Identifying Barriers in Acute Stroke Therapy in Argentina. ARENAS Registry (P2.014)

OBJECTIVE: Our aim was to evaluate barriers in acute stroke therapy in the Argentina Stroke Registry. BACKGROUND:designing public health interventions to improve acute stroke care, requires epidemiological investigations in order to identify the best strategy to reduce stroke morbidity and mortality DESIGN/METHODS:patients older than 18 years from 84 medical centers were included within 24 hours after stroke onset in a multicenter, prospective, observational hospital-based study, during a six months period. Demographic data, vascular risk factors profile and control, and interval between: stroke onset and hospital arrival, first cerebral image, neurologist evaluation in acute period and use of thrombolytic therapy were analyzed RESULTS:an acute vascular lesion was identified in 1213 of 1235 patients (55.7% men), 50 % older than 65 years: 38.6 % (95% CI: 35-41) were hemorrhagic, 61% (95% CI 58-64) ischemic. Main vascular risk factors were: hypertension (78.5%), smoking (28%), dyslipidemia (22%), diabetes (17.6%) and atrial fibrillation (15.2%). CT scan was the initial study in 94.3%, MRI in 3.7%, and no image was performed in 1.9%. Thrombolytic therapy was used in private hospitals in 14 patients (1.2%). The main reasons for patients not to receive rt-PA were: exclusion criteria (hemorrhage 38.6%; admission beyond 3 hours of symptoms onset 20.6%; others 13.8%); no-availability (18.1%) or lack of resources to pay for rt-PA (9.1%). Only 8.4% of strokes were initially evaluated by a neurologist. Public health system provided diagnosis and treatment in 50% of cases and 33% of patients did not have health insurance coverage. Admission to Intensive Care Unit was low (47%). CONCLUSIONS: Only 47% of patients were admitted to an Intensive Care Unit, rt-PA was underused and initial evaluation was not performed by a neurologist in most of cases. The gap between clinical practice guidelines and real world is wide in Argentina and interventions to improve acute stroke care are mandatory. Disclosure: Dr. Atallah has nothing to disclose. Dr. Fustinoni has nothing to disclose. Dr. Zurru has nothing to disclose. Dr. Beigelman has nothing to disclose. Dr. Cirio has nothing to disclose. Dr. Ameriso has nothing to disclose. Dr. Burry has nothing to disclose.