Effect of statin therapy on SARS-CoV-2 infection-related mortality in hospitalized patients.

AIM: Assessing the effect of statin therapy (ST) at hospital admission for COVID-19 on in-hospital mortality. METHODS AND RESULTS: Retrospective observational study. Patients taking statins were 11 years older and had significantly more comorbidities than patients who were not taking statins. A genetic matching (GM) procedure was performed prior to analysis of the mortality risk. A Cox proportional hazards model was used for the cause-specific hazard (CSH) function, and a competing-risks Fine and Gray (FG) model was also used to study the direct effects of statins on risk. Data from reverse transcription-polymerase chain reaction-confirmed 2157 SARS-CoV-2-infected patients [1234 men, 923 women; age: 67 y/o (IQR 54-78)] admitted to the hospital were retrieved from the clinical records in anonymized manner. Three hundred and fifty-three deaths occurred. Five hundred and eighty-one patients were taking statins. Univariate test after GM showed a significantly lower mortality rate in patients on ST than the matched non-statin group (19.8% vs. 25.4%, χ2 with Yates continuity correction: P = 0.027). The mortality rate was even lower in patients (n = 336) who maintained their statin treatments during hospitalization compared with the GM non-statin group (17.4%; P = 0.045). The Cox model applied to the CSH function [HR = 0.58(CI: 0.39-0.89); P = 0.01] and the competing-risks FG model [HR = 0.60 (CI: 0.39-0.92); P = 0.02] suggest that statins are associated with reduced COVID-19-related mortality. CONCLUSIONS: A lower SARS-CoV-2 infection-related mortality was observed in patients treated with ST prior to hospitalization. Statin therapy should not be discontinued due to the global concern of the pandemic or in patients hospitalized for COVID-19.

Triglyceride-Rich Lipoproteins and Glycoprotein A and B Assessed by 1H-NMR in Metabolic-Associated Fatty Liver Disease.

High plasma triglyceride (TG) levels and chronic inflammation are important factors related to metabolic-associated fatty liver disease in patients at cardiovascular risk. Using nuclear magnetic resonance (1H-NMR), we aimed to study the triglyceride-rich lipoprotein (TRL) and acute-phase glycoprotein profiles of a cohort of patients with metabolic disease and their relationship with fatty liver. Plasma samples of 280 patients (type 2 diabetes, 81.1%; obesity, 63.3%; and metabolic syndrome, 91.8%) from the University Hospital Lipid Unit were collected for the measurement of small, medium and large TRL particle numbers and sizes and glycoprotein profiles (Glyc-A and Glyc-B) by 1H-NMR. Liver function parameters, including the fatty liver index (FLI) and fibrosis-4 (FIB-4) score, were assessed. Hepatic echography assessment was performed in 100 patients, and they were followed up for 10 years. TRL particle concentrations showed a strong positive association with Glyc-A and Glyc-B (ρ=0.895 and ρ=0.654, p<0.001, respectively) and with the liver function-related proteins ALT ρ=0.293, p<0.001), AST (ρ=0.318, p<0.001) and GGT (ρ=0.284, p<0.001). Likewise, TRL concentrations showed a positive association with FLI (ρ=0.425, p<0.001) but not with FIB-4. During the follow-up period of 10 years, 18 new cases of steatosis were observed among 64 patients who were disease-free at baseline. Baseline TRL particle numbers and glycoprotein levels were associated with the new development of metabolic-associated fatty liver disease (MAFLD) (AUC=0.692, p=0.018 and AUC=0.669, p=0.037, respectively). Overall, our results indicated that TRL number and acute-phase glycoproteins measured by 1H-NMR could be potential biomarkers of the development of hepatic steatosis in patients at metabolic risk.

