Stroke Epidemiology, Patterns of Management, and Outcomes in Fortaleza, Brazil

Abstract

Background and Purpose-Little information exists on the epidemiology and patterns of treatment of patients admitted to Brazilian hospitals with stroke. Our objective was to describe the frequency of risk factors, patterns of management, and outcome of patients admitted with stroke in Fortaleza, the fifth largest city in Brazil. Methods-Data were prospectively collected from consecutive patients admitted to 19 hospitals in Fortaleza with a diagnosis of stroke or transient ischemic attack from June 2009 to October 2010. Results-We evaluated 2407 consecutive patients (mean age, 67.7Ϯ14.4 years; 51.8% females). Ischemic stroke was the most frequent subtype (72.9%) followed by intraparenchymal hemorrhage (15.2%), subarachnoid hemorrhage (6.0%), transient ischemic attack (3%), and undetermined stroke (2.9%). The median time from symptoms onset to hospital admission was 12.9 (3.8 -32.5) hours. Hypertension was the most common risk factor. Only 1.1% of the patients with ischemic stroke received thrombolysis. The median time from hospital admission to neuroimaging was 3.4 (1.2-26.5) hours. In-hospital mortality was 20.9% and the frequency of modified Rankin Scale score Յ2 at discharge was less than 30%. Older age, prestroke disability, and having a depressed level of consciousness at admission were independent predictors of poor outcome; conversely, male gender was a predictor of good outcome. Conclusions-The prevalence of stroke risk factors and clinical presentation in our cohort were similar to previous series.Treatment with thrombolysis and functional independency after a stroke admission were infrequent. We also found long delays in hospital admission and in evaluation with neuroimaging and high in-hospital mortality. (Stroke. 2011;42:3341-3346.)

Early stroke case-fatality rates in three hospital registries in the Northeast and Southeast of Brazil

“…In our previous hospital-based registry analysis (April 2006 to December 2008) performed in the city of São Paulo 6 , we found stroke subtype proportions (84.9% ischemic stroke, 15.1% intracerebral hemorrhage) that were similar to those in the studies performed in Matão and Joinville. Our results were also similar to other hospital-based registries in the Northeastern region of Brazil, in the cities of Natal, Rio Grande do Norte 7 , and Fortaleza, Ceará 8 . However, the overall stroke 30-day case-fatality rate was lower (12.8%, first-ever and recurrent) than in Matão (18.5%), Joinville (19.1%) and Fortaleza (20.9%), and similar to that in Natal (10.4%) 9 .…”

Prevalence and risk factors for stroke in a population of Southern Brazil

“…Currently, stroke can be considered the greatest public health problem in Brazil and in many countries of Latin America 1,2 . Although scarce, Brazilian epidemiological studies show elevated mortality [3][4][5] and high prevalence of sequels in survivors, such as physical disability, post-stroke depression and dementia 6,7 . Brazilian data are not known, but in United States, in 2008, the cost of care with disability caused by stroke was estimated in 18.8 billion dollars, while productivity loss and premature deaths had cost of 15.5 billion dollars 8 .…”

Brazilian guidelines for endovascular treatment of patients with acute ischemic stroke

“…Despite being one of the leading causes of mortality in the country, stroke has been severely neglected, with very poor stroke awareness in the population and very low rates of treatment with intravenous thrombolysis 10,11 . Unfortunately, Brazil is a country of great economic inequalities, with some stroke units in the private and public hospitals, especially in the wealthier regions of the country, presenting similar thrombolysis rates to those of tertiary stroke centers of developed countries 11,12,13 .…”

“…Despite being one of the leading causes of mortality in the country, stroke has been severely neglected, with very poor stroke awareness in the population and very low rates of treatment with intravenous thrombolysis 10,11 . Unfortunately, Brazil is a country of great economic inequalities, with some stroke units in the private and public hospitals, especially in the wealthier regions of the country, presenting similar thrombolysis rates to those of tertiary stroke centers of developed countries 11,12,13 . These services routinely perform endovascular treatment for stroke and were able to develop a triage and quality control system, with some centers even being certified by international institutions such as the Joint Commission to PAO: proximal arterial occlusions; NIHSS: National Institutes of Health Stroke Scale; IV TPA: intravenous tissue plasminogen activator; MR CLEAN: multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands; EXTEND-IA: extending the time for thrombolysis in emergency neurological deficits -intra-arterial; ESCAPE: endovascular treatment for small core and anterior circulation proximal occlusion with emphasis on minimizing CT to recanalization times; SWIFT-PRIME: solitaire with the Intention for thrombectomy as primary endovascular treatment; REVASCAT: randomized trial of revascularization with solitaire FR device versus best medical therapy in the treatment of acute stroke due to anterior circulation large vessel occlusion presenting within eight hours of symptom onset; IC ICA: intracranial segment of the internal carotid artery; M1 and M2: first and second segments of the MCA; EC ICA: extracranial segment of the internal carotid artery; Tmax: time to maximum; CBF: cerebral blood flow; ASPECTS: Alberta stroke program early CT score; CT: computed tomography; MCA: middle cerebral artery; CTA: CT angiography; CTP: CT perfusion; CBV: cerebral blood volume; DWI: diffusion weighted imaging; Solitaire FR: solitaire stent-retriever device.…”