Population-based register of stroke: manual of operations.

Cardiovascular disease is the leading cause of death and hospitalization in both sexes in nearly all countries of Europe. The main forms of cardiovascular disease are ischaemic heart disease and stroke. Stroke by itself is the second leading cause of death in the European Union, and the annual number of cases of stroke is expected to increase within the next few decades, mainly owing to a growth in the proportion of older people. Stroke is an expensive disease because of the large number of premature deaths, ongoing disability in survivors, and the impact on families or caregivers and on health services (treatment and rehabilitation). Therefore, there is a pressing need to make stroke prevention and treatment a priority, to reduce the growing health burden and lessen its socioeconomic impact. The magnitude of the problem contrasts with the shortage, weak quality, and comparability of data available in most European countries. A stepwise surveillance procedure based on standardized data collection, appropriate record linkage, and validation methods was set up by the EUROCISS project (EUROpean Cardiovascular Indicators Surveillance Set), to build up comparable and reliable indicators for the surveillance of stroke at the population level.This manual of operations is intended for health professionals and policy makers. It provides a standardized and simple model for the implementation of a population-based register, which can provide estimates of attack rate and case fatality. The manual recommends starting from a minimum data set. Before implementing a population-based register, it is important to identify the target population under surveillance, which should preferably cover a well defined geographical and administrative area or region representative of the whole country, where population data and vital statistics (mortality and hospital discharge records at least) are routinely collected and easily available each year. All cases among residents should be recorded even if the case occurs outside the area. Validation of a sample of fatal and nonfatal events is mandatory.