Stroke trends in Australia and New Zealand: mortality, morbidity, and risk factors

Stroke in Northern Sweden

Background: Stroke is one of the most common causes of death and long-term disability worldwide. Although stroke mortality has decreased in most industrialized countries, there are populations, particularly in East Europe, in which the mortality has increased. The WHO initiated, 20 years ago, the MONICA Project. The aim of the study was to measure trends in coronary heart disease and stroke and to assess the extent to which these were related to changes in known risk factors. Design: The Northern Sweden MONICA stroke study started in 1985 and is still ongoing. All individuals with an acute stroke in the age group 25 - 74 years have been included in the stroke register. Death certificates, discharge records, and GPs' records are screened and validated using strict MONICA criteria. Results: Stroke event rates (first ever and recurrent stroke) per 100,000 and year in the age group 25 - 74 years varied little over the years. Between 1985 and 1998 the annual incidence varied between 318 and 372 in men and between 195 and 240 in women, with no secular trends at all. The 28-day case fatality decreased in both men and women, from 19% to 11%. Logistic regression analyses showed a risk reduction in dying from stroke to 0.55 (p<0.0001) the last year compared with the first, with an absolute annual reduction in case fatality of 3%, in both men and women. In international comparison Northern Sweden shows an intermediately high incidence and one of the lowest case fatality rates of all participating populations. The incidence in subarachnoid haemorrhage was among the highest. Conclusion: The ongoing decline in stroke mortality in Sweden is driven exclusively by declining case fatality, whereas event rates (first ever and recurrent stroke) have remained the same since 1985. This, together with more people entering advanced, stroke-prone age groups, implies that the burden of stroke will continue to increase in Sweden.

The Effect of Nutrition Consultation on Dietary Diversity Score of Cardiac Patients Referred to Cardiac Rehabilitation Research Center Isfahan Cardiovascular Research Institute during 2008-2013

BACKGROUND

Dietary diversity score (DDS) measurement was used to assessment of diet quality in different disease like cardiovascular disease. One way to improve the cardiovascular patient's ability is cardiac rehabilitation program that include exercise training, nutrition consultation and psychological treatment. No study was designed to compare the DDS before and after dietary consultation among cardiac rehabilitation patients, so this study was designed to examine this purpose.

METHODS

Subjects were participated in the 2-month cardiac rehabilitation program. All patients that completed the cardiac rehabilitation program and 2 dietary records (before and after nutritional counseling in cardiac rehabilitation program) enrolled in study. Kant et al method was used for scoring dietary diversity. Data were analyzed using the statistical package for social sciences (SPSS version 20). Wilcoxon test were used to compare DDS score for each subgroup and pair sample T test was used to compare total DDS after and before nutrition counseling. P < 0.05 was considered as statistically significant.

RESULTS

The differences between DDS of grain, fruit, vegetable and meat before and after nutrition counseling were not significant (P = 0.635, P = 0.423, P = 0.826, P = 0.207 respectively), but differences of DDS for dairy and total DDS before and after nutrition counseling were significant (P = 0, P = 0.001).

CONCLUSIONS

Dietary diversity was increased after nutrition counseling among patients with cardiac disease.

Evidence-to-practice gaps in post-stroke management: a focus on care in a stroke unit and anticoagulation to prevent death, disability and recurrent stroke

ABSTRACT: 

The global burden of stroke is large. Over the last 15 years significant advances have been made to improve acute stroke care and prevention management providing the ability to mitigate much of this burden. In this article, we describe the importance of two main elements of stroke care: stroke units to reduce death and disability and anticoagulation therapy to prevent recurrent, often fatal or disabling, cardioembolic stroke. We also describe the issues related to translating these interventions into practice and the related economic implications. Despite the proven effectiveness and cost–effectiveness of these and other interventions, many people experiencing stroke are not receiving these interventions. Effective evidence translation initiatives and routine monitoring of healthcare is needed to address important gaps in stroke management in promoting societal well-being.

