ESO East Supplement 2023 - 35

1110745
research-article2022
ESO0010.1177/23969873221110745European Stroke JournalKõrv et al.
ESO EAST Project Supplement
Developments in quality of stroke
care in Estonia
Janika Kõrv1 , Katrin Antsov2, Katrin Gross-Paju3, Inga Kalju4,
Andrus Kreis5, Aive Liigant1,6 and Riina Vibo1
Abstract
Background: Monitoring and measuring different aspects of stroke care pathway is the cornerstone for improvement
of quality. We aim to analyze and give an overview of improvements of stroke care quality in Estonia.
Patients and methods: National stroke care quality indicators are collected and reported using reimbursement data
and include all adult stroke cases. In Estonia, five stroke-ready hospitals are participating in Registry of Stroke Care
Quality (RES-Q), providing data on all stroke patients 1 month every year. Data from the national quality indicators and
RES-Q from 2015 to 2021 are presented.
Results: The proportion of intravenous thrombolysis for all Estonian hospitalized ischemic stroke cases increased from
16% (95% Confidence Interval, CI 15%-18%) in 2015 to 28% (95% CI 27%-30%) in 2021. Mechanical thrombectomy
was provided to 9% (95% CI 8%-10%) in 2021. The 30-day mortality rate has decreased from 21% (95% CI 20%-23%)
to 19% (95% CI 18%-20%). More than 90% of patients with cardioembolic stroke are prescribed anticoagulants at
discharge, but only 50% are on anticoagulant treatment 1 year after stroke. Also, the availability of inpatient rehabilitation
needs improvement, being 21% (95% CI 20%-23%) in 2021. A total of 848 patients are included in the RES-Q. The
proportion of patients receiving recanalization therapies was comparable to the national stroke care quality indicators.
All stroke-ready hospitals show good onset-to-door times.
Conclusion: The overall stroke care quality in Estonia is good, especially the availability of recanalization treatments.
However, secondary prevention and the availability of rehabilitation services need improvement in the future.
Keywords
Stroke, registry, quality, Estonia
Date received: 26 April 2022; accepted: 14 June 2022
European Stroke Journal
2023, Vol. 8(1S) 35 -43
© European Stroke Organisation 2022
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DOI: 10.1177/23969873221110745
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https://doi.org/10.1177/23969873221110745
Introduction
Globally, stroke is the second-leading cause of death and
the third-leading cause of death and disability combined
worldwide.1 Appropriate management is crucial for reducing
the burden of stroke. Several guidelines, both national
and international have been prepared to guide clinicians in
stroke care but the implementation of the results into clinical
practice has proven to be challenging.2 A recent survey
based on expert opinion demonstrated that there are major
inequalities in acute stroke treatment between and within
44 European countries in Europe. In many Eastern European
countries, the access to and delivery of acute stroke care
was more often insufficient or lacking.3 The importance of
voluntary registries on increased provision of evidencebased
care has been reported earlier.4,5 In 2015, the
European Stroke Organisation (ESO) initiated the ESO
Enhancing and Accelerating Stroke Treatment (EAST)
project aiming at improvement of stroke care quality, primarily
in Eastern Europe.2
Estonia is a tiny country at the Baltic Sea, near the
Finnish and Russian border. The population of Estonia is
1,330,068.6 After restoring its independence in 1991, the
economy has dramatically improved and by the World
1 Department of Neurology and Neurosurgery, University of Tartu,
Tartu, Estonia
2 II Department of Internal Diseases, Pärnu Hospital, Pärnu, Estonia
3 Neurology Clinic, West-Tallinn Central Hospital, Tallinn, Estonia
4 Centre of Neurology, East-Tallinn Central Hospital, Tallinn, Estonia
5 Neurology Centre, North Estonia Medical Centre, Tallinn, Estonia
6 Department of Neurology, Tartu University Hospital, Tartu, Estonia
Corresponding author:
Janika Kõrv, Department of Neurology and Neurosurgery, University of
Tartu, L. Puusepa 8, Tartu 50406, Estonia.
Email: Janika.Korv@kliinikum.ee

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