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. 2021 Oct 1:12:743732.
doi: 10.3389/fneur.2021.743732. eCollection 2021.

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

Sheila Cristina Ouriques Martins  1   2   3   4 , Pablo Lavados  5 , Thaís Leite Secchi  1   2   3 , Michael Brainin  4   6 , Sebastian Ameriso  7 , Fernando Gongora-Rivera  8   9   10 , Claudio Sacks  11 , Carlos Cantú-Brito  12 , Tony Fabian Alvarez Guzman  13   14 , Germán Enrique Pérez-Romero  14   15   16 , Mario Muñoz Collazos  17 , Miguel A Barboza  18 , Antonio Arauz  19 , Carlos Abanto Argomedo  20 , Nelson Novarro-Escudero  21 , Hector Ignacio Amorin Costabile  22 , Roberto Crosa  23 , Claudia Camejo  24 , Ricardo Mernes  25 , Nelson Maldonado  26 , Daissy Liliana Mora Cuervo  1   3 , Octávio Marques Pontes Neto  3   27   28 , Gisele Sampaio Silva  3   29   30   31 , Leonardo Augusto Carbonera  1   3 , Ana Claudia de Souza  1   3 , Eduardo David Gomes de Sousa  32 , Alan Flores  25 , Donoban Melgarejo  25   26 , Irving R Santos Carquin  33   34   35 , Arnold Hoppe  5   36 , João José Freitas de Carvalho  29   37 , Francisco Mont'Alverne  36   38 , Pablo Amaya  8   14   39 , Hernan Bayona  14   40 , Victor Hugo Navia González  36 , Juan Carlos Duran  41 , Victor C Urrutia  42 , Denizar Vianna Araujo  32   43 , Valery L Feigin  44 , Raul G Nogueira  45
Affiliations

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

Sheila Cristina Ouriques Martins et al. Front Neurol. .

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.

Keywords: Latin America; stroke; stroke centers; stroke system of care; stroke units.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Map showing Latin American Countries.
Figure 2
Figure 2
Who pays for intravenous thrombolysis?
Figure 3
Figure 3
Who pays for mechanical thrombectomy?
See this image and copyright information in PMC

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