Multiple stroke guidelines and sets of stroke quality metrics exist across the world. Yet, there is no good repository of these documents and little is known about awareness and utilization among practitioners in different countries and regions. To fill this gap, the Stroke Guidelines committee of WSO created a survey that was distributed to all members of the organization in 2020. The responses to this survey are enlightening.
There were 111 respondents representing 45 countries from all continents. Most participants identified themselves as clinical providers. 88% reported knowledge of clinical guidelines in their country/region. Guideline awareness was highest for the guidelines from the American Heart Association [AHA] (87%) followed by the European Stroke Organization [ESO] (77%). Utilization was also greatest for the AHA (64%) and ESO (58%) guidelines, but 57% reported using other guidelines for clinical care. Awareness of the WSO Global Stroke Services Guidelines and Action Plan published in 2014 was reported by 67% of respondents and 92% found them useful (evidence-based recommendations were deemed the most useful section of the document by 88% and nearly half also highlighted the value of the key performance measures). Also, 48% of those who were aware of these WSO guidelines reported having applied them to assess their own practice or to review their local/regional practices. Most commonly, the WSO guidelines were along with national/regional guidelines.
Meanwhile, 58% reported awareness of the WSO Roadmap for Quality Stroke Care released online in 2016 and 72% of those aware of the Roadmap had reviewed it. Among those, 95% had found the document useful and 93% had applied the Roadmap Implementation Guide to their practice. The key quality indicators were considered useful by 81% and guidance to identify current levels of service delivery and capability were regarded as valuable by 59%. The WSO Roadmap was most often used in combination with national quality metrics.
Comments provided by individual respondents were insightful and highlight priorities for our future endeavors at the WSO Guidelines Committee. Several underscored the need to increase the visibility of the WSO guidelines and to keep them regularly updated. Another common theme was the emphasis on keeping them applicable to low-resource environments and to include primary prevention recommendations. Several survey participants also suggested that WSO should serve as a global repository of regional and national guidelines.
The information provided by the responses to this survey serves to establish a platform from which we can build upon. We will use this information at the WSO Guidelines Committee to focus our efforts to provide the global stroke community with guidance that is both evidence-based and eminently applicable to settings with various levels of resources and to identify ways to increase awareness and utilization of WSO guidance material.
Achieving our vision of a life free from stroke is a task that WSO cannot achieve alone. We are committed to building our partnerships at the global, regional and national level to scale up and deliver improvements in prevention, treatment and support to reduce the burden of stroke.