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Risk of Short-Term Mortality after Intracerebral Haemorrhage due to Weekend Hospital Admission in Poland. Emerg Med Int 2020; 2020:2198384. [PMID: 33376607 PMCID: PMC7744225 DOI: 10.1155/2020/2198384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 10/31/2020] [Accepted: 11/24/2020] [Indexed: 11/26/2022] Open
Abstract
Background The mortality rate for spontaneous intracerebral haemorrhage (ICH) has remained high and stable for many years. The unfavourable prognostic factors include age, bleeding volume, location of the haematoma, high blood pressure, and disturbed consciousness on admission. Other risk factors associated with medical care also deserve attention. The study aimed to analyse the relationship between day of admission, concerning other prognostic factors, and short-term mortality in ICH, in a Polish specialist stroke unit. Methods Medical records of 156 patients (74 males, 82 females, mean age 68.7 years) diagnosed with spontaneous ICH and admitted to a specialist stroke center were retrospectively analysed. Demographics, location, volume of bleeding, blood pressure values, and the Glasgow Coma Scale (GCS), as well as the day of admission, were determined. The relationships were analysed between these factors and 30-day mortality in the patients with ICH. Results A total of 83 patients were admitted to the hospital during weekdays (Monday 8 am to Friday 3 pm) and 73 during weekends or holidays. Of these, 65 patients died within 30 days. Patients admitted at weekends initially presented with lower GCS scores. Admission on Saturday was associated with an increased risk of death (OR 3.38, 95% CI 1.2–9.48, p < 0.05), but after correction for clinical state measured with the GCS and ICH score, the association was no longer significant. Conclusions The time and mode of admission were not associated with increased risk of short-term mortality in ICH patients. Prehospital care issues should be additionally considered as prognostic factors of the outcome.
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Faronbi JO, Ademuyiwa IY, Olaogun AA. Patterns of chronic illness among older patients attending a university hospital in Nigeria. Ghana Med J 2020; 54:42-47. [PMID: 32863412 PMCID: PMC7445699 DOI: 10.4314/gmj.v54i1.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background The rising burden of chronic diseases has attracted the attention of public health researchers and policymakers worldwide. Objectives To assess the demographic, morbidity and outcome patterns of chronic illness among the older patients at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Design Retrospective study Setting Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Participants Seven hundred and eighty-eight (788) adults (60 years and over) hospitalized between 2010 and 2014 in the hospital. Interventions None Results The age of the selected study population ranged from 60 to 99 years with a mean of 76.08(±10.42). More than half (53.0%) were between 60–69 years, with a subsequent decline. Male patients accounted for 64.0%, but females were more frequent among patients 80 years and older. The most common health conditions were heart diseases (22.5%), neoplasm (13.2%), cerebrovascular accident (12.4%), and gastrointestinal diseases (14.5%). The records showed that 14.9% were referred to other institution for various reasons (including further management, lack of space, industrial action by workers, discharged against medical advice or dead). Conclusion Heart diseases were the major chronic illnesses among the older adults followed by neoplasm conditions, while musculoskeletal conditions were the least. It also found that there was a poor outcome of conditions among older adults in this setting. Therefore, efforts should be made towards the prevention and reduction of chronic illnesses, as well as improving the outcome of care. Funding Doctoral Fellowship from Consortium for Advanced Research Training in Africa
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Affiliation(s)
- Joel O Faronbi
- Department of Nursing Science, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.,The Frail Elderly Research Support Group (FRESH), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Iyabo Y Ademuyiwa
- Department of Nursing Science, Faculty of Clinical Sciences, University of Lagos, Idi-Araba Lagos, Nigeria
| | - Adenike A Olaogun
- Department of Nursing Science, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Kim J, Thayabaranathan T, Donnan GA, Howard G, Howard VJ, Rothwell PM, Feigin V, Norrving B, Owolabi M, Pandian J, Liu L, Cadilhac DA, Thrift AG. Global Stroke Statistics 2019. Int J Stroke 2020; 15:819-838. [PMID: 32146867 DOI: 10.1177/1747493020909545] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Data on stroke epidemiology and availability of hospital-based stroke services around the world are important for guiding policy decisions and healthcare planning. AIMS To provide the most current incidence, mortality and case-fatality data on stroke and describe current availability of stroke units around the world by country. METHODS We searched multiple databases (based on our existing search strategy) to identify new original manuscripts and review articles published between 1 June 2016 and 31 October 2018 that met the ideal criteria for data on stroke incidence and case-fatality. For data on the availability of hospital-based stroke services, we searched PubMed for all literature published up until 31 June 2018. We further screened reference lists, citation history of manuscripts and gray literature for this information. Mortality codes for International Classification of Diseases-9 and International Classification of Diseases-10 were extracted from the World Health Organization mortality database for each country providing these data. Population denominators were obtained from the World Health Organization, and when these were unavailable within a two-year period of mortality data, population denominators within a two-year period were obtained from the United Nations. Using country-specific population denominators and the most recent years of mortality data available for each country, we calculated both the crude mortality from stroke and mortality adjusted to the World Health Organization world population. RESULTS Since our last report in 2017, there were two countries with new incidence studies, China (n = 1) and India (n = 2) that met the ideal criteria. New data on case-fatality were found for Estonia and India. The most current mortality data were available for the year 2015 (39 countries), 2016 (43 countries), and 2017 (7 countries). No new data on mortality were available for six countries. Availability of stroke units was noted for 63 countries, and the proportion of patients treated in stroke units was reported for 35/63 countries. CONCLUSION Up-to-date data on stroke incidence, case-fatality, and mortality statistics provide evidence of variation among countries and changing magnitudes of burden among high and low-middle income countries. Reporting of hospital-based stroke units remains limited and should be encouraged.
