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Number of acute ischemic stroke patients thrombolyzed during the time frame 2007-2014.
Source publication
Background:
Qatar is located on the northeastern coast of the Arabian Peninsula. The total population is over 2.1 million with around 15% being Qatari citizens. Hamad General Hospital (HGH) is the only tertiary referral governmental hospital in Qatar which admits acute (thrombolysis-eligible) stroke patients.
Objective:
To provide an overview of...
Contexts in source publication
Context 1
... to boost stroke awareness and care have been launched in early 2007, resulting in an increasing number of ischemic stroke patients being thrombolyzed (Fig 1). Although there is an efficient Emergency Medical Ser- vices (EMS) service, state-of-the-art neuroimaging equipment, and treatment free of charge for patients ad- mitted through the emergency department in all governmental hospitals, treating stroke patients remains a challenge. ...
Context 2
... the Arabian Peninsula, the thrombolysis rates for acute ischemic stroke were less than 1% before 2010. 21 However, the creation of a stroke task force at HGH has led to an exponential increase in the number of patients receiving thrombolysis over the past years (Fig 1). In 2012, 6% of patients with ischemic stroke received thromboly- sis, a number that increased to 9% in 2014. ...
Citations
... In Qatar, the rate is around 3.2%, which is higher than the international rate. This is related to the country's policy where care is free for all [38]. ...
Background: Stroke is a major cause of death and disability worldwide and presents a significant burden on healthcare systems. This retrospective study aims to analyze the characteristics and outcomes of stroke patients admitted to Hamad General Hospital (HGH) stroke service in Qatar from January 2014 to July 2022. Methods: The medical records of 15,859 patients admitted during the study period were analyzed. The data collected included patient demographics, stroke types, admission location, procedures performed, mortality rates, and other clinical characteristics. Results: Of the total cohort, 70.9% were diagnosed with a stroke, and 29.1% were diagnosed with stroke mimics. Of the stroke patients, 85.3% had an ischemic stroke, and 14.7% had a hemorrhagic stroke. Male patients below 65 years old (80.2%) and of South Asian ethnicity (44.6%) were the most affected. The mortality rate was 4.6%, significantly higher for hemorrhagic stroke than ischemic stroke (12.6% vs. 3.2%). Female patients had a higher stroke-related mortality rate than male patients (6.8% vs. 4%). The thrombolysis rate was 9.5%, and the thrombectomy rate was 3.4% of the ischemic stroke cohort. The mean door-to-needle time for thrombolysis was 61.2 minutes, and the mean door-to-groin time for thrombectomy was 170 minutes. Stroke outcomes were good, with 59.3% of patients having favorable outcomes upon discharge (mRS ≤2), which improved to 68.2% 90 days after discharge. Conclusion: This study provides valuable insights into stroke characteristics and outcomes in Qatar. The findings suggest that stroke mortality rates are low, and favorable long-term disability outcomes are achievable. However, the study identified a higher stroke-related mortality rate among female patients and areas for improvement in thrombolysis and thrombectomy time.
... While several studies investigated the epidemiology and burden of stroke in the countries located in this region [12,13,[15][16][17][18], no study was found to comprehensively evaluate the age-standardized attributable burden to all stroke subtypes and their risk factors, making it difficult to monitor the effectiveness of health interventions to achieve the SDG 3.4 target: "by 2030 reduce by one third [relative to 2015 levels] premature mortality from noncommunicable diseases (NCDs) through prevention and treatment and promote mental health and well-being" [7]. ...
Background
While several studies investigated the epidemiology and burden of stroke in the North Africa and Middle East region, no study has comprehensively evaluated the age-standardized attributable burden to all stroke subtypes and their risk factors yet.
Objective
The aim of the present study is to explore the regional distribution of the burden of stroke, including ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage, and the attributable burden to its risk factors in 2019 among the 21 countries of North Africa and Middle East super-region.
Methods
The data of the Global Burden of Disease Study (GBD) 2019 on stroke incidence, prevalence, death, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs) rates, and attributed deaths, DALYs, YLLs, and YLDs to stroke risk factors were used for the present study.
Results
The age-standardized deaths, DALYs, and YLLs rates were diminished statistically significant by 27.8, 32.0, and 35.1% from 1990 to 2019, respectively. Attributed deaths, DALYs, and YLLs to stroke risk factors, including high systolic blood pressure, high body-mass index, and high fasting plasma glucose shrank statistically significant by 24.9, 25.8, and 28.8%, respectively.
