Trends in stroke outcomes in the last ten years in a European tertiary hospital

Abstract

Background: Studying the impact of demographic changes and progress in the management of stroke patients is necessary in order to organize care structures for the coming years. Consequently, we analyzed the prognostic trends of patients admitted to the Stroke Unit of a tertiary hospital in the last ten years.

Methods: The University Clinical Hospital of Santiago de Compostela is the referral hospital for stroke in a catchment area that accounts for 16.5% of the population of Galicia. Data from patients admitted to the Stroke Unit were registered prospectively. A multinomial logistic regression was performed to determine the influence of new trends in demographic factors and in the management of patients with acute stroke. For the expected trend of progression, a 2008-2011 and 2012-2017 time series model was made by selecting the most appropriate model.

Results: In the last 10 years, the age of stroke onset has only increased in women (from 74.4 ± 2.2 years in 2008 to 78.8 ± 2.1 years in 2017; p = 0.037), and the same happens with the severity of neurological symptoms (ischemic stroke (IS), p < 0.0001; from 14 [10, 19] in 2008 to 19 [15, 26] in 2017), with a higher percentage of cardioembolic strokes (40.7% vs. 32.2% of cardioembolic strokes in women vs. men, p < 0.0001). In a multiple linear regression model, hospital improvement was mainly associated with the use of reperfusion treatment (B 53.11, CI 95% 49.87, 56.36, p < 0.0001). A differentiated multinomial logistic regression analysis conducted for the whole sample with ischemic strokes in the two time periods (2008-2011 and 2012-2017) showed no differences in the influence of factors associated with higher morbidity and mortality. The modeling of time series showed a distinct falling trend in mortality, with a slight increase in good outcome as well as morbidity in both ischemic and hemorrhagic stroke.

Conclusions: Our results showed that mortality decreased in the entire sample; however, although outcome at discharge improved in ischemic stroke, severe disability also increased in these patients. Importantly, this tendency towards increased morbidity seems to be confirmed for the coming years.

Keywords: Intracerebral hemorrhage; Ischemic stroke; Morbidity; Mortality.

Fig. 1

Demographic data of the Health Area of Santiago de Compostela. [Instituto Galego de Estadística, 2016. Instituto Nacional de Estadística, 2016 (www.ige.eu)]

Fig. 2

Demographic, clinical and progress characteristics of the sample analyzed: a Age pyramid of the sample analyzed by sex. b Trends in the distribution by age and sex. c Trends in intrahospital progress according to the reperfusion treatment. d Trends in the distribution by etiopathogenesis (ischemic stroke)

Fig. 3

Trends of the factors that modify the risk of stroke: a Classic vascular risk factors. b Factors of heart disease, peripheral arterial disease and preventive drugs

Fig. 4

Modified Rankin scale at 3 months: a Patients with ischemic stroke without reperfusion treatment. b Patients with ischemic stroke with reperfusion treatment

Fig. 5

Modeling of time series for good outcome (mRS ≤ 2), morbidity (mRS > 2) and mortality (mRS = 6). The predictions at two years are presented in red, with their confidence intervals at 90% (dark gray) and 95% (light gray)