Hospital de Clínicas de Porto Alegre, Hospital Moinhos de Vento
Neurology
Sheila Cristina Ouriques Martins is neurologist, PhD in Stroke Neurology, Professor of Medicine, Universidade Federal of Rio Grande do Sul / Hospital de Clínicas de Porto Alegre and Chief of Neurology and Neurosurgery of Hospital Moinhos de Vento. She is founder and President of the Brazilian Stroke Network. As advisor of the MOH of Brazil she started the organization and implementation of the National Stroke Policy. She works with research to modify public policies. In 2021 started the implementation of a World Stroke Organization (WSO) program together with the MOH: primary prevention for stroke in middle risk patients based on a polypill associated with lifestyle modification and use of Stroke Riskometer App. Since 2015 is working with other Latin America countries to improve stroke care in the region. She has large experience as clinician in public health, and also as health manager working globally with different levels of governments (Ministries of Health, Health secretaries of States and Cities), helping to implement strategies to improve stroke care. She is part of the World Stroke Organization since 2008 and since 2020 she is the President-Elect.

Moderator Of 1 Session

Session Type
Main Theme Symposium
Date
28.10.2021, Thursday
Session Time
08:00 - 09:30
Room
MAIN THEME A
Session Description
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Live Session

Presenter Of 7 Presentations

Building Stroke Centers

Session Type
WSC Talks
Date
27.10.2021, Wednesday
Session Time
16:10 - 16:30
Room
WSC TALKS
Lecture Time
16:10 - 16:30

Policy and Pragmatic Solutions to Improve Hyperacute and Acute Stroke Care

Session Type
Joint Session
Date
28.10.2021, Thursday
Session Time
15:45 - 17:15
Room
JOINT SESSIONS
Lecture Time
16:19 - 16:36

A case study of Join & JoinTriage Technology for stroke care management in Brazil

Session Type
Industry Sponsored Session
Date
28.10.2021, Thursday
Session Time
13:30 - 14:30
Room
INDUSTRY 2
Lecture Time
13:55 - 14:15

Guest

Session Name
Session Type
Live Studio Broadcast
Date
29.10.2021, Friday
Session Time
09:30 - 09:50
Room
WSC TV
Lecture Time
09:30 - 09:30

Establishing Stroke Systems of Care from the Bottom to the Top: A Global Perspective

Session Type
Main Theme Symposium
Date
28.10.2021, Thursday
Session Time
08:00 - 09:30
Room
MAIN THEME A
Lecture Time
08:00 - 08:14

RESTRUCTURING PRIMARY CARE IN A CONTINENTAL COUNTRY: THE IMPLEMENTATION OF THE “CUT STROKE IN HALF” AND “HEARTS” PROGRAM IN BRAZIL

Session Type
Oral Presentations
Date
27.10.2021, Wednesday
Session Time
10:40 - 12:00
Room
ORAL PRESENTATIONS 1
Lecture Time
11:40 - 11:50

Abstract

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.

Methods

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.

Results

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.

Conclusions

The success of implementation in the country has potential to decrease in 50% the incidence of stroke.

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POLIPILL AND RISCOMETER TO PREVENT STROKE AND COGNITIVE IMPAIRMENT IN PRIMARY HEALTH CARE - PROMOTE STUDY

Session Type
Oral Presentations
Date
27.10.2021, Wednesday
Session Time
10:40 - 12:00
Room
ORAL PRESENTATIONS 1
Lecture Time
11:50 - 12:00

Abstract

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.

Methods

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.

Results

We expect to reduce in 50% the risk of stroke and cognitive decline in 3 years.

Conclusions

With the trial results we expect to change the public prevention policies in primary care.

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