Comparison of cardiac rehabilitation programs combined with relaxation and meditation techniques on reduction of depression and anxiety of cardiovascular patients

Cardiovascular disease (CVD) is a major cause of death in developed countries. Most cardiac rehabilitation programs include psychological interventions. The aim of this study was to determine the effectiveness of rehabilitation techniques in cardiac patients including psychological-physical interventions such as Meditation and Relaxation. We enrolled 45 patients with CVD and depression. The patients were allocated to 3 groups (Relaxation, Meditation and Control). There was a significant reduction on depression, systolic blood pressure and heart rate in the Meditation group compared with the control group. Our findings suggest that meditation techniques have better outcomes in cardiac patients for improving depression, reduction of systolic and diastolic blood pressure, and heart rate than relaxation techniques.

Risk factors for myocardial infarction case fatality and stroke case fatality in type 2 diabetes: UKPDS 66

OBJECTIVE

Patients with diabetes have a higher case fatality rate in myocardial infarction (MI) or stroke than those without diabetes: that is, MI and stroke are more often fatal if diabetes is present. We investigated whether the risk of MI or stroke being fatal in type 2 diabetes can be estimated using information available around the time diabetes is diagnosed.

RESEARCH DESIGN AND METHODS

Analyses were based on 674 cases of MI (351 fatal) that occurred in 597 of 5,102 U.K. Prospective Diabetes Study (UKPDS) patients for whom covariate data were available during a median follow-up of 7 years. Multivariate logistic regression was used to examine differences in risk factors, measured within 2 years of diagnosis of diabetes, between fatal and nonfatal MI. Similar analyses were performed for 234 strokes (48 fatal) that occurred in 199 patients.

RESULTS

Patients with fatal MI had higher HbA(1c) than those with nonfatal MI (odds ratio 1.17 per 1% HbA(1c), P = 0.014). Patients with fatal stroke had higher HbA(1c) than those with nonfatal stroke (odds ratio 1.37 per 1% HbA(1c), P = 0.007). Other risk factors for MI case fatality included increased age, blood pressure, and urine albumin level.

CONCLUSIONS

The risk of MI or stroke being fatal in type 2 diabetes is associated with risk factors, including HbA(1c), measured many years before onset of MI or stroke. Equations have been added to the UKPDS Risk Engine to estimate likely case fatality rates in MI and stroke.

Incidence, risk, and case fatality of first ever stroke in the elderly population. The Rotterdam Study

OBJECTIVE

To estimate the incidence, survival, and lifetime risk of stroke in the elderly population.

METHODS

The authors conducted a study in 7,721 participants from the population based Rotterdam Study who were free from stroke at baseline (1990-1993) and were followed up for stroke until 1 January 1999. Age and sex specific incidence, case fatality rates, and lifetime risks of stroke were calculated.

RESULTS

Mean follow up was 6.0 years and 432 strokes occurred. The incidence rate of stroke per 1,000 person years increased with age and ranged from 1.7 (95% CI 0.4 to 6.6) in men aged 55 to 59 years to 69.8 (95% CI 22.5 to 216.6) in men aged 95 years or over. Corresponding figures for women were 1.2 (95% CI 0.3 to 4.7) and 33.1 (95% CI 17.8 to 61.6). Men and women had similar absolute lifetime risks of stroke (21% for those aged 55 years). The survival after stroke did not differ according to sex.

CONCLUSIONS

Stroke incidence increases with age, also in the very old. Although the incidence rate is higher in men than in women over the entire age range, the lifetime risks were similar for both sexes.

Trends in stroke incidence and acute case fatality in a Japanese rural area : the Oyabe study

BACKGROUND AND PURPOSE

Stroke mortality in Japan has significantly declined during recent decades. To determine the cause of this decrease, we studied the trends in stroke incidence and case fatality within 28 days after stroke in a rural area in Japan.

METHODS

We used a population-based registry during 1977-1991 in Oyabe, a rural area in the central part of Japan. The average population aged 25 years and older numbered 32 859 persons. Changes in age-standardized stroke incidence rate were calculated and compared between the 3 periods 1977-1981, 1982-1986, and 1987-1991. The 28-day case fatality rate was evaluated and also compared between the 3 periods by onset year.

