BMJ  2006;332:551 (4 March), doi:10.1136/bmj.332.7540.551-a

Letter

Cuba: better care for stroke

EDITOR—Stroke is the third leading cause of death in Cuba. The age adjusted mortality in 2003 was 43% lower than in 1970. Rates fell moderately in 1970-9 (2.8% per year), slightly over the following two decades (0.15% per year), and more rapidly in 2000 (3.5% per year).¹ This pattern shows that the impact of high rates of treatment and control of high blood pressure is just now being seen.^{1 2}

Hospital admission rates for stroke doubled in 1990-2003 in Cienfuegos, Cuba's showcase for control of cardiovascular disease, while case fatality rates fell by 48%. This trend probably reflects a combination of the increasing average age of the population, improvements in ascertainment and referral of cases, less severe cases being admitted, and better quality of care.

Following the lessons learnt from the approach to acute myocardial infarction that was applied in Cienfuegos,³ we implemented the fast track treatment to stroke approach, whose 10 components all start with the word early: awareness of the warning signs, medical contact, life support, referral, treatment in the emergency department, brain imaging, admission to the stroke unit, rehabilitation, education for patients and carers, and secondary prevention. Such patients are identified with a red code in the emergency department, and almost all of them are admitted to the stroke unit. Rehabilitation starts during the acute phase of stroke and continues after discharge, in community rehabilitation, where patients are followed up by their family doctor.

Although tertiary medical facilities lack the amenities and technology found in industrialised countries, Cuba emphasises the capability of its health system to coordinate the efforts of stakeholders to provide better care for stroke—just as Jenkinson and Ford suggest.⁴

Hospital Gustavo Aldereguía Lima, Cienfuegos, Cuba pordunez{at}gal.sld.cu

Hospital Gustavo Aldereguía Lima, Cienfuegos, Cuba

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Competing interests: None declared.

References

1. Cooper RS, Ordúñez P, Iraola-Ferrer M, Bernal JL, Espinosa A. Cardiovascular disease and associated risk factors in Cuba: Prospects for prevention and control. Am J Public Health 2006;96: 94-101.[Abstract/Free Full Text]
2. Ordúnez P, Bernal JL, Espinosa-Brito A, Silva LC, Cooper RS. Ethnicity, education and blood pressure in Cuba. Am J Epidemiol 2005;162: 49-56.[Abstract/Free Full Text]
3. Ordúñez P, Iraola M, La Rosa Y. Reducing mortality in myocardial infarction. BMJ 2005;330: 1271-2.[Free Full Text]
4. Jenkinson D, Ford GA. Research and development in stroke services. BMJ 2006;332: 318. (11 February.)[Free Full Text]

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