Hospital service for ischemic stroke patients in Brazilian countryside: are we still in the ‘80s?

 

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Abstract

Background Stroke is one of the most common causes of death and incapacity in the world. The benefits of reperfusion therapies and hospitalization in neurologic intensive care units (ICUs) are undeniable. However, these treatments are not widely available in a continental-sized country like Brazil.

Objective To describe the treatment for ischemic stroke and the functional outcome 90 days after the hospitalization of patients in the Brazilian countryside.

Methods Observational, prospective case series study design. The data collected refer to randomly selected patients hospitalized in 3 hospitals in the south region of the state of Bahia between December 2018 and December 2019.

Results The population consisted of 61 consecutive patients. They were elderly (median age: 62 years old); with a predominance of hypertension (82%); and were light to moderate stroke cases (National Institute of Health Stroke Scale [NIHSS] median: 7). A total of 37.7% of the cases arrived at the hospital in a < 4.5-hour window but received no reperfusion therapy. Of these, 94.3% were discharged from the hospital with a prescription for antiplatelets or anticoagulant. A total of 64.1% of the patients received a statin prescription. At the end of the follow-up period, the general mortality was 21%. Almost half of the population (47.9%) evolved to an unfavored outcome (modified Rankin scale [mRs]: 3 to 6).

Conclusion Our population presented sociodemographic and comorbidities characteristics similar to those of other national samples. No reperfusion therapy was used and the treatment was basically secondary and prophylaxis-oriented, and almost half of the population evolved with incapacities and a high mortality rate, despite the initial low clinical gravity.

Resumo

Antecedentes Acidente vascular cerebral (AVC) é uma das principais causas de morte e incapacidade no mundo. Os benefícios das terapias de reperfusão e hospitalização em unidade intensiva neurológica são inegáveis. Porém, estes tratamentos não estão largamente disponíveis em um país de dimensões continentais como o Brasil.

Objetivos Descrever o tratamento do AVC isquêmico agudo e a funcionalidade, 90 dias após o evento, de pacientes hospitalizados no interior do Brasil.

Métodos Estudo observacional, prospectivo, tipo série de casos. Os dados foram coletados de pacientes consecutivos, aleatoriamente selecionados, internados em 3 hospitais da região Sul da Bahia entre dezembro de 2018 e dezembro de 2019.

Resultados A população amostral consistiu de 61 pacientes. Houve predomínio de idosos (mediana de idade: 62 anos), hipertensos (82%), com AVC leve a moderado (mediana do National Institute ok Health Stroke Scale [NIHSS, na sigla em inglês]: 7), dos quais 37,7% chegaram ao hospital com < 4,5 horas de sintomas, mas não receberam terapias de reperfusão. Um total de 94,3% dos pacientes recebeu alta com prescrição de antiagregante plaquetário ou anticoagulante e 64,1% receberam prescrição de estatina. Ao final do período de seguimento, a mortalidade geral foi de 21% e quase metade da população amostral (47,9%) evoluiu com desfecho desfavorável (escala de Rankin modificada: 3 a 6).

Conclusão A população amostral apresentou características sociodemográficas e comorbidades semelhantes às de outros recortes nacionais. Terapias de reperfusão não foram realizadas e o tratamento foi basicamente orientado para profilaxia secundária. Quase metade da população evoluiu com incapacidade ou morte, apesar da baixa gravidade clínica à admissão.

Authors' contributions

AFRSJ: conception, data collection, formal analysis, project management, resources, draft writing, reviewing, and writing editing; GCS: data collection, project management; CMK: data collection, formal analysis, methodology, reviewing and writing editing; PAPJ: conception, formal analysis, supervision, reviewing and writing editing; PRSM: conception, formal analysis, supervision, methodology, reviewing and writing editing.

Publication History

Received: 30 April 2021

Accepted: 11 October 2021

Article published online:
17 October 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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