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Angels Day In Bulgaria

November’s Angels Day put the spotlight on issues at the heart of stroke care in Bulgaria and established new networks within the country’s stroke community.
Angels team 13 January 2023
Bulgaria's first post-pandemic Angels Day brought together physicians from across the country.

RAZLOG is a lively town with a long history located 150 km south of Sofia and a hop and a skip away from Bulgaria’s most prestigious ski resort.

But the winter skiing season only opens in December, so it wasn't the slopes that brought a flurry of visitors to Razlog on the 11th and 12th of November 2022. Instead, Rila and Pirin Mountains, respectively Bulgaria’s tallest and most beautiful, towered over an assembly of doctors who had traveled to Razlog to attend the country’s first post-pandemic Angels Day.

However enchanting the scenery surrounding the Katarino Hotel & Spa, the agenda kept the attendees engaged throughout, and question time on both days brought lively discussions about the challenges still facing stroke care in Bulgaria.

Angels consultant Ludmila Sheytanova attributes the success of the event to the guidance and expertise provided by Academician Professor Ivan Milanov, chairman of the Bulgarian Society of Neurology, and outstanding contributions from presenters who were without exception “enthusiastic and well-prepared”. Even a severed optic cable that interrupted day one’s masterclasses didn’t impede proceedings as some doctors responded to the emergency by making hot spot connections with their phones.

Dr Rositsa Krasteva facilitated a workshop on key actions to reduce door-to-needle time.
Professor Ivan Staikov lead the masterclass on decision-making.

Local experts lead masterclasses

Participants had been split into three groups to rotate through three multidiciplinary masterclasses that focused on different aspects of the hypercute phase of stroke.

Dr Rositsa Krasteva whose hospital, UMHAT Medika in Russe, has won eight ESO Angels Awards, facilitated a workshop on the hyperacute stroke pathway and key actions to reduce door-to-needle time.

Professor Ivan Staikov lead the masterclass on decision-making during which participants had the opportunity to solve cases using the virtual patient simulator, Body Interact. Acibadem City Clinic UMHAT Tokuda in Sofia, where Prof Staikov is the lead neurologist, is the recipient of 12 ESO Angels Awards. Only UMHAT St Anna in Sofia and MHAT St Panteleimon in Plovdiv have more.

The session on imaging diagnostics in acute stroke was run by leading neuroradiologists, Associate Professor Nikolay Topalov of the UMHATNP St Naum, and Professor Stanimir Sirakov from UMHAT St Ivan Rilski in Sofia.

Finally, Acad Milanov’s overview of stroke treatment in Bulgaria and the role of the Angels Initiative provided food for thought as day one drew to a close.

Acad Ivan Milanov gave an overview of stroke treatment in Bulgaria and the role of the Angels Initiative.
Professor Dimitar Maslarov gave an overview of ESO guidelines for intravenous thrombolysis.

IVT guidelines presentation sparks robust discussion

Professor Dimitar Maslarov of First City MHAT Sofia, opened day two with a presentation on conditions mimicked by stroke and followed with an overview of ESO guidelines for intravenous thrombolysis.

Profressor Maslarov’s comparison of ESO guidelines with the National Consensus on the Prevention, Diagnosis and Treatment of Cerebrovascular Disease and the Clinical Pathway text (CP51) used by the National Health Insurance Fund, sparked a robust discussion.

The three texts contained disparities on a number of key points, Prof Maslarov said. These included the critical tests that should be done before thrombolysis, myocardial infarction as a contraindication for thrombolysis, exclusions based on age and pregnancy, and informed consent.

The upper limit of NIHSS scores also differed between the three texts, with the National Consensus and CP51 setting the upper limit at 25 and 22 points respectively, while the 2021 ESO guidelines effectively removed the cap.

Prof Maslarov left participants with a strong injunction against wasting time, saying: “If you think you can perform some additional action that is not critical to diagnosis and decision-making, but will take you ‘only 2-3 minutes’, don't do it ­– it will always take longer and that’s wasted time!”

RES-Q Global Manager, Rupal Sedani, gave an impactful presentation on quality monitoring.
Professor Ivan Staikov leads a practical workshop using Body Interact.

New networks established

Equally impactful was the presentation on quality monitoring by RES-Q Global Manager, Rupal Sedani, with several hospitals signing up to the quality improvement registry on the spot. Acad Milanov’s consent for the registry to be made available in Bulgarian paves the way for more Bulgarian hospitals becoming eligible for ESO Angels Awards by sharing their data.

Next on the agenda were a Clinical Cases Discussion by Dr Yordan Kuzev from MHAT Haskovo, Associate Professor Rossen Rusev of UMHAT Georgi Stranski in Pleven, and Dr Erai Halil from UMHAT St George in Plovdiv, and a presentation on post-acute care and the FeSS protocol by Liliana Petrova from MHAT Haskovo.

Before a closing session by Acad Milanov and the Angels team, Elica Hadjivalcheva’s passionate presentation about FAST Heroes won new friends for the campaign and left participants with a lump in their throat. 

A post-event feedback survey showed a high rate of satisfaction from Angels Day participants, with positive comments on both content and organisation. Thanks to Acad Milanov’s leadership the agenda had given prominence to issues at the heart of stroke care in Bulgaria, and new networks were established within Bulgaria’s stroke community as participants exchanged both experiences and phone numbers.

The gathering overlooked by Bulgaria’s majestic mountains also opened more hospital doors to future interventions by Angels, ushering in a promising new chapter for stroke care in Bulgaria.


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