Epidemiología de la enfermedad vascular cerebral en España / Epidemiology of cerebrovascular disease in Spain

En España las enfermedades vasculares cerebrales (EVC) son una causa muy frecuente de morbilidad y hospitalización, constituyendo la segunda causa de mortalidad en la población general, y la primera en las mujeres. Además, suponen un gasto sociosanitario muy elevado, que se estima va a incrementarse en los próximos años debido al envejecimiento de nuestra población y a que el número de casos de ictus aumenta con la edad. Los datos de la Encuesta de Morbilidad Hospitalaria del Instituto Nacional de Estadística del año 2011 registraron 116.017 casos de accidentes cerebrovasculares (ACV) y 14.933 de isquemia cerebral transitoria, lo que correspondería, respectivamente, a una incidencia de 252 y 32 episodios por cada 100.000 habitantes. En el año 2002, el coste de hospitalización por cada ACV se estimó en 3.047 (Euros). El importe asistencial total a lo largo de la vida de un paciente con ictus se calcula en 43.129 (Euros). Internacionalmente, los costes directos del infarto cerebral constituyen el 3% del gasto sanitario nacional, siendo esta cantidad similar en distintos países de nuestro entorno. La hipertensión arterial fue el factor de riesgo cardiovascular (FRCV) más prevalente, tanto en los ictus isquémicos como los hemorrágicos, seguida de la dislipidemia y la diabetes mellitus. La enfermedad arterial periférica y la hipertensión arterial fueron los FRCV más asociados a los episodios aterotrombóticos; la fibrilación auricular a los ictus cardioembólicos, y la obesidad y la hipertensión arterial a los lacunares. En España, como demuestran varios estudios, estamos lejos de conseguir un control óptimo de los FRCV, sobre todo en la prevención secundaria de las EVC. Según el estudio ICTUSCARE, la consecución de los valores recomendados fue del 17,6% en el caso de la hipertensión arterial, del 29,8% en el colesterol-LDL, del 74,9% en el hábito tabáquico y del 50,2% en la diabetes mellitus. En la presente revisión se analizan con detalle los aspectos epidemiológicos, preventivos y de costes que originan las EVC

In Spain, cerebrovascular disease (CVD) is a very common cause of morbidity and hospitalization. They are the second leading cause of mortality in the general population, and the first in women. They also constitute a very high social spending, which is estimated to increase in coming years, due to the aging of our population .Data from the Hospital Morbidity Survey of the National Statistics Institute recorded, in2011, 116,017 strokes and 14,933 transient ischemic attacks, corresponding, respectively, to an incidence of 252 and 32 events per 100,000 people. In 2002, the cost of hospitalization for each stroke was estimated at €3,047. The amount of total cost health care throughout the life of a stroke patient is calculated at at €43,129. Internationally, the direct costs of stroke constitute 3% of national health spending, this being similar amount in different countries around us. Hypertension was the cardiovascular risk factor (CVRF) more prevalent in both ischemic and hemorrhagic strokes, followed by dyslipidemia and diabetes mellitus. Peripheral arterial disease and hypertension were more frequently associated with atherothrombotic events, atrial fibrillation with cardioembolic strokes, and obesity and high blood pressure to lacunar infarcts. In Spain, as showing several studies, we are far from optimal control of CVRF, especially in secondary prevention of stroke. According to the ICTUSCARE study, achieving recommended values was 17.6% in the case of hypertension, 29.8% in LDL-cholesterol, 74.9% of smoking, and 50.2% in diabetes mellitus. In this review, we analyze in detail the epidemiology, prevention and costs originated by CVD

[Epidemiology of cerebrovascular disease in Spain]. / Epidemiología de la enfermedad vascular cerebral en España.

In Spain, cerebrovascular disease (CVD) is a very common cause of morbidity and hospitalization. They are the second leading cause of mortality in the general population, and the first in women. They also constitute a very high social spending, which is estimated to increase in coming years, due to the aging of our population. Data from the Hospital Morbidity Survey of the National Statistics Institute recorded, in 2011, 116,017 strokes and 14,933 transient ischemic attacks, corresponding, respectively, to an incidence of 252 and 32 events per 100,000 people. In 2002, the cost of hospitalization for each stroke was estimated at €3,047. The amount of total cost health care throughout the life of a stroke patient is calculated at €43,129. Internationally, the direct costs of stroke constitute 3% of national health spending, this being similar amount in different countries around us. Hypertension was the cardiovascular risk factor (CVRF) more prevalent in both ischemic and hemorrhagic strokes, followed by dyslipidemia and diabetes mellitus. Peripheral arterial disease and hypertension were more frequently associated with atherothrombotic events, atrial fibrillation with cardioembolic strokes, and obesity and high blood pressure to lacunar infarcts. In Spain, as showing several studies, we are far from optimal control of CVRF, especially in secondary prevention of stroke. According to the ICTUSCARE study, achieving recommended values was 17.6% in the case of hypertension, 29.8% in LDL-cholesterol, 74.9% of smoking, and 50.2% in diabetes mellitus. In this review, we analyze in detail the epidemiology, prevention and costs originated by CVD.