RESULTS

The total number of strokes was 2068. The age-standardized incidence rate of all strokes decreased during the 15-year period, from 605 to 417 per 100 000 in men and from 476 to 329 per 100 000 in women. A marked decline was found during 1977-1986 but was not apparent during 1987-1991. Moreover, there was an increase in the group aged 75 years and older. The 28-day case fatality rates for all strokes improved from 18.0% to 14.2% in men and from 26.8% to 19.1% in women during the observation period.

CONCLUSIONS

These data indicate that declines in the stroke incidence and the 28- day case fatality have been associated with a marked decrease in stroke-related mortality in Japan.

Stable stroke occurrence despite incidence reduction in an aging population: stroke trends in the danish monitoring trends and determinants in cardiovascular disease (MONICA) population

BACKGROUND AND PURPOSE

A stroke register was established at the Glostrup Population Studies in 1982 with the objective to monitor stroke occurrence in the population continuously during a 10-year period and contribute data to the WHO Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Project. The purpose of the current analysis was to estimate temporal trends in stroke occurrence.

METHODS

All stroke events in the study population were ascertained and validated according to standardized criteria outlined by the WHO MONICA Project. The study population comprised all subjects > or = 25 years of age. Stroke was defined by the clinical presentation. A total of 5262 stroke events in >2 million person-years were analyzed. Age-adjusted rates for first-ever stroke and for all stroke events were calculated and temporal trends estimated by means of Poisson regression.

RESULTS

The overall annual stroke attack rate per 100,000 person-years in the age range > or = 25 years was 272 in men and 226 in women. Age-adjusted stroke attack rates decreased among men by 3.9% per year and by 4.1% among women. Age-adjusted stroke incidence rates declined by 2.9% in men and by 3. 1% in women. The trends were statistically significant in both sexes. However, the proportion of elderly people in the study population increased during the time period of the study. Hence the numbers of stroke victims in the population remained largely unaltered.

CONCLUSIONS

Decreasing age-adjusted stroke incidence rates point to a reduction of stroke risk during the time period of the study. Cardiovascular prevention, in particular improved hypertension control, is believed to have contributed to the incidence reduction. However, the burden of stroke on the healthcare system did not substantially diminish. The gain likely achieved from reduction of preventable risk factors was almost counterbalanced by population aging.

Time trends in long-term survival after stroke: the Northern Sweden Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, 1985-1994

BACKGROUND AND PURPOSE

Stroke mortality rates and case fatality of stroke have declined since the beginning of the 1970s in Sweden, but the incidence of stroke has been stable. The aim of this study was to analyze trends in long-term survival after stroke.

METHODS

Within the framework of the population-based WHO Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Project, all acute stroke events were recorded in the age group 25 to 74 years in northern Sweden during the period 1985 to 1994. All first-ever stroke patients were followed for information on vital status (minimum follow-up time was 1 year). Survival time was related to time period of stroke onset, stroke diagnosis, and concomitant diseases.

RESULTS

Survival times for a total of 6819 first-ever stroke patients (4057 men and 2762 women) were analyzed. Age-adjusted odds ratio for death within 1 year after stroke was 0.70 (95% confidence interval [CI], 0.55 to 0.88) in the period 1993 to 1994 as compared with the period 1985 to 1986 in men and 0.69 (95% CI, 0.53 to 0.90) in women. Corresponding odds ratios were 0.73 in men and 0.70 in women among those who survived the first 28 days. Similar improvements were seen for 3- and 5-year survival. Improvements in survival over time were most marked among patients with ischemic stroke. There was no improvement in survival over time among patients with the most severe deficits at onset.

CONCLUSIONS

Gradually improved survival, both short and long term, was observed during the 10-year study period. The improvements are not explained by changes in known confounding prognostic factors.

Ethnic differences in stroke incidence and case fatality in Auckland, New Zealand

BACKGROUND AND PURPOSE

This study compares stroke incidence, 28-day case fatality, and hospital management for Maori, Pacific Islands people ("Pacific people"), and others (mostly Europeans) living in Auckland, New Zealand.

