Reduction of Ischemic Stroke Associated Disability in the Population: A State-Wide Stroke Registry Analysis over a Decade
(Background): Effective prevention strategies and acute therapies have been established and distributed in recent years to reduce the global burden of stroke. However, beyond randomized clinical trials, limited data exist on the real-world impact of these measures. Our goal was to analyze whether th...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/23/6942 |
| _version_ | 1797462947104030720 |
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| author | Christian Foerch Martin A. Schaller-Paule Helmuth Steinmetz Björn Misselwitz Ferdinand O. Bohmann |
| author_facet | Christian Foerch Martin A. Schaller-Paule Helmuth Steinmetz Björn Misselwitz Ferdinand O. Bohmann |
| author_sort | Christian Foerch |
| collection | DOAJ |
| description | (Background): Effective prevention strategies and acute therapies have been established and distributed in recent years to reduce the global burden of stroke. However, beyond randomized clinical trials, limited data exist on the real-world impact of these measures. Our goal was to analyze whether the stroke-associated disability in the population decreased over time based on a state-wide stroke registry analysis. (Methods): Consecutive data from a state-wide inpatient stroke registry covering the entire federal state of Hesse, Germany, were obtained. The clinical data of 141,287 patients with ischemic stroke (ICD-10: I63) admitted between 2010 and 2019 were included. The primary outcome was the odds ratio for a change of modified Ranking Scale (mRS) at discharge over time, estimated by ordinary logistic regression and adjusted for age and sex. The secondary outcome was the odds ratio for a lower National Institutes of Health Stroke Scale (NIHSS) score at hospital admission. (Results): The absolute number of severely disabled (mRS 4–5) stroke patients at discharge decreased over time (2010: 3223 (equivalent to 53/100,000 population); 2019: 2429 [39/100,000 population]). The odds at hospital admission for a higher mRS at discharge decreased significantly by 3.7% per year (OR 0.963 (95% CI 0.960–0.966), <i>p</i> < 0.001). The absolute number of severely affected stroke patients (NIHSS > 15) at admission declined over time (2010: 1589 [26/100,000]; 2019: 1185 [19/100,000]; <i>p</i> < 0.001). The odds for a higher NIHSS score at admission to hospital decreased by 3.8% per year (OR 0.962 (95% CI 0.959–0.965), <i>p</i> < 0.001). Trends were most prominent for patients aged 80 years and older and for patients with atrial fibrillation but absent in patients <60 years. (Conclusions): Stroke-associated disability in the population steadily decreased between 2010 and 2019. The improved prevention of severe strokes in elderly patients may be a major driver of this observation. |
| first_indexed | 2024-03-09T17:43:45Z |
| format | Article |
| id | doaj.art-964579f891d241b8861550f2c64fd6a7 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T17:43:45Z |
| publishDate | 2022-11-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-964579f891d241b8861550f2c64fd6a72023-11-24T11:20:21ZengMDPI AGJournal of Clinical Medicine2077-03832022-11-011123694210.3390/jcm11236942Reduction of Ischemic Stroke Associated Disability in the Population: A State-Wide Stroke Registry Analysis over a DecadeChristian Foerch0Martin A. Schaller-Paule1Helmuth Steinmetz2Björn Misselwitz3Ferdinand O. Bohmann4Department of Neurology, University Hospital Frankfurt, Goethe-University, 60528 Frankfurt am Main, GermanyDepartment of Neurology, University Hospital Frankfurt, Goethe-University, 60528 Frankfurt am Main, GermanyDepartment of Neurology, University Hospital Frankfurt, Goethe-University, 60528 Frankfurt am Main, GermanyInstitute of Quality Assurance, 65760 Eschborn, GermanyDepartment of Neurology, University Hospital Frankfurt, Goethe-University, 60528 Frankfurt am Main, Germany(Background): Effective prevention strategies and acute therapies have been established and distributed in recent years to reduce the global burden of stroke. However, beyond randomized clinical trials, limited data exist on the real-world impact of these measures. Our goal was to analyze whether the stroke-associated disability in the population decreased over time based on a state-wide stroke registry analysis. (Methods): Consecutive data from a state-wide inpatient stroke registry covering the entire federal state of Hesse, Germany, were obtained. The clinical data of 141,287 patients with ischemic stroke (ICD-10: I63) admitted between 2010 and 2019 were included. The primary outcome was the odds ratio for a change of modified Ranking Scale (mRS) at discharge over time, estimated by ordinary logistic regression and adjusted for age and sex. The secondary outcome was the odds ratio for a lower National Institutes of Health Stroke Scale (NIHSS) score at hospital admission. (Results): The absolute number of severely disabled (mRS 4–5) stroke patients at discharge decreased over time (2010: 3223 (equivalent to 53/100,000 population); 2019: 2429 [39/100,000 population]). The odds at hospital admission for a higher mRS at discharge decreased significantly by 3.7% per year (OR 0.963 (95% CI 0.960–0.966), <i>p</i> < 0.001). The absolute number of severely affected stroke patients (NIHSS > 15) at admission declined over time (2010: 1589 [26/100,000]; 2019: 1185 [19/100,000]; <i>p</i> < 0.001). The odds for a higher NIHSS score at admission to hospital decreased by 3.8% per year (OR 0.962 (95% CI 0.959–0.965), <i>p</i> < 0.001). Trends were most prominent for patients aged 80 years and older and for patients with atrial fibrillation but absent in patients <60 years. (Conclusions): Stroke-associated disability in the population steadily decreased between 2010 and 2019. The improved prevention of severe strokes in elderly patients may be a major driver of this observation.https://www.mdpi.com/2077-0383/11/23/6942preventionincidenceischemic strokehealth careregistriesanticoagulants |
| spellingShingle | Christian Foerch Martin A. Schaller-Paule Helmuth Steinmetz Björn Misselwitz Ferdinand O. Bohmann Reduction of Ischemic Stroke Associated Disability in the Population: A State-Wide Stroke Registry Analysis over a Decade Journal of Clinical Medicine prevention incidence ischemic stroke health care registries anticoagulants |
| title | Reduction of Ischemic Stroke Associated Disability in the Population: A State-Wide Stroke Registry Analysis over a Decade |
| title_full | Reduction of Ischemic Stroke Associated Disability in the Population: A State-Wide Stroke Registry Analysis over a Decade |
| title_fullStr | Reduction of Ischemic Stroke Associated Disability in the Population: A State-Wide Stroke Registry Analysis over a Decade |
| title_full_unstemmed | Reduction of Ischemic Stroke Associated Disability in the Population: A State-Wide Stroke Registry Analysis over a Decade |
| title_short | Reduction of Ischemic Stroke Associated Disability in the Population: A State-Wide Stroke Registry Analysis over a Decade |
| title_sort | reduction of ischemic stroke associated disability in the population a state wide stroke registry analysis over a decade |
| topic | prevention incidence ischemic stroke health care registries anticoagulants |
| url | https://www.mdpi.com/2077-0383/11/23/6942 |
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