Consenso de expertos sobre la detección y el manejo clínico de la hipercolesterolemia familiar / Expert consensus on the detection and clinical management of familial hypercholesterolemia

La hipercolesterolemia familiar (HF) es una de las enfermedades genéticas más frecuentes y de mayor gravedad, que invalida y acorta la vida a los pacientes que la padecen. El tratamiento hipolipemiante mejora de forma sustancial el pronóstico de los pacientes con HF y, por ello, es imprescindible que reciban el tratamiento adecuado. La Sociedad Española de Arteriosclerosis (SEA) ha sido, y es, pionera en el diagnóstico y el tratamiento de la HF y, desde sus inicios, este grupo de pacientes ha sido objeto de su máximo interés clínico y científico, y muy especialmente para las Unidades de Lípidos de la SEA, donde se atiende a la mayor parte de sujetos con HF en España. Este documento surge de la voluntad de nuestra sociedad de actualizar el conocimiento científico para ofrecer a los médicos que controlan a estos pacientes unas directrices claras con respecto al diagnóstico y al tratamiento. Estas directrices destacan 2 aspectos principales: diagnosticar la enfermedad lo más precozmente posible y reducir de forma más temprana el colesterol LDL hasta valores normales. En los próximos años hay que conseguir, entre todos los agentes implicados, que la inmensa mayoría de los pacientes con HF conozcan su diagnóstico y tengan a su disposición el tratamiento adecuado

Familial hypercholesterolemia (FH) is one of the most common and severe genetic diseases, causing disabilities and premature death to those who suffer it. Lipid-lowering therapy substantially improves the prognosis of FH patients and, therefore, appropriate pharmacological treatment is of the utmost importance. The Spanish Society of Arteriosclerosis (SEA) has always been a pioneer in the diagnosis and treatment of FH. Since its inception, FH has been one of the main areas of clinical and scientific interest, mainly for Lipids Units of the SEA, where most patients with this pathology are referred in Spain. This document arises from the willingness of our society to update the scientific knowledge on this subject and to provide physicians with clear clinical guidelines regarding diagnosis and treatment of FH. These guidelines can be summarized in two main aspects: early diagnosis of the disease and a rapid normalization of LDLcholesterol. In the coming years, health providers should accomplish that the majority of patients with FH are aware of their diagnosis and that adequate treatment is provided

[Expert consensus on the detection and clinical management of familial hypercholesterolemia]. / Consenso de expertos sobre la detección y el manejo clínico de la hipercolesterolemia familiar.

Familial hypercholesterolemia (FH) is one of the most common and severe genetic diseases, causing disabilities and premature death to those who suffer it. Lipid-lowering therapy substantially improves the prognosis of FH patients and, therefore, appropriate pharmacological treatment is of the utmost importance. The Spanish Society of Arteriosclerosis (SEA) has always been a pioneer in the diagnosis and treatment of FH. Since its inception, FH has been one of the main areas of clinical and scientific interest, mainly for Lipids Units of the SEA, where most patients with this pathology are referred in Spain. This document arises from the willingness of our society to update the scientific knowledge on this subject and to provide physicians with clear clinical guidelines regarding diagnosis and treatment of FH. These guidelines can be summarized in two main aspects: early diagnosis of the disease and a rapid normalization of LDLcholesterol. In the coming years, health providers should accomplish that the majority of patients with FH are aware of their diagnosis and that adequate treatment is provided.

