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Hi, everyone. This is Lucas Voss with Becker's
Healthcare. Thanks so much for tuning in to
the Becker's Healthcare podcast series. Fantastic to have
you. Today, we're talking about how technology and
collaboration are transforming stroke care. And I'm so
excited
for my two guests today, doctor Calder Peron,
chief medical officer at Phillips, and doctor Sheila
Martins. She's a stroke neurologist and professor of
neurology of Universidad Ferradario Grande do Sol, and
she's also the head of neurology at Hospital
de Veno, the president of the Brazilian Stroke
Network and past president of the World Stroke
Organization.
Doctor Martins, doctor Perron, it's great to have
you. Thanks for being here today. It's our
pleasure to be here with you today. Appreciate
the opportunity.
Yeah. It's so great to have you. I
wanna start off with introductions here for our
audience. Doctor Perron, if you wanna start us
off here, can you share just a little
bit about yourself and your work in health
care? Of course. Thank you again for the
opportunity. So I'm Carla Peron, as I mentioned,
chief medical officer for Ad Phillips.
I'm a gynecologist by training, Brazilian and American,
and I work it as a researcher and
and a medical officer in different companies,
for the last twenty years. Had the pleasure
to meet Sheila a long time ago,
where we were working together on a research
program,
a clinical trial,
in Brazil,
to enable the introduction of mechanical thrombectomy in
the public health care system. So that's definitely
my passion,
about stroke and how we can expand access
to care
for this disease that is preventable, treatable, and
curable, but is still actually causing so much
damage out there.
Yeah. And I'm sure we'll touch on that
here in a little bit. Doctor Martins, over
to you.
Sheila Martins, the stroke neurologist.
I start to work with the stroke in
2001
after the approval of
thrombolysis
medication
to treat the stroke in Brazil.
And since then, I'm working
in Brazilian stroke network NGO
to support the Ministry of Health to implement,
national policy and also to support,
regional and local people to develop stroke systems
of care. So I'm I'm working with health
managers for a long time too.
And, again, it's so great to have you
both on because you bring such an interesting
perspective to the conversation,
a dual fold conversation from leading innovation within
the global health technology company, of course, to
shaping national stroke policy and care delivery in
Brazil there. And I'd love to start off,
with you, doctor Martins here. How would you
characterize
general knowledge of stroke today, and what's most
important for people,
especially health care leaders, to understand?
Well, people don't know about stroke.
General population don't know about stroke, don't know
what is the stroke, don't know that it's
preventable
in eighty to nine percent of cases,
don't know the stroke signs and that that
it that is a
very effective
treatment
if go straight to the right hospital
the faster as possible. So we know a
lot about this, but population don't know so
it's so important to educate them
and also health care
managers because they don't know almost don't know
about the stroke, don't care about the stroke.
It's so neglected disease until today,
and it's for this, it's so important
to teach them and to help them to
know what we know that is evidence based.
We have strong
evidence,
clinical trials on our side
to say that you should and we can
treat the stroke patients
if they arrive in the right side. So
so important to have
the health care leaders
hearing from from us
and implementing
what we know that really will change people's
lives. And for this,
the also campaign this year is not only
for population, it's also to aware the health
managers
that
every minute counts,
to recognize and treat the stroke, but also
every minute counts to take action and to
change the reality and implement the best treatments.
And every minute counts. Our actions today can
change the life forever. So,
it's really important to to be in touch
with them, to help them to to see
this.
And you've mentioned the the importance of education,
the importance of of having folks know what
a stroke is, how does it work, how
do we communicate about it. I was wondering
if you could talk a little bit more
about from your perspective,
what are some of the biggest challenges and
opportunities
you
see in how stroker is delivered today both
in hospitals, but, of course,
also in the community?
Well, the biggest challenge is one challenge is
this,
the lack of knowledge,
about
the stroke in the population.
The other is
hospitals are not prepared. Of course, we improve
a lot
mainly in Brazil, but still,
there is several hospitals not prepared to receive
stroke patients.
