Improving Outcomes Achieved by a New Stroke Program in Hungary

Abstract

Background: Stroke is a devastating disease with increasing incidence and prevalence due to population aging. Even with the best care, a proportion of patients dies or is left with significant neurological and cognitive disability. Organization of stroke centers markedly improved outcomes worldwide. We initiated a ‘lysis alarm' program in September 2013 at our medical center. Methods: This is a retrospective review of electronic data from patients with acute ischemic stroke before (October 2012-June 2013) and after (October 2013-June 2014) the ‘lysis alarm' program was introduced at our medical center. Results: Prior to the introduction of the stroke program, there were only 19 thrombolysis procedures in 777 acute stroke patients in 9 months, while this figure rose to 32 thrombolysis procedures in 737 acute stroke patients after the initiation of the program. The ‘door-to-needle' time decreased from 88 to 71 min when the two study periods were compared. These changes were associated with decreased stroke mortality in patients receiving thrombolytic treatment (16% prior to the program and 9% during the program). In 2013, there were 1,439 thrombolysis procedures, representing 3.2% of all stroke cases throughout Hungary. After the introduction of the ‘lysis alarm' program, we have reached a 4% thrombolysis rate at our medical center. Conclusions: Our thrombolysis rate is higher than the national average, but still low compared to the rates of Western European countries. We are continuously working to enhance our stroke program. Here, we discuss those components that need to be further refined in order to improve stroke intervention and outcome.

The Emergency Performance of the Hungarian Ambulance Service during the COVID-19 Pandemic

“…Of the four pandemic waves that have taken place to date in Hungary, the third COVID-19 wave required the greatest effort from the NAS. AMI and stroke are primary issues from a public health point of view [ 24 , 25 ], so it is important for the healthcare system that the ambulance service prioritizes the organization and execution of such rescues [ 13 , 26 ]. A previous British study did not report increased STEMI and stroke rescue activity during the period of the COVID-19 epidemic, but only the effect of the first wave was analyzed in their study [ 16 ].…”

Examination of Ambulance Arrival Times by Geoinformatics Tools – Example of Borsod-Abaújzemplén County (Hungary)

“…There is a substantial body of literature available on this topic both from Hungary and internationally (Beke, 2019;Barry et al, 2018;Égi et al, 2015;Ishikawa, 2019;Kolivand, 2020;Knyazkov et al, 2015;Yasunaga et al, 2011), at various territorial levels, with slightly differing methodologies and demographic data.…”

„Dönts és siess!” A prehospitális ellátók szerepe az időveszteség csökkentésében stroke-iránydiagnózisú betegek esetén

“…Az ischaemiás mag körüli agyszövet tekintetében csak annyi oxigén-és glükózpótlás történik a véráramlással, amennyi pusztán a struktúra fenntartására elegendő, ugyanakkor a funkcióban súlyos zavar alakul ki. A véráramlás rendeződése a szövetál lomány megtartását biztosítja, míg egyéb esetben a penumbra szövete is elhal [9][10][11][12]. Hangsúlyos követ kezmény, hogy a terápiás időablak is jelentős változékonyságot mutat az eltelt idő, az eltérő klinikai viszonyok, valamint a penumbraperfúzió biztosítottságának függvényében.…”