What is the Angels Initiative?
The Angels Initiative is a non-profit, non-promotional, global healthcare program supported by Boehringer Ingelheim. The initiative has two aims: first, to increase the number of stroke-ready hospitals, and second, to optimize the quality of existing stroke units.
Launched in Europe in 2016, the Angels Initiative is now global in its reach and is endorsed by and run in partnership with the WSO, European Stroke Organisation (ESO), Stroke Alliance for Europe (SAFE), Ibero-American Stroke Society (SIECV), and many other organizations and healthcare professionals (HCPs) focused on improving stroke outcomes across the world.
What has the Angels Initiative achieved to date?
As of September 2022, the Angels Initiative includes >100,000 HCPs from >7500 hospitals in 147 countries, and 1700 hospitals that did not previously treat stroke according to evidence-based guidelines are now stroke ready. The Angels Initiative has helped >1000 hospitals to become stroke ready, improving health outcomes for an estimated 4.68 million people between 2016 and 2021 (based on an assumption of ~500 patients treated per hospital.
Within LMICs, success stories regarding the number of new stroke-ready hospitals since 2016 include Argentina (664), India (451), Mexico (393), Brazil (328), Ecuador (271), Ukraine (263), Colombia (233), Indonesia (217), Thailand (171), Philippines (165), Peru (157), and Vietnam (139).42 Among these countries, over 3.6 million patients have received treatment in a stroke-ready hospital.
the Angels Initiative reduced thrombolysis administration time from 72 to 45min between 2015 and 2020, representing a 37% relative reduction from baseline. In terms of recanalization, the percentage of thrombolysis procedures carried out in Europe increased from 6.8% to 13.1% between 2015 and 2020. Similar improvements in quality monitoring have also been observed, with data for 500,000 stroke patients from more than 2000 hospitals captured within the RES-Q registry since 2016.
ESO recommended key performance indicators (KPIs) provide the basis for the three tiers of ESO Angels awards, which are categorized as gold, platinum, and diamond (the highest accreditation). In the second quarter (Q2) of 2017, 10 hospitals achieved ESO gold, platinum, or diamond status, and this increased substantially to 317 ESO Angels awards in 2021 Q2, 99 of which were diamond awards. As of Q2 2022, a total of 2707 awards had been granted, of which 729 were diamond awards.
Strengths, weaknesses, and future directions
Angels represents a bridge between science and implementation, designing and delivering practical solutions tailored to local needs. On a practical level, the focus of the work of Angels has now expanded from the hyperacute phase of stroke treatment to the pre-hospital setting as well as to the early pos-acute setting. The training focuses on four action priorities: (1) diagnosing the patient, (2) choosing the correct hospital, (3) emergency transport, and (4) pre-notification to the in-hospital stroke team. Another awareness-raising initiative, FAST Heroes, play a key role in educating families, via a school-based program, to recognize key stroke symptoms and to increase their understanding of how to respond in an emergency. Further investment will be required along every step of the patient pathway to optimize outcomes.
