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Quality indicators in the treatment of acute ischemic stroke

Darina Georgieva-Hristova, Silva Andonova, Evgeniya Kalevska, Vania Argirova, Vladina Dimitrova


Cerebrovascular diseases are a global medical and social issue because of the high morbidity, disability and mortality they cause. WHO announces 15 million new ischemic strokes per year globally, with 5 million associated deaths and 5 million patients left permanently disabled. Thrombolysis (TL) with tissue plasminogen activator (rt-PA) is currently an approved differentiated pharmacotherapeutic treatment of ischemic stroke (IS) in its acute phase. There is irrefutable evidence of better health results and efficient clinical management of ischemic strokes within an integrated therapeutic approach as a key factor for improving the functional outcome in stroke patients. Quality is one of the most widely discussed issues in the theory and practice of disease management. Strict compliance with the standards for ischemic stroke treatment is an indicator of high quality patient management.


management; ischemic stroke; quality indicators

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Petrova Z, Chamov K, Gladilov St. Quality in Health Care. Contemporary Dimensions and Trends. Sofia: Health Media Group; 2008. Bulgarian.

Petrova Z, Genev St. Health System Management. Sofia: Health Media Group; 2013. Bulgarian.

Tityanova E, Velcheva I, Andonova S. Stroke in Bulgaria: Current Issues. Neurosonology and Cerebral Hemodynamics. 2015;11:7-13.

Abilleira S, Ribera A, Sánchez E, Tresserras R, Gallofré M. The second stroke audit of catalonia shows improvements in many, but not all quality indicators. Int J Stroke; 2012;7:19-24.

Abilleira S, Gallofré M, Ribera A, Sánchez E, Tresserras R. Quality of in-hospital stroke care according to evidence-based performance measures: results from the first audit of stroke, Catalonia, Spain. Stroke. 2009;40:1433-8.

Adams HP, del Zoppo G; Alberts MJ. Guidelines for the early management of adults with ischemic stroke: Aguideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Resaerch Interdisciplinary Working Groups.scientific statement from the Stroke Council of the American Stroke Association. Stroke. 2007;38:1655-711.

Alberts MJ, Latchaw RE, Selman WR. Brain Attack Coalition. Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition. Stroke. 2005;36:1597-616.

Asplund K, Hulter Asberg K, Appelros P, Bjarne D, Eriksson M, Johansson A. The Riks-Stroke story: building a sustainable national register for quality assessment of stroke care. Int J Stroke. 2011;6:99-108.

Audebert H, Kukla C, Vatankhah B et al. Comparison of tissue plasminogen activator administration management between Telestroke Network hospitals andacademic stroke centers: the Telemedical Pilot Project for Integrative Stroke Care in Bavaria. Stroke 37, 2006: 1822-1827.

Eissa A, Krass I, Bajorek B. Optimizing the management of acute ischaemic stroke: a review of the utilization of intravenous recombinant tissue plasminogen activator (tPA). Journal of Clinical Pharmacy and Therapeutics. 2012;37:620-9.

Eissa A, Krass I, Bajorek B. Barriers to the utilization of thrombolysis for acute ischaemic stroke. Journal of Clinical Pharmacy and Therapeutics 23, 2012: 211-221.

European Stroke Organisation. Guidelines for management of ischaemic stroke and transient ischaemic attack. Stroke. 2002;33:2850-7.

European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25:457-507.

Ferrari J, Knoflach M, Kiechl S, Willeit J, MatoÅ¡ević B. For the Austrian Stroke Unit Registry Collaborators. Stroke Thrombolysis: Having More Time Translates Into Delayed Therapy. Stroke. 2010;41:2-5.

Grube MM, Dohle C, Djouchadaret D. Evidence-based quality indicators for stroke rehabilitation. Stroke. 2012;43:142-6.

Heuschmann PU, Busse O, Wagner M. Frequency and care of stroke in Germany. Akt Neurologie. 2010;37:333-40.

Heuschmann PU, Kolominsky Rabas PL, Kugler C. Qualitätssicherung in der Schlaganfall-Behandlung: das Basismodu der Arbeitsgemeinschaft Deutscher Schlaganfall-Register (ADSR). Gesundheitswesen. 2000:62;547-52.

Heuschmann PU, Biegler MK, Busse O. Development and implementation of evidence-based indicators for measuring quality of acute stroke care: the Quality Indicator Board of the German Stroke Registers Study Group (ADSR). Stroke. 2006;37:2573-8.

Kjellstrom T, Norrving B, Shatchkute A. Helsingborg Declaration 2006 on European stroke strategies. Cerebrovasc Dis. 2007;23:231-41.

Meretoja A, Roine RO, Kaste M, Linna M, Juntunen M, Erilä T. Stroke monitoring on a national level: PERFECT Stroke, a comprehensive, registry-linkage stroke database in Finland. Stroke. 2010;41:2239-46.

Nabavi DG, Ringelstein EB, Faiss J. Regional and national stroke units in Germany: amended certification criteria. Nervenarzt. 2012;83:1039-52.

Nimptsch U, Mansky T. Trends in acute inpatient stroke care in Germanyan observational study using administrative hospital data from 2005-2010. Dtsch Arztebl Int. 2012;109:885-92.

Olsen TS, Langhorne P, Diener HC, Hennerici M, Ferro J, Sivenius J. European Stroke Initiative Recommendations for Stroke Management-update 2003. Cerebrovasc Dis. 2003;16:311-37.

Reeves MJ, Parker C, Fonarow GC, Smith EE, Schwamm LH. Development of stroke performance measures: definitions, methods, and current measures. Stroke. 2010;41:1573-8.

Wellwood I, Wu O, Langhorne P, McKevitt C, Di Carlo A, Rudd AG. Developing a tool to assess quality of stroke care across European populations: the EROS Quality Assessment Tool. Stroke. 2011;42:1207-11.

Wiedmann S, Norrving B, Nowe T. Variations in quality indicators of acute stroke care in 6 European countries: the European Implementation Score (EIS) Collaboration. Stroke. 2012;43:458-63.



About The Authors

Darina Georgieva-Hristova
Medical University of Varna

Department of Neurology and Neurosciences-Medical University of Varna

Silva Andonova
Medical University of Varna

Department of Neurology and Neurosciences-Medical University of Varna

Evgeniya Kalevska
Medical University of Varna

Department of Neurology and Neurosciences-Medical University of Varna

Vania Argirova
Medical University of Varna

Department of Neurology and Neurosciences-Medical University of Varna

Vladina Dimitrova
Medical University of Varna

Department of Neurology and Neurosciences-Medical University of Varna

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