Conclusion
While the age-standardized stroke burden has reduced during these 30 years, it is still a concerning issue due to its increased burden in all-age numbers. Well-developed primary prevention, timely diagnosis and management of the stroke and its risk factors might be appreciated for further decreasing the burden of stroke and its risk factors and reaching Sustainable Development Goal 3.4 target for reducing premature mortality from non-communicable diseases.
... Qatar's population and age at stroke presentation in Qatar are younger than those in European and North American countries (9,10). The indigenous population has undergone signi cant changes such as urbanization, increasing tobacco consumption, dietary changes, and sedentary lifestyle, contributing to an increased prevalence of vascular diseases (11)(12)(13)(14). The incidence of stroke in Qatar is relatively high compared to European and North American countries (10,12,15). ...
Background
Evaluation of public education stroke campaigns and behavioral studies to assess emergency response at stroke onset are scarce. We aimed to assess patient’s and bystanders’ foreknowledge of stroke signs and symptoms and their response at stroke onset. We also enquired if ‘Act FAST’ stroke campaign in Qatar contributed to their foreknowledge.
Methods
In Qatar, the first national stroke awareness campaign, ‘Act FAST’, was launched in May 2015. The study population included a convenience sample of stroke patients admitted to the stroke service in Qatar’s largest tertiary care hospital from November 2015-February 2016. We interviewed patients with acute onset stroke admitted to the stroke unit using a validated questionnaire. If the patient had disabling stroke, we interviewed relatives/bystanders present at stroke onset. The primary outcome was the correct response of calling Emergency Medical Services (EMS), recognizing the possibility of stroke.
Results
The questionnaire was administered to 165 participants, 142 (86.1%) stroke patients, and 23 (13.9%) bystanders. The mean age of the study population was 52.6 (SD = 11.7), and sex (male-female) ratio was 7:1. Ethnic categories were South-Asian (n = 101, 62.2%), Middle-Eastern (n = 14, 8.5%), Far-Eastern (n = 26, 15.8%), African (n = 16, 9.7%) and Others (n = 8, 4.9%). From the study group, 33 (20.1%) participants had foreknowledge of stroke signs and symptoms, and of these, 27 (16.5%) knew about the Act FAST campaign in Qatar. The behavioral responses of the participants (total n = 165) on stroke onset included; immediately activated EMS (n = 55, 33.3%), called friends/relatives (n = 69, 41.8%), drove to hospital (n = 33, 20%), decided to rest and waited for improvement in condition (n = 21, 12.7%), and 12 (7.3%) responded as none of the above. Of the participants who admitted having watched the Act FAST campaign, 92.6% (25/27) reported that the campaign affected their response to stroke onset. There was no association of ethnicity, marital status or FAST campaign awareness with behavioral response of EMS activation on stroke onset.
Conclusions
The foreknowledge of stroke signs and symptoms and the Act FAST campaign was low in the community. However, seeking help by activating EMS at stroke onset was generally high in the study population irrespective of the awareness to the campaign.
... In a prospective hospitalbased study from 1997, reported a higher incidence where 47 per100,000 with an overall stroke mortality of 16% [7]. Another retrospective population-based study by Ibrahim in 2015, undertook and reported a stroke incidence of 51.8 per 100,000 and a 30-day stroke mortality of 9.3% [9] Motor impairment was the predominant recognized impairment caused by stroke, which is known to restrict muscle movement or mobility function [14]. Most of the stroke patients experience walking difficulties, improving walking function and gait pattern is one of the main goals of rehabilitation [15]. ...
Objective: To evaluate the effectiveness of robotic-assisted gait training (RAGT) in improving the functional outcomes among stroke survivors Design: Retrospective matched control study. Setting: Inpatients stroke unit, Qatar Rehabilitation Institute. Outcome Measures: The Functional Ambulation classification (FAC), The Functional independence measure (FIM), The Berg Balance Scale (BBS), The Dynamic Gait index (DGI), The Ten-meter walk test (10MWT), The timed up and Go test (TUG) and the Five times sit to stand (5XSTS) Data Analysis: A retrospective comparison of stroke patients who received robotic assisted gait training performed statistically using the 20th version of SPSS statistical package (SPSS Inc. Chicago, IL, USA) Study Procedures: The investigators reviewed the medical records, the physiotherapy treatment sessions records and data from the Clinical Management System of Qatar rehabilitation institute of the patients during the period from 1stJanuary 2018 to 31 December 2019. RAGT group was created to assign the patients who received more than four RAGT sessions. The other group was created from the patients who completed the stroke rehabilitation program without RAGT to cross match Conclusion: All the outcome measures were compared between admission and discharge regardless of their group and found that there was a good improvement in the outcome and statistically significant (p value 0.0001) While comparing the lokomat and non lokomat group in functional outcome measurements lokomat group (RAGT) had significant improvement in discharge scores.
