Background: Despite its importance in being amongst the top ten causes of childhood death, there is limited data on the incidence of stroke in children, and whether this has changed over time. Aims: We performed a systematic review and meta-analysis to estimate the worldwide incidence rate of paediatric ischaemic stroke, identify population differences, and trends in incidence. Methods: We screened three databases (Medline, Embase and CINAHL) and a Google Search to October 2021. The protocol was pre-registered :PROSPERO: CRD42021273749). Data extraction and quality assessment was independently undertaken by two reviewers. A random-effects model was used for meta-analysis using Stata SE17 to calculate the overall incidence rate. Heterogeneity was assessed using I2. Meta-regression and assessment for bias were performed. Results: Out of 4,166 records identified, 39 studies were included in the qualitative synthesis and the quantitative meta-analysis. The pooled incidence rate for all ischaemic strokes was varied from 0.9 to 7.9 per 100,000 person-years, with a pooled incidence of 2.09 (95% CI: 1.57–2.76). The pooled incidence was 1.28 (95% CI: 0.75 – 2.19) per 100,000 person-years for arterial ischaemic stroke, and 0.56 (95% CI: 0.31 – 1.02) per 100,000 person-years for cerebral venous sinus thrombosis. The incidence of arterial ischaemic stroke was high in neonates, less than 28 days old (18.51 (95% CI 12.70–26.97). There was significant heterogeneity observed in the stroke incidence estimates initial analyses but geographical region, cohort age upper limit, length of study, study quality, and study design could not explain this. The incidence rate of childhood stroke appeared remained relatively stable over time. Conclusion: Our review provides estimates of global stroke incidence, including stroke subtypes, in children. It demonstrates a particularly high stroke incidence in neonates.

Background: The established link between cardiovascular disease (CVD) and dementia may provide new insights into dementia prevention. Objective: It aims to quantify the burden of dementia attributable to people with CVD. Methods: A Markov microsimulation model was developed to simulate the lifetime cost and quality-adjusted life-years (QALYs) related to people with and without CVD in Australia. A de-novo systematic review was undertaken to identify all evidence around the association between CVD [i.e., stroke, myocardial infarction (MI), atrial fibrillation (AF), and heart failure (HF)] and the risk of developing dementia. Incremental costs and QALY losses were estimated for people by type of CVD compared to the general Australian population without CVD. Results: Of the comprehensive literature search, 19 observational studies were included in the qualitative synthesis. Patients who had CVD incurred both higher healthcare costs over their lifetime (ranging from $73,131 for patients with AF to $127,396 for patients with HF) and fewer QALYs gains (from –1.099 for patients with MI to –5.163 for patients with stroke), compared to people who did not have CVD. The total incremental economic burden of dementia from patients aged 65 years and over with CVD was $6.45 billion (stroke), $11.89 billion (AF), $17.57 billion (MI), or $7.95 billion (HF) over their remaining life expectancy. Conclusion: The results highlighted the importance of CVD prevention to reduce the CVD burden and decrease the prevalence of dementia. Interventions that target patients with dementia risk factors like CVD may prove to be effective and cost-effective strategies.

<b><i>Introduction:</i></b> We aimed to assess the long-term health outcomes and costs of endovascular thrombectomy (EVT) using clinical trials and real-world evidence in patients with large ischaemic core. <b><i>Methods:</i></b> Both clinical trials and the INternational Stroke Perfusion Imaging REgistry (INSPIRE) were used. Patients with acute computed tomography perfusion scan with an ischaemic core of ≥70 mL were included. A Markov model was constructed to simulate the long-term costs and health outcomes (quality-adjusted life year) post-index stroke. Effectiveness of EVT (modified Rankin scale score at 3 months) was derived from the trials and INSPIRE registry (compared to matched patients not treated with EVT), respectively. <b><i>Results:</i></b> Based on the trial and real-world data, the overall results revealed varied health benefits and costs due to EVT, with reduced health benefits and increased costs from EVT treatment in everyday practice. The long-term simulation estimated that offering EVT to large vessel occlusion stroke patients with large ischaemic core was associated with greater benefits (1.12 vs. 0.25 quality-adjusted life year gains) and lower (−A$19,320) or higher costs (A$11,278), using trial and real-world data, respectively. The incremental cost of the EVT procedure (i.e., A$14,356) could be primarily offset to a different extent by the reduction in costs related to the nursing home care (−$31,986 vs. −A$1,874) in the clinical trial and real-world practice. <b><i>Conclusions:</i></b> Our results highlight the potential gaps when implementing an effective intervention in the real world and the importance of the rigorous selection of large infarct core patients for EVT.

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