ESO East Supplement 2023 - 3

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research-article2022
ESO0010.1177/23969873221148632European Stroke JournalESO EAST Project Supplement
ESO EAST Project Supplement
ESO EAST Editorial
Valeria Caso1, Georgios Tsivgoulis2 and Bo Norrving3
Dear Readers,
In this supplement, we would like to share an overview of
the European Stroke Organisation's (ESO) implementation
strategy, specifically focusing on Eastern European countries.
In 2014, the ESO Executive Committee decided, in
line with its mission to reduce the " Stroke Burden in
Europe, " to spearhead an implementation project, having
the aim of reducing the recognized disparities in stroke care
within Eastern European countries, while at the same time
improving patient outcomes after stroke through evidencebased
treatment. The ESO decided to build upon the initiative
for Central Eastern European countries, as they still
had been experiencing increasing rates of stroke incidence
and stroke-related mortality compared to Western Europe.1
Moreover, significant inequalities in acute stroke treatment
between and within Eastern European countries were also
registered.2
Likewise, as the Eastern European healthcare systems
had developed in a similar historical context and shared a
homogenous background, this would facilitate any implementation
process.
Officially, the project was initiated in 2015 at the first
European Stroke Conference in Glasgow, where the delegates
of the " European Stroke Organisation - Enhancing
and Accelerating Stroke Treatment " (ESO EAST) met for
the first time. During this conference, delegates from
Albania, Armenia, Azerbaijan, Bosnia, Bulgaria, Croatia,
Czech Republic, Estonia, Georgia, Hungary, Kazakhstan,
Kyrgyzstan, Lithuania, North Macedonia, Moldova,
Poland, Romania, Russia,
Serbia,
Slovakia,
Slovenia,
Ukraine, and Uzbekistan discussed unmet needs in Eastern
European countries. The participants decided to focus
mainly on the following points: the suboptimal implementation
of evidence-based treatments and the low number of
articles from this region published in international journals
indexed in the Web of Science.
In order to improve implementation, the ESO-EAST program
developed a strategy based on a " detecting-understanding-reducing
disparities " conceptual framework. Specifically,
stroke care quality was first measured (after having developed
a platform for data collection), gaps were identified in
the current service delivery, and ultimately, feedback was
provided to participating hospitals, followed by the application
of interventions to reduce such disparities.3
A software platform for data collection and analysis,
Registry of Stroke Care Quality (RES-Q), was developed
European Stroke Journal
2023, Vol. 8(1S) 3 -4
© European Stroke Organisation 2022
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DOI: 10.1177/23969873221148632
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https://doi.org/10.1177/23969873221148632
and launched in 2016, which was used to collect data for
more than 90,000 patients from >750 hospitals in 56 countries
between September 2016 and May 2019. Training
courses on thrombolysis treatment, nursing, and research
skills were also conducted.3
In 2016, the Angels Initiative, a non-profit, non-promotional,
global healthcare program supported by Boehringer
Ingelheim and endorsed by ESO, joined the ESO- EAST
Initiative. The main goals of the Angels Initiative are:
firstly, to increase the number of stroke-ready hospitals and,
secondly, to optimize the quality of existing stroke units.4
The Angels Initiative employs consultants who provide
support at hospital levels, including strategies focused on
improving stroke care through standardized and improved
logistics, as well as motivational tools, including awards
for the achievement of pre-determined performance thresholds.
One of the flagship achievements has been an increase
in overall stroke-readiness in Romania: from 13 strokeready
hospitals in 2015 to 46 in 2021. Since registering
with the Angels Initiative, the median door-to-treatment
times for stroke patients in Romania and Moldova have
decreased by 35 min (40% reduction vs baseline) and
15 min (19% reduction vs baseline), respectively. These
implementation strategies had been embedded in the
European Stroke Action Plan (SAPE) for 2018 to 2030,
which was prepared in cooperation with the patient organization
" Stroke Alliance for Europe organization " (SAFE).
Here, four overarching targets were identified: (1) reduce
the absolute number of strokes in Europe by 10%, (2) treat
90% or more of all patients with stroke in Europe, (3) have
national plans for stroke encompassing the entire chain of
care, from primary prevention to life after stroke, (4) fully
implement national strategies for multisector public health
interventions, in order to promote and facilitate healthy
lifestyles, and reduce environmental (including air pollution),
socioeconomic and educational factors that are
known to increase the risk of stroke.5
1 Stroke Unit, Department of Emergengy and Vascular Medicine Santa
Maria della MIsericordia Hospital, University of Perugia Perugia Italy
2Second Department of Neurology, School of Medicine, National &
Kapodistrian University of Athens, " Attikon " University Hospital,
Athens, Greece
3Department of Clinical Sciences Lund, Neurology, Skåne University
Hospital, Lund University, Lund, Sweden
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