... In the united states of America, every 4 minutes someone dies because of stroke (2) . In Qatar, cardiovascular disease cause 15% of all death (4) . In sub-Saharan Africa, where it is going through an epidemiology transition, stroke, and other vascular diseases contribute even more to the morbidity of the disease (6) . ...
Stroke to this day is still a disease that causes a high disability. In the future, it will require a prohibitive cost so that it has an impact on the socio-economic consequences for patients and their families. The price is prohibitive so that the impact on socioeconomic implications for patients and their families. Because of that, the purpose of the study is to estimate the cause of the cost that causes an economic burden from a stroke. The method that is used is a content analysis by doing a further literature review from various sources, from journal to textbook from a national level to international. Literature studies show that direct medical cost, which is rehabilitation, and nursing care cost is identified as the leading contributor to the high price of economic burden from a stroke. High costs incurred cause family to experience catastrophic financial disaster; it even impacts to drop welfare level. Social preventive action is needed to reduce the high prevalence of stroke to reduce the cost, to protect every household from financial disaster from a stroke.
... Qatar is a peninsula that is located in the Northeastern boarder of the Arabian Peninsula and has a sole land border with Saudi Arabia [4,5]. It is an oil and gas rich country, but native Qataris represent only 15% of the total population [6]. Qatar is considered to be endemic with obesity, diabetes and cardiovascular disease [7]. ...
... Qatar is considered to be endemic with obesity, diabetes and cardiovascular disease [7]. Whilst the epidemiology of stroke in Qatar has been well documented [6,[8][9][10], most studies have focused on the entire population (a population of over 2.7 million) which is disproportionately represented by young able-bodied expatriates working in the country whereas the local Qatari population is only around 300,000. ...
... The demographics of the Qatari cohort presenting with stroke is different to previous reports which included predominantly expatriates. The Qataris in general are older, had a greater number of risk factors and higher prevalence of obesity, diabetes, dyslipidemia and higher prevalence of AF and large artery atherosclerosis compared [6,22] to non-Qataris. ...
Background:
Studies assessing the burden of stroke in Qataris are limited. We aim to study stroke in the Qatari population.
Methods:
A retrospective review was undertaken of all Qatari adults presenting with stroke to Hamad Medical Corporation over a 5-year period. Descriptive statistics were used to summarize demographic and all other clinical characteristics of the patients. The primary outcome was the incidence of stroke in the Qatari patients. Comparison was made between the sexes.
Results:
862 patients were included, with 58.9% being male. The average incidence of stroke over the 5-year period was 92.04 per 100,000 adult Qatari population. The mean age of the cohort was 64.3±14.4 years, (range 19-105 years). The mean age of first ever cerebrovascular event was 63.2±14.5 years. The diagnosis was ischemic stroke in (73.7%), transient ischemic attack in (13.8%), intracerebral hemorrhage (ICH) in (11.6%), subarachnoid hemorrhage in (0.7%) and (0.2%) cerebral venous sinus thrombosis. Small vessel disease was the most common cause of ischemic stroke accounting for (46.5%), followed by large artery atherosclerosis (24.5%). Hypertension (82.7%) and diabetes (71.6%) were particularly prevalent in this cohort. Females were older (65.8±14.1 vs 63.4±14.5 years), had more hypertension and diabetes and more disability or death at 90 days (p<0.05) compared to Qatari males.
Conclusion:
Stroke occurs at a significantly lower age in Qataris compared to the western population. This study has uncovered sex differences that need to be studied further.
... This has been supported by increased financing from health authorities and support from the European Stroke Organisation (ESO) Angels initiative but is still limited to university hospitals and centers with large urban catchment areas. [1][2][3][4][5] The SITS MENA network, created in 2013, is a non-profit academic collaboration of researchers who use the SITS Registry platform. Its goal is supporting the dissemination of evidence-based treatments in a region where stroke incidence is high and rising, as well as monitor the implementation and outcomes of acute stroke treatments in MENA. ...
