ESO East Supplement 2023 - 29

Yeghiazaryan et al.
29
summarize the recent advances, the current state, and plans
for the future of stroke care in Armenia.
Stroke epidemiology in Armenia
Compared to high-income countries, Armenia has a relatively
younger population.6 Nearly 15% of its population is
over 60 years of age, while the same age segment is 22% in
high-income countries.6 In 2019, life expectancy at birth
was 75 years for the general population, 71.3 years for
males, and 78.5 for females. Over the last two decades, the
average life expectancy has improved by approximately
4 years.7
The combined ischemic and hemorrhagic stroke incidence
was 240.2/100,000, and the prevalence was
828/100,000 in 2020.3 The ischemic stroke incidence was
185.3/100,000.3 Ischemic strokes accounted for 78.9% of
all stroke-related hospital admissions, while 16.4% were
hemorrhagic strokes and 4.7% were subarachnoid hemorrhages.3
When combined, cardiovascular and cerebrovascular
causes were the leading cause of mortality in 2020,
which has not improved over the last 5 years.3 In 2020,
4180 patients with ischemic stroke, 865 with brain hemorrhage,
and 252 with subarachnoid hemorrhage received
medical care (Figure 1).3
The in-hospital case-fatality rate (Figure 2) was also
very high at almost 16.0% for ischemic stroke and 41.7%
and 40.2% for subarachnoid and intracerebral hemorrhage.3
Overall, the in-hospital case-fatality rate for all cerebrovascular
disorders was 21.0% in 2020. The average length of
stay for patients with ischemic stroke was approximately
7 days.3
Epidemiology of stroke risk factors
Reliable statistics regarding common vascular risk factors
for stroke are lacking in Armenia, and available figures
seem to be underestimations. However, major behavioral
risk factors such as tobacco use, high salt intake, low physical
activity, and other treatable risk factors such as high
blood pressure, elevated cholesterol, obesity, and diabetes
remain highly prevalent.8 Among adults aged 18-69 years,
the prevalence of high blood pressure is 38%, and of those
diagnosed with hypertension, only 64% receive treatment.
Blood pressure is controlled in only 16% of those receiving
treatment.9 The prevalence of hyperlipidemia and diabetes
is 24% and 6%, respectively. Nearly half of adults (48%)
are overweight (BMI ⩾ 25 kg/m2), and one-fifth (20%) are
obese (BMI ⩾ 30 kg/m2).9 Smoking remains a substantial
modifiable risk factor. About 28% of Armenians in the 18-
69 age group smoke, and nearly all smoke daily.9 Almost
52% of men and 2% of women smoke, and secondhand
smoke exposure is between 21% and 58%.9 Average daily
salt consumption is 9.8 g,9 exceeding the World Health
Organization (WHO) recommendations.10 One fifth of
Figure 2. In-hospital case-fatality in Armenia (2016-2020).
adults (21%) report insufficient moderate-intensity physical
activity, and the majority (78%) are not involved in
vigorous-intensity activity.9,11
Evolution of stroke care in Armenia
The health system in transition
After the fall of the Soviet Union and the subsequent dissolution
of the Soviet economic model, a quasi-privatization
process was implemented in several socioeconomic
sectors in Armenia, including healthcare.12 In the early
2000s a new healthcare funding model was gradually introduced
with only a few most essential health care costs covered
by the state. In addition, several hospitals were
transferred to private ownership, but many remained under
the state's ownership and governance.12 Economic difficulties
during the immediate post-Soviet era and the lack of
political will emerged as major obstacles preventing the
implementation of modern standards of care, including
stroke care. The greatest difficulty was securing funding for
costly interventions for acute stroke, including thrombolysis
and thrombectomy. Although by 2016, thrombolytic
therapy and mechanical thrombectomy were available in
Yerevan, the capital, access to these interventions was limited
only to those patients who could privately cover the
costs. A fortuitous and productive collaboration, as detailed
below, resulted in free and universal access to acute stroke
Figure 1. The number of patients received medical care in
hospital (2016-2020).
ESO East Supplement 2023

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