Marek Gierlotka1, Beata Labuz-Roszak2, Bogdan Wojtyniak3, Anetta Lasek-Bal4, Tomasz Zdrojewski5, Monika Adamczyk-Sowa6, Kamil Chwojnicki7, Michal Skrzypek8, Daniel Ciesla9, Mariusz Gasior1. 1. 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. 2. Department of Basic Medical Sciences, Faculty of Public Health, Medical University of Silesia, Katowice, Poland. 3. Department-Centre of Monitoring and Analyses of Population Health, National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland. 4. Department of Neurology, School of Health Sciences, Medical University of Silesia, Medical Centre of Upper Silesia, Katowice, Poland. 5. Department of Arterial Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland. 6. Department of Neurology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland. 7. Department of Neurology, Medical University of Gdansk, Gdansk, Poland. 8. Department of Biostatistics, Faculty of Public Health, Medical University of Silesia, Katowice, Poland. 9. Department of Science, Training and New Medical Technologies, Silesian Centre for Heart Diseases, Zabrze, Poland.
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.
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.
Authors: Marta Nowakowska-Kotas; Marta Waliszewska-Prosół; Paulina Papier; Sławomir Budrewicz; Tomasz Bańkowski; Anna Pokryszko-Dragan Journal: Emerg Med Int Date: 2020-12-09 Impact factor: 1.112