New scheme sav­ing lives of stroke pa­tients in Iran

Tehran Times - - HEALTH -

TEHRAN — Some 23 thou­sand peo­ple have been saved from stroke by a scheme ti­tled “724”, a na­tional health plan start­ing from Au­gust 2016 to con­trol and treat stroke pa­tients at 54 care cen­ters, ISNA re­ported on Satur­day.

The 7-day, 24-hour plan has been im­ple­mented by a col­lab­o­ra­tion among Health Min­istry, Emer­gency Care Ser­vice, and in­surance or­ga­ni­za­tions. It con­tains “Sama Code” which ex­pe­dites the process of iden­ti­fy­ing stroke pa­tients as well as trans­fer­ring them to hos­pi­tals and treat­ing them.

Brain stroke is the sec­ond lead­ing cause of death and dis­abil­ity in adults in Iran; how­ever, as a non­com­mu­ni­ca­ble dis­ease, it can be pre­vented by chang­ing life­style and pick­ing up a healthy diet.

Stroke: the sec­ond cause of death

Dr. Ma­soud Mehrpour, the di­rec­tor of

“724” Na­tional Acute Stroke Treat­ment Plan says the in­ci­dence of stroke and its death rate has been in­creas­ing rapidly.

“15 years ago, acute stroke was the third lead­ing cause of death in the world, but now it has be­come the sec­ond cause, and it is pre­dicted that the num­ber of vic­itims will keep ris­ing,” said Mehrpour in an in­ter­view with ISNA.

“West­ern coun­tries have come up with new plans and treat­ments to re­duce stroke vic­tims. Now, stroke has de­clined from the sec­ond to 5th po­si­tion among death causes in de­vel­oped coun­tries, but it has moved up to the sec­ond po­si­tion in de­vel­op­ing coun­tries,” he said.

“In Iran, there are 150,000 to 200,000 strokes per year, one fourth of which oc­curs in peo­ple un­der 55, that is an alarm­ing con­di­tion but un­for­tu­nately there isn’t enough aware­ness about stroke among peo­ple,” he said.

”724” scheme: key to treat acute stroke

The in­creased in­ci­dence of stroke was the main cause for devel­op­ment of “724” na­tional plan, Mehrpour said, adding, the scheme was de­vised fol­low­ing the “247” plan which was tar­geted at heart dis­eases and was part of an ini­tia­tive to fight non­com­mu­ni­ca­ble dis­eases.

“Luck­ily, com­mu­ni­ca­ble dis­eases have been ma­jorly con­trolled, but non-com­mu­ni­ca­ble dis­eases are gain­ing weight and need ur­gent at­ten­tion,” said Mehrpour.

“There are two ma­jor kinds of stroke, is­chemic and hem­or­rhagic. In an is­chemic stroke a blood ves­sel be­comes blocked, usu­ally by a blood clot and a por­tion of the brain be­comes de­prived of oxy­gen and will stop func­tion­ing. Is­chemic strokes ac­count for 80% of all strokes.

A hem­or­rhagic stroke oc­curs when a blood ves­sel that car­ries oxy­gen and nu­tri­ents to the brain burst and spills blood into the brain. When this hap­pens, a por­tion of the brain be­comes de­prived of oxy­gen and will stop func­tion­ing. Hem­or­rhagic stroke ac­counts for about 20% of strokes,” he said.

The “724” plan, he added, was de­vised for treat­ment of the is­chemic stroke which is more preva­lent.

Col­lab­o­ra­tion by Health Min­istry, in­surance and Emer­gency Care Ser­vice

“Fol­low­ing to con­sul­ta­tions be­tween Health Min­istry and in­surance com­pa­nies, drugs for treat­ment of acute stroke are now cov­ered by in­surance and are avail­able to the pa­tients,” said Mehrpour.

“An­other prob­lem is that there is a short win­dow of time for treat­ing stroke pa­tients, as they need to get proper treat­ment within 3 to 4 hours af­ter be­ing ad­mit­ted, so as part of the plan, we ne­go­ti­ated with Emer­gency Care Ser­vice to pro­vide the staff with proper train­ing,” he added.

“Sama”, the sav­ing code

“Sama code was cre­ated specif­i­cally for stroke pa­tients. When this code is ac­ti­vated, the pa­tients are di­rectly sent to the hos­pi­tals with proper fa­cil­i­ties for stroke pa­tients, so that no time is lost for their treat­ment,” said Mehrpur.

“Cur­rently, 54 cen­ters around the coun­try in­clud­ing 8 clin­i­cal-aca­demic cen­ters in Tehran pro­vide treat­ment for stroke pa­tients,” he said.

The fi­nal goal, how­ever, he added, is to in­crease these num­bers so that there would be one hos­pi­tal with proper equip­ment in ev­ery city with more than 300,000 pop­u­la­tion.

Mod­ern am­bu­lances dou­ble the chances of sav­ing stroke pa­tients

“As time is the key fac­tor in treat­ing stroke pa­tients, we have used air am­bu­lances to pro­vide care in re­mote ar­eas as well,” said Mehrpour.

In some coun­tries, he added, there are now am­bu­lances equipped with CT scan­ner for rapid stroke treat­ment. The pri­mary func­tion of these am­bu­lances is to al­low the medics to per­form a CT scan on the pa­tient at the scene.

He said, “We are aim­ing to have these am­bu­lances in Iran as well, but we haven’t suc­ceeded yet.”

This is im­por­tant, he said, be­cause they will re­duce care time by half which is crit­i­cal in cities with heavy traf­fic such as Tehran.

Mo­ments that save lives

Ac­cord­ing to Mehrpour, re­duc­ing the trans­fer time to the hos­pi­tal is a key part of “724” scheme as many stroke pa­tients don’t get to the care cen­ters on time.

Sur­veys show that ev­ery ex­tra minute in trans­fer­ring such pa­tients to the hos­pi­tal pro­longs the re­cov­ery process by days, said Mehrpour.

Ac­cord­ing to him, 90% of pa­tients who ar­rive at the care cen­ters on time re­ceive proper treat­ment, but the av­er­age rate of stroke pa­tients’ treat­ment stands at around 8%.

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