The Decline in Stroke Mortality

Kunst, Anton E.; Amiri, Masoud; Janssen, Fanny

doi:10.1161/strokeaha.110.599712

Cited by 94 publications

(49 citation statements)

References 24 publications

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“…1,5 Case-fatality has decreased in the last decades in highincome countries, likely reflecting advances in stroke care and secondary prevention. [21][22][23] A possible consequence of the increasing number of stroke survivors might be an increase of recurrent strokes and comorbidities in stroke patients. Indeed, in our population, patients were observed to be more often functionally impaired before the stroke.…”

Section: Discussionmentioning

confidence: 99%

Time Trends in Patient Characteristics Treated on Acute Stroke-Units

Teuschl

Brainin²,

Matz³

et al. 2013

Stroke

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Since 2003, the Austrian Stroke Unit Registry prospectively collects data on baseline characteristics, management, and outcome of all stroke patients admitted to 33 of 34 Austrian stroke-units. Data entry, administration, and scientific analysis are approved and coordinated by an expert committee from the Austrian Stroke Society. Data collection, ratings and data entry are performed by experienced Background and Purpose-Demographic changes, increased awareness of vascular risk factors, better diagnostic, progress in medical care, and increasing primary stroke prevention influence the profile of patients admitted to stroke-units. Changes in patient population and stroke type have important consequences on outcome and management at stroke-units. Methods-Data from the national database of the Austrian Stroke Unit Registry were analyzed for time-trends in demography, risk factors, cause, and stroke severity. Results-Data of 48 038 ischemic and 5088 hemorrhagic strokes were analyzed. Between 2003 and 2011, median age increased significantly for ischemic strokes from 68 to 71 years in men and from 76 to 78 years in women, respectively. Ischemic stroke patients showed significantly increased rates of hypertension, hypercholesterolemia, and atrial fibrillation. In hemorrhagic strokes an increase for hypercholesterolemia and cardiac diseases other than atrial fibrillation and myocardial infarction were only found in men. A small but significant decrease in stroke severity was found for ischemic strokes from 4 to 3 points on the National Institutes of Health Stroke Scale in men and from 5 to 4 in women, and for hemorrhagic strokes from 9 to 6 points in men and from 9 to 7 in women. Cardioembolic strokes increased slightly, whereas macroangiopathy decreased. Conclusions-Significant time trends were seen for characteristics of ischemic and hemorrhagic stroke patients admitted to acute stroke-units in Austria. These include trends for older age and toward milder strokes with more cardioembolic causes. This signals a need for increased resources for managing multimorbidity and enabling early mobilization. (Stroke. 2013;44:1070-1074.)

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Section: Discussionmentioning

confidence: 99%

Time Trends in Patient Characteristics Treated on Acute Stroke-Units

Teuschl

Brainin²,

Matz³

et al. 2013

Stroke

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“…Fortschritte in der Präven-tion und Therapie des Schlaganfalls haben in den letzten Jahrzehnten zu stetig fallenden Inzidenz-und Mortalitäts-raten in hoch entwickelten Ländern geführt [5,6]. Dennoch ist aufgrund des demografischen Wandels in den kommenden Jahren in vielen Ländern mit einem Anstieg der Gesamtzahl an Schlaganfäl-len zu rechnen [7,8].…”

Section: Prävalenz Des Schlaganfalls Bei Erwachsenen Im Alter Von 40 unclassified

Prävalenz des Schlaganfalls bei Erwachsenen im Alter von 40 bis 79 Jahren in Deutschland

Busch

Schienkiewitz

Nowossadeck

et al. 2013

Bundesgesundheitsbl.

