World Stroke Day: Ukraine is significantly closer to the indicators of the Stroke Action Plan for Europe

According to the World Health Organization, cardiovascular disease is the leading cause of disability and premature death in the European region. Even though stroke affects the brain, not the heart, it is classified as a cardiovascular disease because it is caused by problems with blood supply, usually a blockage or rupture of a blood vessel in the brain. Strokes are increasingly impacting the young working-age population, which is due to the spread of hypertension, which has become significantly “younger” and is a major risk factor.

Over the past few years, the state has been systematically working to provide stroke patients with high-quality diagnostics, treatment and rehabilitation, which are free of charge, as they are funded by the state under the Medical Guarantee Program (hereinafter referred to as the MGP).

To understand the starting point of our movement: in 2018, out of 521 departments, each of which received at least 50 patients a year with acute cerebral stroke, 268 of these departments made a diagnosis clinically, not by CT or MRI, as this equipment was not available. At the same time, thrombolytic therapy (injection of a special drug that dissolves a thrombus in the brain) was performed in 0.5% of ischemic stroke cases, and mechanical thrombectomy (removal of a thrombus from the lumen of an artery or vein) was performed in 0.1% of cases, respectively.

To implement qualitative changes, the Ministry of Health has begun to work systematically on several areas that meet the goals of the Stroke Action Plan for Europe until 2030.

First of all, as part of the infrastructure phase of the reform, a network of medical institutions - stroke centers - was clearly defined, with all the necessary equipment and a team of multidisciplinary specialists. It is extremely important that the emergency medical team takes a person with a suspected stroke directly to such a facility, not just the nearest one, because this is the only way to provide quality medical care in a timely manner.

Currently, 227 hospitals across the country are contracted under the relevant package with the National Health Service of Ukraine (hereinafter referred to as the NHSU), where patients can receive free acute cerebral stroke services. Since the beginning of 2024, 106,029 patients have received stroke care under the MGP.

Stroke centers are able to provide patients with the necessary laboratory tests and examinations using computed tomography (CT) or magnetic resonance imaging (MRI) around the clock. It should be emphasized that the diagnosis of stroke is determined only by CT or MRI if there are clinical signs. Over the past three years (until the beginning of 2024), the Ministry of Health has procured and distributed more than 200 CT scanners that allow for CT angiography of cerebral vessels and CT perfusion of the brain, which makes it possible to extend the “therapeutic window” for mechanical thrombectomy to 24 hours and thrombolysis to 9 hours.

The capacity of medical institutions where stroke centers are being set up is also enhanced by high-precision angiographs. Thus, in 2021-2024, 51 such devices were purchased for Ukrainian hospitals. Angiographs are an essential part of modern stroke treatment. The peculiarity of this equipment is that it allows doctors to perform computed tomography directly in the X-ray operating room before the mechanical thrombus removal procedure, thus, reducing the time for necessary preoperative examinations and increasing the success of treatment.

Thanks to the above steps, the Ministry of Health of Ukraine has managed to significantly approach the indicators set out in the signed Declaration on the Implementation of the Stroke Action Plan until 2030: 15% of thrombolysis and 5% of mechanical thrombectomy. These medical procedures are critical to improving the chances of recovery from stroke and reducing disability in patients. In cases where thrombolysis is performed within the first few hours, the risk of disability is reduced by 10-30%. In the case of a severe stroke, mechanical thrombectomy gives up to 50% chance of preserving functionality.

Currently, in Ukraine, the percentage of patients undergoing thrombolysis in the first half of 2024 was 12.5%, which is a 25-fold increase compared to 2018. The growth of indicators is also recorded for mechanical thrombectomy - 1.9% of patients in the first half of 2024, which is 20 times higher compared to 2018.

High blood pressure is one of the most important risk factors for stroke, but it can and should be controlled. Patients with hypertension can take advantage of the government’s Affordable Medicines reimbursement program and receive the necessary medicines free of charge or with a partial co-payment. The list of “affordable medicines” includes 241 trade names of medicines (with different drug forms and dosages) included in the section of medicines for the treatment of cardiovascular and cerebrovascular diseases. In January-September 2024, more than 800 thousand patients filled 1,321,238 prescriptions for medicines for the prevention and treatment of strokes and heart attacks.

The symptoms of stroke are easy to remember by the abbreviation FAST:

F - Facial drooping - A section of the face, usually only on one side, that is drooping and hard to move. This can be recognized by a crooked smile, or difficulty preventing saliva from leaking at a corner of the mouth.

A - Arm (or leg) weakness - Inability to raise one’s arm fully, or the inability to hold or squeeze something (such as someone’s hand), or a new reduction in strength of an arm or leg when raising/supporting an extra weight (such as new difficulty of carrying/lifting a typical object, or raising one’s body from squatting/sitting position).

S - Speech difficulties - An inability or difficulty to understand or produce speech, slurred speech, or having difficulty repeating even a basic sentence such as “The sky is blue”.

T - Time - If any of the symptoms above are showing, time is of the essence; emergency medical services should be called and/or the person taken to a hospital immediately if possible. It is also important to note the time the symptoms first started appearing and pass on this information (“Time is brain”).

We remind you that the best way to reduce the risk of stroke is prevention:

• control your blood pressure;
• limit your salt intake, eat foods low in trans fats, and try to eat a healthy diet;
• be physically active;
• stop smoking and drinking alcohol;
• if your doctor has prescribed treatment for the disease you have been diagnosed with, follow their recommendations.

At the first sign of a stroke, it is important not to waste precious time and call an ambulance immediately (103). This will significantly increase a person’s chances of successful treatment and rehabilitation.