Research and development in stroke servicesBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7537.318 (Published 09 February 2006) Cite this as: BMJ 2006;332:318
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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
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:
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: No competing interests