[Clinical profile of patients with very high hypertriglyceridemia from the Registry of Hypertriglyceridemia of the Spanish Atherosclerosis Society]. / Perfil clínico de los pacientes con hipertrigliceridemia muy severa del Registro de Hipertrigliceridemias de la Sociedad Española de Arteriosclerosis.

BACKGROUND AND OBJECTIVE: To describe clinical and epidemiological characteristics of patients with very high hypertriglyceridemia (HTG) who were attended in lipid units of the Spanish Society of Atherosclerosis (SEA). PATIENTS AND METHOD: Patients of the HTG Registry of SEA with at least one triglyceride concentration greater than 1,000mg/dL (n=298, HTG severe group) and those whose baseline triglycerides were between 200 and 246mg/dL (HTG control group, n=272) were included. RESULTS: Patients with very high triglyceride levels were younger (46.9±11.5 years vs 52.7±13 years; p<0.0001), with a larger waist circumference (100.5±10.6cm vs 98.5±11.1cm; p=0.0426), higher alcohol intake (170.7±179.1g/wk vs 118.8±106.4g/wk; p=0,0473), active smoking status (45.6% vs 26.8%; p<0.0001) and a higher frequency of pancreatitis (10.2% vs 3%; p=0.0006) than HTG control group. There was a higher percentage of patients with atherogenic dietary pattern in severe HTG group compared with the control group (138 [46.3%] vs. 94 [34.5%]; p=0,001). The multivariate analysis showed that factors associated with a triglyceride concentration greater than 1,000mg/dl were age, male sex, weight, waist circumference, alcohol, physical inactivity in non-business hours and the presence of diabetes mellitus. CONCLUSIONS: Patients with very high HTG were usually men in the fourth decade of life, with abdominal obesity, smoking and alcohol consumption. In 60% of cases the HTG was primary, and pancreatitis the most frequently complication.

Perfil clínico de los pacientes con hipertrigliceridemia muy severa del Registro de Hipertrigliceridemias de la Sociedad Española de Arteriosclerosis / Clinical profile of patients with very high hypertriglyceridemia from the Registry of Hypertriglyceridemia of the Spanish Atherosclerosis Society

Fundamento y objetivo Describir las características clínico-epidemiológicas de los pacientes con hipertrigliceridemia (HTG) muy severa atendidos en las Unidades de Lípidos de la Sociedad Española de Arteriosclerosis (SEA).Pacientes y método Se incluyeron los pacientes del Registro de HTG de la SEA con al menos una trigliceridemia superior a 1.000mg/dl (n=298, grupo HTG muy severa) y aquellos cuya trigliceridemia basal fuese entre 200 y 246mg/dl (grupo HTG control, n=272). Resultados Los pacientes con HTG muy severa eran más jóvenes (46,9±11,5 vs 52,7±13 años; p<0,0001), con un perímetro de cintura abdominal mayor (100,5±10,6 vs 98,5±11,1cm; p=0,0426), mayor ingesta de alcohol (170,7±179,1 vs 118,8±106,4g/semana; p=0,0473), tabaquismo activo (45,6 vs 26,8%; p<0,0001) y una mayor frecuencia de pancreatitis (10,2 vs 3%; p=0,0006) que el grupo control. Hubo un mayor porcentaje de pacientes con un patrón de consumo aterógeno en el grupo de HTG muy severa comparado con el grupo control (138 [46,3%] vs. 94 [34,5%]; p=0,001). El modelo multivariante mostró que los factores asociados a alguna determinación de triglicéridos mayor de 1.000mg/dl fueron la edad, el sexo masculino, el peso, el perímetro de cintura abdominal, el alcohol, la inactividad física fuera de la jornada laboral y la presencia de diabetes mellitus. Conclusiones Los pacientes con HTG muy severa suelen ser varones en la cuarta década de la vida, con obesidad abdominal, fumadores y consumidores de alcohol. En el 60% de los casos la HTG fue primaria, y la pancreatitis fue la complicación más frecuente (AU)

