Sex Differences in Stroke Care and Outcome 2005–2018: Observations From the Swedish Stroke Register

Background and Purpose: Previous studies of stroke management and outcome in Sweden have revealed differences between men and women. We aimed to analyze if differences in stroke incidence, care, and outcome have altered over time. Methods: All stroke events registered in the Swedish Stroke Register 2005 to 2018 were included. Background variables and treatment were collected during the acute hospital stay. Survival data were obtained from the national cause of death register by individual linkage. We used unadjusted proportions and estimated age-adjusted marginal means, using a generalized linear model, to present outcome. Results: We identified 335 183 stroke events and a decreasing incidence in men and women 2005 to 2018. Men were on average younger than women (73.3 versus 78.1 years) at stroke onset. The age-adjusted proportion of reperfusion therapy 2005 to 2018 increased more rapidly in women than in men (2.3%–15.1% in men versus 1.4%–16.9% in women), but in 2018, women still had a lower probability of receiving thrombolysis within 30 minutes. Among patients with atrial fibrillation, oral anticoagulants at discharge increased more rapidly in women (31.2%–78.6% in men versus 26.7%–81.9% in women). Statins remained higher in men (36.9%–83.7% in men versus 32.3%–81.2% in women). Men had better functional outcome and survival after stroke. After adjustment for women’s higher age, more severe strokes, and background characteristics, the absolute difference in functional outcome was <1% and survival did not differ. Conclusions: Stroke incidence, care, and outcome show continuous improvements in Sweden, and previously reported differences between men and women become less evident. More severe strokes and older age in women at stroke onset are explanations to persisting differences.

Data from national health registers as endpoints for the Tromsø Study: Correctness and completeness of stroke diagnoses

Aim: To assess whether stroke diagnoses in national health registers are sufficiently correct and complete to replace manual collection of endpoint data for the Tromsø Study, a population-based epidemiological study. Method: Using the Tromsø Study Cardiovascular Disease Register for 2013–2014 as the gold standard, we calculated correctness (defined as positive predictive value, PPV) and completeness (defined as sensitivity) of stroke cases in four different data subsets derived from the Norwegian Patient Register and the Norwegian Stroke Register. We calculated the sensitivity and PPV with 95% confidence intervals (CIs) assuming a normal approximation of the binomial distribution. Results: In the Norwegian Stroke Register we found a sensitivity of 79.8% (95% CI 74.2–85.4) and a PPV of 97.5% (95% CI 95.1–99.9). In the Norwegian Patient Register the sensitivity was 86.4% (95% CI 81.6–91.1) and the PPV was 84.2% (95% CI 79.2–89.2). The overall highest levels were found in a subset based on a linkage between the Norwegian Stroke Register and the Norwegian Patient Register, with a sensitivity of 88.9% (95% CI 84.5–93.3), and a PPV of 89.3% (95% CI 85.0–93.6). Conclusions: Data from the Norwegian Patient Register and from the linked data set between the Norwegian Patient Register and the Norwegian Stroke Register had acceptable levels of correctness and completeness to be considered as endpoint sources for the Tromsø Study Cardiovascular Disease Register. The benefits of using data from national registers as endpoints in epidemiological studies must be weighed against the impact of potentially decreased data quality.

Possible Associations between Space Weather and the Incidence of Stroke

The aim of our study was to detect the possible association between daily numbers of ischemic strokes (ISs) and hemorrhagic strokes (HSs) and space weather events. The daily numbers of ISs, subarachnoid hemorrhages (SAHs), and intracerebral hemorrhages (ICHs) were obtained from Kaunas Stroke Register during the period of 1986 to 2010. We used time- and season-stratified multivariate Poisson regression. We analyzed data of 597 patients with SAH, 1147 patients with ICH, and 7482 patients with IS. Strong/severe geomagnetic storms (GSs) were associated with an increase in the risk of SAH (by 58%) and HS (by 30%). Only GSs occurring during 6:00–12:00 UT were associated with the risk of IS. Low geomagnetic activity (GMA) was associated with the risk of ICH, HS, and IS (Rate Ratios with 95% CI were 2.51 (1.50–4.21), 2.33 (1.50–3.61), and 1.36 (1.03–1.81), respectively). The days of ≥ X9 class solar flare (SF) were associated with a 39% higher risk of IS. The risk of HS occurrence was greater than two times higher on the day after the maximum of a strong/severe solar proton event (SPE). These results showed that GSs, very low GMA, and stronger SFs and SPEs may be associated with an increased risk of different subtypes of stroke.

