A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project 1981-86. 1. Methodology, demography and incident cases of first-ever stroke.

154

112

Background and Purpose: A stroke registry covering the city of Malmo, Sweden (population 232,000) was started in January of 1989 to prospectively follow up stroke incidence, recurrence, and fatality rates.Methods: Patients with presumed stroke were interviewed within 1 week after admission to the hospital, and their medical records were examined. Continuous validation against hospital diagnosis showed well over 90% of all stroke cases in Malmo to have been included. Results: Incidence rates per 100,000 residents were 300 for all stroke events and 225 for first-ever stroke, lower than those reported from other studies. The distribution of stroke diagnostic categories was 3% subarachnoid hemorrhage, 10% intracerebral hemorrhage, 50% cerebral infarction, and 38% unspecified stroke. The diagnosis was based on computed tomography in 51% of first-ever stroke cases. Median age was 73.1 years for men and 79.7 years for women. Incidence rates for all stroke diagnostic categories except subarachnoid hemorrhage increased with age. Prior stroke, hypertension, smoking, atrial fibrillation, and diabetes mellitus were major risk factors for all stroke events. The presenting symptoms were hemiparesis in 74%, speech disorder in 49%, and clouded consciousness in 19% of the patients. The overall case-fatality rate at 30 days was 15%; the rate for intracerebral hemorrhage was 37% and that for cerebral infarction was 10%.Conclusions: Our findings confirm the value of a stroke registry for stroke epidemiology purposes and as a tool for specific stroke research. (Stroke 1992;23:357-361) KEY WORDS • incidence • stroke registry • Sweden

Section: -10supporting

confidence: 57%

Stroke registry in Malmö, Sweden.

Jerntorp

Berglund

1992

154

112

“…Rates from Shibata, Japan, 7 Soderhamn, Sweden, 8 were higher, whereas rates were lower in the other "ideal" studies. 8 - 13 The high rates in our study can be explained only partially by the high proportion of older people in the Danish population.…”

Section: Downloaded Frommentioning

confidence: 85%

Stroke incidence in Copenhagen, 1976-1988.

Lindenstrøm

Boysen

Nyboe

et al. 1992

Background and Purpose: Temporal trends in stroke incidence in Denmark have not been previously reported. The Copenhagen City Heart Study is a prospective study based on a randomly selected sample of an urban population of, initially, 19,698 participants followed since 1976. Over a period of 12 years, we studied three important aspects of stroke incidence in 848 identified cases: temporal trends, dependence on age and sex, and comparison of responders and nonresponders.Methods: The participants were invited to two health examinations at 5-year intervals. The participants who attended at least one of the two examinations are termed responders and those who attended none nonresponders. The cases of first-ever stroke were collected from responders, the National Patient Register, and the National Register of Deaths and were verified by study of hospital records and death certificates.Results: For responders aged 35-64 years and ^65 years, there were no significant changes in the weighted rates in four consecutive 3-year periods. There was a tendency toward decreasing rates among younger women, but not in older women or men. The age-and sex-adjusted rates per 1,000 (based on the Danish population in 1982) in responders in the entire 12-year follow-up period were 1.61 in women, 2.67 in men, and 2.14 in both sexes combined. Stroke incidence rates increased exponentially with age in both sexes, with rates in men generally twice those in women, even in the ^75 years of age group. Age-adjusted rates were higher in nonresponders than in responders. For women, this ratio was 1.7; for men, 1.1.Conclusions: The stroke incidence in Copenhagen is relatively high and has shown no decreasing tendency over the period 1976-1988. {Stroke 1992^3^8-32)

“…The distinction between lacunar and nonlacunar infarcts was made on the basis of the Bamford Classification. 20 The severity of stroke was documented by the lowest Glasgow Coma Scale (GCS) score 21 during the first week and by the Barthel Index (BI) score 22 ascertained 5 days after the stroke.…”

Section: Case Ascertainmentmentioning

confidence: 99%

Antithrombotic and Antihypertensive Management 3 Months After Ischemic Stroke

Hillen

Dundas

Lawrence

et al. 2000

Background and Purpose-We sought to examine the frequency, predictors, and effects of nontreatment with antithrombotic and antihypertensive therapies 3 months after ischemic stroke. Methods-The population-based South London Community Stroke Register prospectively collected data on first-in-alifetime strokes between 1995 and 1997. Among patients registered with ischemic stroke, treatment status with antithrombotic and antihypertensive therapies was examined 3 months after the event. Results-In a cohort of 457 patients with ischemic stroke, 393 (86.0%) were considered appropriate for antiplatelet medication, 32 (7.0%) for anticoagulant medication, and 254 (55.9%) for antihypertensive medication. The rates of nontreatment observed 3 months after the event were 24.4% for antiplatelet, 59.4% for anticoagulant, and 29.5% for antihypertensive medication. Independent risk factors for nontreatment with antithrombotic therapies (antiplatelets and anticoagulants) were the subtype of stroke (nonlacunar infarct: ORϭ1.60, 95% CI 1.07 to 2.54), stroke severity measured by the Glasgow Coma Scale (GCS) score (GCS Յ13: OR 2.08, 95% CI 1.18 to 3.66) and the Barthel Index (BI) score 5 days after the event (BI Յ10: OR 1.85, 95% CI 1.17 to 2.93). For antihypertensive therapies the stroke subtype (OR 2.46, 95% CI 1.33 to 4.54), GCS score (OR 2.97, 95% CI 1.35 to 6.53), BI score (OR 2.33, 95% CI 1.27 to 4.29), and ethnicity (Caucasian: OR 2.43, 95% CI 1.15 to 5.14) were independently associated with nontreatment. Cox regression modeling showed no significant association between the treatment status and recurrence-free 3-year survival rates after controlling for severity and subtype of stroke. Conclusions-Secondary prevention for a common disease such as stroke appears to be inadequate in the study area.Healthcare professionals need to consider antithrombotic and antihypertensive therapies for all stroke patients. (Stroke. 2000;31:469-475.)