Background and objective To describe clinical and epidemiological characteristics of patients with very high hypertriglyceridemia (HTG) who were attended in lipid units of the Spanish Society of Atherosclerosis (SEA).Patients and method Patients of the HTG Registry of SEA with at least one triglyceride concentration greater than 1,000mg/dL (n=298, HTG severe group) and those whose baseline triglycerides were between 200 and 246mg/dL (HTG control group, n=272) were included.ResultsPatients with very high triglyceride levels were younger (46.9±11.5 years vs 52.7±13 years; p<0.0001), with a larger waist circumference (100.5±10.6cm vs 98.5±11.1cm; p=0.0426), higher alcohol intake (170.7±179.1g/wk vs 118.8±106.4g/wk; p=0,0473), active smoking status (45.6% vs 26.8%; p<0.0001) and a higher frequency of pancreatitis (10.2% vs 3%; p=0.0006) than HTG control group. There was a higher percentage of patients with atherogenic dietary pattern in severe HTG group compared with the control group (138 [46.3%] vs. 94 [34.5%]; p=0,001). The multivariate analysis showed that factors associated with a triglyceride concentration greater than 1,000mg/dl were age, male sex, weight, waist circumference, alcohol, physical inactivity in non-business hours and the presence of diabetes mellitus. Conclusions Patients with very high HTG were usually men in the fourth decade of life, with abdominal obesity, smoking and alcohol consumption. In 60% of cases the HTG was primary, and pancreatitis the most frequently complication (AU)

Impact of telemedicine on acute management of stroke patients undergoing endovascular procedures.

BACKGROUND: Telemedicine is improving acute stroke care in remote areas. Delay in hospital-to-hospital transfer is a common reason why acute ischemic stroke patients are excluded from interventional therapy. The progressive implementation of these procedures, requiring highly specialized professionals in comprehensive stroke centers, will certainly challenge even more the geographic equity in the access to the best acute stroke treatments. We aimed to assess the benefits of telemedicine in selecting stroke patients for endovascular treatments. METHODS: In our Reference Comprehensive Stroke Center (RCSC), we perform urgent intra-arterial procedures in acute stroke patients. Patients may be primarily admitted (PA) or referred from community hospitals with (TMHs; 2 centers) or without telemedicine (nonTMHs; 7 centers). We prospectively studied all consecutive stroke patients undergoing urgent endovascular recanalization procedures in the RCSC. We studied different outcome measures according to the patients' initial admission: PA patients, TMH patients or nonTMH patients. For all patients, demographic and outcome data including serial National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores at 3 months were recorded. Clinical improvement was defined as a decrease ≥4 points on the NIHSS at 7 days or discharge and favorable outcome as mRS ≤2 at 3 months. Whether an endovascular procedure was indicated was decided according to clinical, radiological and transcranial Doppler (TCD) data, independently of the patient's initial admission center. RESULTS: During a 2-year period, 119 patients received endovascular treatment: PA patients 74 (63.1%), TMH patients 25 (20.5%), nonTM patients 20 (16.4%). The mean distance to the RCSC was 52 ± 15 km for TMHs and 34.5 ± 12 km for nonTMHs (p = 0.4). There were no differences in baseline characteristics including age (71, 71.6 and 66.5 years; p = 0.25), baseline NIHSS (18.5, 19 and 18; p = 0.57) and previous use of intravenous tissue plasminogen activator (56.5, 56.5 and 57.9%; p = 0.95). The rate of recanalization (modified Thrombolysis in Cerebral Infarction Score ≥2a) was similar in all groups (75, 66.6 and 68.4%; p = 0.682). TMH and PA patients had similar clinical improvement (61 vs. 63.8%; p = 0.51) and good functional outcome (36.8 vs. 35.3%; p = 0.722). Conversely, nonTMH patients presented a lesser degree of clinical improvement (31.3%) and poorer functional outcome (15.8%) than TMH (p = 0.019 and p = 0.046) and PA patients (p = 0.05 and p = 0.013). TMH patients had significantly shorter door-to-groin puncture times (47 vs. 69 min; p = 0.047). CONCLUSIONS: Telemedicine assessment to select patients for endovascular procedures improves the efficiency in stroke management and possibly the early and long-term outcome in patients receiving intra-arterial reperfusion treatment.

