Trends of the Incidence of Ischemic Stroke Thrombolysis over Seven Years and One-Year Outcome: A Population-Based Study in Joinville, Brazil

Abstract

Background: In a population-based setting, we aimed to measure the incidence trends of ischemic stroke (IS) thrombolysis, thrombolysis times, proportion of symptomatic intracerebral hemorrhage (sICH), 30-day case fatality and functional outcomes. We also compared the 12-month functional status between thrombolyzed and nonthrombolyzed patients. Methods: Using data from the Joinville Population-Based Stroke Registry, we prospectively ascertained a cohort of all thrombolyses done in Joinville citizens, Southern Brazil, from 2005 to 2011. For the definition of sICH we used European Cooperative Acute Stroke Study (ECASS) II criteria. Results: Over 7 years, 6% (220/3,552) of all IS were thrombolyzed. The thrombolysis incidence increased from 1.4 [95% confidence interval (CI), 0.6-2.9] in 2005 to 9.8 (7.3-12.9) per 100,000 population in 2011 (p < 0.0001). The thrombolysis incidence age-adjusted to the world population in 2011 was 11 (8.2-14.3) per 100,000. Only 30% (50/165) were thrombolyzed within 1 h of arrival at hospital. In 7 days, 6.4% (14/220) had sICH and 57% (8/14) of those died. In the 2009-2011 period, a favorable functional outcome [modified Rankin scale (mRS) 0-1] at 12 months among patients who received thrombolysis was more frequent [mRS 0-1; 36% (38/107)] than among patients who did not receive thrombolysis [mRS 0-1; 24% (131/544); p = 0.016]. The logistic regression showed that thrombolyzed IS patients had a more favorable outcome (mRS 0-1; HR 2.13; 95% CI, 1.2-3.7; p < 0.016) than nonthrombolyzed patients. Conclusion: In a population setting of a middle income country, the thrombolysis incidence and outcomes were similar to those of other well-structured services. After 1 year, patients thrombolyzed in the 4.5-hour time window had a better outcome. More than proportions, rates provide additional information and could be used to benchmark services against others.

Norberto Cabral: A Pioneer in Stroke Research in Brazil Leaves a Huge Legacy for Latin America

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well as a researcher and clinical neurologist at the Hospital Municipal São José and Neurological Clinic in Joinville.As one of the most distinguished Brazilian stroke researchers, he started the JOINVASC in 2005, a population-based registry in the city of Joinville, one of the largest stroke databases in the world, providing information to plan the stroke assistance in his city, and also establishing important knowledge about stroke [1][2][3][4][5][6][7][8][9][10][11].With his persistence, leadership and expertise, he put Joinville on the Brazilian and world map, showing the work of his group in the first stroke unit created in Brazil (1997) [1]. He always followed what he preached: "who has numbers has argument, who has information has power."

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“…Disagreeing with social injustices, he always defended those who had no voice to defend themselves, striving for better public health for all. His determination and his tireless work leave us a huge legacy of fundamental studies that supported stroke research and planning of stroke care in Brazil [1,[3][4][5][6][7][9][10][11][12][13], including the most important population-based study on stroke on a national level performed through the National Research Network of the Ministry of Health.With important models in his professional life, he was strongly influenced by Valery Feigin, Peter Sandercock and Joanna Wardlaw as well as his friends, researchers from Chile, Pablo Lavados and Claudio…”

“…As one of the most distinguished Brazilian stroke researchers, he started the JOINVASC in 2005, a population-based registry in the city of Joinville, one of the largest stroke databases in the world, providing information to plan the stroke assistance in his city, and also establishing important knowledge about stroke [1][2][3][4][5][6][7][8][9][10][11].…”

Performance of four ischemic stroke prognostic scores in a Brazilian population

“…In recent years, a growing number of stroke centers have been settled in this country 7 . Consequently, an increasing number of patients with acute IS have benefited from validated therapies, including the use of tPA 8 . However, only few studies have evaluated IS outcome in Brazil 9 and none of them have assessed the utility of prognostic scores in a Brazilian population.…”

Stroke treatment: metrics and processes

“…It should be acknowledged, however, that mean or median OTT cannot tell us the whole story 9,10 . Central tendency measures may represent a final result of divergent forces: greater symptom recognition by the public and more efficient hospital processes, and, on the other hand, the parallel inclusion of more patients in the extended 3 to 4.5 hour-window.…”