Dorjan Marusic‚MD,Chairman Board of Directors
Dorjan Marusic‚MD Chairman Board of Directors

Together, IHD and stroke comprise around 60% of all cardiovascular deaths, and caused more than one quarter of all deaths in EU member states in 2011. Despite substantial declines in recent decades, cardiovascular diseases remain the main cause of mortality in most OECD countries, accounting for nearly one-third (32.3%) of all deaths in 2013.

Cerebrovascular disease refers to a group of diseases that relate to problems with the blood vessels that supply the brain. Common manifestations of cerebrovascular disease include ischemic stroke, which develops when the brain’s blood supply is blocked or interrupted, and hemorrhagic stroke which occurs when blood leaks from blood vessels into the surface of the brain.

Stroke was the underlying cause for about 11% of all deaths in EU countries in 2011. Stroke is caused by the disruption of the blood supply to the brain. In addition to being an important cause of mortality, the disability burden from stroke and other cerebrovascular diseases is also substantial (Murray et al., 2015). Ischemic stroke represented around 85% of all cerebrovascular disease cases. It occurs when the blood supply to a part of the brain is interrupted, leading to a necrosis (i.e. the cells that die) of the affected part.

There are large variations in cerebrovascular disease mortality rates across countries. In Slovenia the age-standardized cerebrovascular disease mortality rates per 100.000 populations in 2013 was 92 that is nearly three times higher than that of Austria and twice as in OECD34. Figure 8.12 shows the case-fatality rates within 30 days of admission for ischemic stroke when the death occurred in the same hospital as the initial stroke admission. In Slovenia in 2103 nearly 13% of patients in 2013 died within 30 days in the same hospital in which the initial admission for ischemic stroke occurred.

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In the period from 1990 to 2013 it decreased for 51%, which is less than the OECD34 average with 54%. Better access to high quality stroke care, including timely transportation of patients, evidence-based medical interventions and highquality specialised facilities such as stroke units have helped to reduce 30-day case-fatality rates. Despite the progress seen so far, there is still room to improve implementation of best practice acute care for cardiovascular diseases including stroke across countries. To shorten acute care treatment time, targeted strategies can be highly effective. But to encourage the use of evidencebased advanced technologies in acute care, wider approaches are needed. Adequate funding and trained professionals should be made available, and health care delivery systems should be adjusted to enable easy access

Prospects for further reductions may be hampered by a rise in certain risk factors such as obesity and diabetes. Part of the reduction in stroke mortality can be attributed at least partly to a reduction in risk factors. Tobacco smoking and hypertension are the main modifiable risk factors for stroke. Improvements in medical treatment for stroke have also increased survival rates, treatment for ischemic stroke has advanced dramatically over the last decade. Clinical trials have demonstrated clear benefits of thrombolytic treatment for ischemic stroke as well as receiving care in dedicated stroke units to facilitate timely and aggressive diagnosis and therapy for stroke victims (Hacke et al., 1995; Seenan et al., 2007).

Launching the national specific strategy for tackling cerebro-vascular diseases and establishment of network of stroke units should be one of the main priorities. Establishment and implementation of standardized treatments following the clinical guidelines is crucial. Specific disease indicators implementation will support monitoring and evaluation of clinical certification on diseases based on specific problem solution. AACI is about to publish new Certification Programme for Stroke Clinical Certification. The standard for Clinical Certification of Stroke Centers is focused on improvement of clinical indicators for Stoke, and is developed with the world’s leading Stroke Associations. Publishing is expected in June 2016.

References.

Murray, C.J.L. et al. (2015), “Global, Regional, and National Disability-adjusted Life Years (DALYs) for 306 Diseases and Injuries and Healthy Life Expectancy (HALE) for 188 Countries, 1990-2013: Quantifying the Epidemiological Transition”, The Lancet, published online: 26 August 2015.

OECD (2015), Cardiovascular Disease and Diabetes: Policies for Better Health and Quality of Care, OECD Publishing, Paris, http://dx.doi.org/10.1787/9789264233010-en.

OECD (2012), OECD Reviews of Health Care Quality: Korea: Raising Standards, OECD Publishing, Paris, http://dx.doi.org/10.1787/9789264173446-en.

OECD (2015), Cardiovascular Disease and Diabetes: Policies for Better Health and Quality of Care, OECD Publishing, Paris, http://dx.doi.org/10.1787/9789264233010-en.

Hacke, W. et al. (1995), “Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator for Acute Hemispheric Stroke. The European Co-operative Acute Stroke Study (ECASS)”, Journal of the American Medical Association, Vol. 274, No. 13, pp. 1017-1025.

Seenan, P., M. Long and P. Langhorne (2007), “Stroke Units in Their Natural Habitat: Systematic Review of Observational Studies”, Stroke, Vol. 38, pp. 1886-1892.