ABSTRACT NUMBER: ESOC2026A609 ACUTE STROKE CARE IN UKRAINE 2021–2024: TRENDS, QUALITY IMPROVEMENT, AND SYSTEM PERFORMANCE DURING WARTIME

Abstract Background and aims Ukraine faces one of the highest stroke burdens in the WHO European Region, further exacerbated by demographic upheaval and health-system disruptions caused by the ongoing war. This analysis examines national stroke care trends from 2021–2024 to assess access, quality, treatment performance, and emerging system gaps, building on WHO’s technical support for stroke system strengthening. Methods Data were drawn from the mandatory e-Health centralized database, covering all hospitals. Indicators included admission patterns, access to revascularization, rehabilitation utilization, disability at discharge, and in-hospital and 30-day mortality. Qualitative insights from a 2024 WHO-supported clinical audit in six regions complemented quantitative findings. Results Acute stroke admissions increased by 16% in 2021-2024 despite population decline. By 2024, 96% of all stroke cases were treated in hospitals contracted by the National Health Service of Ukraine for the stroke package, up from 85% in 2021, indicating successful network consolidation. Revascularization rates improved substantially: intravenous thrombolysis increased from 4.6% to 13.2%, and endovascular thrombectomy from 0.3% to 2.4%. Access to inpatient rehabilitation nearly tripled (4.8% to 13.4%), although outpatient rehabilitation remained very low (1–2%). In-hospital (16–17%) and 30-day (24%) mortality rates remained high and unchanged. Audit findings highlighted uneven adherence to standards, gaps in EVT capability, staffing shortages, and variable coordination with Emergency Medical Services. Conclusions Ukraine has achieved notable progress in expanding access to evidence-based acute stroke care despite wartime pressures. Nonetheless, persistently high mortality, limited rehabilitation coverage, and coordination challenges signal a continued need for system strengthening, national surveillance, and rigorous quality-of-care monitoring. Conflict of interest Andrii Skipalskyi: nothing to disclose.