Fewer ischemic strokes, despite an ageing population: stroke models from observed incidence in Norway 2010–2015

Rand‐Hendriksen, Kim; Dahl, Fredrik A.; Viana, Joe; Rønning, Ole Morten; Faiz, Kashif Waqar; Barra, Mathias

doi:10.1186/s12913-019-4538-7

Cited by 17 publications

(17 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The CVA sequela subcategory displayed the expected male sex association, consistent with male sex increased risk for CVAs. No discernible temporal trend for CVAs was observed, which is consistent with the stable or declining stroke incidence rates observed in Norway 49,50 …”

Section: Discussionsupporting

confidence: 76%

Stroke Mimics on the Stroke Unit – Temporal trends 2008–2017 at a large Norwegian university hospital

Barra

Faiz

Dahl

et al. 2021

Acta Neuro Scandinavica

Self Cite

View full text Add to dashboard Cite

Objectives The objective was to quantify temporal trends in stroke mimics (SM) admissions relative to cerebrovascular accidents (CVA), incidence of hospitalized SMs and characterize the SM case‐mix at a general hospital's stroke unit (SU). Materials & Methods All SU admissions (n = 11240) of patients aged 15 or older to Haukeland University Hospital between 2008–2017 were prospectively included and categorized as CVA or SM. Logistic regression was used to estimate time trends in the proportion of SMs among the admissions. Poisson regression was used to estimate time trends in age‐ and sex‐dependent SM incidence. Results SMs were on average younger thaan CVA patients (68.3 vs. 71.4 years) and had a higher proportion of females (53.6% vs. 44.5%). The total proportion of SM admissions was 51.0%. There was an increasing time trend in the proportion of SM admissions, odds ratio 1.150 per year (p < 0.001), but this trend appears flattening, represented by a significant quadratic time‐term, odds ratio 1.009 (p < 0.001). A higher SM proportion was also associated with the time period of a Mass Media Intervention (FAST campaign) in 2014. There was also an increasing trend in SM incidence, that remains after adjusting for age, sex, and population; also, for incidence the trend appears to be flattening. Conclusions SMs account for approximately half of the SU admissions, and the proportion has been increasing. A FAST campaign appears to have temporarily increased the SM proportion. The age‐ and sex‐dependent incidence of SM has been increasing but appears to flatten out.

show abstract

Section: Discussionsupporting

confidence: 76%

Stroke Mimics on the Stroke Unit – Temporal trends 2008–2017 at a large Norwegian university hospital

Barra

Faiz

Dahl

et al. 2021

Acta Neuro Scandinavica

Self Cite

View full text Add to dashboard Cite

show abstract

“… 10 , 11 Approximately 20% reduction in stroke incidence was observed in community cohorts 10 , 12 and inpatient datasets over the last decades. 13 , 14 More than 1:4 mid-life strokes were AF-related. 10 Trends were explained by lower smoking prevalence, better blood pressure, and cholesterol control, whereas obesity prevalence increased.…”

Section: Context Of Atrial Fibrillation and Vascular Brain Injurymentioning

confidence: 99%

Atrial fibrillation: villain or bystander in vascular brain injury

Freedman

Kamel

Gelder

et al. 2020

European Heart Journal Supplements

View full text Add to dashboard Cite

Atrial fibrillation (AF) and stroke are inextricably connected, with classical Virchow pathophysiology explaining thromboembolism through blood stasis in the fibrillating left atrium. This conceptualization has been reinforced by the remarkable efficacy of oral anticoagulant (OAC) for stroke prevention in AF. A number of observations showing that the presence of AF is neither necessary nor sufficient for stroke, cast doubt on the causal role of AF as a villain in vascular brain injury (VBI). The requirement for additional risk factors before AF increases stroke risk; temporal disconnect of AF from a stroke in patients with no AF for months before stroke during continuous ECG monitoring but manifesting AF only after stroke; and increasing recognition of the role of atrial cardiomyopathy and atrial substrate in AF-related stroke, and also stroke without AF, have led to rethinking the pathogenetic model of cardioembolic stroke. This is quite separate from recognition that in AF, shared cardiovascular risk factors can lead both to non-embolic stroke, or emboli from the aorta and carotid arteries. Meanwhile, VBI is now expanded to include dementia and cognitive decline: research is required to see if reduced by OAC. A changed conceptual model with less focus on the arrhythmia, and more on atrial substrate/cardiomyopathy causing VBI both in the presence or absence of AF, is required to allow us to better prevent AF-related VBI. It could direct focus towards prevention of the atrial cardiomyopathy though much work is required to better define this entity before the balance between AF as villain or bystander can be determined.

show abstract

“…Although declining stroke incidence rates have been observed in high-income countries over the last 30 years, the trend in absolute numbers is offset by an aging population [ 8 – 10 ], and more liberal admission guidelines [ 3 , 11 ]. Recent estimates of incidence rates in Norway have found a decline in age- and sex-adjusted incidence for IS and non-significant trends for intracerebral haemorrhage (ICH) and TIA during the years 2010–2015 [ 12 , 13 ]. In addition, there appears to be a general reduction in the average length of stay (LOS) for stroke patients [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…The aim of the present study is to integrate our previous findings with demographic projections in order to estimate the demand for SU beds in Norway for the years 2020–2040. We thereby account for trends in incidence rates for stroke and TIA, demographic projections, accounting for the effects of LOS and utilisation of SU beds by patients with SMs [ 7 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Stroke unit demand in Norway – present and future estimates

Dahl

Barra

Faiz

et al. 2022

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

Background All stroke patients should receive timely admission to a stroke unit (SU). Consequently, most patients with suspected strokes – including stroke mimics (SM) are admitted. The aim of this study was to estimate the current total demand for SU bed capacity today and give estimates for future (2020–2040) demand. Methods Time trend estimates for stroke incidence and time constant estimates for length of stay (LOS) were estimated from the Norwegian Patient Registry (2010–2015). Incidence and LOS models for SMs were based on data from Haukeland University Hospital (2008–2017) and Akershus University Hospital (2020), respectively. The incidence and LOS models were combined with scenarios from Statistic Norway’s population predictions to estimate SU demands for each health region. A telephone survey collected data on the number of currently available SU beds. Results In 2020, 361 SU beds are available, while demand was estimated to 302. The models predict a reduction in stroke incidence, which offsets projected demographic shifts. Still, the estimated demand for 2040 rose to 316, due to an increase in SMs. A variation of this reference scenario, where stroke incidence was frozen at the 2020-level, gave a 2040-demand of 480 beds. Conclusions While the stroke incidence is likely to continue to fall, this appears to be balanced by an increase in SMs. An important uncertainty is how long the trend of decreasing stroke incidence can be expected to continue. Since the most important uncertainty factors point toward a potential increase, which may be as large as 50%, we would recommend that the health authorities plan for a potential increase in the demand for SU bed capacity.

show abstract

Fewer ischemic strokes, despite an ageing population: stroke models from observed incidence in Norway 2010–2015

Cited by 17 publications

References 21 publications

Stroke Mimics on the Stroke Unit – Temporal trends 2008–2017 at a large Norwegian university hospital

Stroke Mimics on the Stroke Unit – Temporal trends 2008–2017 at a large Norwegian university hospital

Atrial fibrillation: villain or bystander in vascular brain injury

Stroke unit demand in Norway – present and future estimates

Contact Info

Product

Resources

About