To describe the incidence of ischemic stroke, short-term mortality, recurrences, and prescription patterns.
Data from administrative health databases of the Lombardy Region from 2002 to 2010 (about 4 million people) were analyzed for stroke incidence and recurrence, mortality, and drug prescriptions after an ischemic stroke.
A total of 43,352 patients with a first hospital admission for ischemic stroke were identified. During 8 years, stroke incidence decreased from 3.2 of 1000 to 2.4 of 1000 (P < .001) in people aged 65-74 years, from 7.1 of 1000 to 5.3 of 1000 (P < .001) at ages 75-84 years and from 11.9 of 1000 to 9.4 of 1000 (P < .001) at age 85 years or older. Stroke recurrences dropped by 30% (from 10.0% to 7.0%, P < .001) and 30-day mortality rate also decreased. Prescription trends showed linear increase in antiplatelets and lipid-lowering drugs, respectively, from 60.2% to 65.0% (P < .001) and from 19.1% to 34.6% (P < .001), whereas antihypertensive prescriptions did not change appreciably. Anticoagulant prescription increased in patients with atrial fibrillation, from 64.8% to 72.1% in the 65-74 years age group, (P = .004) and from 40.2% to 53.7% in the 75-84 years age group (P < .001); less than 20% of the 85 years or older age group were treated with anticoagulants (P < .0001).
Stroke incidence, recurrence, and 30-day mortality decreased from 2002 to 2010 concomitant with an increase in prescriptions of secondary stroke prevention drugs.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Stroke and Cerebrovascular Diseases
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010.Lancet. 2014; 383: 245-255
- Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis.Lancet Neurol. 2009; 8: 1006-1018
- Human and economic burden of stroke.Age and Ageing. 2009; 38: 4-5
- Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review.Lancet Neurol. 2009; 8: 355-369
- Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010.Lancet Glob Health. 2013; 1: e259-e281
- Epidemiology of stroke in Italy.Int J Stroke. 2011; 6: 219-227
- Guidelines for the primary prevention of stroke. A guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2011; 42: 517-584
SPREAD 2012 – Stroke prevention and educational awareness diffusion. Ictus cerebrale: Linee guida italiane. Available at www.siapav.it/pdf/SPREAD%202012.pdf.
- Stroke: working toward a prioritized world agenda.Int J Stroke. 2010; 5: 238-256
- Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 2160-2236
- 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. An update of the 2010 ESC Guidelines for the management of atrial fibrillation.Eur Heart J. 2012; 33: 2719-2747
- UK stroke incidence, mortality and cardiovascular risk management 1999-2008: time-trend analysis from the General Practice Research Database.BMJ Open. 2011; 1: e000269https://doi.org/10.1136/bmjopen-2011-000269
- Trends in one-year recurrent ischemic stroke among the elderly in the USA: 1994-2002.Cerebrovasc Dis. 2010; 30: 525-532
- Trends in stroke incidence rates and stroke risk factors in Rotterdam, the Netherlands from 1990 to 2008.Eur J Epidemiol. 2012; 27: 287-295
- Organised inpatient (stroke unit) care for stroke.Cochrane Database Syst Rev. 2013; 9: CD000197https://doi.org/10.1002/14651858.CD000197.pub3
- Effectiveness of primary and comprehensive stroke centers PERFECT stroke: a nationwide observational study from Finland.Stroke. 2010; 41: 1102-1107
- Stroke unit care trends of in-hospital mortality for stroke in Germany 2005-2010.Int J Stroke. 2014; 9: 260-265
- Eighteen-year trends in stroke mortality and the prognostic influence of comorbidity.Neurology. 2014; 82: 340-350
- Factors influencing the decline in stroke mortality. A statement from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 315-353
- Stroke unit care for acute stroke patients: an observational follow-up study.Lancet. 2007; 369: 299-305
- Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke r-tPA Stroke Study Group.N Engl J Med. 1995; 333: 1581-1587
- Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association.Stroke. 2009; 40: 2945-2948
- Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guidelines for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 2160-2236
- Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke.N Engl J Med. 2008; 359: 1238-1251
- High-dose atorvastatin after stroke or transient ischemic attack.N Engl J Med. 2006; 355: 549-559
- Atrial fibrillation: a major contributor to stroke in the elderly: the Framingham Study.Arch Intern Med. 1987; 147: 1561-1564
- Bleeding risk assessment and management in atrial fibrillation patients: a position document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis.Europace. 2011; 13: 723-746
- Bleeding risk in very old patients on vitamin K antagonist treatment: results of a prospective collaborative study on elderly patients followed by Italian Centres for Anticoagulation.Circulation. 2011; 124: 824-829
- Why do patients with atrial fibrillation not receive warfarin?.Arch Intern Med. 2000; 160: 41-46
- Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation.Ann Intern Med. 2007; 146: 857-867
- Anticoagulant therapy for stroke prevention in atrial fibrillation: how well do randomized trials translate into clinical trial?.JAMA. 2003; 290: 2685-2692
- Risks of thromboembolism and bleeding with thromboprophylaxis in patients with atrial fibrillation: a net clinical benefit using a “real world” nationwide cohort study.Thromb Haemost. 2011; 106: 739-749
- Effect of clopidogrel added to aspirin in patients with atrial fibrillation.N Engl J Med. 2009; 360: 2066-2078
- Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the EuroHeart Survey on atrial fibrillation.Chest. 2010; 137: 263-272
Published online: June 04, 2015
Accepted: May 6, 2015
Received in revised form: March 10, 2015
Received: January 8, 2015
There are no conflicts of interest.
© 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.