| Abstract [eng] |
Stroke is one of the major causes of death and disability-adjusted life years worldwide. The incidence of acute ischemic stroke (AIS) and stroke mortality in Lithuania is amongst the highest in the world, in large part due to a high prevalence and poor control of cardiovascular risk factors. Reperfusion therapy (RT) – thrombolysis using intravenous recombinant tissue plasminogen activator and endovascular treatment, is a widely accepted, safe, and cost-effective method to treat AIS with proven clinical efficacy. However, its broad implementation in daily clinical practice is challenging. This doctoral dissertation is based on five published research articles. The aim of this thesis was to evaluate the effects of a comprehensive national policy, stroke characteristics, and external factors on multiple stroke care performance measures, reflecting access to and outcomes of RT for AIS patients. We observed significant trend improvements in RT rates, and a statistically significant decreasing trend in mean door-to-needle time within the Lithuanian comprehensive and primary stroke centers since the enactment of a comprehensive national policy in 2014, when it was started to be recorded. Second, we found that interactive paramedic training significantly improves the accuracy of stroke patient recognition and their prehospital transport time. Third, our data suggest that RT improves AIS patients’ 90-day functional outcome and health-related quality of life, but not patient survival, when adjusted for different stroke characteristics. In addition, we found that the COVID-19 lockdown measures are associated with decreased stroke alerts and admissions, and changes in the pattern of conditions mimicking stroke. Finally, our data show that COVID-19 is a significant predictor for poorer 90-day patient survival in AIS patients after RT. |
