Europe's stroke care remains dangerously unequal, study reveals
A sweeping 47-country survey found that access to life-saving stroke treatments varies wildly across Europe, with some nations treating fewer than 2% of stroke patients in specialist units versus 97% elsewhere. The gap signals major inefficiencies in healthcare infrastructure and patient outcomes—and points to what works for policymakers willing to invest.
Originaltitel: Accessibility and use of organised stroke care and reperfusion therapies in Europe: results from the SAP-E Stroke Service Tracker 2023.
**Stora skillnader i strokevård över Europa kräver omprövning av implementeringsstrategier** Tillgången till organiserad strokebehandling och återperfusionsterapi varierar dramatiskt mellan europeiska länder, enligt SAP-E Stroke Service Tracker 2023. Data från 47 länder visar att strokeenheternas täckning sträcker sig från 0,8 procent till 96,7 procent av strokepatienter, medan trombolysbehandling ligger mellan 1,3 och 34,7 procent. Forskarna identifierade att tätheten av strokeenheter korrelerar med inläggningsproportioner, men påträdande av nationella strokeplaner och kvalitetsprogram visar ingen statistisk koppling till tillgänglighet. Detta resultat påpekar att policy-ramverk inte automatiskt översätts till klinisk praktik. För regionvård och inköpschefer innebär detta att enhetstäckning och geografisk infrastruktur måste prioriteras före administrativ dokumentation. Länder måste revidera implementeringsmetoder för att sluta gapen mellan plan och verklighet.
INTRODUCTION: Organised stroke care and reperfusion therapies are key components of modern stroke treatment. We assessed accessibility of organised stroke care and reperfusion therapies in Europe and explored its association with key organisational indicators. PATIENTS AND METHODS: Stroke Action Plan for Europe (SAP-E) Stroke Service Tracker data from 2023 reported by 47 European countries was assessed. Accessibility indicators included stroke unit (SU) admission proportions, intravenous thrombolysis (IVT) and EVT treatment proportions. Organisational indicators included the facility density of SU, IVT-capable centres and EVT-capable centres per capita (number of centres per 100,000 population), presence of national stroke plans and quality programmes. RESULTS: Across Europe, marked variations were observed in facility density of SU (0.21-0.48), IVT-capable centres (0.19-0.45) and EVT-capable centres (0.06-0.15). SU admission proportions ranked from 0.8% to 96.7%, IVT treatment proportions from 1.3% to 34.7% and EVT treatment proportions from 0.2% to 14.3%. Stroke unit admission proportions were associated with SU density (r = 0.42, P = .03). Density of reperfusion-capable centres showed a possible trending association with IVT treatment proportions (r = 0.34, P = .08), but no association with EVT treatment proportions (r = 0.22, P = .23). Neither the presence of a national stroke plan nor a quality programme were associated with accessibility of SU care, IVT or EVT. CONCLUSION: Large inequities in access to organised stroke care and reperfusion therapies persist across Europe. At the country level, national stroke plans and quality programmes have not yet translated into effect on accessibility indicators, suggesting that achieving effective implementation takes time or could primarily manifest as within-country improvements.