... 7 Similarly, a study from Qatar showed that 79% of all stroke patients were male and that almost half of them were 50 years or less, which is in line with the present study population. 4 Despite comparable age and gender profiles in previous studies, it is important to mention that pre-or in-hospital patient selection could have resulted in younger male patients being treated with IVT, in the past and in the present study. ...
Abstract
Background and methods: Intravenous thrombolysis for acute ischemic stroke in the Middle-East and North African
(MENA) countries is still confined to the main urban and university hospitals. This was a prospective observational study
to examine outcomes of intravenous thrombolysis-treated stroke patients in the MENA region compared to the non-
MENA stroke cohort in the SITS International Registry.
Results: Of 32,160 patients with ischemic stroke registered using the SITS intravenous thrombolysis protocol between
June 2014 and May 2016, 500 (1.6%) were recruited in MENA. Compared to non-MENA (all p<0.001), median age in
MENA was 55 versus 73 years, NIH Stroke Scale score 12 versus 9, onset-to-treatment time 138 versus 155 min and
door-to-needle time 54 min versus 64 min. Hypertension was the most reported risk factor, but lower in MENA (51.7 vs.
69.7%). Diabetes was more frequent in MENA (28.5 vs. 20.8%) as well as smoking (20.8 vs. 15.9%). Hyperlipidemia was
less observed in MENA (17.6 vs. 29.3%). Functional independence (mRS 0–2) at seven days or discharge was similar (53%
vs. 52% in non-MENA), with mortality slightly lower in MENA (2.3% vs. 4.8%). SICH rates by SITS-MOST definition were
low (<1.4%) in both groups.
Conclusions: Intravenous thrombolysis patients in MENA were younger, had more severe strokes and more often
diabetes. Although stroke severity was higher in MENA, short-term functional independency and mortality were not
worse compared to non-MENA, which could partly be explained by younger age and shorter OTT in MENA. Decreasing
the burden of stroke in this young population should be prioritized.
Keywords
Ischemic stroke, hemorrhagic stroke, door-to-needle, door-to-imaging, burden of stroke
... 10 Although no official government data have been published, it has been estimated that Qatari nationals make up less than 15% of its total population. 11 Consequently, Qatar's population is relatively young and predominantly male. Despite Qatar's assignment by the UN as a high-income country, it is still recognised as a developing country due to its majority migrant population, and the fact that most of its wealth is concentrated with the minority Qataris. ...
... Out of 899 stroke admissions in Qatar in 2014, 81.5% were admitted in HGH. 11 In order to tackle the growing problem of stroke in developing countries, a better understanding of its existence is required. In this paper, we will review stroke in Qatar making reference to published epidemiological data regarding the dynamics of Qatar's stroke burden. ...
... In the Global Burden of Diseases, Injuries and Risk Factors 2010 (GBD 2010) study, a similarly low agestandardized incidence rate for ischaemic stroke in Qatar was estimated at 51.88 per 100,000 personyears in 2010, having risen from 46.52 per 100,000 person-years in 1990. 11,18,19 Bener et al. 20 performed a cohort study over a fiveyear period between 1999 and 2003, in which stroke patients were recruited at HGH. The average annual incidence calculated from this study was found to be even less at 11.7 per 100,000 of the population. ...
Background:
Qatar is located on the north-eastern coast of the Arabian Peninsula. Qatari natives account for less than 15% of the population while the largest migrant group comprising 60% derives from South Asia. Despite projections that stroke burden in Qatar will increase with population ageing, epidemiological studies focusing on stroke in Qatar are relatively scarce.
Method:
We reviewed the available epidemiological publications relating to Qatar. In addition, we have added to this knowledge by incorporating Qatari data from the on-going Bio-Repository of DNA in Stroke, an independent multinational database of stroke patients.
Results:
Qatar has low reported incidence and mortality rates of 58 and 9.17 per 100,000 per year, respectively, which may be explained by its middle-aged migrant worker majority population. Correspondingly, South Asian migrants in Qatar suffered younger strokes than Qatari natives (48.7 vs 63.4 years, P < 0.001). Among the most common risk factors identified in stroke patients were hypertension (77.9%), diabetes (43.8%) and hypercholesterolemia (28.5%). Ischaemic stroke was the most frequent subtype amongst migrant South Asians (71.1%). The majority of stroke cases had computed tomography and/or magnetic resonance imaging scans, but only 11.1% of ischaemic strokes were thrombolysed. Qataris on one-year follow up were more often found to have died (6.5% vs 0.3%) and had further stroke/transient ischaemic attack events (17.4% vs 6.4%, P = 0.009) compared to South Asians.