Someone's cannot
understand that is,
our responsibility
and the responsibility
of the health managers
to implement and to give the best treatment
of, stroke for the patients. We cannot
accept more that patients are treated as, like,
thirty years ago. We really need to implement
everything that is evidence based and save the
people's lives and also
decrease or avoid
disability. So challenges
and knowledge, challenge the infrastructure
that is so important. I need at least,
hospitals with CT scan, emergency room, personnel trained,
and sometimes, I don't have neurologists. I cannot
implement. Yes. You can implement, and telemedicine
now can help the hospital and the doctor
in the hospital to treat patients with more
basic thrombolysis and also identify patients that have
more severe stroke and treat these patients to
a more comprehensive center to mechanical thrombectomy that
is more,
stabilized treatment,
but needs more specialized
hospital with more structure. We can do this,
but we need to
convince
people and health managers that it's feasible to
implement. And for this was so important,
a clinical trial
we performed in Brazil
with support
of
industry. That time, Meditronic
was a
huge partner
that help us to set up together with
minister of health a clinical trial in Brazil
for this treatment that was not approved yet.
And, in Brazil, we spend seventeen
years to approve the more basic thrombolysis,
intravenous thrombolysis.
So you can imagine a more comprehensive with
a set of brain catheterism.
We we convinced the minister of health to
create a clinical trial in public health system
sponsored by the Ministry of Health and with
industry partners to donate the devices.
So with this, we had our clinical
trial about thrombectomy in Brazil, and this changed
the national policy for stroke incorporating
the treatment
for free for the patients. So this is
magic because
Brazil, we have 200,000,000
people
and one of the,
only global systems that pay everything for the
patients. The patient don't need to pay anything,
in stroke care, but, of course, you need
to incorporate
the treatment. So this is a a game
changer and so important for us. It's so
important model for other parts of the world.
Doctor Perron, we talked about partnership there a
little bit, which is certainly really key, from
an industry perspective as well. I wanna touch
on a specific part of partnership, which is
technology.
That's a lot of, a lot of what
partnership is. A lot of folks bring in
bring in, companies for technology specifically. I wanna
talk a little bit about AI and informatics.
How does that those aspects, that technology help
in addressing some of those challenges that doctor
Martin's just outlined?
Yeah. So I think there's a lot of
things that AI can do, definitely, and we
are seeing that trending up.
What what it expects us in the future,
I think it's a big question mark, and
everybody's very excited to jump into that next
step,
of the development for AI. But as today,
you heard doctor directly from doctor Martins. Right?
So
every single minute counts in stroke care. So
early detection of the symptoms, not necessarily an
easy one for us to kind of,
teach the people out there in the community.
So AI is already being used
to help to identify
symptoms
and and trigger,
the the first responders
that this can can be potentially a stroke.
It's already there. When you get to the
hospital, as as as doctor Martins pointed out,
we need CT scans, and we need to
get all the these images
being quickly identified as a potential stroke,
ischemic or hemorrhagic stroke. Also identify which kind
of vessel or where is the occlusion.
AI is already there as well, being used
today as we speak to facilitate,
that diagnosis,
not only in the hands of, experts,
but also
through telemedicine, through ability to connect,
people from different places to look at the
those images and identify the patients, that should
be eligible to the the the most effective
treatment.
And after we actually realize the procedure, whatever
is IV thrombolytics or mechanical thrombectomy for those
large occlusions,
you also need to make sure you monitor
those patients after a discharge
to ensure that a a new, stroke,
can be prevented. For example so we have
AI
in Holter systems that are monitoring cardiovascular,
signal and help us to identify, do we
need to do something else for those patients?
So, today, AI has been largely used already
by physicians in different specialties that are, kind
of identifying
and treating stroke.
But I really see that for the future,
this can even be a a more game
changer. I think you heard doctor Martins alluding
to how challenge is for us to create
and develop the infrastructure.
Right? As a Brazilian, I can tell that
when Sheila and I connected for the first
time in that initiative around the the collaboration
to run the clinical trial,
I really thought this cannot be done.
Right? Because the infrastructure is not there. The
personnel is not there. The awareness in the
population, the reimbursement is there's so many barriers,
and definitely technology,
AI, informatics,
connectivity,
was part of the solution and to make
that a successful story. So I think that
is the critical part of how we actually
reduce significantly the impact of stroke worldwide.
Yeah. It's certainly a critical enabler to be
able to make that process easier for people
and for organizations at the same time.
For both of you, as you look ahead,
as you look towards the future,
what does an effective collaborative model for stroke
prevention and treatment look like? And what are
some of those partnerships or innovations that are
going to be most critical
to achieve them? Doctor Martins, we'll start with
you on this one.
Well, it's fundamental
because we we need a lot of help.
