Research Article| Volume 24, ISSUE 12, P2701-2709, December 2015

Acute Stroke Registry Malaysia, 2010-2014: Results from the National Neurology Registry

      Background: Stroke remains a major health burden worldwide. The incidence and prevalence rates of stroke are decreasing in developed countries, an opposite trend is taking place in the Asia Pacific, where an increasing number of patients are being diagnosed with acute stroke. The results of the present study on acute stroke in multi-ethnic Malaysia will significantly contribute to the global stroke epidemiological data. We aimed to present epidemiological data of stroke including incidence and prevalence rates as well as associated risk factors from a prospective nationwide hospital-based registry from 2010 to 2014. Methods: Patients diagnosed with stroke upon admission at the hospital were prospectively enrolled into the registry from January 1, 2010, to December 31, 2014. Descriptive analyses were performed. Results: A total of 7668 patients were available for analysis. On average, patients were aged 62.7 years (standard deviation of 12.5). Ischemic stroke accounts for 79.4% of the cohort with a slightly higher proportion of male patients (55%). Ischemic stroke incidence is estimated to increase annually by 29.5% and hemorrhagic stroke by 18.7%. Hypertension is a major risk factor for both ischemic and hemorrhagic strokes regardless of stroke event with an excess of 8.4% hypertensive female compare to male patients (P ≤ .001). Majority of patients with ischemic and hemorrhagic strokes experienced mild and moderate stroke with 11.7% and 21.1%, respectively, documented as severe (P ≤ .001). Conclusions: The incidence and prevalence of stroke in Malaysia increased dramatically in the 5-year study period. Therefore, implementation of risk factor control strategies is important to prevent further increase of stroke burden in the country.

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        • Department of Statistics Malaysia
        Statistics cause of death.
        • Neelamegam M.
        • Looi I.
        • Cheah W.K.
        • et al.
        Stroke incidence in the South West District of the Penang Island, Malaysia: PEARLs: Penang Acute Stroke Research Longitudinal Study.
        Prev Med. 2013; 57: S77-S79
      1. Department of Statistics Malaysia, 2014. Population statistics 1891-2013.

        • Ovbiagele B.
        • Goldstein L.B.
        • Higashida R.T.
        • et al.
        Forecasting the future of stroke in the United States: a policy statement from the American Heart Association and American Stroke Association.
        Stroke. 2013; 44: 2361-2375
        • Nazifah S.N.
        • Azmi I.K.
        • Hamidon B.B.
        • et al.
        National Stroke Registry (NSR): Terengganu and Seberang Jaya experience.
        Med J Malaysia. 2012; 67: 302-304
        • World Health Organization
        The World Health Report.
        World Health Organization, Geneva2004: 190-195
        • Aho K.
        • Harmsen P.
        • Hatano S.
        • et al.
        Cerebrovascular disease in the community: results of a WHO collaborative study.
        Bull World Health Organ. 1980; 58: 113-130
        • McGrath E.R.
        • Kapral M.K.
        • Fang J.
        • et al.
        Association of atrial fibrillation with mortality and disability after ischemic stroke.
        Neurology. 2013; 81: 825-832
        • Ezzati M.
        • Hoorn S.V.
        • Rodgers A.
        • et al.
        Estimates of global and regional potential health gains from reducing multiple major risk factors.
        Lancet. 2003; 362: 271-280
        • Chen X.
        • Zhou L.
        • Zhang Y.
        • et al.
        Risk factors of stroke in Western and Asian countries: a systematic review and meta-analysis of prospective cohort studies.
        BMC Public Health. 2014; 14: 776
        • Synhaeve N.E.
        • Arntz R.M.
        • Maaijwee N.A.M.
        • et al.
        Poor long-term functional outcome after stroke among adults aged 18 to 50 years: follow-up of transient ischemic attack and stroke patients and unelucidated risk factor evaluation (FUTURE) study.
        Stroke. 2014; 45: 1157-1160
        • Murray C.J.L.
        • Lopez A.D.
        The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020.
        Harvard School of Public Health on behalf of World Health Organization and the World Bank; distributed by Harvard University Press, Cambridge, MA1996
        • Khatri I.A.
        • Wasay M.
        Can we strop the stroke epidemic in Pakistan?.
        J Coll Physicians Surg Pak. 2011; 21: 195-196
        • National Registry of Diseases Office
        Singapore stroke Registry Interim Annual Registry Report trends in stroke in Singapore 2009-2013.
        Health Promotion Board, Singapore2014
        • Tsai C.F.
        • Thomas B.
        • Sudlow C.L.M.
        Epidemiology of stroke and its subtypes in Chinese vs White populations.
        Neurology. 2013; 8: 264-272
        • Thorvaldsen P.
        • Asplund K.
        • Kuulasmaa K.
        • et al.
        Stroke incidence, case fatality, and mortality in the WHO MONICA project.
        Stroke. 1995; 26: 361-367
        • Feigin V.L.
        • Lawes C.M.
        • Bennett D.A.
        • et al.
        Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review.
        Lancet Neurol. 2009; 8: 355-369
        • Goldstein L.B.
        • Adams R.
        • Alberts M.J.
        • et al.
        Primary prevention of ischemic stroke. A guideline from the American Heart Association/American Stroke Association Stroke Council: co-sponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council.
        Stroke. 2006; 37: 1583-1633
        • Jing B.
        • Wang W.
        • Chen H.L.
        • et al.
        Incidence and trends of stroke and its subtypes in China results from three large cities.
        Stroke. 2006; 37: 63-65
        • Planning Division
        Health facts 2014.
        (Ministry of Health Malaysia: Health Informatics Centre; Available at:) (Accessed June 17, 2015)
        • Ministry of Health Malaysia
        Clinical practice guidelines—management of ischemic stroke.
        2nd ed. Ministry of Health Malaysia, Kuala Lumpur2012
        • Malaysia National Health Accounts Unit, Ministry of Health Malaysia
        Health expenditure report 1997-2012.
        Malaysia National Health Accounts Unit, Ministry of Health Malaysia, Kuala Lumpur2013
        • CDC
        Consensus stroke performance measures.
        US Department of Health and Human Services, CDC, Atlanta, GA2010 (Available at:) (Accessed June 17, 2015)