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Affiliation(s)
- Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Tharshanah Thayabaranathan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Geoffrey A Donnan
- Melbourne Brain Centre, University of Melbourne, Parkville, Victoria, Australia
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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Kotlęga D, Gołąb-Janowska M, Meller A, Bajer-Czajkowska A, Zembroń-Łacny A, Nowacki P, Banach M. Beneficial effects of pre-stroke statins use in cardioembolic stroke patients with atrial fibrillation: a hospital-based retrospective analysis. Arch Med Sci 2019; 15:385-392. [PMID: 30899291 PMCID: PMC6425215 DOI: 10.5114/aoms.2019.82925] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 08/04/2018] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Statins are widely used in stroke patients. The AHA/ASA guidelines recommend aggressive statin therapy in atherosclerotic stroke patients. Their beneficial effects are due to both their hypolipemic and pleiotropic properties. The aim of this study was to establish potential benefits from statin use in ischemic stroke patients with the diagnosis of atrial fibrillation (AF). MATERIAL AND METHODS Ischemic stroke patients with AF were enrolled in the study. Group I, the statin group (n = 181), consisted of patients who had been treated with statins before stroke. Group II, the non-statin group (n = 153), consisted of patients who had not received such treatment in the last year. In-hospital mortality and neurological deficit on admission and at discharge were analyzed using the National Institutes of Health Stroke Scale (NIHSS) score. RESULTS Patients from the non-statin group had greater initial and discharge NIHSS scores (10 vs. 11.9, probability value p < 0.05; 7.6 vs. 9.5, p < 0.05 respectively). The improvement in NIHSS score was greater in the statin group (73.5% vs. 59.5%, p < 0.01). In-hospital mortality was more frequent in the non-statin group (9.9% vs. 18.3%, p < 0.05). CONCLUSIONS Despite the predominant use of statins in atherothrombotic stroke patients, we demonstrated the beneficial effects of statins in cardioembolic stroke patients. Detailed cardiovascular screening for statin therapy should be carried out in all AF patients with regard to primary and secondary stroke prevention.
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Affiliation(s)
- Dariusz Kotlęga
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | | | - Agnieszka Meller
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | | | - Agnieszka Zembroń-Łacny
- Department of Applied and Clinical Physiology, University of Zielona Gora, Zielona Gora, Poland
| | - Przemysław Nowacki
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | - Maciej Banach
- Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
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Gierlotka M, Labuz-Roszak B, Wojtyniak B, Lasek-Bal A, Zdrojewski T, Adamczyk-Sowa M, Chwojnicki K, Skrzypek M, Ciesla D, Gasior M. Early and One-Year Outcomes of Acute Stroke in the Industrial Region of Poland During the Decade 2006-2015: The Silesian Stroke Registry. Neuroepidemiology 2018; 50:183-194. [PMID: 29587253 DOI: 10.1159/000487324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/29/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Poland, classified as a high-income country, is still considered to have a high cardiovascular risk population. During the last decade, the standards of care in acute stroke (AS) had markedly improved; thus, we aimed to assess whether and how it translated into early and late outcomes. METHODS Silesian Stroke Registry was created from the administrative database of the public, obligatory, health -insurer in Poland. The AS cases were selected based on primary diagnosis coded in ICD-10 as I60-I64 for years 2006-2015 (n = 120,844). Index hospitalization together with data on re-hospitalizations, procedures, ambulatory visits, rehabilitation and all-cause deaths in a 1-year follow-up were analyzed. RESULTS The rates of admissions per 100,000 adult population varied between 41-47 for haemorrhagic and 257-275 for ischaemic stroke with substantial decrease in almost all age groups except for the oldest patients. In ischaemic stroke, thrombolytic therapy raised from 0 to 8.8% in 2015, along with significant trends of decreasing 30-day (from 20 to 16%) and 12-month (from 35 to 31%) case fatality. In haemorrhagic stroke, case fatality had not changed. After ischaemic stroke, 12-month readmissions due to AS declined from 11-12% in 2006-2009 to 9% in 2010-2014. The percentage of patients benefiting from rehabilitation increased from 24 to 32%. CONCLUSIONS In a large population of industrial province, we showed recent, positive trends in AS admissions, treatment and 1-year outcomes. Development of stroke unit networks and increase in thrombolytic treatment were at least in part responsible for survival improvement and reduction of recurrence of AS. However, case-fatality and stroke recurrence remain high compared to those of other developed countries.
