ESO East Supplement 2023 - 6

6
European Stroke Journal 8(1S)
Results: A total of 3590 acute stroke patients were treated in 20 Greek sites (61% men, median age 64 years; median
baseline NIHSS 4; 74% ischemic stroke). Acute reperfusion therapies were administered in almost 20% of acute ischemic
stroke patients, with a door to needle and door to groin puncture times of 40 and 64 min, respectively. After adjustment
for contributing sites, the rates of acute reperfusion therapies were higher during the time epoch 2020-2021 compared
to 2017-2019 (adjusted OR 1.31; 95% CI 1.04-1.64; p < 0.022; Cochran-Mantel-Haenszel test). After propensity-scorematching,
acute reperfusion therapies administration was independently associated with higher odds of reduced disability
(one point reduction across all mRS scores) at hospital discharge (common OR 1.93; 95% CI 1.45-2.58; p < 0.001).
Conclusions: Implementation and maintenance of a nationwide stroke registry in Greece may guide the stroke
management planning, so that prompt patient transportation, acute reperfusion therapies, and stroke unit hospitalization
become more widely accessible, improving the functional outcomes of stroke patients.
Keywords
Stroke, registry, quality, acute reperfusion treatment, functional outcome, Greece
Date received: 13 March 2022; accepted: 9 May 2022
Introduction
Stroke is a major cause of mortality and disability worldwide,
presenting an increasing incidence during the last
decades.1 In Greece, the incidence of stroke, as extrapolated
from a prospective population-based study in North
Eastern Greece, has been calculated to more than 530
strokes per 100,000 person-years, which is one of the highest
rates in South-Eastern Europe.2 Furthermore, all-cause
mortality at 1-year post-stroke was reported at 34.7%,
while the stroke recurrence at 1-year was also significant
(6.7%).3 However, nowadays, effective treatments, regarding
both acute management and secondary prevention therapies,
exist and continue to expand, and should become
readily available for stroke patients.4 Prompt patient transportation
to a stroke-ready center,5 delivery of acute reperfusion
therapies in cases of acute ischemic stroke (AIS),6
hospitalization in dedicated stroke units,7 early rehabilitation
assessment,8 and thorough patient evaluation regarding
the etiopathogenetic stroke mechanism shall be all provided
with the aim of post-stroke functional recovery.
Nationwide implementation of a stroke management plan
becomes even more important when considering the rapid
aging of the Greek population9 and the potential further
increase of stroke incidence, stroke-associated dependency,
and societal costs.10
To facilitate the efforts toward stroke management
implementation in Greece, the development and maintenance
of national stroke registries may help understand
the current status of stroke care by providing objective
quality metrics and identifying any potential implementation
gaps.11 Establishment of a web-based, prospective
registry system for acute stroke care quality surveillance
seems feasible and may promote the documentation and
improvement of early treatment and care of acute
stroke.12,13 To that aim, the European Stroke Organisation
- Enhancing and Accelerating Stroke Treatment (ESOEAST)
program has developed a platform for data collection
and established a stroke quality registry for use
primarily in Eastern Europe (but later worldwide, as well),
which was launched in 2016; the Registry of Stroke Care
Quality (RES-Q) registry.14
Greece has been participating in RES-Q registry since
2017, registering stroke patients during a 5-year time
period. Using these prospectively collected data, we aim to
characterize the status of stroke management in Greece by
retrospectively analyzing and presenting stroke quality
metrics, with a specific interest in confirming the association
between acute reperfusion treatment delivery and functional
recovery in AIS patients.
Methods
Consecutive patients with acute stroke were prospectively
registered in the RES-Q registry by contributing sites in
Greece during the years 2017-2021. Participation and data
completion in the RES-Q registry were available through
an online platform which was free for noncommercial use
and was developed as an initiative of the ESO-EAST
Project.15 The study was approved by the local Ethics
Committee of " Attikon " University Hospital (decision
number EBΔ37) which was the coordinating center of the
RES-Q registry in Greece; signed informed consent was
obtained from the patients or their legal representatives
before enrollment in all cases.
Patient inclusion
Patients presenting with any type of acute stroke, including
AIS, intracerebral hemorrhage (ICH), transient ischemic
attack (TIA), subarachnoid hemorrhage (SAH), or cerebral
venous thrombosis (CVT), that were evaluated at the emergency
department (ER) of each site and were admitted for
further management, were considered eligible. Exclusion
criteria were patients younger than 18 years old, diagnosis
at discharge other than stroke (i.e. stroke mimics), and lack
of informed consent.
ESO East Supplement 2023

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