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

Stroke and Health Policy in France International recommendations on : Stroke Unit Fibrinolysis with rt-pa ( 2003)  1st national recommendations for : Use of rt-pa November 2003  2nd : March 2007

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

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

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

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

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

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

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

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

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

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

Case-fatality rates at 1 year in Dijon for 25 years (Béjot et al Case-fatality rates at 1 year in Dijon for 25 years (Béjot et al. CVD 2010) 1985 1990 2000 2010 26 % 24 % 21 % 16 %

Vascular risk factors - stable VRF :

- moving VRF

Trends of preventive treatments for 20 years

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)

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