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Affiliation(s)
- Marek Gierlotka
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Beata Labuz-Roszak
- Department of Basic Medical Sciences, Faculty of Public Health, Medical University of Silesia, Katowice, Poland
| | - Bogdan Wojtyniak
- Department-Centre of Monitoring and Analyses of Population Health, National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Medical Centre of Upper Silesia, Katowice, Poland
| | - Tomasz Zdrojewski
- Department of Arterial Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Monika Adamczyk-Sowa
- Department of Neurology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Kamil Chwojnicki
- Department of Neurology, Medical University of Gdansk, Gdansk, Poland
| | - Michal Skrzypek
- Department of Biostatistics, Faculty of Public Health, Medical University of Silesia, Katowice, Poland
| | - Daniel Ciesla
- Department of Science, Training and New Medical Technologies, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Mariusz Gasior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
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Chwojnicki K, Ryglewicz D, Wojtyniak B, Zagożdżon P, Członkowska A, Jędrzejczyk T, Karaszewski B, Kozera G, Gierlotka M, Ezzati M, Zdrojewski T. Acute Ischemic Stroke Hospital Admissions, Treatment, and Outcomes in Poland in 2009-2013. Front Neurol 2018; 9:134. [PMID: 29593634 PMCID: PMC5858531 DOI: 10.3389/fneur.2018.00134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 02/22/2018] [Indexed: 01/05/2023] Open
Abstract
Introduction Ischemic stroke (IS) still constitutes a serious problem for public health worldwide. The data on its burden in Poland before 2009 is limited and came only from a few metropolitan areas. The aims of the study were To assess temporal trends in the hospital admissions, treatment, and outcomes of IS in Poland in 2009-2013, to identify risk factors for IS mortality and to compare the results with other countries. Methods The data from the Polish Stroke Registry were analyzed. The data concerned all subjects hospitalized due to IS (classified according to the ICD10 classification as I63.0-I63.9) as primary diagnosis in Poland in 2009-2013. Temporal trends in treatment and outcome were analyzed. Hospital admissions rates as well as case fatality and 12-month mortality rates were calculated. Results Altogether, 360,556 patients (47.5% of males) were hospitalized due to IS in Poland in 2009-2013. The median of age was 75 years, IQR 18 (Women 78, IQR 14 vs. Men 70, IQR 17; p < 0.001). The hospital admissions age-standardized annual rate for IS in Poland in 2013 was 8% lower than in 2009 (169 vs. 157/100,000; p for trend < 0.001). In-hospital case fatality has slightly decreased (from 13.6% in 2009 to 12.9% in 2013; p for trend < 0.001). One-year posthospital mortality rate has not changed (19.3% in 2009 and 2013). The percentage of IS subjects treated with intravenous thrombolysis was low but increased from 1.7% in 2009 to 6.3% in 2013 (p for trend <0.001). Conclusion Since 2009, Poland has had national epidemiological data on the hospital admissions, treatment, and outcomes in IS. The data indicate a slow improvement of in-hospital survival and suggest the need for better stroke prevention and further dissemination of reperfusion therapy.
