Background: Many registers containing routine medical information have been developed for research and surveillance purposes. In epidemiological research assessment of endpoints is often conducted via registers. In the present study we validated stroke and transient ischemic attack (TIA) diagnoses in the Danish National Register of Patients (DNRP). Methods: Subjects from a Danish cohort study, the Copenhagen City Heart Study (n = 19,698), were crosslinked with the DNRP. The following International Classification of Disease 10th revision codes were used to identify possible strokes and TIAs: I60–I69 and G45. Two independent raters reviewed all cases. Positive predictive values of stroke, TIA and stroke subtypes were estimated by dividing the confirmed cases by the total number of cases located in the DNRP. Interrater reliability was tested using ĸ statistics. Results: Of 236 possible cerebrovascular events, 1 in 6 stroke diagnoses did not meet study criteria. The majority of events in the DNRP were registered as unspecified stroke (I64), n = 105 (44%), of which two thirds were diagnosed as ischemic stroke events by the raters. Intracerebral hemorrhage and ischemic stroke had a positive predictive value from 74 to 97%, respectively. Conclusion: Our results show that the DNRP tends to overestimate the number of cerebrovascular events, while ischemic stroke is underestimated.

In the present study physical activity prior to stroke was associated with a less severe stroke and better long-term outcome.

Objectives To investigate if repeated verbal instructions about physical activity to patients with ischaemic stroke could increase long term physical activity.Design Multicentre, multinational, randomised clinical trial with masked outcome assessment.Setting Stroke units in Denmark, China, Poland, and Estonia.Participants 314 patients with ischaemic stroke aged ≥40 years who were able to walk—157 (mean age 69.7 years) randomised to the intervention, 157 (mean age 69.4 years) in the control group.Interventions Patients randomised to the intervention were instructed in a detailed training programme before discharge and at five follow-up visits during 24 months. Control patients had follow-up visits with the same frequency but without instructions in physical activity.Main outcome measures Physical activity assessed with the Physical Activity Scale for the Elderly (PASE) at each visit. Secondary outcomes were clinical events.Results The estimated mean PASE scores were 69.1 in the intervention group and 64.0 in the control group (difference 5.0 (95% confidence interval −5.8 to 15.9), P=0.36. The intervention had no significant effect on mortality, recurrent stroke, myocardial infarction, or falls and fractures.Conclusion Repeated encouragement and verbal instruction in being physically active did not lead to a significant increase in physical activity measured by the PASE score. More intensive strategies seem to be needed to promote physical activity after ischaemic stroke.Trial registration Clinical Trials NCT00132483

Background: This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke. Methods: A total of 3,520 subjects were invited to participate in the study, using a web-based, closed questionnaire. The recruitment was stratified by region, age and gender to represent the composition of the general Danish population aged 40+ years. Enrolment was competitive with a predefined target of 800 responses. The subjects were asked to rank the 4 most important acute stroke symptoms, and the 3 most important risk factors for stroke. Multivariable ordinal logistic regression was used for assessing factors associated with awareness of stroke symptoms and major stroke risk factors. Results: From December 12 to December 17, 2008, a total of 811 subjects (mean age: 58 years; SD: 11 years) were included, of which 405 (50%) were women. The 4 most frequently identified stroke symptoms were sudden onset of: speech disturbances (n = 636; 78.4%), facial palsy (n = 450; 55.5%), hemiparesis (n = 435; 53.6%) and visual disturbances (n = 429; 52.9%). The 3 most frequently identified stroke risk factors were: hypertension (n = 586; 72.3%), history of cerebrovascular disease (n = 401; 49.5%) and high concentration of cholesterol (n = 269; 33.2%). Compared with men, women had better knowledge of major stroke symptoms (OR = 1.33; 95% CI: 1.12–1.50) and stroke risk factors (OR = 1.33; 95% CI: 1.10–1.51) in multivariable analyses. Conclusions: The awareness of major stroke symptoms is insufficient. Whereas hypertension was the most often mentioned stroke risk factor, few subjects recognized tobacco smoking and diabetes mellitus as major risk factors for stroke.