Abstract
Stroke is a public health problem. For patients with ischemic stroke, venous thrombolysis and mechanical thrombectomy are effective therapeutic options. However, even after the National Stroke Treatment Guidelines were published in 2012, the number of cases treated is still lower than expected. To identify the determining factors for obtaining access to acute-phase therapies in the state of Espírito Santo (ES) and investigate the profile of stroke patients treated at the Central State Hospital (HEC). Retrospective data from the medical records of 1078 patients from May 2018 to December 2019 were analyzed. Among the 1,078 patients, 54.9% were men and the most prevalent age group was 60 to 79 years. Systemic arterial hypertension was the main single risk factor. Regarding treatment modality among the patients who arrived at the HEC within the therapeutic window, 47% received some type of acute-phase therapy. Waking up with the deficit was the main contraindication for venous thrombolysis in these cases. Application of the flowchart established by SESA-ES seemed to be effective for enabling responsiveness of care for stroke victims. Public emergency transport services had a fundamental role in this process. In addition, the care provided by the tertiary stroke center provided excellent access to acute-phase therapies. However, despite the efficiency of the service provided at the HEC, it only reached a maximum of 50% of the ES population. This service model therefore needs to be expanded throughout the state.
Highlights
Stroke is an important public health problem and has been the second leading cause of death worldwide since the year 20001
This form of treatment was approved in Brazil in 2001 but, despite recent advances in this treatment class, the number of patients who have access to it is still low in this country[7].Mechanical thrombectomy (MT) is another acute-phase treatment that has been established for stroke
The state of Espírito Santo has more than 4,000 hospitalizations caused by stroke per year[2]
Summary
Stroke is an important public health problem and has been the second leading cause of death worldwide since the year 20001. VT is currently indicated for patients with evolution of up to 4.5 hours from the time of symptom onset (ictus), while respecting inclusion and exclusion criteria[6] This form of treatment was approved in Brazil in 2001 but, despite recent advances in this treatment class, the number of patients who have access to it is still low in this country[7].Mechanical thrombectomy (MT) is another acute-phase treatment that has been established for stroke. Its use has been correlated with a chance more than 50% of reducing functional impairment[8] It has been indicated for patients who present arterial occlusion of proximal vessels and with up to 6 hours of ictus, while respecting clinical and radiological criteria[9]. Objective: To identify the determining factors for obtaining access to acute-phase therapies in the state of Espírito Santo (ES) and investigate the profile of stroke patients treated at the Central State Hospital (HEC). This service model needs to be expanded throughout the state
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