Foerch Christian, Schaller-Paule Martin A, Steinmetz Helmuth, Misselwitz Björn, Bohmann Ferdinand O
Department of Neurology, University Hospital Frankfurt, Goethe-University, 60528 Frankfurt am Main, Germany.
Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
J Clin Med. 2022 Nov 25;11(23):6942. doi: 10.3390/jcm11236942.
(Background): Effective prevention strategies and acute therapies have been established and distributed in recent years to reduce the global burden of stroke. However, beyond randomized clinical trials, limited data exist on the real-world impact of these measures. Our goal was to analyze whether the stroke-associated disability in the population decreased over time based on a state-wide stroke registry analysis. (Methods): Consecutive data from a state-wide inpatient stroke registry covering the entire federal state of Hesse, Germany, were obtained. The clinical data of 141,287 patients with ischemic stroke (ICD-10: I63) admitted between 2010 and 2019 were included. The primary outcome was the odds ratio for a change of modified Ranking Scale (mRS) at discharge over time, estimated by ordinary logistic regression and adjusted for age and sex. The secondary outcome was the odds ratio for a lower National Institutes of Health Stroke Scale (NIHSS) score at hospital admission. (Results): The absolute number of severely disabled (mRS 4−5) stroke patients at discharge decreased over time (2010: 3223 (equivalent to 53/100,000 population); 2019: 2429 [39/100,000 population]). The odds at hospital admission for a higher mRS at discharge decreased significantly by 3.7% per year (OR 0.963 (95% CI 0.960−0.966), p < 0.001). The absolute number of severely affected stroke patients (NIHSS > 15) at admission declined over time (2010: 1589 [26/100,000]; 2019: 1185 [19/100,000]; p < 0.001). The odds for a higher NIHSS score at admission to hospital decreased by 3.8% per year (OR 0.962 (95% CI 0.959−0.965), p < 0.001). Trends were most prominent for patients aged 80 years and older and for patients with atrial fibrillation but absent in patients <60 years. (Conclusions): Stroke-associated disability in the population steadily decreased between 2010 and 2019. The improved prevention of severe strokes in elderly patients may be a major driver of this observation.
（背景）：近年来已制定并推广了有效的预防策略和急性治疗方法，以减轻全球中风负担。然而，除了随机临床试验外，关于这些措施在现实世界中的影响的数据有限。我们的目标是基于全州范围的中风登记分析，分析人群中与中风相关的残疾是否随时间减少。（方法）：获取了来自德国黑森州全州住院中风登记处的连续数据，该登记处覆盖了整个黑森州。纳入了2010年至2019年间收治的141287例缺血性中风患者（国际疾病分类第十版：I63）的临床数据。主要结局是出院时改良Rankin量表（mRS）变化的比值比，通过普通逻辑回归估计，并根据年龄和性别进行调整。次要结局是入院时美国国立卫生研究院中风量表（NIHSS）得分较低的比值比。（结果）：出院时严重残疾（mRS 4-5）中风患者的绝对数量随时间减少（2010年：3223例[相当于每10万人口中有53例]；2019年：2429例[每10万人口中有39例]）。出院时mRS较高的入院几率每年显著下降3.7%（比值比0.963[95%置信区间0.960-0.966]，p<0.001）。入院时严重受影响中风患者（NIHSS>15）的绝对数量随时间下降（2010年：1589例[每10万人口中有26例]；2019年：1185例[每10万人口中有19例]；p<0.001）。入院时NIHSS得分较高的几率每年下降3.8%（比值比0.962[95%置信区间0.959-0.965]，p<0.001）。80岁及以上患者和房颤患者的趋势最为明显，但60岁以下患者没有这种趋势。（结论）：2010年至2019年间，人群中与中风相关的残疾稳步下降。老年患者严重中风预防的改善可能是这一观察结果的主要驱动因素。