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Affiliation(s)
- Kamil Chwojnicki
- Department of Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | - Danuta Ryglewicz
- Department of Neurology, Polish Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Paweł Zagożdżon
- Department of Hygiene and Epidemiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Członkowska
- Department of Neurology, Polish Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | | | - Grzegorz Kozera
- Department of Neurology, Ludwik Rydygier Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Marek Gierlotka
- Department of Cardiology, Department of Cardiovascular Diseases, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Majid Ezzati
- Faculty of Medicine, School of Public Health, Imperial College of London, London, United Kingdom
| | - Tomasz Zdrojewski
- Department of Arterial Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
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Starostka-Tatar A, Łabuz-Roszak B, Skrzypek M, Lasek-Bal A, Gąsior M, Gierlotka M. Characteristics of hospitalizations due to acute stroke in the Silesian Province, Poland, between 2009 and 2015. Neurol Neurochir Pol 2017; 52:252-262. [PMID: 29221869 DOI: 10.1016/j.pjnns.2017.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 10/17/2017] [Accepted: 11/21/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The available data on acute stroke (AS) in Poland come mainly from non-representative cohorts or are outdated. Therefore, the current study was done to access the most recent data on AS in the industrial region that covers 12% (4.6mln) of the country's population. OBJECTIVE To evaluate the epidemiological data of AS in the Silesian Province, Poland. PATIENTS AND METHODS Analysis of the data from stroke questionnaires, obligatory for all patients hospitalized due to AS and administered by the only public health insurer in Poland (the National Health Fund) between 2009 and 2015 (n=81,193). RESULTS The annual number of hospitalizations due to AS in the analyzed period was between 239 and 259 per 100,000 inhabitants of the Silesian Province. Haemorrhagic stroke constituted 13.3%, ischaemic stroke - 85.5%, and unspecified stroke - 1.2%. The average age of patients was 71.6±12.2 years (M 68.2±11.9, F 74.8±11.9, P<0.05). The mean duration of hospitalization was 17±16 days for haemorrhagic stroke, and 14±11 days for ischaemic stroke. Large-artery atherosclerosis (36.1%) and cardioembolism (18.7%) constituted the main causes of ischaemic stroke. Overall hospital mortality for AS was 18% (haemorrhagic - 40.8%, ischaemic - 14.9%). A decreasing trend in mortality was observed in ischaemic but not in haemorrhagic stroke. In-hospital mortality was significantly higher in women than in men (P<0.05). CONCLUSIONS This comprehensive long-term analysis of the epidemiological situation related to AS in the industrial region of Poland should encourage further development of educational and treatment programmes for improvement in the health status of the population.
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Affiliation(s)
- Anna Starostka-Tatar
- Department of Neurology, Independent Public Clinical Hospital No. 1 in Zabrze, Medical University of Silesia, Katowice, Poland.
| | - Beata Łabuz-Roszak
- Department of Basic Medical Sciences, Faculty of Public Health, Medical University of Silesia, Katowice, Poland.
| | - Michał Skrzypek
- Department of Biostatistics, Faculty of Public Health, Medical University of Silesia, Katowice, Poland.
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Medical Centre of Upper Silesia, Katowice, Poland.
| | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Center for Heart Diseases in Zabrze, Poland.
| | - Marek Gierlotka
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Center for Heart Diseases in Zabrze, Poland.
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Łabuz-Roszak B, Skrzypek M, Machowska-Majchrzak A, Mossakowska M, Chudek J, Więcek A, Pierzchała K, Łącka-Gaździk B, Grodzicki T. Pharmacological stroke prevention in the elderly with atrial fibrillation in Poland - Results of PolSenior study. Neurol Neurochir Pol 2017; 51:382-387. [PMID: 28756016 DOI: 10.1016/j.pjnns.2017.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/04/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most frequent clinically significant arrhythmia, especially common in the elderly. As it is known, AF is associated with increased risk of stroke. Little is known about pharmacological cardiovascular prevention in the elderly with AF in Poland. OBJECTIVES The purpose of the study was to evaluate the frequency of pharmacological stroke prevention among the elderly with AF in Poland and its association with clinical characteristics and concomitant cardiovascular risk factors. PATIENTS AND METHODS The analysis included elderly (≥65 years) participants of the PolSenior study performed in years 2008-2012. RESULTS The study group consisted of 4979 people (mean age: 79.3±8.7 years). Among them, there were 875 patients (18.7%) with documented history of AF. Pharmacological prevention with the use of vitamin K antagonists (VKA) was applied by 117 (13.4%) of the elderly with AF, including 15 (1.7%) on dual therapy. Additionally, 386 (45.3%) subjects with AF were using oral antiplatelet therapy (OAPs), mostly aspirin. Acenocoumarol was much more often used than warfarin. New oral anticoagulant drugs (NOACs) were not used at all. Only personal income was associated with the use of VKA. No significant correlation was found for the age, sex, place of residence and level of education. CONCLUSIONS The study was unique to determine the frequency of pharmacological stroke prevention among elderly people with AF in Poland. It occurred that oral anticoagulant drugs were applied too rarely in this group of patients. Educational programs should be developed among general practitioners concerning current recommendations for patients with AF.
