Frontiers in stroke · 2026
The Quindío stroke network: impact of an integrated care model on mortality and functional outcomes in a middle-income country.
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García-Espinosa Laura Sofía, Corredor-Quintero Ángel Basilio, Lineros-Franco Ricardo Andrés, Hernández-Cardona Adriana, Loaiza-Giraldo Ivett Natalia, Torres-Gómez Felipe, Igirio-Gamero Jorge Luis
Аннотация
INTRODUCTION: Stroke is a major cause of death and disability worldwide, with low- and middle-income countries bearing the highest burden of this condition. To address regional shortcomings in access to reperfusion therapies-particularly thrombolysis-the Red ACV-Quindío was established as the first integrated network for stroke management in central Colombia.
METHODOLOGY: This pre-post quasi-experimental study evaluated the Red ACV-Quindío strategy. The study estimated functional outcomes and in-hospital mortality in patients diagnosed with stroke before and after the implementation of the network.
RESULTS: The study included a total of 841 cases. Although year-by-year variations in patient volume were detected, linear tests confirmed a homogeneous population across the study period. Baseline clinical characteristics remained stable throughout: most patients presented with minor stroke (47.1%) and low functional dependency at admission (89.0%). At discharge, overall functional independence reached 55.0% (95% CI: 51.6-58.4, p = 0.23) and was associated with favorable safety outcomes. Thrombolyzed patients demonstrated a significantly reduced risk of fatal outcomes (OR = 0.61; 95% CI: 0.38-0.96; p = 0.037). Complications were rare, with hemorrhagic transformation occurring in 4.5% of cases and malignant edema in 3.9%. In-hospital mortality showed minor fluctuations but remained under 10% overall (9.9%, p = 0.39).
DISCUSSION: These findings suggest that regionally integrated stroke care networks represent an effective public health intervention to mitigate stroke-associated disability and mortality in resource-limited settings.
METHODOLOGY: This pre-post quasi-experimental study evaluated the Red ACV-Quindío strategy. The study estimated functional outcomes and in-hospital mortality in patients diagnosed with stroke before and after the implementation of the network.
RESULTS: The study included a total of 841 cases. Although year-by-year variations in patient volume were detected, linear tests confirmed a homogeneous population across the study period. Baseline clinical characteristics remained stable throughout: most patients presented with minor stroke (47.1%) and low functional dependency at admission (89.0%). At discharge, overall functional independence reached 55.0% (95% CI: 51.6-58.4, p = 0.23) and was associated with favorable safety outcomes. Thrombolyzed patients demonstrated a significantly reduced risk of fatal outcomes (OR = 0.61; 95% CI: 0.38-0.96; p = 0.037). Complications were rare, with hemorrhagic transformation occurring in 4.5% of cases and malignant edema in 3.9%. In-hospital mortality showed minor fluctuations but remained under 10% overall (9.9%, p = 0.39).
DISCUSSION: These findings suggest that regionally integrated stroke care networks represent an effective public health intervention to mitigate stroke-associated disability and mortality in resource-limited settings.