I think what's so first, I'm I I
like to see patients. I still,
have my outpatient clinic, assist patients at the
hospital.
But I saw first that,
it's so important
this
management
of stroke care,
understand how to create the stroke systems of
care and teach and to be in touch
with the health managers to help them to
support them to be available to support the
organization of stroke systems of care. The other
thing was I saw
working like this, I saw that I need
a clinical trial. I need research
to prove the concept and to show that
it's feasible and cost effective in the
regional, in the system we are working. And
this was,
really game changer because we show in our
public system
support sponsored by the government
that the treatment was feasible and cost effective.
And first, for this was so important to
have the industry partners together.
This first step first, before this, when we
start to create the stroke network,
we are planning the national policy for stroke.
The same Medtronic and Carol was together.
We sponsored the teaching course, a national teaching
course. So we had a Brazilian stroke network,
government,
Ministry of Health of Brazil, and Meditronic
for a national
teaching course to educate
everybody, primary care,
pre hospital,
hospitals, acute care, and rehabilitation. So we create
a a strong
teaching course in person and virtual
that was fundamental for the first step teaching
them on how to create an organized system
in the in the entire country. Second super
important partnership
clinical trial. Without the industry, you could not
do the clinical trial because you didn't have
enough money. The government gave gave us part
of the money, and we we need the
device to prove that the treatment
works. So this was fundamental. And now after
approval, we need so so much,
education, not only the basic because to to
organize the clinical trial, we have built the
stroke system of care in Brazil. We train
everyone together. The ambulance
needs to know,
what patient should go for a more comprehensive
stroke center where we are implementing,
the more comprehensive treatment, mechanical thrombectomy,
or for primary stroke center essential stroke centers
only for thrombolytes.
So we need to reorganize these with the
health managers. We need to train the neurologists
and the emergency physicians to assist this patient
and and go with them to cath lab,
and we need to teach the neurointerventionalist
because that time, few of them had experience
with the treatment. You it it was so
fundamental
to train them for a better care for
the patient. And now we need more neurointerventionalist
to be feasible to expand the treatment in
the entire country and not only in Brazil,
in Latin America, and the entire world.
It's a holistic approach, which is so important.
Right? It it takes so many different factors
into account, including the technology
with, dark with doctor Perron just mentioning how
important that is to be able to enable
some of this. And and I wanna come
to you, doctor Perron for for this, as
well.
What are you seeing as most critical in
the future to be able to to build
that collaborative model for stroke prevention and treatment?
What does that look like for you?
Yeah. So I'll summarize. I think mark doctor
Martin has already covered a lot of things.
If the in my view are three pathways.
Right? The first one is really collaborate very
closely from the industry perspective
with magical societies and hostels for the technology
development.
Whatever new solution, we created needs to be
very much aligned with the specific need that
we have in front of us.
So technology development. The second one in my
view is as as doctor Sheila mentioned,
how we partner to ensure that we are
not only covering the clinical trial perspective to
prove that those products, that we are developing,
those technologies are safe and effective,
But also that from the cost effectiveness perspective,
it is feasible for the hospitals and the
providers to adopt it. Because it may be
amazing, but if there is no room for
the economics,
then, the health care system will struggle to
adopt. And the third one, it's definitely how
we partner not only between industry hospitals and
providers, but also beyond that
with nonprofit organizations, with governments,
with different types of societies,
to help,
incorporate
those technologies and those solutions in the health
care system. So I think today, we do
have a very good example. Mhmm. We are
all part of a global stroke coalition
that is a group of experts,
between nongovernment institutions,
industries,
like, Phillips and Medtronic and other companies,
patients and and other experts that are coming
together to really work around the globe,
to kind of reduce the burden of stroke,
in The US and outside of The US.
I think that is a a great example
of a good what a good collaboration look
like.
It often sounds like a cliche, but it
really does take all of us. It's one
of those things that I like to say,
and it is an important model in terms
of partnership and innovation itself.
Doctor Martins, doctor Perron, thank you so much
for being here and taking some time to
be with us today. It's been a fantastic
conversation. Thank you.
Thank you so much. Thank you very much
for the opportunity again, Lucas. Appreciate it. It's
great to have you. And we also want
to thank our podcast sponsor, Philips. You can
tune into more podcasts from Becker's Healthcare by
visiting our podcast page at beckershospitalreview.com.