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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.

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Présentation au sujet: "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."— Transcription de la présentation:

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

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  2 nd : 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 : Euros per stroke / 15 days Euros per stroke per day in SU

5 5 90 UNV Début 2010 Antilles Fort de France 1 Pointe à Pitre 1 Réunion St Denis 1 Bayonne Bordeaux Clermont F Caen Cherbourg Saint Lô Chalon Dijon St Brieuc St Malo Rennes Brest Lorient VannesOrléans Bourges Tours Dreux Reims Besançon Belfort Rouen Le Havre Limoges Perpignan Toulouse Auch Montauban Albi 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 Annecy Villefranche Haguenau Strasbourg Colmar Mulhouse Dunkerque Lille Roubaix Tourcoing Calais Boulogne Valenciennes Béthune Lens Valence ES CHU Privé Armées Rodez F Woimant Results

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

7 Number of fibrinolysis ( 2009 ) :the Top per year = Lyon per year = Toulouse per year = Marseille 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 Dijon ( ) : 20 years Trends of incidence rates Large artery infarct lacunes Cardio-embolic Cerebral hemorrhage SAH

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

11 Increase of hope of life without any stroke Oxford : + 1 yearNS Soderham : + 3 years p < 0.01 Auckland : + 3 yearsp < Dijon : + 5 years menp < years womenp < 0.001

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

13 Case-fatality rates at 1 year in Dijon for 25 years (Béjot et al. CVD 2010) %24 %21 %16 %

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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

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