Dislipidemia diabética, macro y microangiopatía / Diabetic dyslipidemia, macro and macroangiopathy

Las complicaciones micro y macrovasculares tienen un impacto negativo en la calidad de vida de los pacientes con diabetes tipo2. Diferentes evidencias clínicas corroboran que la dislipidemia aterogénica, caracterizada por un aumento de la concentración de triglicéridos, descenso del colesterol HDL y la presencia de partículas LDL pequeñas y densas, desempeña un papel crucial en el incremento de la morbimortalidad cardiovascular de la diabetes. Por ello, aun cuando las alteraciones lipídicas en la diabetes son cuantitativamente de escasa importancia, cualitativamente existe la necesidad de intervenir para reducir el elevado riesgo cardiovascular de estos pacientes. Asimismo, la dislipidemia diabética se encuentra implicada en el riesgo de complicaciones microvasculares. Considerados conjuntamente, estos datos respaldan la necesidad de aumentar la percepción de la importancia de la dislipidemia diabética en las complicaciones macro y microangiopáticas (AU)

The micro-and macrovascular complications have a negative impact on quality of life of patients with type 2 diabetes. Different clinical evidence support that atherogenic dyslipidemia, characterized by increased triglycerides, decreased HDL cholesterol and the presence of small and dense LDL particles, plays a crucial role in the increased cardiovascular morbidity and mortality of diabetes. Therefore, even when lipid abnormalities in diabetes are quantitatively minor, qualitatively there is a need to reduce the high cardiovascular risk of these patients. Moreover, diabetic dyslipidemia is involved in the risk of microvascular complications. Taken together, these data support the need to increase awareness of the importance of diabetic dyslipidemia in macro and microangiopathic complications (AU)

Trombólisis endovenosa en un hospital comarcal mediante el sistema teleictus / Endovenous thrombolysis in a district hospital using the telestroke system

Introducción. En enero de 2007 se instaló un sistema de telemedicina entre un hospital comarcal carente de neurólogo de guardia y el hospital de referencia, situado a 70 km de distancia, para la atención en la fase aguda del ictus isquémico. Objetivo. Estudiar el impacto de un sistema de telemedicina para la atención urgente de los ictus agudos (teleictus) atendidos en un hospital comarcal y la seguridad en la administración de tratamiento fibrinolítico endovenoso a distancia. Pacientes y métodos. Estudio observacional, prospectivo, de 334 pacientes consecutivos con ictus isquémico agudo atendidos n urgencias de un hospital comarcal entre 2007 y 2010. Resultados. Se realizó ‘teleconsulta’ en 133 (37,6%) pacientes y 46 de ellos recibieron tratamiento trombolítico en el hospital comarcal. El tiempo medio puerta-aguja fue de 53,4 ± 38,2 minutos. Un 60,9% de los pacientes fue tratado entro de las tres primeras horas desde el inicio de los síntomas, y el 100% dentro de las primeras 4,5 horas. El 71,7% de los pacientes presentó mejoría neurológica a las 24 horas, 4 pacientes (8,7%) tuvieron transformación hemorrágica y en 2 (4,3%) fue sintomática. La frecuencia de evolución favorable (escala de Rankin modificada igual o inferior a 2) a los tres meses fue del 53,6% y la mortalidad del 10,9%. Un total de 39 pacientes (29,3%) se trasladaron al hospital de referencia y 9 pacientes recibieron tratamiento intraarterial. Conclusiones. La administración de tratamiento trombolítico en un hospital comarcal mediante teleictus es segura y eficaz. La telemedicina puede ayudar a la selección de pacientes tributarios de traslado urgente para la realización de procedimientos de rescate intraarterial (AU)

