Armenia is an upper-middle-income country with a population of nearly 3 million. Its population is aging. As of 2020, stroke was the sixth leading cause of death in Armenia, with a mortality of 75.5 per 100,000 population. Advances in stroke prevention, therapeutic interventions for acute stroke, the development of stroke centers, and national organizations advocating for stroke care have lowered stroke incidence, morbidity, and mortality in high-income countries. During the last four decades, while stroke incidence declined by 50% in high-income countries, it doubled in low- and middle-income countries, including Armenia. Until recently, modern stroke therapies such as thrombolysis and mechanical thrombectomy were not available in Armenia. Significant steps have been taken in stroke care during the last 8 years to reflect state-of-the-art evidence-based practices.
Prehospital emergency care remains a weak link in stroke care in Armenia. Pre-hospital physicians have not been consistently trained in rapid stroke rating systems or stroke mimics. There are no well delineated geographic zones and guidelines in Yerevan to direct the transfer of patients to the nearest stroke center meaning possible prolonged transport times. In addition, there is currently little hospital-based emergency care. Patients arriving at the hospital triage area are frequently seen by a non-emergency trained on-duty physician. Stroke training of prehospital and triaging physicians in-hospital remains inadequate and inconsistent. Quality improvement and physician and public education remain major challenges to be addressed.
The urban and regional adult population of the Republic of Armenia. The project aims to examine parameters related to stroke in an effort to improve emergency medical systems overall.
There are 4 aims of this project.
1) Improve and advance emergency stroke care by collecting and analyzing internationally accepted quality measures such as ambulance team response time, percent performance of stroke scale, percent collection of time of symptom onset, percent screened for stroke mimics, time to notification of hospital team, time for arrival of team to hospital arrival.
2) Improve overall capacity for emergency systems research by working with committed partners the American University of Armenia (AUA), the Yerevan Municipal Ambulance Service (YMAS), as well as the Ministry of Health (MOH) and the National Institute of Health (NIH) to organize, extract, analyze and publish baseline data from the existing dispatch database.
3) Understand and update the current state of stroke knowledge in the pool of physicians staffing the pre-hospital system.
4) Understand the current state of knowledge in the general public via survey administration to assess knowledge of risk factors, stroke recognition and ability to activate the emergency system.
Thank you to the Doximity Foundation for this support! This project aimed to lay the groundwork to strengthen prehospital and emergency stroke care in Armenia by addressing critical gaps in early recognition, patient transport, and hospital triage.
We developed and delivered standardized training programs for prehospital providers and hospital triage physicians, focusing on rapid stroke identification and the use of validated assessment tools. Simulation-based workshops and continuous education sessions were conducted to improve clinical decision-making and response times.
To reduce delays in care, we worked on coordinated stroke transport protocols in Yerevan, including defined geographic routing zones and pre-notification systems between ambulance services and stroke centers. These measures will improve the efficiency of patient transfer to appropriate facilities.
We also strengthened hospital-based emergency care by introducing standardized triage procedures and supporting the formation of dedicated stroke response teams in key hospitals.
Finally, we introduced the concept of quality improvement mechanisms, including performance monitoring and data collection systems, to track outcomes such as transport times and treatment rates.
Together, these interventions improved early stroke recognition, reduced delays in treatment, and enhanced the overall coordination of stroke care services.
