Although
stroke patients in Slovakia had been treated according to European recommendations, no network of primary and comprehensive
stroke centers had been officially established; the ESO recommended quality parameters had not been fulfilled. Therefore, the Slovak
Stroke Society decided to change the
stroke management concept and introduced mandatory evaluation of quality parameters. This article focuses on key success factors of the change in
stroke management in Slovakia and presents the 5-year results and perspectives for the future.
Material and methods: Since 2016, we have started to change
stroke management. New National Guideline for
Stroke Care was prepared in 2017 and published in 2018 as a Recommendation of the Ministry of Health of the Slovak Republic. The recommendation included pre-hospital as well as in-hospital
stroke care, a network of primary
stroke centers (hospitals administering intravenous thrombolysis - 37), and secondary
stroke centers (hospitals treating with intravenous thrombolysis + endovascular treatment (ET) - 6). A
stroke priority was instituted, having equally high priority as
myocardial infarction. More efficient in-hospital workflow and pre-hospital patient triage shortened the
time to treatment. Prenotification became mandatory in all hospitals. Non-contrast CT, and CT angiography is mandatory in all hospitals. In patients with suspected proximal large-vessel occlusion the EMS stays at the CT facility in primary
stroke centers until the CT angiography is finished. If LVO is confirmed, the patient is transported to an EVT secondary
stroke center by the same EMS. From 2019 all secondary
stroke centers offer endovascular
thrombectomy in a 24/7/365 system. We consider the introduction of quality control one of the most critical steps in
stroke management. The result of these activities is 25.2% of patients treated with IVT and 10.2% by endovascular treatment, and median
DNT 30 min. Number of patients screened for
dysphagia increased from 26.4% in 2019 to 85.9% in 2020. In the most of the hospitals the proportion of
ischemic stroke patients discharged with antiplatelets and in case of AF with
anticoagulants was >85%.
Discussion: Our results indicate that it is possible to change
stroke management at a single hospital and national level. For continuous and further improvement, regular quality monitoring is necessary; therefore, the results of
stroke hospital management are presented regularly once a year at national and international level. Collaboration with the "Second for Life" patient organization is very important for the "time is brain" campaign in Slovakia.
Conclusion: Due to the change in
stroke management over the last 5 years, we have reduced the time for
acute stroke treatment and improved the proportion of patients with acute treatment, and in this area, we have achieved and exceeded the goals of the
Stroke Action Plan for Europe for 2018-2030. Nevertheless, we still have many insufficiencies in
stroke rehabilitation and post-
stroke nursing that need to be addressed.