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Prävalenz des Schlaganfalls bei Erwachsenen im Alter von 40 bis 79 Jahren in Deutschland Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1)Der Schlaganfall ist weltweit die zweithäufigste Todesursache, eine Hauptursache von Behinderung und ein wesentlicher Kostenfaktor für Gesundheitssysteme [1,2,3,4]. Fortschritte in der Präven-tion und Therapie des Schlaganfalls haben in den letzten Jahrzehnten zu stetig fallenden Inzidenz-und Mortalitäts-raten in hoch entwickelten Ländern geführt [5,6]. Dennoch ist aufgrund des demografischen Wandels in den kommenden Jahren in vielen Ländern mit einem Anstieg der Gesamtzahl an Schlaganfäl-len zu rechnen [7,8]. Aktuelle epidemiologische Daten zum Schlaganfall und deren Entwicklung über die Zeit sind dabei eine wichtige Grundlage für die Abschät-zung der zukünftigen gesellschaftlichen Krankheitslast und des Versorgungsbedarfs in der Bevölkerung.Auch in Deutschland ist der Schlaganfall unverändert die zweithäufigste Todesursache nach der koronaren Herzkrankheit, obwohl die Mortalitätsrate durch Schlaganfall in den vergangenen Jahrzehnten kontinuierlich gefallen ist [9] Methoden Studiendesign und StichprobeDie "Studie zur Gesundheit Erwachsener in Deutschland" (DEGS) ist Bestandteil des Gesundheitsmonitorings des Robert Koch-Instituts (RKI). Konzept und Design von DEGS sind an anderer Stelle ausführlich beschrieben [16,17,18,19,20] Statistische AnalyseDie Lebenszeitprävalenz des Schlaganfalls wurde als Anteil der Personen mit der Antwort "Ja" an der Gesamtzahl aller Personen mit gültigen Antworten ("Ja" oder "Nein") auf die Frage nach jemals diagnostiziertem Schlaganfall berechnet und in Prozent mit 95%-Konfidenzintervall (95%-KI) dargestellt. Personen mit fehlenden Angaben oder der Antwort "Weiß nicht" wurden von den Analysen ausgeschlossen.Die Querschnittsanalysen zur Schlaganfallprävalenz in DEGS1 wurden mit einem Gewichtungsfaktor durchgeführt, der Abweichungen der Stichprobe von der Bevölkerungsstruktur (Stand 31.12.2010) 3-1,7) 1,8 (1,0-3,4) 5,4 (3,6-8,0) 8,1 (5,5-11,9) 3,3 (2,6-4,2) Gesamt 0,9 (0,4-1,8) 1,3 (0,8-2,2) 4,2 (3,0-5,9) 7,1 (5,2-9,7) 2,9 (2,3-3,6) % (95%-KI) % (95%-KI) % (95%-KI) % (95%-KI) % (95%-KI)Frauen 2,3 (1,7-3,2) 2,3 (1,7-3,2) 2,5 (1,8-3,4) +0,2 (−0,9; +1,2) +0,2 (−0,9; +1,2) Männer 2,4 (1,8-3,2) 2,8 (2,1-3,9) 3,3 (2,6-4,2) +0,9 (−0,1; +1,9) +0,5 (−0,6; +1,6) Gesamt 2,4 (1,9-2,9) 2,6 (2,1-3,2) 2,9 (2,3-3,6) +0,5 (−0,2; +1,3) +0,3 (−0,5; +1,1)

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“…1 Recent analyses showed that in Western Europe mortality from stroke declined until the most recent years of observation. 2,3 This decline was even greater in the new millennium in the Netherlands. 4 However, whether these mortality trends mainly reflect favorable changes in risk factors or improvement of acute treatment and secondary prevention is unclear.…”

mentioning

confidence: 99%

Remarkable Decline in Ischemic Stroke Mortality is Not Matched by Changes in Incidence

Vaartjes

O’Flaherty²,

Capewell³

et al. 2013

Stroke

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To determine 30-day case fatality and 1-year mortality after hospital admission, a cohort of incident hospitalized IS patients for the period 1997-2005 was constructed. This period was selected because good quality data were available for these years and include surrounding Background and Purpose-In Western Europe, mortality from ischemic stroke (IS) has declined over several decades. Agesex-specific IS mortality, IS incidence, 30-day case fatality, and 1-year mortality after hospital admission are essential for explaining recent trends in IS mortality in the new millennium. Methods-Data for all IS deaths in the Netherlands were grouped by year, sex, and age. A joinpoint regression was fitted to detect points in time at which significant changes in the trends occur. By linking nationwide registers, a cohort of patients first admitted for IS between 1997 and 2005 was constructed and age-sex-specific 30-day case fatality and 1-year mortality were computed. IS incidence (admitted IS patients and out-of-hospital IS deaths) was computed by age and sex. Mann-Kendall tests were used for trend evaluation. Results-IS mortality declined continuously between1980 and 2000 with an attenuation of decline in the 1990s in some of the age-sex groups. A remarkable decline in IS mortality after 2000 was observed in all age-sex groups, except for young men. An improved decline in 30-day case fatality and in 1-year mortality was also observed in almost all age-sex groups.In contrast, IS incidence remained stable between 1997 and 2005 or even increased slightly. Conclusions-The recent remarkable decline in IS mortality was not matched by a decline in the number of incident nonfatal IS events. This is worrying, because IS is already a leading cause of adult disability, claiming a heavy human and economic burden. Prevention of IS is therefore now of the greatest importance. IS IncidenceThe incidence of IS was defined as the sum of patients with first hospitalization for IS and patients who died from first IS before hospitalization.The number of patients with an incident hospitalization for IS between 1997 and 2007 was determined by constructing a cohort as was described above. The risk of IS does not depend on whether a unique combination of linking variables is present or not. Therefore we increased the observed number of IS in the constructed cohort using the age-sex-specific uniquity percentage (% of uniqueness ranges from 79.3% in age group 35-44 years to 99.8% in age group >95 years) allowing us to calculate an absolute number of first IS events in the Netherlands.To construct a cohort of patients who died from an incident IS before hospitalization, information from the cause of death register, the population registry, and hospital discharge registry were linked. All out-of-hospital deaths attributable to IS (ICD-10 code I63 and I64) between January 1, 1997 and December 31, 2005 were selected from the cause of death register. Information was subsequently collected on hospital admissions that may have occurred previously for the ...

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The Decline in Stroke Mortality

Cited by 94 publications

References 24 publications

Time Trends in Patient Characteristics Treated on Acute Stroke-Units

Time Trends in Patient Characteristics Treated on Acute Stroke-Units

Prävalenz des Schlaganfalls bei Erwachsenen im Alter von 40 bis 79 Jahren in Deutschland

Remarkable Decline in Ischemic Stroke Mortality is Not Matched by Changes in Incidence

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