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. 2015 Jul 8;10(7):e0131473.
doi: 10.1371/journal.pone.0131473. eCollection 2015.

Explaining the Decrease of In-Hospital Mortality from Ischemic Stroke

Jens Minnerup  1 , Heike Wersching  2 , Michael Unrath  2 , Klaus Berger  2
Affiliations

Explaining the Decrease of In-Hospital Mortality from Ischemic Stroke

Jens Minnerup et al. PLoS One. .

Abstract

Background: Mortality from ischemic stroke has declined over time. However, little is known about the reasons for the decreased mortality. We therefore aimed to evaluate trends in in-hospital mortality and to identify factors associated with these trends.

Methods: This study was based on a prospective database of 26 hospitals of the Stroke Register of Northwestern Germany, which included 73,614 patients admitted between 2000 and 2011. Time trends in observed (crude) and risk-adjusted in-hospital mortality were assessed. Independent factors associated with death after stroke were evaluated using multivariable logistic regression analysis.

Results: The observed in-hospital mortality decreased from 6.6% in 2000 to 4.6% in 2008 (P < 0.001 for trend) and then remained fairly stable. The risk-adjusted mortality decreased from 2.85% in 2000 to 1.86% in 2008 (P < 0.01 for trend) and then increased to 2.32% in 2011. Use of in-hospital treatments including antiplatelets within 48 hours, antihypertensive therapy, statins, antidiabetics, physiotherapy and anticoagulants increased over time and was significantly associated with a decrease in mortality. The association of the year of admission with mortality became insignificant after adjustment for antiplatelet therapy within 48 hours (from OR 0.96; 95% CI, 0.94-0.98, to OR 0.99; 95% CI, 0.97-1.01) and physiotherapy (from OR 0.96; 95% CI, 0.94-0.97, to OR 0.99; 95% CI, 0.97-1.00).

Conclusions: In-hospital mortality decreased by approximately one third between 2000 and 2008. This decline was paralleled by improvements in different in-hospital managements, and we demonstrated that it was partly mediated by early antiplatelet therapy and physiotherapy use.

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Conflict of interest statement

Competing Interests: Dr. Berger has received investigator-initiated research funding as principal or coordinating investigator in the areas of stroke, diabetes, depression and subclinical atherosclerosis, multimorbidity and health services research from the German Ministry of Research and Technology (BMBF). In addition, for the conduction (2003–2006) of a study on regional variations of migraine and other types of headache he has received unrestricted grants to the University of Muenster from the German Migraine and Headache Society and a consortium with equal shares formed by Allmiral, Astra-Zeneca, Berlin-Chemie, Boehringer Ingelheim Pharma, Boots Healthcare, GlaxoSmithKline, Janssen Cilag, McNeil Pharmaceuticals, MSD Sharp & Dohme, Pfizer. For a study on the Course of Restless Legs Syndrome (2008–2013) he has received unrestricted grants to the University of Muenster from the German Restless Legs Society and a consortium formed by Boehringer Ingelheim Pharma, Mundipharma Research, Neurobiotec, UCB Germany and Switzerland, Vifor Pharma and Roche Pharma. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. In-hospital mortality among patients with ischemic stroke between 2000 and 2011.
A, Observed (crude) mortality. B, Risk-adjusted mortality was determined with the use of logistic regression models to adjust for age, sex, initial stroke severity, and the number of comorbidities.
See this image and copyright information in PMC

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References

    1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380: 2095–2128. 10.1016/S0140-6736(12)61728-0 - DOI - PMC - PubMed
    1. Carandang R, Seshadri S, Beiser A, Kelly-Hayes M, Kase CS, Kannel WB, et al. (2006) Trends in incidence, lifetime risk, severity, and 30-day mortality of stroke over the past 50 years. JAMA 296: 2939–2946.. - PubMed
    1. Vaartjes I, O’Flaherty M, Capewell S, Kappelle J, Bots M (2013) Remarkable Decline in Ischemic Stroke Mortality is Not Matched by Changes in Incidence. Stroke 44: 591–597. 10.1161/STROKEAHA.112.677724 - DOI - PubMed
    1. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJB, Demaerschalk BM, et al. (2013) Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke 44: 870–947. 10.1161/STR.0b013e318284056a - DOI - PubMed
    1. Teuschl Y, Brainin M, Matz K, Dachenhausen A, Ferrari J, Seyfang L, et al. (2013) Time trends in patient characteristics treated on acute stroke-units: results from the austrian stroke unit registry 2003–2011. Stroke 44: 1070–1074. 10.1161/STROKEAHA.111.676114 - DOI - PubMed

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