PREVISTA

  PRogram for the Epidemiological EValuatIon of Stroke in Tandil, Argentina

Tandil

The city of Tandil is located in the province of Buenos Aires, ARGENTINA, 360 km south from Buenos Aires City and more than 100 km from the nearest stroke center. It is considered a referral city for hospitalization and clinic consultations.
The Tandilean population is originated from few local inhabitants and a large immigration influx from Italy, Spain, France and Denmark.
The population is distributed along an urbanized area of 22.07 km2 (13.7 sq mi) surrounded by a suburban area of 30.3 km2 (18.8 sq mi). There are 7 nearby cities at a mean distance of 103 ± 32 km (64 ± 20 mi). The nearest cities are Ayacucho and Benito Juárez (both at 80 km / 50 mi).
Owing to these unique features, it is unlikely for Tandilean patients with acute stroke or TIA to seek medical attention elsewhere. According to the 2010 National Census, the population of Tandil was of 123 871 inhabitants. There is one public hospital with 101 beds, two private hospitals with a total 134 beds, and 10 outpatient clinics. Four neurologists work in these outpatient clinics and approximately 350 physicians work in the city. There are no stroke units in Tandil

Hospital ramon santamarina, tandil, argentina

Summary

The availability of population-based epidemiological data on the incident risk of stroke is very scarce in Argentina and other Latin American countries. In response to the priorities established by the World Health Organization and the United Nations, PREVISTA was developed as a population-based program to determine the incident risk of first-ever and recurrent stroke and transient ischemic attack incidence and mortality in Tandil, Buenos Aires Province, Argentina.

The study will be conducted according to Standardized Tools for Stroke Surveillance (STEPS Stroke) methodology and will enroll all new (incident) consecutive events of first or recurrent stroke and transient ischemic attack in the City of Tandil between 05/01/2013 and 04/30/2015. The study will include patients with ischemic stroke, non-traumatic primary intracerebral hemorrhage, subarachnoid hemorrhage, and transient ischemic attack. To ensure the inclusion of all listed cerebrovascular events during an observation period of two years, we will instrument an "intensive screening program” (hot pursuit), which consists of a comprehensive daily tracking of every potential event of stroke or transient ischemic attack using multiple overlapping sources. Mortality would be determined during follow-up for every enrolled patient. Also, fatal community events would be screened daily through revision of death certificates at funeral homes and local offices of vital statistics. All causes of death will be adjudicated by an ad-hoc committee.

The close population of Tandil is representative of a large proportion of Latin-American countries with low- and middle-income economies. The findings and conclusions of PREVISTA may provide new data that could support future health policy decision-making in the region. 

Rationale

Stroke is the second cause of death and a leading cause of acquired adult disability worldwide. While the incidence of cerebrovascular disease has increased by over 100% between 1970 and 2008 in low- and middle-income countries, there has been a 42% decrease in high-income nations. Low and middle-income countries have the largest burden of cerebrovascular disease and this burden will increase in the future unless effective preventive interventions are implemented.   
The scarce availability of high-quality epidemiological data on cerebrovascular disease in many of these countries, particularly in Latin America, is a limitation for health authorities awareness of the stroke burden and for identification of priority areas for preventive interventions. The United Nations (UN) has stated that it is crucial that Latin-American countries improve their data collection systems for assessing health indicators at the population level and for measuring the impact of public health policies and resources utilization. The availability of high-quality data on the epidemiological burden of cerebrovascular disease in these countries is crucial for developing health policies aimed at distributing resources more efficiently.  

There are only a few well-designed, population-based, stroke incidence studies in Latin America. Since year 2000, only four population-based stroke incidence studies were conducted in Latin-America: Iquique (Chile, 2000-2002), Matao (Brazil, 2003-2004), Joinville (Brazil 2005-2006), and Durango (Mexico, 2007-2008).          
Extrapolation of the findings of these studies to other Latin-American countries is methodologically problematic since they included different race-ethnic communities and socio-demographically diverse populations, where data was collected at least more than 5 years ago. Also, socioeconomic indicators, which are important determinants of stroke incidence and mortality, were not completely assessed. In addition, no stroke incidence studies have ever been conducted in Argentina. The population of Tandil is representative of most of Latin-American populations with low- and middle-income economies. Thus, the findings and conclusions of PREVISTA could provide data that may guide future health policy initiatives in the region. 

Objective

PREVISTA is an investigator-initiated population-based study aimed at assessing the incidence and the risk of recurrent stroke/transient ischemic attack and death at different points of time (28 days, 6 months and 12 months) in the city of Tandil, Buenos Aires, Argentina.

Implications

The WHO and the UN have made their formal statements about the need of high quality data on noncommunicable diseases from low- and middle-income countries. PREVISTA is one of the first results of this call to action. Our study will provide information on stroke epidemiology within the population of Tandil, which is representative of a large proportion of Latin-American countries with low- and middle-income economies. Thus, PREVISTA may contribute to reduce this gap in knowledge. Providing actual and current stroke incidence data will serve as the substrate for developing of more accurate and efficient health care policies. These data could help to generate higher stroke awareness among policy makers, professionals, and the general population. The results of the Argentinean National Stroke Registry (ReNACer) served as a source for drafting the first National Stroke ACT by the Argentinean Neurological Society, and the results of PREVISTA could help to reinforce the enactment of this law, as well to promote of new provincial initiatives. Additionally, by gathering data on specific risk factors profiles in a Latin-American population, it will be possible to develop more efficient prevention strategies. Finally, PREVISTA could provide a useful model for stroke studies in  other low- and middle-income countries within and beyond Latin America.