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- [00:01]
A
Philips is a health tech leader focused on innovation that improves the health and well being of people. Our healthcare technology and informatics solutions help care teams diagnose, treat and manage more patients with greater precision, speed and confidence. Across the care journey with Philips, clinicians are empowered with streamlined insights in the moments that matter for every patient. Better care for more people. Phillips.
- [00:29]
B
Hi everyone, this is Lucas Voss with Becker's Healthcare. Thanks so much for tuning into 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. Dr. Khalil Perron, Chief Medical Officer at Philips, and Dr. Sheila Martens. She's a stroke neurologist and professor of Neurology of Universidad Federal de Rio Grando do Sol, and she's also the head of Neurology at Hospital Munoz de Vento, the president of the Brazilian Stroke Network and past president of the world stroke organization. Dr. Martins. Dr. Peron, it's great to have you. Thanks for being here today.
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C
It's our pleasure to be here with you today.
- [01:10]
D
Appreciate the opportunity.
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B
Yeah, it's so great to have you. I want to start off with introductions here for our audience. Dr. Perrone, if you want to start us off here, can you share just a little bit about yourself and your work in healthcare?
- [01:20]
D
Of course. Thank you again for the opportunity. So, I'm Carla Peron, as I mentioned, chief medical officer for A.T. phillips. I'm a gynecologist by training, Brazilian and American, and I work as a researcher and a medical officer in different companies for the last 20 years. I had the pleasure to meet Shayla 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. 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.
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B
Yeah, and I'm sure we'll touch on that here in a little bit. Dr. Martins, over to you.
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C
Shayla 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 Ministry of Health to implement national policy and also to support regional and local people to develop stroke systems of care. So I'm working with health managers for a long time too, and Again, it's.
- [02:42]
B
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 a 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, Dr. Martins here. How would you characterize general knowledge of stroke today and what's most important for people, especially healthcare leaders, to understand?
- [03:11]
C
Well, people don't know about stroke, general population don't know about stroke, don't know what is stroke, don't know that is preventable in 80 to 90% of cases don't know the stroke signs. And 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 healthcare managers because they don't know almost don't know about the stroke, don't care about the stroke is so neglected disease until today. And it's for this is 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 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. This the world Stroke campaign this year is not only for population is also to aware the health managers that every minute counts to recognize and treat a 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 see this.
- [04:58]
B
And you've mentioned the importance of education, the importance 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 stroke care is delivered today both in hospitals, but of course also in the community.
- [05:22]
C
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 cannot understand that is still 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 30 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 are I need at least hospitals with CT scan, emergency room, personal training and sometimes I don't have neurologist I cannot implement. Yes, you can implement in 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 transfer these patients to a more comprehensive center to mechanical thrombectomy that is more save lives treatment, but needs more specialized hospital with more structure. We can do this, but we need to convince people and health managers that is 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 Ministry of Health a clinical trial in Brazil for this treatment that was not approved yet. And in Brazil we spent 17 years to approve the more basic thrombolysis, intravenous thrombolysis. So you can imagine a more comprehensive with a set of brain catheterism. 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 million 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 game changer in so important for us. It's so important model for other parts of the world.
- [08:30]
B
Dr. Perrone, we talked about partnership there a little bit, which is certainly really key from an industry perspective as well. I want to 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 companies for technology. Specifically. I want to talk a little bit about AI and informatics. How does those aspects that technology help in addressing some of those challenges that Dr. Martin's just outlined?
- [08:57]
D
Yeah, so I think there's a lot of things that AI can do. Definitely. And we are seeing that trending up. What 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 directly from Dr. Martins. Right. So every single minute counts in stroke care. Early detection of the symptoms, not necessarily an easy one for us to teach the people out there in the community. AI is already being used to help to identify symptoms and trigger the first responders that this can be potentially a stroke. It's already there when you get to the hospital. As Dr. Martins pointed out, we need CT scans and we need to get all these images being quickly identified as a potential stroke, ischemic or hemorrhojic 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 those images and identify the patients that should be eligible to the most effective treatment. 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 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. Today, AI has been largely used already by physicians in different specialties that are identifying and treating stroke. But I really see that for the future this can even be a more game changer. I think you heard Dr. Martins alluding to how challenged is for us to create and develop the infrastructure. Right. As a Brazilian, I can tell that when Shayla and I connected for the first time in that initiative around the collaboration to run the clinical trial, I really thought, this cannot be done right, because the infrastructure is not there, the personnel was not there, the awareness in the population, the reimbursement system, there's so many barriers and definitely technology, AI, informatics, connectivity was part of the solution 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.
- [11:45]
B
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? Dr. Martins, we'll start with you on this one.
- [12:13]
C
Well, it's fundamental because we. We need a lot of help. I think what's so important first I'm. I like to see patients. I still have my outpatient clinic, assist patients at the hospital. But I saw first that is so important this management of stroke care. Understand how to create 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 is feasible and cost effective in the regional and the system we are working. And this was a really game changer because we show in our public system support, sponsored by the government that the treatment was feasible and cost effective. And for. For this was so important to have the industry partners together. This first step. First, before this, when we start to create this stroke network. We are planning the national policy for stroke. The same Mediterronic and Carlo was together sponsored a teaching course, A national teaching course. So we had a Brazilian stroke network, Minister 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 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 was with the clinical trial. Without the industry, you could not do the clinical trial because you didn't have enough money. The government gave us part of the money. And we need the device to prove that the treatment works. So this was fundamental. And now after approved, we need so. So much education. Not only the basic. Because to. To organize the clinical trial. We have built this stroke system of care in Brazil. We train everyone together. The ambulance needs to know what patients 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 thrombolysis. 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 go with them to cath lab. And we need to teach the neuro interventionalists because that time few of them had experience with the treatment. It was so fundamental to train them for a better care for the patient. And now we need more neuro interventionalists to be feasible to expand the treatment in the entire country. And not only in Brazil, in Latin America and the entire world.
- [15:35]
B
It's a holistic approach, which is so important. Right. It takes so many different factors into account, including the technology. With Dr. Perrone just mentioning how important that is to be able to enable some of this. And I want to come to you, Dr. Perrone, for this as well. What are you seeing as most critical in the future to be able to build that collaborative model for stroke prevention and treatment? What does that look like for you?
- [15:59]
D
Yeah, so I'll summarize. I think Dr. Martin has already covered a lot of things. In my view are three pathways. Right. The first one is really collaborate very closely from the industry perspective with medical societies and hospitals 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 Dr. Shaila 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 healthcare 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 healthcare system. So I think today we do have a very good example. We are all part of a global stroke coalition that is a group of experts between non government institutions, industries like Philips and Medtronic and other companies, patients and other experts that are coming together to really work around the globe to kind of reduce the burden of stroke in the U.S. and outside of the U.S. i think that is a great example of what a good collaboration look like.
- [17:42]
B
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. Dr. Martins, Dr. 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.
- [17:59]
C
Thank you so much.
- [18:00]
D
Thank you very much for the opportunity. Again, Lucas, appreciate it.
- [18:03]
B
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@beckershospitalreview.com.