ESO East Supplement 2023 - 52

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research-article2022
ESO0010.1177/23969873221115457European Stroke JournalGdovinova et al.
ESO EAST Project Supplement
How stroke care has changed in
Slovakia in the last 5 years
Zuzana Gdovinova1 , Michal Kovačik2 and Diana Urbani3
Abstract
Introduction: Although stroke patients in Slovakia had been treated according to European recommendations, no
network of primary and comprehensive stroke centers had been officially established; the ESO recommended quality
parameters had not been fulfilled. Therefore, the Slovak Stroke Society decided to change the stroke management
concept and introduced mandatory evaluation of quality parameters. This article focuses on key success factors of the
change in stroke management in Slovakia and presents the 5-year results and perspectives for the future.
Material and methods: We processed data from the stroke register at the National Health Information Center,
which is mandatory in Slovakia for all hospitals designated as primary and secondary stroke care centers.
Results: Since 2016, we have started to change stroke management. New National Guideline for Stroke Care was
prepared in 2017 and published in 2018 as a Recommendation of the Ministry of Health of the Slovak Republic. The
recommendation included pre-hospital as well as in-hospital stroke care, a network of primary stroke centers (hospitals
administering intravenous thrombolysis - 37), and secondary stroke centers (hospitals treating with intravenous
thrombolysis + endovascular treatment (ET) - 6). A stroke priority was instituted, having equally high priority
as myocardial infarction. More efficient in-hospital workflow and pre-hospital patient triage shortened the time to
treatment. Prenotification became mandatory in all hospitals. Non-contrast CT, and CT angiography is mandatory in all
hospitals. In patients with suspected proximal large-vessel occlusion the EMS stays at the CT facility in primary stroke
centers until the CT angiography is finished. If LVO is confirmed, the patient is transported to an EVT secondary stroke
center by the same EMS. From 2019 all secondary stroke centers offer endovascular thrombectomy in a 24/7/365
system. We consider the introduction of quality control one of the most critical steps in stroke management. The result
of these activities is 25.2% of patients treated with IVT and 10.2% by endovascular treatment, and median DNT 30 min.
Number of patients screened for dysphagia increased from 26.4% in 2019 to 85.9% in 2020. In the most of the hospitals
the proportion of ischemic stroke patients discharged with antiplatelets and in case of AF with anticoagulants was >85%.
Discussion: Our results indicate that it is possible to change stroke management at a single hospital and national
level. For continuous and further improvement, regular quality monitoring is necessary; therefore, the results of stroke
hospital management are presented regularly once a year at national and international level. Collaboration with the
" Second for Life " patient organization is very important for the " time is brain " campaign in Slovakia.
Conclusion: Due to the change in stroke management over the last 5 years, we have reduced the time for acute
stroke treatment and improved the proportion of patients with acute treatment, and in this area, we have achieved and
exceeded the goals of the Stroke Action Plan for Europe for 2018-2030. Nevertheless, we still have many insufficiencies
in stroke rehabilitation and post-stroke nursing that need to be addressed.
Keywords
Stroke management, intravenous thrombolysis, mechanical thrombectomy, door-to-needle time, quality control,
Angels Initiative
Date received: 19 May 2022; accepted: 24 June 2022
1Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University Kosice, Kosice, Slovakia
2Ivan Stodola Liptovsky Hospital With Polyclinics, Liptovsky Mikulas, Žilina Region, Slovakia
3Angels Consultant, Bratislava, Slovakia
Corresponding author:
Zuzana Gdovinova, Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University Kosice, Trieda SNP 1, Kosice 04011, Slovakia.
Email: z.gdovin@gmail.com
European Stroke Journal
2023, Vol. 8(1S) 52 -58
© European Stroke Organisation 2022
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