Browsing by Author "Sacks, Claudio"
Now showing 1 - 4 of 4
Results Per Page
Sort Options
Item Fighting Against Stroke in Latin America: A Joint Effort of Medical Professional Societies and Governments(2021) Ouriques Martins, Sheila Cristina; Lavados, Pablo; Secchi, Thaís Leite; Brainin, Michael; Ameriso, Sebastián; Gongora-Rivera, Fernando; Sacks, Claudio; Cantú-Brito, Carlos; Álvarez Guzmán, Tony Fabián; Pérez-Romero, Germán Enrique; Muñoz Collazos, Mario; Barboza, Miguel A.; Arauz, Antonio; Abanto Argomedo, Carlos; Novarro-Escudero, Nelson; Amorin Costabile, Héctor Ignacio; Crosa, Roberto; Camejo, Claudia; Mernes, Ricardo; Maldonado, Nelson; Mora Cuervo, Daissy Liliana; Pontes Neto, Octávio Marques; Sampaio Silva, Gisele; Carbonera, Leonardo Augusto,; Souza, Ana Claudia; Gomes de Sousa, Eduardo David; Flores, Alan; Melgarejo, Donoban; Santos Carquín, Irving R.; Hoppe, Arnold; Freitas de Carvalho, João José; Mont'Alverne, Francisco; Amaya, Pablo; Bayona, Hernán; Navia, Víctor; Duran, Juan Carlos; Urrutia, Víctor C.; Vianna Araujo, Denizar; Feigin, Valery L.; Nogueira, Raúl G.Introduction: Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden. In 2018, at the first Latin American Stroke Ministerial Meeting, stroke physician and healthcare manager representatives from 13 countries signed the Declaration of Gramado with the priorities to improve the region, with the commitment to implement all evidence-based strategies for stroke care. The second meeting in March 2020 reviewed the achievements in 2 years and discussed new objectives. This paper will review the 2-year advances and future plans of the Latin American alliance for stroke. Method: In March 2020, a survey based on the Declaration of Gramado items was sent to the neurologists participants of the Stroke Ministerial Meetings. The results were confirmed with representatives of the Ministries of Health and leaders from the countries at the second Latin American Stroke Ministerial Meeting. Results: In 2 years, public stroke awareness initiatives increased from 25 to 75% of countries. All countries have started programs to encourage physical activity, and there has been an increase in the number of countries that implement, at least partially, strategies to identify and treat hypertension, diabetes, and lifestyle risk factors. Programs to identify and treat dyslipidemia and atrial fibrillation still remained poor. The number of stroke centers increased from 322 to 448, all of them providing intravenous thrombolysis, with an increase in countries with stroke units. All countries have mechanical thrombectomy, but mostly restricted to a few private hospitals. Pre-hospital organization remains limited. The utilization of telemedicine has increased but is restricted to a few hospitals and is not widely available throughout the country. Patients have late, if any, access to rehabilitation after hospital discharge. Conclusion: The initiative to collaborate, exchange experiences, and unite societies and governments to improve stroke care in Latin America has yielded good results. Important advances have been made in the region in terms of increasing the number of acute stroke care services, implementing reperfusion treatments and creating programs for the detection and treatment of risk factors. We hope that this approach can reduce inequalities in stroke care in Latin America and serves as a model for other under-resourced environments.Item Incidence, risk factors, prognosis, and health-related quality of life after stroke in a low-resource community in Chile (ÑANDU): a prospective population-based study(2021) Lavados, Pablo; Hoffmeister, Lorena; Moraga, Ana M.; Vejar, Angélica; Vidal, Carolina; Gajardo, Constanza; Portales, María Bernardita; San Martín, Daniela; López, Eduardo; Rojo, Alexis; Olavarría, Verónica V.; Almeida, Juan; Brunser, Alejandro M.; Muñoz Venturelli, Paula; Hoppe, Arnold; Díaz, Violeta; Sacks, ClaudioBackground Stroke is a leading cause of disability and death worldwide. The best estimates of local, national, and global burden of stroke are derived from prospective population-based studies. We aimed to investigate the incidence, risk factors, long-term prognosis, care, and quality of life after stroke in the Ñuble region of Chile. Methods We did a prospective community-based study with use of multiple overlapping sources of hospitalised, ambulatory, and deceased cases. Standardised diagnostic criteria were used to identify and follow up all cases occurring in the resident population of the Ñuble region, Chile (in a low-income rural-urban population including predominantly people of Indigenous-European heritage), for 1 year. Participants were included if they had a clinical diagnosis of stroke confirmed according to the study criteria. All cases were adjudicated by vascular neurologists. Incidence rates of first-ever stroke were calculated from the population of Ñuble according to the 2017 national census. Findings From April 1, 2015, to March 31, 2016, we ascertained 1103 stroke cases, of which 890 (80·7%) were first-ever incident cases. The mean age of patients with first-ever stroke was 70·3 years (SD 14·1) and 443 (49·8%) were women. A CT scan was obtained in 801 (90%) of 890 patients (mean time from symptom onset to scan of 13·4 h (SD 29·8). The incidence of first-ever stroke age-adjusted to the world population was 121·7 (95% CI 113·7–130·1) per 100 000. The age-adjusted incidence rates, per 100000 inhabitants, by main pathological subtypes were as follows: ischaemic stroke (101·5 [95% CI 90·9–113·0]); intracerebral haemorrhage (17·9 [13·5–23·4]), and subarachnoid haemorrhage (4·2 [2·1–7·3]). The 30-day case-fatality rate was 