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Affiliation(s)
- Beata Łabuz-Roszak
- Department of Basic Medical Sciences, Faculty of Public Health, Medical University of Silesia, Katowice, Poland.
| | - Michał Skrzypek
- Department of Biostatistics, Faculty of Public Health, Medical University of Silesia, Katowice, Poland
| | | | | | - Jerzy Chudek
- Department of Pathophysiology, Medical Faculty in Katowice, Medical University of Silesia, Katowice, Poland
| | - Andrzej Więcek
- Department of Nephrology, Transplantation and Internal Medicine, Medical Faculty in Katowice, Medical University of Silesia, Katowice, Poland
| | - Krystyna Pierzchała
- Department of Neurology, Medical Faculty in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Beata Łącka-Gaździk
- Department of Nephrology, Diabetology and Internal Diseases, Medical University of Silesia, Katowice, Poland
| | - Tomasz Grodzicki
- Department of Internal Diseases and Gerontology, Jagiellonian University Collegium Medicum, Krakow, Poland
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Thrift AG, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Feigin VL, Norrving B, Donnan GA, Cadilhac DA. Global stroke statistics. Int J Stroke 2016; 12:13-32. [PMID: 27794138 DOI: 10.1177/1747493016676285] [Citation(s) in RCA: 281] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Up to date data on incidence, mortality, and case-fatality for stroke are important for setting the agenda for prevention and healthcare. Aims and/or hypothesis We aim to update the most current incidence and mortality data on stroke available by country, and to expand the scope to case-fatality and explore how registry data might be complementary. Methods Data were compiled using two approaches: (1) an updated literature review building from our previous review and (2) direct acquisition and analysis of stroke events in the World Health Organization (WHO) mortality database for each country providing these data. To assess new and/or updated data on incidence, we searched multiple databases to identify new original papers and review articles that met ideal criteria for stroke incidence studies and were published between 15 May 2013 and 31 May 2016. For data on case-fatality, we searched between 1980 and 31 May 2016. We further screened reference lists and citation history of papers to identify other studies not obtained from these sources. Mortality codes for ICD-8, ICD-9, and ICD-10 were extracted. Using population denominators provided for each country, we calculated both the crude mortality from stroke and mortality adjusted to the WHO world population. We used only the most recent year reported to the WHO for which both population and mortality data were available. Results Fifty-one countries had data on stroke incidence, some with data over many time periods, and some with data in more than one region. Since our last review, there were new incidence studies from 12 countries, with four meeting pre-determined quality criteria. In these four studies, the incidence of stroke, adjusted to the WHO World standard population, ranged from 76 per 100,000 population per year in Australia (2009-10) up to 119 per 100,000 population per year in New Zealand (2011-12), with the latter being in those aged at least 15 years. Only in Martinique (2011-12) was the incidence of stroke greater in women than men. In countries either lacking or with old data on stroke incidence, eight had national clinical registries of hospital based data. Of the 128 countries reporting mortality data to the WHO, crude mortality was greatest in Kazhakstan (in 2003), Bulgaria, and Greece. Crude mortality and crude incidence of stroke were both positively correlated with the proportion of the population aged ≥ 65 years, but not with time. Data on case-fatality were available in 42 studies in 22 countries, with large variations between regions. Conclusions In this updated review, we describe the current data on stroke incidence, case-fatality and mortality in different countries, and highlight the growing trend for national clinical registries to provide estimates in lieu of community-based incidence studies.
