Department of Neurology, St. John's Hospital, Vienna, Austria.
Gesundheit Österreich GmbH/BIQG, Vienna, Austria.
J Neurol. 2022 Aug;269(8):4396-4403. doi: 10.1007/s00415-022-11079-x. Epub 2022 Mar 21.
With aging population, there is an increase of atrial fibrillation (AF) and other vascular risk factors. We investigated trends in stroke severity at hospital admission with respect to AF and other risk factors in a prospective national stroke registry from 2005 to 2020.
Data from the prospective Austrian Stroke Unit Registry were used to study demographic and clinical factors associated with the change in admission stroke severity over years. Time trends in admission stroke severity of patients with pre-stroke modified Rankin Score ≤ 3 were investigated with respect to clinical variables and predefined age groups 18-54, 55-64, 65-74, 75-84 and ≥ 85 years. Time trends were studied using robust generalized linear models assuming normal distribution with a log link. Stroke severity on admission was assessed according to the National Institutes of Health Stroke Scale Score (NIHSS).
In total, 140,312 patients with acute ischemic stroke were included in the analysis. Within the study period, mean patients' age increased from 70 to 72 years (p < 0.001) and median NIHSS at admission decreased from 4 to 3 (p < 0.001). The frequency of AF increased from 25 to 32% (p < 0.001). The decrease in median admission NIHSS was evident in all relevant subgroups but more pronounced in patients with risk factors including AF, diabetes, hypercholesterolemia, smoking, elderly patients and those with pre-stroke disability.
Despite an aging population and generally increasing AF frequency, we observed a consistent trend towards less disabling strokes on admission.
随着人口老龄化，房颤（AF）和其他血管危险因素的发病率增加。我们调查了 2005 年至 2020 年期间前瞻性全国卒中登记处中，与 AF 和其他危险因素相关的入院卒中严重程度的趋势。
使用前瞻性奥地利卒中单元登记处的数据，研究与多年来入院卒中严重程度变化相关的人口统计学和临床因素。使用稳健广义线性模型，假设正态分布和对数链接，研究了入院时卒中严重程度与临床变量和预先定义的年龄组（18-54、55-64、65-74、75-84 和≥85 岁）的时间趋势。入院卒中严重程度根据美国国立卫生研究院卒中量表评分（NIHSS）进行评估。
共纳入了 140312 例急性缺血性卒中患者。在研究期间，患者的平均年龄从 70 岁增加到 72 岁（p<0.001），入院时的 NIHSS 中位数从 4 分降低到 3 分（p<0.001）。AF 的发生率从 25%增加到 32%（p<0.001）。所有相关亚组的入院 NIHSS 中位数均呈下降趋势，但在伴有 AF、糖尿病、高胆固醇血症、吸烟、老年患者和有既往残疾的患者等危险因素的患者中更为明显。
尽管人口老龄化和 AF 的发病率普遍增加，但我们观察到入院时致残性卒中的一致趋势有所下降。