24·6% (21·9–27·6). At 6 months after the stroke, 55·9% (432 of 773) of cases had died or were disabled, which increased to 61·0% (456 of 747) at 12 months. Health-related quality of life in survivors was low at 6 months, improving slightly at 12 months after the stroke. Interpretation The incidence of stroke in this low-resource population was higher than our previous finding in northern Chile and within the mid-range of most population-based stroke studies. This result was due mainly to a higher incidence of ischaemic stroke, probably associated with increasing age and a high prevalence of cardiometabolic risk factors in the population studied. Our findings suggest that more should be done for the prevention and care of stroke in communities like the Ñuble population. Funding The National Agency for Research and Development and the Technology-Health Research Fund, Clínica Alemana de Santiago, Boehringer Ingelheim, Bristol Meyers Squibb, The Herminda Martin Clinical Hospital of Chillán, Universidad Mayor, and Universidad de Concepción.Item Long-term Adherence to National Guidelines for Secondary Prevention of Ischemic Stroke: A Prospective Cohort Study in a Public Hospital in Chile(Elsevier, 2014) Muñoz Venturelli, Paula; Sacks, Claudio; Madrid, Eva; Lavados, PabloBackground Clinical guidelines for the secondary prevention of ischemic stroke have been developed, but their publication is insufficient to make them effective. Our aim was to investigate adherence to Chilean guidelines, its associated variables, and to determine prognosis at follow-up. Methods: We prospectively included all consecutive patients discharged with a diagnosis of ischemic stroke from Valparaíso Regional Hospital between July 15, 2007 and January 15, 2008. Patient follow-up was performed at 5, 10, and 15 months using a standardized questionnaire. We used the Chi-square and Fisher exact tests to compare discrete variables and multivariate logistic regression analysis to adjust for potential confounding factors. A Cox regression model was fitted. Results: We included 156 patients; 128 patients (82%) completed follow-up. Adherence to oral anticoagulation decreased significantly compared to all other medications during follow-up (P = .004). This was not associated with any of the studied variables. Adherence to antihypertensives, statins, and hypoglycemic medications remained >65% without a significant variation. Patients with cardioembolic stroke had greater mortality (P = .003) and recurrence rates. Conclusions: The observed significant decrease in adherence to oral anticoagulation in patients with cardioembolic stroke suggests a need for the implementation of specific strategies to achieve the desired secondary prevention goals in these patients. Future research into the evaluation of other factors that could be associated with the lack of adherence to these guidelines, measurements of therapeutic goals, and new therapeutic strategies that are easier to use and that are associated with less risk could improve the prognosis of these patients.Item Stroke Care and Application of Thrombolysis in Ibero-America: Report From the SITS-SIECV Ibero-American Stroke Register(2019) Alonso de Leciñana, María; Mazya, Michael V.; Kostulas, Nikolaos; Del Brutto, Oscar H.; Abanto, Carlos; Massaro, Ayrton; Bastos, Mario de; Martins, Sheila; Ameriso, Sebastian F.; Gongora-Rivera, Fernando; Sacks, Claudio; Hoppe, Arnold; Abad, Patricio; Meza, Gloria; Arauz-Gongora, Antonio; Wahlgren, Nils; Díez-Tejedor, Exuperio; SITS-SIECV InvestigatorsBackground and Purpose— Standardized registries may provide valuable data to further improve stroke care. Our aim was to obtain updated information about characteristics of stroke patients and management of stroke across the Ibero-American countries, using a common in-hospital registry (Safe Implementation of Treatments in Stroke–Sociedad Iberoamericana de Enfermedades Cerebrovasculares) as a basis for further quality improvement. Methods— Data for this study were entered into the Safe Implementation of Treatments in Stroke registry from September 2009 to December 2013 by 58 centers in 14 countries. Data included demographics, risk factors, onset-to-door time, National Institutes of Health Stroke Scale score, stroke subtype, ischemic stroke etiology, treatments, 3-month mortality, and modified Rankin Scale score. Time to treatment was also recorded for patients treated with thrombolysis. Results— Five thousand four hundred one patients were registered; median age, 65 years; 46% women; 3915 (72.5%) ischemic strokes; 686 (13.7%) hemorrhagic strokes; 213 (4.3%) subarachnoid hemorrhages; 414 (8.3%) transient ischemic attacks; and 31 (0.6%) cerebral vein thrombosis. The most prevalent risk factors were hypertension (71.3%), dyslipidemia (35.2%), and diabetes mellitus (23.6%). Atrial fibrillation was present in 15.1%. Three hundred one ischemic strokes were treated with intravenous thrombolysis (IVT; 7.7%). Patients undergoing IVT were more severely affected (median baseline National Institutes of Health Stroke Scale score, 11 versus 6). The rate of symptomatic intracerebral hemorrhages after IVT was 5.7%. At 3 months, 60.3% of IVT-treated patients and 59.1% of untreated patients were independent (modified Rankin Scale score, 0–2). Mortality was 11.4% in treated and 12.8% in untreated patients. Conclusions— Safe Implementation of Treatments in Stroke–Sociedad Iberoamericana de Enfermedades Cerebrovasculares is the largest registry of a general stroke population and the first study to evaluate the level of IVT use in Ibero-America. It provides valuable information that may help to improve the quality of stroke care in the Ibero-American region.