Aim. To study the impact of a telemedicine system for acute stroke care in a community hospital and the security of thrombolytic treatment. Patients and methods. Observational study of acute stroke patients attended in the emergency room in a community hospital between 2007 and 2010. Results. 662 acute stroke patients were attended. 133 ‘tele-consults’ were done (37.6% ischemic stroke established). 39 patients (29.3%) were transferred to the stroke centre, 5 (12.8%) of them were considered unnecessary. 46 patients received thrombolytic treatment in the community hospital. The average time door-needle was 53.4 ± 38.2 minutes. 60.9% patients were treated during the first three hours since symptoms onset, and 100% in less than 4.5 hours. 9 patients received intra-arterial treatment. 4 patients (8.69%) presented hemorrhagic transformation 2 (4.3%) were symptomatic. 71.7% presented neurological improvement in 24 hours. 53.65% were functionally independent (mRS equal or less than 2) to three months. The mortality was 10.86%. Conclusions. Tele-stroke allows a specialized attention for acute stroke in a community hospital, to administer thrombolytic treatment and could be an indispensable tool for select patient to transfer to the stroke centre for intra-arterial rescue procedures (AU)

Impact of a telemedicine system on acute stroke care in a community hospital.

In January 2007, a telestroke system was established between a community hospital lacking a neurologist on call and a stroke centre 70 km away. The telestroke system allowed urgent remote evaluation of the patient by a specialized neurologist, supervised thrombolytic treatment or a decision for urgent transfer to the stroke centre. During the first year of operation of the telestroke system, we studied all acute ischaemic stroke patients admitted to the community hospital and compared the results with the previous year. Approximately the same number of acute stroke patients were admitted to the community hospital in each year (201 cases in 2006 and 198 in 2007). The telestroke system was activated 75 times in 2007, the number of stroke patients evaluated by a specialized neurologist increased (17% vs. 38%, P > 0.001) and interhospital transfers were reduced (17% vs. 6%, P = 0.001). The number of thrombolytic treatments was doubled: 4.5% (n = 9) in 2006 vs. 9.6% (n = 19, 12 of them in the community hospital) in 2007 (P = 0.073). The telestroke system also reduced the time to tPA treatment from symptom onset (210 vs. 162 min, P = 0.05) and increased the number of patients treated in the 0-3 hours window (40% vs. 63%, P = 0.09). Telemedicine improved the quality of care administered to acute stroke patients admitted to a community hospital and reduced the number of inter-hospital transfers.

Geographic differences in acute stroke care in Catalunya: impact of a regional interhospital network.

UNLABELLED: Limited resources prevent specialized care in community hospitals (CH) challenging geographical equity. We studied the impact of a regional interhospital network based on urgent transfer from 4 CH to a referral stroke center (RSC). METHODS: During 2006, all stroke patients admitted to the 5 networked hospitals (4 CH, 1 RSC) were studied: clinical pathways and stroke interventions were recorded. Physicians at CH decided emergent transfer under their clinical judgment. Quality therapeutic measures where defined: urgent expert neurological evaluation, stroke unit admission and thrombolytic treatment. For patients receiving tissue plasminogen activator, demographic and outcome data were recorded: clinical improvement (decrease > or =4 National Institute of Health Stroke Scale points at discharge), total recovery (3-month modified Rankin Scale score > or =1). RESULTS: From a total of 1,925 acute stroke patients, 1,587 were admitted to the RSC (1,396 primarily). Of 529 primarily admitted to CH, 191 (36.1%) were emergently transferred. Patients primarily admitted to the RSC were more frequently evaluated by a neurologist (100 vs. 34%; p < 0.001) and admitted to a stroke unit (22.7 vs. 11.7%; p < 0.001). However, the rate of thrombolytic treatment was similar (4.4 vs. 5.1%; p = 0.491). After initial assessment at the RSC, 92 (48.2%) transfers were considered unnecessary. Transferred patients accounted for 27/88 (30.7%) thrombolyses performed in the RSC. Baseline characteristics were similar, except a longer time to treatment (164 vs. 211 min; p = 0.004) and more frequent early ischemia CT signs among transferred patients (23 vs. 53%; p = 0.037). Clinical improvement (62 vs. 50%; p = 0.273) and symptomatic hemorrhagic transformation (6.8 vs. 3.8%; p = 0.596) were similar. However, among transferred patients, the degree of total recovery was lower (44 vs. 22%; p = 0.05). CONCLUSION: An interhospital network based on transfers to an RSC does not warrant geographical equity: equal access to best therapeutic interventions is only partially achieved at the expense of a high proportion of unnecessary transfers.