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Affiliation(s)
- Amanda G Thrift
- 1 Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Tharshanah Thayabaranathan
- 1 Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - George Howard
- 2 Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Virginia J Howard
- 3 Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Peter M Rothwell
- 4 Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (Clinical Neurology), University of Oxford, Oxford, UK
| | - Valery L Feigin
- 5 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Bo Norrving
- 6 Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
| | - Geoffrey A Donnan
- 7 Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.,8 Neurology Department, The University of Melbourne, Melbourne, Australia
| | - Dominique A Cadilhac
- 1 Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,7 Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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10
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Global burden of stroke in 2010: a pooling analysis of worldwide population-based data on stroke incidence. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0748-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kazlauskas HA, Raskauskiene N, Radziuviene R, Janusonis V. Twenty years trends in mortality rates from stroke in Klaipeda. Brain Behav 2016; 6:e00499. [PMID: 27547501 PMCID: PMC4893389 DOI: 10.1002/brb3.499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 04/02/2016] [Accepted: 04/27/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND During the past decades, mortality from stroke decreased in many western European countries; however, changes concerning long-term stroke mortality in eastern European countries are less evident. OBJECTIVE To assess age- and gender-specific trends in stroke mortality in Klaipeda (Lithuania) from 1994 to 2013. DESIGN Descriptive epidemiological study. SETTING/SUBJECTS Permanent population of Klaipeda. METHODS Data on 2509 permanent residents of Klaipeda aged 35-79 years who died from stroke between 1994 and 2013 were gathered. Directly, age-standardized (European population) stroke mortality rates were analyzed using joinpoint regression separately for specific age groups (35-64, 65-79, and 35-79 years) and by gender. Annual percentage change (APC) and 95% CIs were presented. RESULTS Stroke mortality in the 35- to 79-year-old age group peaked in 1994-1997, it then decreased by -9.9% (95% CI: -18.7, -0.2) yearly up until 2001 and leveled off by -0.2% (-5.1, 4.9) between 2001 and 2013. Among men aged 35-64 years, mortality decreased substantially by 12.8% (-21.5, -3.3) per year from 1994 to 2001 and turned positive by 6.3% (0.8, 12.1) between 2000 and 2013. Among women aged 35-64 years, mortality decreased significantly by 15.5% (-28.1, -0.7) from 1994 to 2000. There was evidence of recent plateauing of trends for 35- to 64-year-old women between 2000 and 2013. In the 65- to 79-year-old age group, mortality decreased from 1994 onward yearly by -5.5% (-7.9, -3.0) in women and by -3.3% (-5.6, -0.9) in men. CONCLUSIONS Joinpoint regression revealed steadily decreasing trend in stroke mortality between 1994 and 2001. The decline in death rates flattened out in the recent decade. Mortality rates varied among age groups and were more pronounced in adults aged 35-64 years. It is essential to monitor and manage stroke risk factors, especially among middle-aged population.
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Affiliation(s)
- Henrikas A. Kazlauskas
- Department of Neurology and RehabilitationKlaipeda University HospitalKlaipedaLithuania
- Behavioral Medicine Institute Lithuanian University of Health SciencesPalangaLithuania
| | - Nijole Raskauskiene
- Behavioral Medicine Institute Lithuanian University of Health SciencesPalangaLithuania
| | - Rima Radziuviene
- Behavioral Medicine Institute Lithuanian University of Health SciencesPalangaLithuania
| | - Vinsas Janusonis
- Klaipeda University HospitalKlaipeda UniversityKlaipedaLithuania
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Comprehensive imaging of stroke – Looking for the gold standard. Neurol Neurochir Pol 2016; 50:241-50. [DOI: 10.1016/j.pjnns.2016.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 11/20/2022]
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Swarowska M, Burkot J, Janowska A, Klimkowicz-Mrowiec A, Pera J, Slowik A, Dziedzic T. Improvement of survival in Polish stroke patients is related to reduced stroke severity and better control of risk factors: the Krakow Stroke Database. Arch Med Sci 2016; 12:552-5. [PMID: 27279847 PMCID: PMC4889689 DOI: 10.5114/aoms.2016.59928] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/27/2014] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION In the last decade, the stroke mortality rate in Poland significantly decreased. We hypothesised that stroke severity, the major determinant of outcome, is lowered in Polish stroke patients. MATERIAL AND METHODS We compared the stroke severity in two cohorts of first-ever ischaemic stroke patients admitted within 24 h after stroke onset to the Department of Neurology, Jagiellonian University, Krakow in the years 1994-2000 and 2008-2012. To assess stroke severity we used the National Institute of Health Stroke Scale (NIHSS). We defined mild stroke as an NIHSS score ≤ 4. RESULTS We included 816 patients hospitalised in the years 1994-2000 and 569 patients hospitalised in the years 2008-2012. NIHSS score on admission was higher in the former (mean: 12.0 ±7.0 vs. 8.0 ±6.0, p < 0.01), and the frequency of mild stroke was higher in the latter (12.7% vs. 41.8%, p < 0.01). Although the frequency of hypertension (67.3% vs. 81.2%, p < 0.01), diabetes mellitus (20.8% vs. 26.4%, p = 0.02) and atrial fibrillation (20.7% vs. 26.2%, p = 0.02) was higher in patients hospitalised in the years 2008-2012, the systolic and diastolic blood pressure values and the frequency of fasting hyperglycaemia were lower in this cohort. This cohort also less frequently suffered from hypercholesterolaemia (25.4% vs. 16.3%, p < 0.01). CONCLUSIONS Reduced stroke severity is associated with better recognition and control of risk factors and explains the improvement of survival in Polish stroke patients.
