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Selected and basic indicators of acute ischaemic stroke care in Poland are reported cross-regionally based on the analysis of claims data of the National Health Fund (NFZ) in 2017, the most reliable source of healthcare funding in the country, being a single public payer. For research purposes, a selection algorithm based on the diagnosis coded as I63 according to the International Classification of Diseases (ICD-10) was used to identify all ischaemic stroke patients in the claims database provided by the NFZ. Stroke units and other centres providing treatment for acute ischaemic stroke patients were examined. The analysis showed marked differences between provinces in terms of stroke unit treatment availability. The crude and standardised rates of acute ischaemic stroke admissions to stroke units varied between provinces. Moreover, substantial differences were observed for the thrombolysis implementation rate, access to rehabilitation, hospital stay and early prognosis. As the leading cause of disability and the second leading cause of death in developed countries, stroke requires a well-organised, evidence-based healthcare system provided for both acute treatment and rehabilitation. Continuous monitoring of healthcare is crucial to identify weaknesses and areas for improvement.

Aim of study. The Fluoxetine Or Control Under Supervision (FOCUS)-Poland trial tested in a Polish cohort the hypothesis that fluoxetine improves recovery after stroke. Clinical rationale for study. Some studies have suggested that fluoxetine may improve functional outcomes after stroke, but these results needed confirmation. Between 2012 and 2014, large clinical trials were initiated by the FOCUS Trial Collaboration. Recently, results from the UK, Sweden, Australia, New Zealand and Vietnam have been published. We here present the results of the FOCUS trial conducted in Poland. Material and methods. This was a randomised, double-blind, placebo-controlled study based on the FOCUS trial protocol. Patients who had a persisting neurological deficit were randomly assigned 2-15 days after stroke onset to receive for six months either fluoxetine 20 mg/day or a placebo. The primary outcome was functional status measured using the modified Rankin Scale (mRS) at six months after randomisation. Functional status at 12 months was also assessed, as was neurological deficit at six and 12 months. Data was also collected on adverse events. Results. Between 19 December 2014 and 13 March 2018, 30 patients were given fluoxetine and 31 were given a placebo. For the primary outcome, the distribution across mRS categories was similar for the fluoxetine and placebo groups at six months (common odds ratio 0.88; 95% confidence interval 0.31–2.50; p = 0.81), and there was no difference at 12 months (p = 0.864). There were no differences between groups in stroke recovery or in motor function recovery of the affected hand. There were no significant differences in any other secondary outcomes at six or 12 months. Patients given fluoxetine were less likely than those given the placebo to receive new antidepressant medication within six months (2 [6.67%] vs. 4 [12.90%]). Conclusions and clinical implications. Consistent with other trials based on the FOCUS protocol, fluoxetine did not improve motor recovery or general stroke outcome at six and 12 months in the Polish cohort studied. However, patients receiving fluoxetine required therapy with additional antidepressant medication less frequently.

Background and purpose Haemorrhagic stroke is associated with substantial mortality and disability, thus prevention and appropriate treatment of acute intracerebral haemorrhage is crucial. We aimed to evaluate the use and the early and late outcomes impact of drugs administered before and in acute haemorrhagic stroke in a real-world practice. Material and methods Haemorrhagic stroke patients hospitalized between 1 st March 2007 and 29 th February 2008 and reported in Polish Hospital Stroke Registry were analysed. Fully anonymous data were collected with standardized, authorized access, web-based questionnaire. Multivariate regression models were used to adjust for case-mix and evaluate the impact of drugs used prior to or in acute haemorrhagic stroke on outcomes. The early outcomes were defined as in-hospital mortality or poor outcome (death or dependency – modified Rankin Scale ≥ 3) at hospital discharge, while late outcomes covered one-year survival. Results A total of 3111 haemorrhagic stroke patients (mean age: 68.9 years; females: 46.7%) was reported. The analysis of pharmacotherapy showed low preventive use of hypotensive agents in hypertensive patients, high consumption of antibiotics and still overuse of vasoactive or neuroprotective compounds in acute haemorrhagic stroke. Regression models confirmed expected negative impact on stroke outcomes associated with oral anticoagulants but not antiplatelets and inconsistent impact of statins used prior to or in acute haemorrhagic stroke. Conclusions Preventive underuse of hypotensive compounds contribute substantially to haemorrhagic stroke risk. The high consumption of antibiotics and neuroprotective or vasoactive compounds in haemorrhagic acute stroke reflect the need to improved quality and evidence-based clinical practice.