Conclusion:
The burden of stroke is increasing in Qatar, and considerable disparities are observed between the native and migrant populations which likely will require different approaches to management by its healthcare system.
... Approximately 1200 stroke patients are admitted to our Hospital every year (8). Each patient is registered prospectively in a "stroke database" with an ancillary section for interventional cases. ...
Background: Etiology of a large vessel occlusion is relevant in the management of acute ischemic stroke patients and often difficult to determine in the acute phase.
Aims: We aim to investigate whether the angiographic appearance of the occlusion is related to its etiology and outcome.
Materials and Methods: Patients without cervical carotid occlusions who underwent mechanical thrombectomy in our center from April 2015 to September 2018 were studied. Demographics, clinical and radiological variables and outcome measures, including etiological classification of stroke, were collected. Underlying intracranial atherosclerosis was estimated according to the presence of stenosis after recanalization. Patients were assigned to groups based on the appearance of the occlusion observed in the first angiogram as “tapered” or “non-tapered.” Differences were searched amongst them.
Results: 131 patients met inclusion criteria. 31 (23.6%) were “tapered” and 100 (76.3%) non-tapered. Tapered presented lower mean baseline NIHSS (10.3 ± 6.2 vs. 16.1 ± 7.2; p < 0.001), smaller acute infarct cores as CTP CBV ASPECTS (8.6 ± 1.6 vs. 7.2 ± 2.4; p = 0.003), higher proportion of instant re-occlusions (26.7 vs. 8.2%; p = 0.025), fewer complete recanalization (45.2 vs. 71.0%; p = 0.028), and more persistent occlusions (37.5 vs. 10.6%; p = 0.011) on follow up MRA. There were no differences in reperfusion rates (83.9 vs. 84.0%; p = 0.986) nor in good long term functional outcome (50.0 vs. 51.1%; p = 0.921). Intracranial atherosclerosis etiology was more common in tapered than in non-tapered occlusions (54.8 vs. 18.0%; p < 0.001).
Conclusion: The angiographic appearance of an occlusion in mechanical thrombectomy patients may determine its etiology, predict likelihood of successful recanalization, and risk of reocclusion.
... Qatar has one of the highest rates of diagnosed 7 and undiagnosed DM 8 in the world and a diverse expatriate community, making it a unique population to study the effect of DM on stroke outcomes. 9 We have undertaken a large prospective cohort study to assess the effect of DM on the type and severity of stroke, risk of immediate in-hospital complications, and 90-day recurrence of stroke and mortality in patients presenting with AIS. ...
Background: Stroke in diabetics may delay recovery and increases the risk of early recurrence of stroke. We compared the outcomes of patients (with and without diabetes) admitted with an acute ischemic stroke (AIS) in the state of Qatar. Patients and methods: We prospectively compared the clinical presentation, complications, discharge outcome, and stroke recurrence at 90 days in patients with and without diabetes. Results: Five thousand two hundred twenty-eight stroke patients were admitted between January 2014 and December 2017. Two thousand nine hundred sixty-one had confirmed AIS, 1695 (57.2%) had diabetes, 429 (14.5%) had prediabetes and 873 (29.5%) had no diabetes. Comparing diabetic patients to prediabetic and nondiabetics, they were significantly older (58.5 ± 11.9 versus 54.0 ± 12.9 versus 49.5 ± 13.8, P =.0001), had higher rates of hypertension (80.8% versus 67.4% versus 59.2%), previous stroke (18.0% versus 5.4% versus 6.2%), and coronary artery disease (12.9% versus 5.6% versus 5.0%; P =.001 for all). The percentage of patients with modified Rankin scale 3-6 at discharge (39.7% versus 32.6% versus 30.2%; P =.0001) and 90 days (26.7% versus 18.8% versus 21.4%, P =.001); 90-day mortality (6.2% versus 2.2% versus 5.2%; P =.03) and stroke recurrence (4.2% versus.7% versus 2.2%; P =.005) was significantly higher in diabetic patients. Conclusions: Patients with diabetes and AIS have more in-hospital complications, worse discharge outcomes, higher mortality and stroke recurrence at 90 days, compared to prediabetes and no diabetes.
