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Updated: May 27, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Intravenous thrombolysis in acute ischemic stroke after POLKARD: one center analysis of program impact on clinical
M Arkuszewski1, M Targosz-Gajniak, M Swiat
1Department of Neurology, Medical University of Silesia, Katowice, Poland. michal.arkuszewski@gmail.com
Insights
Following a change in funding, more acute ischemic stroke patients received intravenous thrombolysis in Poland. However, this did not significantly alter clinical outcomes or mortality rates.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Public Health Policy
Background:
- Intravenous thrombolysis for acute ischemic stroke was introduced in Poland under the POLKARD program (2003-2008).
- Reimbursement shifted to the National Health Fund (NFZ) in 2009.
- This study evaluates the impact of this funding change on treatment rates and patient outcomes.
Purpose of the Study:
- To assess if the change in financing institution (POLKARD to NFZ) affected the proportion of acute ischemic stroke patients treated with IV thrombolysis.
- To determine if clinical parameters or stroke outcomes changed following the shift in reimbursement.
Main Methods:
- Retrospective analysis of 90 consecutive acute ischemic stroke patients treated within 3 hours of symptom onset.
- Comparison of clinical data, time delays, mortality, and 90-day functional outcomes between the POLKARD period and 2009.
- Binary logistic regression used to analyze the association between outcomes and baseline characteristics.
Main Results:
- A significant increase in treated patients was observed in 2009 (7.6%) compared to the POLKARD period (4.3%, p=0.013).
- No significant differences were found in patient demographics, risk factors, treatment delays, or hemorrhagic complications.
- A trend towards higher, though not statistically significant, 90-day mortality was noted in 2009 (32.1% vs. 16.1%, p=0.101).
- Baseline neurological deficits and in-hospital delays predicted disability and death.
Conclusions:
- The shift in financing and removal of reimbursement limits allowed a greater proportion of ischemic stroke patients to receive intravenous thrombolysis.
- While treatment rates increased, further research is needed to address the observed trend in mortality.
Purpose:
Intravenous thrombolysis in the acute ischemic stroke was initiated in Poland within the National Cardiovascular Disease Prevention and Treatment Program POLKARD in the years 2003-2008. Since 2009 the procedure has been reimbursed by the National Health Fund (Narodowy Fundusz Zdrowia - NFZ). The purpose of the presented study was to assess whether the change of financing institution was associated with the change in proportion of patients treated and with any of the clinical parameters or stroke outcomes.
Patients And Methods:
We reviewed the data of the 90 consecutive patients with acute ischemic stroke treated with intravenous thrombolysis within 3-hours from symptoms onset. The differences between the POLKARD period and the year 2009, regarding clinical parameters, time delays, death rates and functional outcomes on day 90 after the stroke were analyzed. The association of outcome measures with baseline characteristics of the patients was analyzed with binary logistic regression.
Results:
In 2009 there was a significant increase in the proportion of patients treated (7.6%, 95%CI 5.3-10.7%, vs. 4.3%, 95%CI 3.3-5.5% respectively, p=0.013). There were no differences in age, baseline neurological presentation, prevalence of stoke risk factors, treatment time delays or hemorrhagic complications. Higher, but not significantly, 90-day mortality was observed (32.1%, 95%CI 13.3-54.1% vs. 16.1%, 95%CI 6.4-29.7% respectively, p=0.101). Baseline neurological deficits and in-hospital treatment time delays were significant predictors of disability and death.
Conclusions:
After the Polish Ministry of Health program POLKARD termination and elimination of the reimbursement limits, higher proportion of ischemic stroke patients could be treated with the intravenous thrombolysis.
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