Stroke services in the Middle East and adjacent region: A survey of 34 hospital-based stroke services

Amal M Al Hashmi 1, Ashfaq Shuaib 2, Yahia Imam 3, Dareen Amr 4, Hani Humaidan 5, Firas Al Nidawi 6, Ahmed Sarhan 7, Wessam Mustafa 8, Wael Khalefa 9, Ismail Ramadan 10, Fritz Sumantri Usman 11, Elyar Sadeghi Hokmabadi 12, Mohammed Ghorbani 13, Temeem Nassir 14, Farid Aladham 15, Athari Salmeen 16, Raghid Kikano 17, Sobri Muda 18, Sachin Jose 19, Manal Al Bulushi 20, Badrai Sajwani 21, Mohammad Wasay 22, Qasim Bashir 23, Adel Al Hazzani 24, Waleed Khoja 25, Radwan Alkadere 26, Haytham Osman 27, Abbashar Hussein 28, Anchalee Churojana 29, Nadia Hammami 30, Atilla Ozcan Ozdemir 31, Semih Giray 32, Erdem Gurkas 33, Seyd Irteza Hussain 34, Abdul Rahman Sallam 35, Ossama Yassin Mansour 36

Affiliations

doi: 10.3389/fneur.2022.1016376

Abstract

Background: Acute stroke care is complex and requires multidisciplinary networking. There are insufficient data on stroke care in the Middle East and adjacent regions in Asia and Africa.

Objective: Evaluate the state of readiness of stroke programs in the Middle East North Africa and surrounding regions (MENA+) to treat acute stroke.

Method: Online questionnaire survey on the evaluation of stroke care across hospitals of MENA+ region between April 2021 and January 2022.

Results: The survey was completed by 34/50 (68%) hospitals. The median population serviced by participating hospitals was 2 million. The median admission of patients with stroke/year was 600 (250-1,100). The median length of stay at the stroke units was 5 days. 34/34 (100%) of these hospitals have 24/7 CT head available. 17/34 (50%) have emergency guidelines for prehospital acute stroke care. Mechanical thrombectomy with/without IVT was available in 24/34 (70.6%). 51% was the median (IQR; 15-75%) of patients treated with IVT within 60 min from arrival. Thirty-five minutes were the median time to reverse warfarin-associated ICH.

Conclusion: This is the first large study on the availability of resources for the management of acute stroke in the MENA+ region. We noted the disparity in stroke care between high-income and low-income countries. Concerted efforts are required to improve stroke care in low-income countries. Accreditation of stroke programs in the region will be helpful.

Keywords: MENA+ region; MENA-SINO; stroke care; stroke centers; stroke units.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Similar articles

Current Recommendations for the Management of Stroke Patients in the Middle East in the Era of COVID-19 Pandemic; Statement from the MENA SINO.

Al Hashmi AM, Ozdemir AO, Shuaib A, Al-Jehani H, Mansour OY, Alhazzani A, Aladhem F, Farhoudi M, John S, Saqqur M.J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105181. doi: 10.1016/j.jstrokecerebrovasdis.2020.105181. Epub 2020 Jul 22.PMID: 33066945 Free PMC article.

Stroke in the Middle-East and North Africa: A 2-year prospective observational study of stroke characteristics in the region-Results from the Safe Implementation of Treatments in Stroke (SITS)-Middle-East and North African (MENA).

Rukn SA, Mazya MV, Hentati F, Sassi SB, Nabli F, Said Z, Faouzi B, Hashim H, Abd-Allah F, Mansouri B, Kesraoui S, Gebeily S, Abdulrahman H, Akhtar N, Ahmed N, Wahlgren N, Aref H, Almekhlafi M, Moreira T.Int J Stroke. 2019 Oct;14(7):715-722. doi: 10.1177/1747493019830331. Epub 2019 Mar 12.PMID: 30860454

Stroke in the Middle-East and North Africa: A 2-year prospective observational study of intravenous thrombolysis treatment in the region. Results from the SITS-MENA Registry.

Al-Rukn S, Mazya M, Akhtar N, Hashim H, Mansouri B, Faouzi B, Aref H, Abdulrahman H, Kesraoui S, Hentati F, Gebelly S, Ahmed N, Wahlgren N, Abd-Allah F, Almekhlafi M, Moreira T.Int J Stroke. 2020 Dec;15(9):980-987. doi: 10.1177/1747493019874729. Epub 2019 Oct 8.PMID: 31594533

Practical perspectives on the use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with nonvalvular atrial fibrillation: A view from the Middle East and North Africa.

Hersi AS, Alhebaishi YS, Hamoui O, Hassan T, Khalifa Hamad A, Magdy M, Sabbour H, Shaheen S.J Saudi Heart Assoc. 2018 Apr;30(2):122-139. doi: 10.1016/j.jsha.2017.05.001. Epub 2017 Jun 8.PMID: 29910583 Free PMC article. Review.

Pharmaceutical care education at pharmacy colleges in the Middle East and North Africa region: A systematic review.

Boura F, Awaisu A, ElGeed H, Katoue M, Kheir N.J Clin Pharm Ther. 2022 Aug;47(8):1134-1148. doi: 10.1111/jcpt.13674. Epub 2022 May 4.PMID: 35509234 Review.

