 ( 53 % ) 450 15( 12%) 125 Jiho český 62526714 ( 56%) 16 ( 64 % ) 2515 (21%) 22( 31%) 70 Liberecký42818414 ( 82%) 17 ( 100 %) 1713 (27%) 17(36%) 47 Ústecký82021929 ( 87%) 18 ( 54 % ) 3314 (15%) 35(38 %) 92 Karlo varský 3043434 (33%) 11 ( 91%) 124 ( 11%) 5(14 %) 34 Plzeňský5506886 (27%) 224 (6%) 35(56 %) 62 Total275 (67%) 287 ( 70 %) 409255 (22%) 526(46 %) 1142

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

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

22. Thrombolysis percentage 2006

23. Thrombolysis percentage 2007

24. Beds effectivity coefficient % thrombolysis / % stroke beds 2006

25. Beds effectivity coefficient % thrombolysis / % stroke beds 2007

26. 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

27. 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)

28. THANK YOU FOR YOUR ATTENTION