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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.