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Article

Six years of the Angels Initiative: Aims, achievements, and future directions to improve stroke care worldwide

Caso, Valeria
Author Caso, Valeria ORCID University of Perugia, Perugia, Italy
Martins, Sheila
Author Martins, Sheila Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
Mikulik, Robert
Author Mikulik, Robert International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
Middleton, Sandy
Author Middleton, Sandy ORCID Australian Catholic University and St. Vincent's Health Network Sydney, Sydney, NSW, Australia
Groppa, Stanislav
Author Groppa, Stanislav State University of Medicine and Pharmacy 'Nicolae Testemitanu,' Chisinau, Moldova
Pandian, Jeyaraj Durai
Author Pandian, Jeyaraj Durai Christian Medical College, Ludhiana, India
Thang, Nguyen Huy
Author Thang, Nguyen Huy Hospital, Ho Chi Minh City, Vietnam
Danays, Thierry
Author Danays, Thierry ORCID TDC, Aix en Provence, France
van der Merwe, Jan
Author van der Merwe, Jan Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
Fischer, Thomas
Author Fischer, Thomas Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany

International journal of stroke. 2023 ; 18 (8) : 898-907. [pub] 20230802

Int J Stroke
ISSN 1747-4949
Medvik
Source

The rate of stroke-related death and disability is four times higher in low- and middle-income countries (LMICs) than in high-income countries (HICs), yet stroke units exist in only 18% of LMICs, compared with 91% of HICs. In order to ensure universal and equitable access to timely, guideline-recommended stroke care, multidisciplinary stroke-ready hospitals with coordinated teams of healthcare professionals and appropriate facilities are essential.Established in 2016, the Angels Initiative is an international, not-for-profit, public-private partnership. It is run in collaboration with the World Stroke Organization, European Stroke Organisation, and regional and national stroke societies in over 50 countries. The Angels Initiative aims to increase the global number of stroke-ready hospitals and to optimize the quality of existing stroke units. It does this through the work of dedicated consultants, who help to standardize care procedures and build coordinated, informed communities of stroke professionals. Angels consultants also establish quality monitoring frameworks using online audit platforms such as the Registry of Stroke Care Quality (RES-Q), which forms the basis of the Angels award system (gold/platinum/diamond) for all stroke-ready hospitals across the world.The Angels Initiative has supported over 1700 hospitals (>1000 in LMICs) that did not previously treat stroke patients to become "stroke ready." Since its inception in 2016, the Angels Initiative has impacted the health outcomes of an estimated 7.46 million stroke patients globally (including an estimated 4.68 million patients in LMICs). The Angels Initiative has increased the number of stroke-ready hospitals in many countries (e.g. in South Africa: 5 stroke-ready hospitals in 2015 vs 185 in 2021), reduced "door to treatment time" (e.g. in Egypt: 50% reduction vs baseline), and increased quality monitoring substantially.The focus of the work of the Angels Initiative has now expanded from the hyperacute phase of stroke treatment to the pre-hospital setting, as well as to the early post-acute setting. A continued and coordinated global effort is needed to achieve the target of the Angels Initiative of >10,000 stroke-ready hospitals by 2030, and >7500 of these in LMICs.

Online article

Professional guideline versus product label selection for treatment with IV thrombolysis: An analysis from SITS registry

European stroke journal. 2018 ; 3 (1) : 39-46. [pub] 20171208

Eur Stroke J
ISSN 2396-9881
Medvik
Source

Introduction: Thrombolysis usage in ischaemic stroke varies across sites. Divergent advice from professional guidelines and product labels may contribute. Patients and methods: We analysed SITS-International registry patients enrolled January 2010 through June 2016. We grouped sites into organisational tertiles by number of patients arriving ≤2.5 h and treated ≤3 h, percentage arriving ≤2.5 h and treated ≤3 h, and numbers treated ≤3 h. We assigned scores of 1-3 (lower/middle/upper) per variable and 2 for onsite thrombectomy. We classified sites as lower efficiency (summed scores 3-5), medium efficiency (6-8) or higher efficiency (9-11). Sites were also grouped by adherence with European product label and ESO guideline: 'label adherent' (>95% on-label), 'guideline adherent' (≥5% off-label, ≥95% on-guideline) or 'guideline non-adherent' (>5% off-guideline). We cross-tabulated site-efficiency and adherence. We estimated the potential benefit of universally selecting by ESO guidance, using onset-to-treatment time-specific numbers needed to treat for day 90 mRS 0-1. Results: A total of 56,689 patients at 597 sites were included: 163 sites were higher efficiency, 204 medium efficiency and 230 lower efficiency. Fifty-six sites were 'label adherent', 204 'guideline adherent' and 337 'guideline non-adherent'. There were strong associations between site-efficiency and adherence (P < 0.001). Almost all 'label adherent' sites (55, 98%) were lower efficiency. If all patients were treated by ESO guidelines, an additional 17,031 would receive alteplase, which translates into 1922 more patients with favourable three-month outcomes. Discussion: Adherence with product labels is highest in lower efficiency sites. Closer alignment with professional guidelines would increase patients treated and favourable outcomes. Conclusion: Product labels should be revised to allow treatment of patients ≤4.5 h from onset and aged ≥80 years.