The National Health Policy on stroke in France

1. The National Health Policy on stroke in France Pr Maurice GIROUD Stroke 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

2. 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

3. Evaluation • Slow development  National Plan on Stroke Care. March 2010

4. 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. Dunkerque 90 UNV Début 2010 Calais Roubaix Lille Boulogne Tourcoing Lens Béthune Valenciennes Results Amiens Cherbourg St Quentin Rouen Le Havre Beauvais Compiègne Saint Lô Caen Soissons Freyming Creil Reims Haguenau Brest St Brieuc St Malo Strasbourg Dreux Nancy Rennes l Colmar Vannes Orléans Lorient Belfort Angers Dijon Mulhouse Nantes Tours Besançon Chalon ES Poitiers Bourges CHU Bourg Privé Villefranche Annecy La Rochelle Limoges Armées Lyon Chambéry Clermont F Grenoble Bordeaux Antilles Fort de France 1 Pointe à Pitre 1 Réunion St Denis 1 Valence Rodez Montauban Albi Nîmes Auch Toulouse Nice Montpellier Toulon Bayonne Marseille Carcassonne Perpignan F Woimant 5

6. Dunkerque UNV prévues 142 UNV en 2011 Calais Lille Boulogne Roubaix Lens Béthune Valenciennes Maubeuge Amiens Cherbourg St Quentin Le Havre Charleville Compiègne Rouen Saint Lô Beauvais Thionville Soissons Verdun Caen Freyming Reims Avranches Creil Haguenau Metz Metz Brest St Brieuc St Malo Strasbourg Dreux Nancy Pontivy Troyes Rennes Chartres Epinal Colmar Vannes Laval Orléans Vesoul Quimper Le Mans Lorient Belfort Angers Dijon Mulhouse Nantes Tours Dole Besançon Chalon Châteauroux Poitiers Bourges Lons le Saunier La Roche sur Yon Macon Montluçon Niort Bourg Vichy UNV reconnues Villefranche La Rochelle Angoulême Annecy Limoges Lyon UNV prévues Chambéry Clermont F Grenoble Brive St Etienne Bordeaux Périgueux Aurillac Vienne Antilles Fort de France 1 Pointe à Pitre 1 Réunion St Denis 1 St Pierre prévue Romans Libourne Valence Cahors Agen Rodez Montélimar Montauban Avignon Albi Nîmes Auch Dax Aix Toulouse Nice Montpellier Pau Toulon Bayonne Béziers Marseille Tarbes Carcassonne Perpignan 6 F Woimant

7. 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

8. Distribution of stroke management • Public hospital = 92 % (80 % in 1985) • Private Hospital = 5 % (13%) • Home = 3 %.(7%)

9. Trends of incidence rates Large artery infarct lacunes Cardio-embolic Cerebral hemorrhage SAH Dijon (1985-2004) : 20 years

10. International trends on incidence rates Auckland. Stroke. 2005 Oxford. Lancet. 2004 Dijon. Stroke. 2006

11. 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

12. Stroke and cardiac - Infarct in Dijon (2001-2007) (A. Gentil. CVD 2009)

13. Case-fatality rates at 1 year in Dijon for 25 years(Béjot et al. CVD 2010)

15. Vascular risk factors - stable VRF :

16. - moving VRF

17. Trends of preventive treatments for 20 years

18. 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)

19. 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