Trends in stroke outcomes in the last ten years in a European tertiary hospital

Abstract

BackgroundStudying the impact of demographic changes and progress in the management of stroke patients is necessary in order to organize care structures for the coming years. Consequently, we analyzed the prognostic trends of patients admitted to the Stroke Unit of a tertiary hospital in the last ten years.MethodsThe University Clinical Hospital of Santiago de Compostela is the referral hospital for stroke in a catchment area that accounts for 16.5% of the population of Galicia. Data from patients admitted to the Stroke Unit were registered prospectively. A multinomial logistic regression was performed to determine the influence of new trends in demographic factors and in the management of patients with acute stroke. For the expected trend of progression, a 2008–2011 and 2012–2017 time series model was made by selecting the most appropriate model.ResultsIn the last 10 years, the age of stroke onset has only increased in women (from 74.4 ± 2.2 years in 2008 to 78.8 ± 2.1 years in 2017; p = 0.037), and the same happens with the severity of neurological symptoms (ischemic stroke (IS), p < 0.0001; from 14 [10, 19] in 2008 to 19 [15, 26] in 2017), with a higher percentage of cardioembolic strokes (40.7% vs. 32.2% of cardioembolic strokes in women vs. men, p < 0.0001). In a multiple linear regression model, hospital improvement was mainly associated with the use of reperfusion treatment (B 53.11, CI 95% 49.87, 56.36, p < 0.0001). A differentiated multinomial logistic regression analysis conducted for the whole sample with ischemic strokes in the two time periods (2008–2011 and 2012–2017) showed no differences in the influence of factors associated with higher morbidity and mortality. The modeling of time series showed a distinct falling trend in mortality, with a slight increase in good outcome as well as morbidity in both ischemic and hemorrhagic stroke.ConclusionsOur results showed that mortality decreased in the entire sample; however, although outcome at discharge improved in ischemic stroke, severe disability also increased in these patients. Importantly, this tendency towards increased morbidity seems to be confirmed for the coming years.

Trends in ischemic stroke outcomes in a rural population in the United States

“…The observed decrease in mortality is consistent with other studies in Europe and the United States [21][22][23]. The mortality decline after 2013 parallels increased availability and utilization of endovascular stent thrombectomy [21,[24][25][26][27]. Geisinger has considerably increased its mechanical thrombectomy capacity since 2014; 151 (3.4%) patients in this study were treated with thrombectomy between 2014 and 2018, and 24 (0.6%) before 2014.…”

“…This study demonstrates an increasing trend in one-year stroke recurrence over a period of 15 years despite a significant decrease in one-year mortality over the same period. The observed decrease in mortality is consistent with other studies in Europe and the United States [21][22][23]. The mortality decline after 2013 parallels increased availability and utilization of endovascular stent thrombectomy [21,[24][25][26][27].…”

Antihyperthermic treatment decreases perihematomal hypodensity

“…1 In the last decade, mortality due to ICH has decreased but, unlike ischemic stroke, both morbidity and dependence are increasing, probably due to the absence of effective treatments and to population aging. 2,3 ICH growth during the first hours is a critical factor for neurologic deterioration and poor outcome, regardless of other factors that determine high mortality and poor outcome at the time of ICH, such as hematoma volume and intracranial hypertension with displacement of intracerebral structures. 4,5 The relation between ICH growth in the first hours and poor outcome was recently confirmed in an extensive meta-analysis.…”

Regulatory T cells participate in the recovery of ischemic stroke patients

“…Stroke represents the second cause of death in Europe and developed countries. In addition to mortality, longterm morbidity remains as one of the main consequence associated to stroke patients [1,2]. Although stroke causes enormous medical and economic costs associated to stroke, thrombolysis with recombinant plasminogen activator (rtPA) remains as the only approved pharmacological treatment for ischemic stroke (IS).…”