The National Health Policy on stroke in France Pr Maurice GIROUD Stroke Registry of Dijon ( 1985)...
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Transcript of The National Health Policy on stroke in France Pr Maurice GIROUD Stroke Registry of Dijon ( 1985)...
The National Health Policy on stroke
in France
Pr Maurice GIROUDStroke Registry of Dijon ( 1985)
President of the Council of National Institute of Health Survey (2005)
Member of the Council of the National Stroke Projet(2009)
MG 05.11.10
Stroke and Health Policy in France
International recommendations on :• Stroke Unit• Fibrinolysis with rt-pa ( 2003)
1st national recommendations for :• Stroke Unit• Use of rt-pa• November 2003
2nd : March 2007
Evaluation
Slow development
National Plan on Stroke Care. March 2010
Objectives
142 Stroke Units for 60 millions of inhabitants
Fibrinolysis for 5 % of cerebral infarcts
Financial aid :
- 6 500 Euros per stroke / 15 days
- 450 Euros per stroke
per day
in SU
5
90 UNV Début 2010
AntillesFort de France 1Pointe à Pitre 1
Réunion St Denis 1 Bayonne
Bordeaux
Clermont F
Caen
Cherbourg
Saint Lô
Chalon
Dijon
St Brieuc St Malo
Rennes
Brest
LorientVannes Orléans
Bourges
Tours
Dreux
Reims
Besançon
Belfort
RouenLe Havre
Limoges
Perpignan
ToulouseAuch
MontaubanAlbi
Montpellier
Nîmes
Carcassonne
Toulon
Nice
Marseille
Freyming
Nancy
l
Nantes
Angers
Amiens St Quentin
Beauvais
Creil
Compiègne
Soissons
La Rochelle
Poitiers
Bourg
Lyon
Grenoble
Chambéry
AnnecyVillefranche
Haguenau
Strasbourg
Colmar
Mulhouse
DunkerqueLille
Roubaix
Tourcoing
CalaisBoulogne
ValenciennesBéthune Lens
Valence
ESCHU
PrivéArmées
Rodez
F Woimant
Results
6
UNV prévues142 UNV en 2011
AntillesFort de France 1Pointe à Pitre 1
Réunion St Denis 1St Pierre prévue
PauBayonne
PérigueuxBordeaux
AgenLibourne
Dax
Aurillac
Clermont F
Montluçon
Vichy
Caen
Cherbourg
Saint Lô
Avranches
Chalon
Macon
Dijon
St Brieuc St Malo
Rennes
Brest
Quimper LorientVannes
Pontivy
Orléans
Bourges
Chartres
Châteauroux
Tours
Dreux
Charleville
Reims
Troyes
Besançon
Belfort
RouenLe Havre
Limoges
Brive
Perpignan
Toulouse
Rodez
Tarbes
Auch
Cahors
MontaubanAlbi
Montpellier
Nîmes
CarcassonneBéziers
Lons le Saunier
Toulon
Nice
Marseille
Aix
Avignon
FreymingThionville
Metz
Nancy
Epinal
Nantes
La Roche sur Yon
AngersLaval Le Mans
Amiens St Quentin
Beauvais
Creil
Compiègne
Soissons
AngoulêmeLa Rochelle
Poitiers
Niort Bourg
Lyon
St Etienne Grenoble
ChambéryAnnecy
Villefranche
VienneRomans
Haguenau
Strasbourg
Colmar
Mulhouse
DunkerqueLille
Roubaix
CalaisBoulogne
ValenciennesMaubeuge
Béthune Lens
Valence
Montélimar
Dole
Metz
Verdun
UNV reconnues
UNV prévues
Vesoul
F Woimant
Number of fibrinolysis (2009) :the Top 4
- 155 per year = Lyon
- 127 per year = Toulouse
- 124 per year = Marseille
- 102 per year = Dijon
- 87 per year = Bordeaux
- 83 per year = Montpellier
Distribution of stroke management
Public hospital = 92 % (80 % in 1985)
Private Hospital = 5 % (13%)
Home = 3 %.(7%)
Dijon (1985-2004) : 20 years
Trends of incidence rates
Large artery infarct
lacunes
Cardio-embolic
Cerebral hemorrhage
SAH
0
50
100
150
200
250
300
1985 1990 1995 2000 2004
Auckland (p < 0.05)
Oxford (p < 0.05)
Dijon (NS)
Auckland. Stroke. 2005Oxford. Lancet. 2004Dijon. Stroke. 2006
International trends on incidence rates
Increase of hope of life without any stroke
Oxford : + 1 year NS
Soderham : + 3 years p < 0.01
Auckland : + 3 years p < 0.001
Dijon : + 5 years men p < 0.001
+ 8 years women p < 0.001
Stroke and cardiac - Infarct in Dijon (2001-2007) (A. Gentil. CVD 2009)
Case-fatality rates at 1 year in Dijon for 25 years(Béjot et al. CVD 2010)
1985 1990 2000 2010
26 % 24 % 21 % 16 %
Vascular risk factors
- stable VRF :
65% 64%
48%52%
22% 23%25%
22%
12% 10%
0%
10%
20%
30%
40%
50%
60%
70%
HTA TAS >= 180 FA TIA MI
1985
2004
- moving VRF
11%
28%
10%
17%
37%
25%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Cholestérol Diabetes Tobacco
1985
2004
Trends of preventive treatments for 20 years
47% 49%
5%
27%
3%
8%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Anti-HTA Anti-agrégants Anti-coagulants
1985
2004
Perspectives
To allow to the non-neurologists (emergency doctors) to practice fibrinolysis
With a specific training for fibrinolysis (Licence for Fibrinolysis)
And control with Tele-Stroke-Medecine from the regional SU (order of October 2010)
Conclusion
A Stroke National Health Policy is able to improve the management of patients with stroke
The efficacy of this policy :
- of mortality rate
- rt-pa use
- SU
Ref. : Y.Béjot et al. Cerebrovascular Disease.2010