METHODS

Data come from the Auckland Stroke Study, a population-based study that registered all stroke events occurring among Auckland residents aged 15 years or more during a 1-year period ending February 29, 1992.

RESULTS

During the study year, 1803 stroke events were registered, including 82 (4.5%) in Maori, 113 (6.3%) in Pacific people, 1572 (87.2%) in Europeans, and 36 (2.0%) in others of Indian or Chinese origin. The mean +/- SD age of stroke patients was 55.0 +/- 16.0 years in Maori, 59.7 +/- 14.9 years in Pacific people, and 73.3 +/- 12.1 years in Europeans. Maori and Pacific people have significantly higher estimated relative risks of stroke compared with Europeans (OR, 1.34; 95% confidence interval [CI], 1.05 to 1.67 in Maori; and OR, 1.63; 95% CI, 1.33 to 1.98 in Pacific people). Maori and Pacific people also have higher estimated relative risks of death within 28 days of stroke compared with Europeans, especially men.

CONCLUSIONS

This study indicates that there are important differences in stroke incidence rates and case fatality among the major ethnic groups in Auckland. The reasons for the higher incidence rates in Maori and Pacific people may be related to levels of risk factors, but this requires further investigation. Ongoing monitoring of stroke incidence and outcome should include separate reporting by ethnicity.

Stroke trends in the WHO MONICA project

BACKGROUND AND PURPOSE

Stroke registers were established as part of the international collaborative World Health Organization Monitoring of Trends and Determinants in Cardiovascular Disease (WHO MONICA) Project in 17 centers in 10 countries. The aim of the present analyses was to estimate and compare temporal stroke trends across the MONICA populations.

METHODS

All stroke events in defined populations were ascertained and validated according to a common protocol and uniform criteria. Almost 25,000 stroke events in more than 15 million person-years were analyzed. Age-standardized rates for fatal stroke and for all stroke events were calculated for whole calendar years for each of the populations. Temporal stroke trends were estimated using annual rates for 5 to 6 years.

RESULTS

Annual stroke attack rates decreased among men in 13 populations and among women in 15 of the 17 MONICA populations. Stroke mortality rates declined among men in 11 populations and among women in 14 of the populations studied. The estimated trends reached the level of statistical significance at the 5% level in only a small number of populations. The trends in official cerebrovascular death rates were in agreement with those estimated on the basis of MONICA data in the majority of the populations studied.

CONCLUSIONS

Decreasing stroke mortality and attack rates in a large proportion of populations studied can be interpreted as an indication of declining stroke rates in most of the populations studied. The numbers of populations with statistically significant trends were small, and it is therefore not possible to determine with certainty in which of the populations were the changes real.

Stroke incidence and 30-day case-fatality rates in Novosibirsk, Russia, 1982 through 1992

BACKGROUND AND PURPOSE

The present study was conducted to investigate the incidence of stroke and 30-day case-fatality rates for stroke in a defined Russian population.

METHODS

This is a population-based study that was established in 1982. All residents of an administratively defined and typical district of Novosibirsk (approximately 150,000 subjects) who had an incident (first-ever) stroke from January 1, 1982, through December 31, 1992, were registered.

RESULTS

During an 11-year study period, 3406 incident stroke patients were registered, for an overall crude average annual incidence rate of 202/100,000 population. The rates were higher with increasing age and were significantly higher for men than for women. The age- and sex-adjusted annual incidence rate of stroke declined from 271/100,000 in 1982 to 232/100,000 in 1992. Slowing of the decline in stroke incidence was observed after 1988, and stroke incidence increased slightly in 1992. No significant differences in 30-day stroke case-fatality rates were noted from 1982 through 1992, but a slight trend toward decreasing rates was observed after 1988. There was no major change in patient age at stroke onset.

CONCLUSIONS

Stroke incidence rates in Novosibirsk are among the highest in the world. We observed a decline in stroke incidence but little change in 30-day case-fatality rates in Novosibirsk from 1982 through 1992.