Let's talk openly about stroke - how we treat it in our country and how in Europe. How quickly we react, what the relatives face... Assoc. Prof. Rosen Kalpachki, head of the largest specialized center for stroke treatment at the Sofia University Hospital “St. Anna“, spoke to FACTI. He was a lecturer at the seminar he recently held “Give Hope“, organized by the MOST Foundation.
– Dr. Kalpachki, you gave a very interesting lecture about stroke. Does this remain one of the biggest challenges facing healthcare in our country and in Europe – the reaction to stroke?
– Unfortunately, yes. In the best countries in Europe, there is a slowdown and retention of the trend in stroke. A decrease is more valid as a trend in heart attacks, but stroke cases continue to grow. Stroke is still the leading cause of mortality. In Bulgaria, the problem is even more drastic – strokes are increasing, getting younger and no one can replace them in terms of mortality. Our cardiologist colleagues have done a lot in the last 20 years, because heart attacks have almost halved. We just need to look at this know-how and we will see light at the end of the tunnel if we apply it to stroke.
– Why do you think the situation is so serious?
– There are many reasons. A stroke is not a heart attack. The most important thing is prevention – not to have a stroke. This is the main goal of healthcare, keeping the person healthy. But in our country, prevention is weak. I - as a doctor, participate in the second phase, when the person has already had a stroke. Although with serious boxing we try to turn on second gear and we are already succeeding. People simply do not control the risk factors, and the system does not stimulate them enough.
– And when a stroke has already occurred? Do we manage to treat in time in the so-called “golden hour“?
– This is the second big problem. In 2024, only 4% of patients with ischemic stroke received treatment in the so-called “golden hour“. Out of 100 people, 4 are in the “golden hour“, and 96 are not. But these 4% are a record for Bulgaria, because we have improved 40 times compared to 10 years ago. But we are 4%. And in Europe the minimum is 15%.
- Do even ambulances in Europe respond better and faster?
- There is a lack of organization – we do not have a pre-notification system in which the ambulance would notify the hospital in advance that a patient with a stroke is coming. In Sofia, ambulances often go around looking for free beds. And on Friday afternoons, only two hospitals are actually open.
– How many medical institutions in Bulgaria can respond adequately?
– According to documents, we have over 140 neurological departments in Bulgaria. But half of them perform less than 10 thrombolysis per year – this is less than one per month. In reality, we cannot say that they treat strokes qualitatively. If we compare with European standards, in Bulgaria we can count no more than 10 centers that work at the required level. In our country, the ambulance flies, but looks for a free place. 10 years ago in “St. Anna“ we performed every second thrombolysis. Many people they went through us, they learned. But I hope that it will increasingly happen that when a daughter brings her father with a stroke, the doctor will be ready and will know what to do, and not be spinning around and wondering how to react. Everyone knows how it is done, because thrombolysis is an injection. But here I want to open the topic of health education. There is no way for a doctor to go to the patient's home and make the person control his risk factors. There is no way. We formed a company, I invited cardiologists, endocrinologists, because I told them that their patients would also become our patients - of neurologists, but everyone says that they have their own problems. Diabetes is diabetes, heart problems, etc. Everyone says that they will help, but they look after their own.
– And what happens after the acute treatment?
– The situation there is even worse. We have about 40,000 strokes a year, which means at least 20 000 new disabled people every year. We don't have enough centers for follow-up treatment and rehabilitation. In the end, families take on the enormous burden – they look for rehabilitators, speech therapists, social workers, assistive devices. Each such case literally makes an entire family sick. We are at the bottom of the queue in terms of how we care for a person with a stroke.
– You often compare Bulgaria with Germany, because you have direct observation. What do things look like there?
– Like another planet. I have relatives in Germany who have experienced a stroke. The patient immediately receives a special bed, assistive devices, rehabilitation and social care – all taken care of by the state. Blood pressure machines, consultations – everything is free and organized. In our country, everything is done “with muscle“ – with the efforts of the patients and their relatives.