Background and purpose Disparities in resources, access to the expertise and healthcare providers both at hospital and before admission, or patients’ awareness of stroke symptoms can cause differences in weekend and weekday stroke severity and prognosis. The aim of the study was to explore differences in baseline characteristics and outcomes of ischaemic stroke patients admitted on weekdays and weekends. Material and methods A questionnaire based on the WHO Step Stroke and Swedish Stroke Registry was used to collect data on patients admitted to centres participating in the POLKARD Hospital Stroke Registry between June 1 st , 2004 and May 31 st , 2005. To ensure the quality, only centres reporting at least 100 patients were analysed. Clinical characteristics and early outcomes (death rate and poor outcome defined as modified Rankin scale score of 3 or above) were compared between patients admitted on weekdays and weekends. Results A total of 19667 ischaemic stroke patients, including 5924 admitted during weekends, were reported by 72 stroke centres. Weekend patients were older, more often disabled prior to stroke and more commonly presented with atrial fibrillation and coronary heart disease. Weekend patients were more likely to present consciousness disturbances at admission. More patients admitted on weekends died during hospitalization or had poor outcome at discharge than weekday patients (15.9% and 59.8% vs. 14.1% and 55.3%, respectively). After adjusting for baseline severity of stroke and case-mix, the regression model showed that weekend ischaemic stroke patients had worse prognosis (odds of 1.137 and 1.147 for death and poor outcome, respectively). Conclusions Admissions on weekends are associated with higher mortality and poor outcome, and that can be only partially explained by differences in baseline characteristics of admitted patients.

Haemorrhagic stroke is associated with substantial mortality and disability, thus prevention and appropriate treatment of acute intracerebral haemorrhage is crucial. We aimed to evaluate the use and the early and late outcomes impact of drugs administered before and in acute haemorrhagic stroke in a real-world practice.Haemorrhagic stroke patients hospitalized between 1st March 2007 and 29th February 2008 and reported in Polish Hospital Stroke Registry were analysed. Fully anonymous data were collected with standardized, authorized access, web-based questionnaire. Multivariate regression models were used to adjust for case-mix and evaluate the impact of drugs used prior to or in acute haemorrhagic stroke on outcomes. The early outcomes were defined as in-hospital mortality or poor outcome (death or dependency - modified Rankin Scale  3) at hospital discharge, while late outcomes covered one-year survival.A total of 3111 haemorrhagic stroke patients (mean age: 68.9 years; females: 46.7%) was reported. The analysis of pharmacotherapy showed low preventive use of hypotensive agents in hypertensive patients, high consumption of antibiotics and still overuse of vasoactive or neuroprotective compounds in acute haemorrhagic stroke. Regression models confirmed expected negative impact on stroke outcomes associated with oral anticoagulants but not antiplatelets and inconsistent impact of statins used prior to or in acute haemorrhagic stroke.Preventive underuse of hypotensive compounds contribute substantially to haemorrhagic stroke risk. The high consumption of antibiotics and neuroprotective or vasoactive compounds in haemorrhagic acute stroke reflect the need to improved quality and evidence-based clinical practice.

Background and purpose According to official statistics, the stroke mortality rate has remained high in Eastern European countries for a few decades. It has been shown that also in Poland stroke mortality failed to decline in the period 1984 to 1992. Since that time, stroke management in our country has changed, especially in the cities, where stroke units have been developed. The aim of the present study was to compare incidence and case fatality rates, estimated on the basis of two prospective population-based studies performed in Warsaw in 1991/1992 and 2005. Material and methods Incidence rates and case fatality rates for the first-ever-in-a-lifetime stroke have been estimated on the basis of two population-based studies: the Warsaw Stroke Registry (population 182 649) conducted in 1991 and 1992, and the European Register of Stroke (population 120 186) – registration in 2005. In both studies data were standardized to the European population by the direct methods. Results Contrary to the incidence rates, which did not change significantly between 1991/1992 and 2005, 30-day and 1-year case fatality rates decreased significantly from 43% to 14.9% and from 59.7% to 33.1%, respectively. Conclusions Comparison of data from two population-based prospective stroke registries showed that stroke case fatality and mortality significantly decreased. This may be associated with the better management of patients in the acute phase of stroke and implementation of secondary prevention strategies for stroke.

Thrombolysis for acute ischaemic stoke was introduced and licensed in Poland in 2003. The aim of the study was to assess the potential eligibility of patients for intravenous recombinant tissue plasminogen activator (rt-PA). We also investigated whether widespread information about stroke and organisational changes in the 2nd Department of Neurology influenced eligibility and the number of treated patients.An analysis of the 2nd Department of Neurology of the Institute of Psychiatry and Neurology database of stroke patients admitted in the years 1995-2003 and 2003-2005 was performed. Eligibility for rt-PA treatment was assessed using the criteria outlined by the SITS (Safe Implementation of Thrombolysis in Stroke) protocol. The number of patients eligible for thrombolysis was estimated and then compared with the number of treated patients.A total of 1541 patients with ischaemic stroke were admitted between 1 June 1995 and 1 November 2003, 18.7% within 2 hours of onset, 78% aged under 80. 4.6% of patients were found eligible for rt-PA. 552 ischaemic stroke patients were admitted between 1 November 2003 and 30 September 2005, 19.2% within 2 hours from onset, 71.6% under 80 years old. 6.9% were eligible for rt-PA, and 8.6% were treated.Age and time from onset to admission were the most common exclusion criteria. The number of actually treated patients was higher than estimated. After providing the information about stroke symptoms there was a trend in decreasing time from onset to admission. Organizational changes increased the number of treated patients.