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Affiliation(s)
- Marta Swarowska
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Burkot
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Aleksandra Janowska
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Joanna Pera
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Dziedzic
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
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Gołąb-Janowska M, Meller A, Kotlęga D, Bajer-Czajkowska A, Nowacki P. Atrial fibrillation and stroke - Coexistence and attitude to preventive therapy on the basis of Szczecin and Szczecin region patients. Neurol Neurochir Pol 2014; 48:410-5. [PMID: 25482252 DOI: 10.1016/j.pjnns.2014.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 10/03/2014] [Accepted: 10/09/2014] [Indexed: 11/18/2022]
Abstract
Atrial fibrillation (AF) is an independent factor increasing the risk of an ischemic stroke (IS) fivefold. The objective of the study was to evaluate the frequency of coexistence of non-valvular AF and IS during the acute stroke and to analyze the attitude of AF patients to treatment. The study included 3712 successive patients presenting either an IS or a transient ischemic attack. The analysis revealed a significant increase in the rate of patients with AF and IS in the years 2010-2013 (31.9%) compared with 2002-2005 (20.2%). A rise in the proportion of AF and IS patients was recorded over the course of consecutive years in group II. The proportion of newly detected AF cases during hospital stay differed significantly between the groups (16.9% vs. 31.9%). Group I and II patients differed essentially with regards to hypertension incidence and female rates. Antiplatelet medications or OACs were taken by a significantly greater number of AF patients in group II. Low number of therapeutic levels of INR was recorded in both groups. IS and AF coexist more frequently than indicated by previous assessments and demographic data from other countries. Increase in the number of IS and AF patients may result from higher detectability of AF and older age of patients affected with stroke, women in particular. Despite a well grounded knowledge about the benefits of OACs use in the prophylaxis of thrombotic-embolic events in AF patients, they are rarely used. A surprisingly low proportion of patients taking OACs reaches a therapeutic INR level.
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Affiliation(s)
| | - Agnieszka Meller
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | - Dariusz Kotlęga
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | | | - Przemysław Nowacki
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
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Thrift AG, Cadilhac DA, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Donnan GA. Global stroke statistics. Int J Stroke 2014; 9:6-18. [PMID: 24350870 DOI: 10.1111/ijs.12245] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In many countries, stroke is a lower priority than other diseases despite its public health impact. One issue is a lack of readily accessible comparative data to help make the case for the development of national stroke strategies. To assist in this process, we need to have a common repository of the latest published information on the impact of stroke worldwide. We aim to provide a repository of the most current incidence and mortality data on stroke available by country and illustrate the gaps in these data. We plan to update this repository annually and expand the scope to address other aspects of the burden of stroke. Data were compiled using two approaches: (1) an extensive literature review with a major focus on published systematic reviews on stroke incidence (between 1980 and May 14, 2013); and (2) direct acquisition and collation of data from the World Health Organization to present the most current estimates of stroke mortality for each country recognized by the World Health Organization. For mortality, ICD8, ICD9, and ICD10 mortality codes were extracted. Using population denominators crude stroke mortality was calculated, as well as adjusting for the World Health Organization world population. We used only the most recent year reported to the World Health Organization. Incidence rates for stroke were available for 52 countries, with some countries having incidence studies undertaken in more than one region. When adjusted to the World Health Organization world standard population, incidence rates for stroke ranged from 41 per 100 000 population per year in Nigeria (1971-74) to 316/ 100 000/year in urban Dar-es-Salaam (Tanzania). Some regions had three to fivefold greater incidence than other countries. Of the 123 countries reporting mortality data, crude mortality was greatest in Kazhakstan (in 2003). In many regions data were very old or nonexistent. Such country-level data are important for citizens, clinicians, and policy makers so that local and global strategies to reduce the overall burden of stroke can be implemented. Through this first annual review of country-specific stroke epidemiology, we hope to promote discussion and provide insights into the worldwide burden of stroke.
