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EDITORIALS: Damian Jenkinson and Gary A Ford Research and development in stroke services BMJ 2006; 332: 318 [Full text]

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Cuba, better care for stroke

Pedro O Orduñez-García MD, Marcos D Iraola-Ferrer MD, Rubén Bembibre Taboada MD, PhD   (14 February 2006)

Cuba, better care for stroke 14 February 2006
Pedro O Orduñez-García MD, Director Hospital Gustavo Aldereguía Lima, Cienfuegos, Cuba, Marcos D Iraola-Ferrer MD, Rubén Bembibre Taboada MD, PhD Send response to journal: Re: Cuba, better care for stroke	Stroke is the 3rd leading cause of death in Cuba. The age adjusted mortality in 2003 was 43% lower than 1970. Rates declined moderately over the period 1970-1979 (2.8% per year), declined slightly over the following two decades (0.15% per year), and entered more rapid phase of decline in the 2000 (3,5% per year). (1) This pattern suggests that the impact of high levels of treatment and control of high blood pressure is just now being felt. (1-2) Hospitalization rates for stroke doubled in 1990-2003 in Cienfuegos, Cuba’s showcase for control of cardiovascular disease. Over the same period, case fatality rates declined by 48%. This latter trend probably reflects a combination of the increasing average age of the population, improvements in ascertainment and referral of cases, less severe cases are being admitted and better quality of care. Following the lessons learned from the Acute Myocardial Infarction approach applied in Cienfuegos, (3) we implemented the Fast Track Treatment to Stroke Approach which 10 components start with the word Early: 1) awareness of the warning signs, 2) medical contact, 3) life support; 4) referral, 5) treatment in Emergency Department (ED), 6) brain imaging, 7) admission in stroke unit, 8) rehabilitation, 9) education to patients and carers and 10) secondary prevention. Such patients are identified with a red code in the ED and almost 100% of those are admitted in stroke unit previous CT scan. Rehabilitation begins during acute phase of stroke and continues after discharge in the community rehabilitation services where patients are follow-up by their family’s physician. Although tertiary medical facilities lack both the amenities and the technology found in industrialized countries, Cuba emphasize the capability of its health system to coordinate the efforts of stakeholder to provide better care for stroke just the call made by Jenkinson and Ford. (4) 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. 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. 3. Ordúñez P, Iraola M, La Rosa Y. Experience in Cuba shows optimizing thrombolysis may reduce death rates in poor countries. BMJ 2005; 330: 1271-72. 4. Jenkinson D, Ford GA. Research and development in stroke services. BMJ 2006; 332: 318. Competing interests: None declared