Stroke is a clinical syndrome characterized by the rapid development of focal or general signs of impaired brain function that last more than 24 hours and can lead to death, with vascular origin. There are different types of stroke with different pathogenesis.Approximately 80-85% of strokes are ischemic in nature, while approximately 15-20% are hemorrhagic in origin (mostly cerebral hemorrhage, less frequently subarachnoid hemorrhage).In the case of ischemic stroke, the most common cause is thrombotic occlusion of an arterial vessel or occlusion by an embolus originating from another site (e.g., the carotid artery or heart).In the case of cerebral hemorrhage or hemorrhagic stroke, the pathogenesis is most often attributable to the rupture of an arterial vessel due to hypertension. Subarachnoid hemorrhage, more common among young people, is due to the rupture of a vascular aneurysm or an arteriovenous malformation in the space between the dura mater and the leptomeninges. Ischemic forms generally have a better prognosis than hemorrhagic forms and have a 30-day fatality rate ranging from 10% to 15% in various studies. In this context, the definition of stroke includes ischemic forms and excludes hemorrhagic forms, subarachnoid hemorrhage, and other unspecified intracranial hemorrhages due to their more dire prognosis. In the acute phase of stroke, the emergency system (118 service and emergency department/dea) is primarily involved (pre-hospital phase).In acute hospitalization—possibly in a dedicated stroke unit—a complete clinical diagnostic assessment, acute phase treatment, and monitoring and control of complications (both neurotic and general) are performed.Continuity of care offered to stroke patients in the post-acute phase is particularly important, aimed at functional recovery and the prevention of complications and recurrences.
Thirty-day mortality after hospitalization for stroke is considered a valid and reproducible indicator of the appropriateness and effectiveness of the diagnostic-therapeutic process that begins with hospital admission. The indicator “thirty-day mortality after first hospitalization for ischemic stroke” measures the outcome starting from the date of the patient’s first hospital admission. Attributing the outcome to the hospital does not imply an assessment of the quality of care provided by that facility, but rather of the appropriateness and effectiveness of the care process that begins with the patient’s arrival at that facility. Given the likelihood of recurrence, another short-term outcome is “hospital readmissions within 30 days of treatment for ischemic stroke.”
The rate of readmissions within 30 days of a hospital discharge for stroke can be an indicator of the quality of both in- and out-of-hospital care for cerebrovascular events. The indicators “12-month mortality of ischemic stroke survivors” and “12-month MACCE of ischemic stroke survivors” are calculated to evaluate the appropriate clinical and therapeutic management of patients in the community after a hospitalization for stroke.The clinical therapeutic pathway includes a secondary prevention program that must include dietary recommendations, lifestyle modifications, and the definition of an appropriate pharmacological strategy with the aim of avoiding subsequent cardiovascular or cerebrovascular events that can be fatal in these patients.
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Indicators 
