Fighting Against Stroke in Latin America: A Joint Effort of Medical Professional Societies and Governments

• Authors: Sheila Cristina Ouriques Martins, Hospital Moinhos de Vento; Pablo Lavados, Universidad del Desarrollo; Thaís Leite Secchi Secchi, Hospital Moinhos de Vento; Michael Brainin, World Stroke Organization; Sebastian Ameriso, Fundacion Para La Lucha Contra Las Enfermedades Neurologicas de La Infancia; Fernando Gongora-Rivera, Hospital Universitario Dr. Jose Eleuterio Gonzalez; Claudio Sacks, Universidad de Valparaiso; Carlos Cantú-Brito, Instituto Nacional de la Nutrición Salvador Zubiran; Tony F Alvarez Guzman, Hospital Manuela Beltrán; Germán Enrique Pérez-Romero, Asociación Colombiana de Reumatología; Mario Muñoz Collazos, Colombian Stroke Network; Miguel A Barboza, Hospital Dr. Rafael A. Calderón Guardia; Antonio Arauz, Instituto Nacional de Neurología y Neurocirugía; Carlos Abanto Argomedo, Instituto Nacional de Ciencias Neurologicas; Nelson Novarro-Escudero, Pacífica Salud - Hospital Punta Pacífica; Hector I Amorin Costabile, Ministry of Public Health Uruguay; Roberto Crosa, Médica Uruguaya; Claudia Camejo, Hospital da Clínicas; Ricard Mernes, Hospital de Clínicas; Nelson Maldonado, Hospital Central Instituto de Previsiín Social; Daissy L Mora Cuervo, Hospital Moinhos de Vento; Octávio Marques Pontes Neto, Brazilian Stroke Network; Gisele Sampaio Silva, Brazilian Stroke Network; Leobardo Augusto Carbonera, Hospital Moinhos de Vento; Ana Claudia D Souza, Hospital Moinhos de Vento; Eduardo DGD Sousa, Ministry of Health, Brasília; Alan Flores, Universidad Nacional de Asuncion, San Lorenzo; Donoban Melgarejo, Universidad Nacional de Asuncion, San Lorenzo; Irving R Santos Carquin, Emergency Hospital Public Assistance; Arnold Hoppe, Universidad del Desarrollo; João José Freitas de Carvalho, Brazilian Stroke Society; Francisco Mont'Alverne, Universidad del Desarrollo; Pablo Amaya, Hospital Universitario Dr. Jose Eleuterio Gonzalez; Hernan Bayona, Asociación Colombiana de Reumatología; Victor Hugo Navia González, Universidad del Desarrollo; Juan Carlos Duran, Sociedad Boliviana de Neurología; Victor C Urrutia, Johns Hopkins School of Medicine; Denizar V Araujo, Ministry of Health, Brasília,; Valery L Feigin, Auckland University of Technology; Raul Nogueira, Emory University
• Journal Title: Frontiers in Neurology
• Volume: Volume 12
• Publisher: Frontiers | 2021-10-01, Pages 743732-743732
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3389/fneur.2021.743732
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Latin America; stroke; stroke centers; stroke system of care; stroke units

Abstract

Introduction: Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden. In 2018, at the first Latin American Stroke Ministerial Meeting, stroke physician and healthcare manager representatives from 13 countries signed the Declaration of Gramado with the priorities to improve the region, with the commitment to implement all evidence-based strategies for stroke care. The second meeting in March 2020 reviewed the achievements in 2 years and discussed new objectives. This paper will review the 2-year advances and future plans of the Latin American alliance for stroke. Method: In March 2020, a survey based on the Declaration of Gramado items was sent to the neurologists participants of the Stroke Ministerial Meetings. The results were confirmed with representatives of the Ministries of Health and leaders from the countries at the second Latin American Stroke Ministerial Meeting. Results: In 2 years, public stroke awareness initiatives increased from 25 to 75% of countries. All countries have started programs to encourage physical activity, and there has been an increase in the number of countries that implement, at least partially, strategies to identify and treat hypertension, diabetes, and lifestyle risk factors. Programs to identify and treat dyslipidemia and atrial fibrillation still remained poor. The number of stroke centers increased from 322 to 448, all of them providing intravenous thrombolysis, with an increase in countries with stroke units. All countries have mechanical thrombectomy, but mostly restricted to a few private hospitals. Pre-hospital organization remains limited. The utilization of telemedicine has increased but is restricted to a few hospitals and is not widely available throughout the country. Patients have late, if any, access to rehabilitation after hospital discharge. Conclusion: The initiative to collaborate, exchange experiences, and unite societies and governments to improve stroke care in Latin America has yielded good results. Important advances have been made in the region in terms of increasing the number of acute stroke care services, implementing reperfusion treatments and creating programs for the detection and treatment of risk factors. We hope that this approach can reduce inequalities in stroke care in Latin America and serves as a model for other under-resourced environments.