Transforming self-reported outcomes from a stroke register to the modified Rankin Scale: a cross-sectional, explorative study

The aim was to create an algorithm to transform self-reported outcomes from a stroke register to the modified Rankin Scale (mRS). Two stroke registers were used: the Väststroke, a local register in Gothenburg, Sweden, and the Riksstroke, a Swedish national register. The reference variable, mRS (from Väststroke), was mapped with seven self-reported questions from Riksstroke. The transformation algorithm was created as a result of manual mapping performed by healthcare professionals. A supervised machine learning method—decision tree—was used to further evaluate the transformation algorithm. Of 1145 patients, 54% were male, the mean age was 71 y. The mRS grades 0, 1 and 2 could not be distinguished as a result of manual mapping or by using the decision tree analysis. Thus, these grades were merged. With manual mapping, 78% of the patients were correctly classified, and the level of agreement was almost perfect, weighted Kappa (Kw) was 0.81. With the decision tree, 80% of the patients were correctly classified, and substantial agreement was achieved, Kw = 0.67. The self-reported outcomes from a stroke register can be transformed to the mRS. A mRS algorithm based on manual mapping might be useful for researchers using self-reported questionnaire data.

Patterns in hospital readmissions after ischaemic stroke – An observational study from the Swedish stroke register (Riksstroke)

Introduction While acute treatment and secondary prevention in stroke have undergone major improvements, hospital readmission after index stroke remains high. However, there are few reports on long-term readmission patterns. Patients and methods For this prospective observational study, data on demographics, functional status and living conditions were obtained from the Swedish Stroke Register (Riksstroke). Data on comorbidity and hospital readmissions up to five years post-index stroke were obtained from the Swedish National Patient Register. Patients were grouped based on number of readmissions: low (0–1) intermediate (2–4), high (5–9) or very high (≥10). Results Of the 10,092 patients included, 43.7% had been readmitted within 12 months and 74.0% within 5 years. There was an average of three readmissions per individual during the five-year interval. A small group of patients with a high-comorbidity burden accounted for the majority of readmissions: approximately 20% of patients accounted for 60% of readmissions, and 5% of patients accounted for 25%. Circulatory conditions were the most common cause followed by infectious disease, stroke, trauma and diseases of the nervous system other than stroke. The proportion of readmissions due to stroke decreased sharply in the first six months. Conclusion A small number of patients with a high degree of comorbidity accounted for the majority of hospital readmissions after index stroke. Our results highlight the need for further development of strategies to support high-risk comorbid stroke patients in the community setting. Further research describing characteristics and healthcare utilisation patterns in this group is warranted.

Analysis of risk factors and stroke structure according to the hospital register of clinics in Vinnytsia for 2017-2019

Due to the analysis of a whole set of indicators of the quality of medical care for acute cerebrovascular accident (ACA), and above all, the identification of major shortcomings in the maintenance of stroke register, it is possible to reduce morbidity, mortality and disability from this nosology. The purpose of the work is to study and compare the structure and risk factors of stroke according to the hospitals of Vinnytsia for the period 2017-2019. The stroke register was created on the basis of medical documentation of hospitals of the municipal non-profit enterprise “Vinnytsia Regional Clinical Psychoneurological Hospital named after Academician O.I. Yushchenko of Vinnytsia Regional Council” (VRCPNH) and Vinnytsia City Clinical Hospital of Emergency Medical Services (VCCHEMS), which are the most typical for this region of Ukraine. Statistical processing of the results was performed using the licensed statistical package “Statistica 5.5” using parametric evaluation methods. Between the two medical institutions in Vinnytsia and in the dynamics of time there were significant differences in different age, sex, type of stroke contingent of patients. When comparing the data of the territorial-population register of stroke in hospitals in Vinnytsia in 2017-2019, it was found that in both studied institutions the percentage of young and middle-aged patients, especially men, increased. The percentage of young and middle-aged patients in VRCPNH is higher than in VCCHEMS. Modified risk factors, which are currently the most important medical and social problem, are analyzed. There were no significant differences in the dynamics of stroke in both hospitals. The percentage of patients who had a stroke in hospital has decreased over time. The meteorological dependence of stroke has been proved, which points to the importance of preventive measures for people at risk. The main shortcomings in the collection of anamnestic data are analyzed. Analysis of risk factors for stroke suggests that the disease is based on various causes.