“The main challenge is not to discover new treatments, but to make them available to more people.”
Ana Urmeneta, Head of Sustainability at Boehringer Ingelheim, talks to neurologist Carlos Molina about the Angels Initiative, a global project that aims to improve the survival chances of stroke patients and promote good long-term recovery. Since its inception in 2016, some 7.5 million people have been treated in more than 6,000 Angels hospitals worldwide.
Ana Urmeneta: Since its launch in 2016 Angels’ Initiative has helped improve acute stroke care. The initiative is led by Boehringer Ingelheimin collaboration with the European Stroke Organization, the European Stroke Alliance and various national organizations, companies and health institutions. In 2021, Dr. Carlos Molina received the Spirit of Excellence award granted by the Angels initiative in Spain. With a career recognized nationally and internationally, Carlos Molina has been Director of the Stroke Unit at the Vall d’Hebron University Hospital for over 15 years. He also heads the Stroke Research Unit and has extensive experience in coordinating clinical trials. What are the achievements achieved through the Angels initiative?
Carlos Molina: As you said, the Angels Initiative started about eight years ago with a huge effort by Boehringer Ingelheim to support not only stroke treatment but also acute stroke care, and it has had a dramatic global impact. In South Africa, for example, the number of stroke units has increased. In Latin America, it has also increased exponentially. As part of the Angels Initiative, I have been fortunate to help coordinate a program to establish stroke units and improve access to treatment for the consequences of brain injury at the regional level in Latin America. Five years ago, there were virtually no stroke units, and now there are more than 150 accredited in Latin America.
What elements do you think were key to the success of this initiative?
The most important thing is determination and persistence in coordinating everything parties concerned. Coordinate and align the actions of all the actors involved, including those who are payers. Understand the health systems, adapt solutions to the cultural aspects of each country. There is no single solution to the problem of stroke. We need to understand other aspects that are also important for access to health care. It depends not only on the pathology, but also on the cultural and social environment, as well as the health system in which we are located, and the solution must be adapted. And this is where the Angels initiative really makes an impact: in adapting, adjusting these solutions to the realities of each country, each region.
“The main challenge is no longer to discover new treatments, but to reach more people.”
What do you think is the main problem that currently exists in the fight against stroke?
The big challenge now is pre-hospital stroke diagnosis: the ability to differentiate between ischemic and hemorrhagic strokes already in ambulances. Telemedicine connections improve diagnosis in small hospitals, allowing patients to be treated remotely from reference hospitals. But at the ambulance level, we need systems that diagnose patients quickly, reproducibly and easily. That is, like myocardial infarction, strokes can be treated in ambulances. For stroke patients, the challenge is not in developing new treatments, but in implementing them. And how to implement this from a hospital management perspective? Improving flows between hospitals, work processes. From the patient’s arrival in the emergency department to the CT scan. Engels was one of the big proponents of this direct translation to TAC. I think it’s already a global culture and it can be further optimized and it needs to get used to the different realities of hospitals in different health systems. I think the big challenge is not so much discovering new treatments, a lot has already been discovered, we know how to treat stroke, the main thing is to get them to more people.
What are the key aspects in patient care and treatment?
Time is everything. Every minute counts. Over 2 million neurons die every minute, and this needs to be communicated to society. Communication between professionals is basic, fundamental, but it starts with a call to 911.
How does the Angels initiative help more people become aware of symptoms and take action?
Over the past few years, the initiative has developed various strategies to promote health and, in particular, to prevent the signs of stroke. I believe that the most notable and original campaign is Heroesa children’s series. Children recognize the symptoms of a stroke and save a grandfather’s life. It has a global impact. I think it was a big success in promoting health, especially in what to do in case of a stroke and target What is very important is that the youngest ones.
“More than 2 million neurons die every minute, and this needs to be communicated to society”
How important is long-term follow-up and continuity of care after acute stroke care?
Patients may have a relapse of stroke, that is, it may happen again. It is also possible for the stroke to progress despite initial treatment, complications in the acute phase are possible. Therefore, it is very important to manage stroke units and, after the patient is discharged, to monitor and control vascular risk factors and special treatment methods in order to reduce the risk of relapse, improve quality of life and optimize all the results that we have obtained in the acute phase.
In 2021, you received the Angels Spirit of Excellence award. What does this award mean?
Well, this award is a recognition of the efforts to coordinate, promote and educate the initiative. It was a privilege to receive it, a great honor to be part of this great family. This shared leadership, which I believe represents a new way of managing things at a global level, not only seeing things from our European perspective, with established resources and a system that works, but also approaching things from a different perspective. with a different system of health care, management and payment. Taking into account the cultural and spiritual aspects of people, which must be respected from the very beginning. In developing all these strategies, it is necessary to consider the interests of people from the very beginning, not at the end.
Finally, where do you hope Angels will evolve?
It’s difficult because I think the initial expectations have been exceeded. I think it’s reaching every corner of the planet. I hope that one day the regional differences in treatment can be reduced and access improved. I think that’s a very important issue: improving access to patients. That’s the key. That’s why we’re working.
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