Changes in stroke incidence, outcome, and associated factors in Porto between 1998 and 2011

Abstract

Objective Year 2000 marked a turning point in stroke prevention and treatment in Portugal. In face of high incidence rates stroke awareness campaigns, close surveillance of vascular risk factors and implementation of hospital stroke units were advanced by the National Health Authorities. To understand the effect of such measures, we assessed changes in stroke incidence and short-term outcome using data from two community-based registers undertaken in Porto in 1998-2000 and 2009-2011. Methods We used standard diagnostic criteria and multiple overlapping sources of case-ascertainment for first-ever strokes. Short-term outcome was measured by the modified Rankin Scale; disabling stroke was defined whenever post-stroke mRS score>pre-stroke mRS and >1. Results Globally, 462 and 405 first-ever stroke cases were registered in 1998-2000 and 2009-2011, respectively. Stroke incidence decreased by 23%, from 261 to 203/100,000 after adjustment for the Portuguese population. Significant reduction was found in those aged <75 years (31%) and in women (32%). Incidence of disabling strokes was reduced by 29%. Fatal strokes decreased by 46%, while intracerebral hemorrhage decreased by 51%. Risk of disability from stroke decreased by 11% (RR = 0.89; 95%CI, 0.81-0.98) in 2009-2011, as found after adjusting for patient/stroke characteristics in a Poisson model. Moreover, when patients arrived hospital within 3 h from stroke onset, the risk of disabling stroke was 0.76 (95%CI, 0.67-0.87) in 2009-2011 vs. 1998-2000, compared to 1.03 (95%CI, 0.89-1.12) for late arrival. Conclusion Risk of stroke, mainly of hemorrhagic stroke, was substantially reduced over time. Timely action in acute phase was responsible for the decline in disability across periods.

Results of the implementation of the code stroke protocol in a Portuguese hospital

“…Another objective of this study was to determine the percentage of ischemic stroke, hemorrhagic stroke, and TIA during the period under analysis. The results are in line with epidemiological surveys that indicate that the ischemic stroke is more prevalent than the hemorrhagic stroke (Correia et al, 2017). Atrial fibrillation (AF) has presented, in this study, a higher prevalence in ischemic strokes.…”

“…A recent study concluded that patients with ischemic stroke residing in rural areas are less likely to access the fibrinolysis within the therapeutic window, in comparison with patients residing in urban environments (Gonzales, Mullen, Skolarus, Thibault, & Udoeyo, 2017). On the other hand, it is known that, in Portugal, the incidence of stroke is higher in rural areas of the northern countryside (Correia et al, 2017). Another objective of this study was to determine the percentage of ischemic stroke, hemorrhagic stroke, and TIA during the period under analysis.…”

Readmissions and Mortality During the First Year After Stroke—Data From a Population-Based Incidence Study

“…The sample was obtained from the second population-based register undertaken in Northern Portugal (ACIN2), comprising all FELS recorded between October 2009 and September 2011 in the population registered in the Health Centers Group of Western Porto main city (190,000 persons) and two health centers in rural regions in Northern Portugal (Mirandela and Vila Pouca de Aguiar, involving about 46,000 persons) (6). Multiple sources of information were used to identify all patients with a FELS using a record-linkage methodology based on the National Health Number, a unique identifier for residents in Portugal to contact the National Health Service (NHS).…”

“…Multiple sources of information were used to identify all patients with a FELS using a record-linkage methodology based on the National Health Number, a unique identifier for residents in Portugal to contact the National Health Service (NHS). Hot-pursuit and cold-pursuit ascertainment involving community-based and hospital-based information sources were used (6). Hot-pursuit encompassed a daily review of emergency admissions and referrals to the project out-patient clinic at Hospital de Santo António.…”

“…Patients were examined as soon as possible after symptoms' onset at the emergency room, during their hospital stay or at the project out-patient clinic, within 1 month and then were followed-up until 3 months after a stroke. More detailed information is described elsewhere (6). This study includes all patients from Porto admitted to the hospital after a FELS.…”