Moderator Of 1 Session
Presenter Of 7 Presentations
Policy and Pragmatic Solutions to Improve Hyperacute and Acute Stroke Care
A case study of Join & JoinTriage Technology for stroke care management in Brazil
Establishing Stroke Systems of Care from the Bottom to the Top: A Global Perspective
RESTRUCTURING PRIMARY CARE IN A CONTINENTAL COUNTRY: THE IMPLEMENTATION OF THE “CUT STROKE IN HALF” AND “HEARTS” PROGRAM IN BRAZIL
Background and Aims
Stroke care in Brazil has improved with the organization of acute stroke care. But it was not enough to reduce the 400,000 cases that occur each year. We present a strategy of modifying the primary prevention for stroke in Brazil with the restructuring of primary care.
The strategy is a task force, uniting the Pan American Health Organization, the Brazilian Ministry of Health, the Medical Societies acting to plan, train and implement the restructuring of primary care, based on the HEARTS program of the World Health Organization and Cut Stroke in Half of the World Stroke Organization. It is a gradual and monitored change in the way of care in primary care, adapting the programs through flowcharts and simplification of processes through protocols.
The steps for implementation: 1)Organization of a committee with neurologists, cardiologists and family doctors; 2)Choice of 8 health units to implement a pilot; 3)Preparation and adaptation of technical protocols for screening and treatment of hypertension and diabetes (based on the HEARTS program); 4)Implementation of a protocol for atrial fibrilation screening with a point-of-care mobile ECG recording; 5)Preparation of printed material for lifestyle modification; 6)Implementation of Stroke Riskometer App; 6)Preparation of an educacion course for primary care professionals including community health works; 7)Implementation of decision, data collection and monitoring software enriched with artificial intelligence.
The implementation starts on June 2021 and will be expanded to 60 Units of Health in the whole country in 2022.
The success of implementation in the country has potential to decrease in 50% the incidence of stroke.
POLIPILL AND RISCOMETER TO PREVENT STROKE AND COGNITIVE IMPAIRMENT IN PRIMARY HEALTH CARE - PROMOTE STUDY
Background and Aims
The increase burden of stroke and dementia provides strong evidence that currently used primary prevention strategies are not enough and 80% of strokes occur in people with low to moderate risk. The purpose is to test whether a polypill used alone or in combination with lifestyle modification will reduce the incidence of stroke and cognitive impairment in a population of individuals with low to moderate risk of stroke.
Phase III Randomized Clinical Trial, prospective, factorial 2x2, of 12,268 subjects followed by 3 years. 60 Health Units will be randomized (clusters) to use or not the approach of community health workers with the Stroke Riskometer. After a run-in phase (30 days, all participants with active drug), patients will be randomized to receive the polypill (valsartan 80 mg, anlodipina 5 mg e rosuvastatina 10 mg) or placebo (dose adjustment of amlodipine 2,5 for patients with adverse events). It will be included: (1)adults aged 50-75 years; (2) no previous history of stroke, TIA or cardiovascular disease; (3)systolic blood pressure (BP) 120-139 mmHg; (4) one or more lifestyle risk factors (smoking, overweight, physical inactivity or inadequate diet. It will be excluded patients with hypercholesterolemia or diabetes or take other antihypertensive drugs or open label statins. Subjects will be randomized under a minimization process using age, sex, BP, education level, total cholesterol.
We expect to reduce in 50% the risk of stroke and cognitive decline in 3 years.
With the trial results we expect to change the public prevention policies in primary care.