Decrease in the Stroke Case Fatality Rates in a French Population-Based Twenty-Year Study

Abstract

Background: The aim of the study was to estimate trends in stroke case fatality in a French population-based study over the last 20 years, and to compare trends in men and women. Methods: We prospectively ascertained first-ever strokes in a well-defined population-based study, from 1985 to 2004, in Dijon (France) (150,000 inhabitants). The study was both specific and exhaustive. The follow-up made it possible to analyze case fatality, according to stroke subtypes and sex. Results: From the ascertainment of 3,691 strokes divided in 1,920 cerebral infarcts from large artery atheroma, 725 cerebral infarcts from small perforating artery atheroma, 497 cardioembolic infarcts, 134 cerebral infarcts from undetermined mechanism, 341 primary cerebral hemorrhages and 74 subarachnoïd hemorrhages, we observed a significant decrease in 28-day case fatality rates of almost 25% (p = 0.03). Case fatality rates decreased in men aged >75 years (p = 0.01) and in women aged >75 years (p = 0.02) and >65 years (p = 0.03). The magnitude of the decrease was smaller in women but not significantly so. According to stroke subtypes, case fatality rates significantly decreased for small perforating artery infarct (p = 0.04) and for primary cerebral hemorrhage (p = 0.03). In multivariate regression analyses, hemorrhagic stroke, the first period of the study (1985–1989), blood hypertension, previous myocardial infarction and age <85 years had a negative effect. Conclusion: This is the first population-based study using continuous ascertainment over a period of 20 years that has demonstrated a significant reduction in case fatality rates. We did not observe any significant differences between men and women.

Prior antiplatelet therapy and outcome following intracerebral hemorrhage

“…4 Two cohorts excluded patients admitted later than 24 hours after symptom onset, 21,23 2 excluded patients with prior stroke, 5,26 1 excluded patients "diagnosed with amyloid angiopathy," 20 and 1 excluded patients with multiple ICH, prior ICH, pre-ICH disability, or need for surgery. 30 We contacted study authors to request cohort data excluding patients taking anticoagulation and ultimately received data from 23 cohorts that specifically excluded patients on anticoagulation, [1][2][3][4][5]8,9,11,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] while one cohort included patients on anticoagulation, 10 and one cohort included patients on anticoagulation but controlled for its use in the multivariable model of mortality. 12 There was no evidence of publication bias in the 10 previously published studies ( p ϭ 0.34 for mortality and p ϭ 0.54 for poor outcome, by Egger's test) or when considering all 25 studies ( p ϭ 0.24 for mortality and p ϭ 0.49 for poor outcome) (figure 1).…”

“…[2][3][4]8,11,[13][14][15][16]18,[20][21][22][23][24]26,27 All models adjusted for age, 6 adjusted for premorbid disability, 4,13,15,16,18,27 and 1 adjusted for sex and diabetes. 3 The pooled univariate OR for poor functional outcome was 1.29 (95% CI 1.09 to 1.53, p ϭ 0.002) (figure 3).…”

“…Data from an additional 15 cohorts were obtained by these methods. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] In many cases, authors contributed more patients than described in the original cohort, which was allowed as long as these patients were collected and characterized according to the same published methods. Study quality was evaluated using the same criteria cited above.…”

Épidémiologie des accidents vasculaires cérébraux

“…Alors que la mortalité précoce est généralement directement imputée à l'AVC et est influencée par la prise en charge à la phase aiguë, la mortalité à plus long terme implique certainement d'autres mécanismes dont le risque de pathologie coronarienne qui augmente de façon continue dans les années suivant un AVC [7]. Sur le plan de l'évolution temporelle, une baisse de 25 % de la mortalité à un mois des AVC a été constatée au cours de ces vingt dernières années à Dijon, témoi-gnant probablement de l'amélioration de la prise en charge en phase aiguë préhospitalière et hospitalière, mais aussi d'un meilleur état de santé global de la population ; ce dernier paramètre explique la probabilité accrue de survie après un AVC et possiblement la sévérité moindre des AVC [8]. Des résultats similaires ont été observés dans d'autres pays occidentaux [1].…”

The safety and efficacy of Heparin and Nadroparin compared to placebo in acute ischemic stroke - pilot study

“…It is a frequent cause of acute hospitalization (150,000 cases per year vs. 130,000 cases of myocardial infarction in France), severe morbidity (the first cause of disability, the second cause of dementia), and the third cause of overall mortality 5 . Since 1995, when the results of the NINDS clinical study were published, causal therapy (intravenous thrombolysis -IVT) has been generally available.…”