KMEL References

https://pubmed.ncbi.nlm.nih.gov/

References

  1.  
    1. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett D, et al. . Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet. (2014) 383:245–55. 10.1016/S0140-6736(13)61953-4 - DOI - PMC - PubMed
  2.  
    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M et al. American Heart Association Statistics Committee, Stroke Statistics Subcommittee. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. (2016) 133:e38–60. 10.1161/CIR.0000000000000350 - DOI - PubMed
  3.  
    1. Top 10 causes of death, WHO, 2019 . 2021 Heart Disease & Stroke Statistical Update Fact Sheet—Global Burden of Disease.
  4.  
    1. Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res. (2017) 120:439–48. 10.1161/CIRCRESAHA.116.308413 - DOI - PubMed
  5.  
    1. Khan M, Al-Rukn S, Alhazzani AA, Aref H, Moreira T, Wahlgren N. Changing the face of stroke care in the Middle East North Africa region J Neurol Sci. (2020) 412:116727. 10.1016/j.jns.2020.116727 - DOI - PubMed
  6.  
    1. Jackie T, Masoud M, Laurie A, Stephen RL. The epidemiology of stroke in the Middle East and North Africa. J Neurol Sci. (2010) 295:38–40. 10.1016/j.jns.2010.05.016 - DOI - PubMed
  7.  
    1. Streletz LJ, Mushtak A, Gad H, Abbasi S, Dimassi DM, Akhtar N et al. Epidemiology of stroke in the MENA region: a systematic review. Int J Neu Dis. (2017) 1: 10-21. - PubMed
  8.  
    1. Al Hashmi AM, Ozdemir AO, Shuaib A, Al-Jehani H, Mansour OY, Alhazzani A, et al. . Current recommendations for the management of stroke patients in the middle east in the era of COVID-19 pandemic) statement from the MENA SINO. J Stroke Cerebrovasc Dis. (2020) 29:105181. 10.1016/j.jstrokecerebrovasdis.2020.105181 - DOI - PMC - PubMed
  9.  
    1. Al-Jehani H, John S, Hussain SI, Al Hashmi A, Alhamid MA, Amr D, et al. . Consensus statement of the MENA-SINO on implementing care pathway for acute neurovascular emergencies during the COVID-19 pandemic. Front Neurol. (2020) 11:928. 10.3389/fneur.2020.00928 - DOI - PMC - PubMed
  10.  
    1. Al Hashmi A, von Bandemer S, Shuaib A, Mansour OY, Wassy M, Ozdemir AO, et al. . Lessons learned in stroke care during COVID-19 pandemic and preparing for future pandemics in the MENA+ region: A consensus statement from the MENA+-SINO. J Neurol Scie. (2022) 432:120060. 10.1016/j.jns.2021.120060 - DOI - PMC - PubMed
  11.  
    1. Al Hashmi AM, Akhtar N, Al Rukin S, Gaba W, Mehrpour M, Shuaib A, et al. . Maintaining stroke care in the era of Covid-19: A review of practices implemented in the Gulf and Iran). Neurology. (2020) 25:545–53
  12.  
    1. Simpson SH. Creating a data analysis plan: what to consider when choosing statistics for a study. Can J Hosp Pharm. (2015) 68:311–7. 10.4212/cjhp.v68i4.1471 - DOI - PMC - PubMed
  13.  
    1. Suwanwela NC, Poungvarin N. Stroke burden and stroke care system in Asia. Asian Stroke Advisory Panel. (2016) 64:46–51 10.4103/0028-3886.178042 - DOI - PubMed
  14.  
    1. Apor ADAO, Pagaling GT. Espiritu AI, Jamora RDG. Stroke research disparity in southeast asia: socioeconomic factors, healthcare delivery, and stroke disease burden. J Stroke Cerebrovasc Dis. (2021) 30:105481. - PubMed
  15.  
    1. Al-Rukn S, Mazya M, Akhtar N, Hashim H, Mansouri B, Faouzi B et al. Stroke in the Middle-East and North Africa: A 2-year prospective observational study of intravenous thrombolysis treatment in the region. Results from the SITS-MENA Registry. Int J Stroke. (2020) 15:980–7. 10.1177/1747493019874729 - DOI - PubMed
  16.  
    1. Jasne AS, Sucharew H, Alwell K, Moomaw CJ, Flaherty ML, Adeoye O, et al. . Stroke center certification is associated with improved guideline concordance. Am J Med Qual. (2019) 34:585–9. 10.1177/1062860619835317 - DOI - PMC - PubMed
  17.  
    1. Abd-Allah F, Wasay M. Roadmap for improved stroke care: implications for global stroke guidelines and action plan Int J Stroke. (2015) 10:E52. 10.1111/ijs.12528 - DOI - PubMed
  18.  
    1. Ringelstein EB, Meckes-Ferber S, Hacke W, Kaste M, Brainin M, Leys D, et al. . European stroke facilities survey: the German and Austrian perspective. Cerebrovasc Dis. (2009) 27:138–45. 10.1159/000177922 - DOI - PubMed
  19.  
    1. Owolabi MO, Thrift AG, Martins M, Johnson W, Pandian J, Abd-Allah F, et al. . The state of stroke services across the globe: Report of World Stroke Organization-World Health Organization surveys. Int J Stroke. (2021) 16:889–901. 10.1177/17474930211019568 - DOI - PMC - PubMed
  20.  
    1. McAlister FA, Majumdar SR, Padwal RS, Fradette M, Thompson A, Buck B. Case management for blood pressure and lipid level control after minor stroke: PREVENTION randomized controlled trial. CMAJ. (2014) 186:577–84) 10.1503/cmaj.140053 - DOI - PMC - PubMed

Page Navigation