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Affiliation(s)
- Amanda G Thrift
- Department of Medicine, Stroke and Ageing Research Centre, Southern Clinical School, Monash University, Clayton, Vic., Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia
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Jaracz K, Grabowska-Fudala B, Górna K, Kozubski W. Consequences of stroke in the light of objective and subjective indices: A review of recent literature. Neurol Neurochir Pol 2014; 48:280-6. [DOI: 10.1016/j.pjnns.2014.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
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Dynamic cerebral autoregulation is compromised in ischaemic stroke of undetermined aetiology only in the non-affected hemisphere. Neurol Neurochir Pol 2014; 48:91-7. [DOI: 10.1016/j.pjnns.2013.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 12/06/2013] [Indexed: 11/30/2022]
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Labuz-Roszak B, Skrzypek M, Pierzchała K, Machowska-Majchrzak A, Mossakowska M, Chudek J, Mańka-Gaca I, Bartman W, Więcek A. Secondary prevention of stroke in elderly people in Poland--results of PolSenior study. Neurol Neurochir Pol 2014; 48:85-90. [PMID: 24821632 DOI: 10.1016/j.pjnns.2013.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/24/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of the study was to evaluate the frequency of use of oral antiplatelet (OAP) and anticoagulant (OAC) drugs as secondary stroke prevention among older people in Poland and its association with sociodemographic factors, place of residence, and concomitant cardiovascular risk factors. MATERIAL AND METHODS The study group consisted of 426 subjects with a history of a previous stroke (mean age of 81.5±8.2 years), participants of multicentre, population-based PolSenior study. RESULTS Among the study group, 261 people (61.3%) used at least one drug as a secondary prevention. OAPs were regularly used by 237 people (55.6%), and OACs-by 25 people (5.9%). The most often used drug was acetylsalicylic acid. Ticlopidine was more frequently used than clopidogrel, and acenocoumarol was used more often than warfarin. Among all of the concomitant cardiovascular risk factors, congestive heart failure was mostly associated with OAP treatment, and a history of atrial fibrillation-with OAC treatment. Use of drugs did not depend on age, sex, place of residence (rural or urban), level of education and personal income, but it was associated with the region where the respondents lived. CONCLUSIONS Secondary cardiovascular preventive therapy in Poland is used too rarely in older people after stroke, and it especially concerns anticoagulant therapy in those with a history of atrial fibrillation. Structured educational programmes should be developed in Poland to improve usage of secondary preventive therapy in the elderly.
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Affiliation(s)
| | - Michał Skrzypek
- Department of Biostatistics, Faculty of Public Health, Medical University of Silesia, Katowice, Poland
| | | | | | | | - Jerzy Chudek
- Department of Pathophysiology, Medical University of Silesia, Katowice, Poland
| | - Iwona Mańka-Gaca
- Department of Neurology, Medical University of Silesia, Zabrze, Poland
| | - Wojciech Bartman
- Department of Neurology, Medical University of Silesia, Zabrze, Poland
| | - Andrzej Więcek
- Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
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Hoy DG, Rao C, Hoa NP, Suhardi S, Lwin AMM. Stroke mortality variations in South-East Asia: empirical evidence from the field. Int J Stroke 2012; 8 Suppl A100:21-7. [PMID: 23013164 DOI: 10.1111/j.1747-4949.2012.00903.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Stroke is a leading cause of death in Asia; however, many estimates of stroke mortality are based on epidemiological models rather than empirical data. Since 2005, initiatives have been undertaken in a number of Asian countries to strengthen and analyse vital registration data. This has increased the availability of empirical data on stroke mortality. AIMS The aim of this paper is to present estimates of stroke mortality for Indonesia, Myanmar, Viet Nam, Thailand, and Malaysia, which have been derived using these empirical data. METHODS Age-specific stroke mortality rates were calculated in each of the five countries, and adjusted for data completeness or misclassification where feasible. All data were age-standardized and the resulting rates were compared with World Health Organization estimates, which are largely based on epidemiological models. RESULTS Using empirical data, stroke ranked as the leading cause of death in all countries except Malaysia, where it ranked as the second leading cause. Age-standardized rates for males ranged from 94 per 100,000 in Thailand, to over 300 per 100,000 in Indonesia. In all countries, rates were higher for males than for females, and those compiled from empirical data were generally higher than modelled estimates published by World Health Organization. CONCLUSIONS This study highlights the extent of stroke mortality in selected Asian countries, and provides important baseline information to investigate the aetiology of stroke in Asia and design appropriate public health strategies to address the rapidly growing burden from stroke.
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Affiliation(s)
- Damian G Hoy
- School of Population Health, University of Queensland, Herston, QLD, Australia
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