By Francesco Correa

Chairs Serefnur Öztürk (Turkey), Cristina Tiu (Romania)

This session was comprised of six talks. The first one was on inequity in access to stroke care in Europe: overlook based on mappings given by Urs Fischer (Switzerland). In 2020 and 2019 the pandemic had a large impact in Europe, data are starting point. What type of stroke societies and support organization do we have in Europe to monitor any progress ? Mapping was the first aspect and 53 societies were identified. National stroke registries are not available in all countries. He pointed out that some progress in acute stroke care in Europe was obtained for both IVY and EVT in a group of countries. The figures available were obtained and together with the global burden of diseases study data. The GBD data are available for 2016 and can hardly be compared to 2019 which saw a peculiar trend. The 2019 saw large variabilities all over europe. Central European and Scandinavian countries had higher performance of procedures. A large gap needs to be filled all over Europe. Both 2019 and 2020 saw no major drop of procedures. Comparing 2016 to 2019 IVT in proportion was improving for EVT as well the trend is encouraging. Inequalities are still large but according to incidence the pandemic did not lead to large drop. The relative trend is encouraging. Still many patients are untreated.

The second speech was on Stroke risk factors in migrants – Regional or global effects and potential solution by Serefnur Öztürk (Turkey) the speaker reported how stroke in migrante is a growing problem. The human kind from ancient times saw migration as a chance to survival. Global trends from WHO reported how 82 millions people from developing countries are moving to other areas of the planet to find better chances. Turkey has a particular burden of around 6 million displaced people from Middle East. From 2014 to 2023 the trend is steadily increasing. Life conditions are very heavy for this population. Cerebrovascular diseases are on the top conditions that may affect these populations. The pattern of risk factors is similar to the general populations. A health care coverage is not always guaranteed for migrants this will bring to a lost chance of vascular risk factors control. Together with stroke also seizures and headache are usually reported as frequent neurological conditions. Migration medicine is a field of interest for the health care community.

The next talk was on Cerebrovascular disease in homeless city dwellers, a growing universal problem. Speaker was Thalia Field from Vancouver, Canada. Social determinants of health must be taken into account when treating stroke. Low socio economic level predicts the prognosis in manu conditions. Precarious housing is more frequent then expected. Leading to spec of pattern of infectious diseases exposure, mental health problerms etc etc. Traumatic brain injury TBI is more frequent in homeless subjects (and vice versa) . They are more vulnerable to assaults and injuries. She cited the hotel study 2008-2014 demonstrated on 371 subjects a high mortality around 18% and high rate of co-morbidities.The white matter abnormalities as well as brain atrophy were more severe in HOTEL study population respect to other controls. Specific project may reach population at risk to reduce harm.

The forth speech entitled, Income inequalities in stroke incidence and mortality, followed by Søren Paaske Johnsen (Denmark) socioeconomic problems leads to higher risks of stroke. Stroke mortality is decreasing but low-medium income countries had higher DALYs burden. What explain the disparities. ? The deprivation index may help understanding, a Uk study demonstrated in 2018 how most deprived citizens a 3 fold increase of cerebrovascular risk. Danish studies JaHa 2014 also showed how risk of stroke was associated with annual income irrespective from etnicity. Education is connected with employment as well as income. Poverty will reduce chances of education and employment. quality of care delivered is influenced by socioeconomic aspects. Still the gap is large according to a paper in press in stroke by Buus et Al found how low income is connected with lower chance of getting appropriate stroke treatment mostly for late arrival in the hospital. The urgent tasks to reduce the gap are stroke awareness campaign and social support to most fragile subjects.

The next speech was about Strategies to improve access to stroke care in rural and remote areas was given by Inna Lutsenko from Kyrgyzstan. She opened with the key processes involved from initial assessment and rapid transport issues. The notification to the EMS system may be delayed. The income of the country may influence the quality of EMS. Not all countries have access to stroke therapy. Acute stroke ready hospitals must be implemented with algorithms to simplify decision making process. Telemedicine may fill the gap from rural areas and comprehensive stroke centers. Rural communities with low population density face limited local resources.Central Asia distribution of stroke services was discussed, reporting large variability. Data from a survey showed around 7 hrs vs 44 hrs as onset to door time for stroke patients in suburban vs rural areas. Specific education programmes were undertaken for the population and paramedical personnel leading to an improvement of the decision process. The survey also showed statistical significant shortening of the hospital arrival of patients were observed. Involving all the stakeholders (medical, paramedic, population) together with telemedicine will reduce the gap and reduce stroke burden.

The last talk was on Stroke Care in unprecedented times: taking care of patients and health-workers in conflict zones and emergency settings from Francesca R. Pezzella from Rome (Italy.) A complex mechanisms underlies health care in emergencies. From earthquakes to war and pandemics in large parts of the planet compromises access to stroke care. Access to hospital beds may be compromised by above mentioned conditions. Also treatment chances may be compromised by emergency settings. In absence of emergency plans improvisation is the rule. The latest threat in Europe is a conflict In literature data on non communicable diseases NCD in emergencies are limited. Impact of war in Ukraine may help understanding effects on stroke care. The first 30-90 days the focus is according to available data on life threatening conditions. The second phase called “continuing the response” the later chronic reaction to ensure access to other diseases. Stroke needs to be included in emergency preparedness plans.