Acute Ischemic Stroke Hospital Admissions, Treatment, and Outcomes in Poland in 2009-2013.

Kamil Chwojnicki,Majid Ezzati,Danuta Ryglewicz,Grzegorz Kozera,Paweł Zagożdżon,Bogdan Wojtyniak,Tomasz Zdrojewski,Bartosz Karaszewski,Marek Gierlotka,Anna Członkowska,Tadeusz Jędrzejczyk

doi:10.3389/fneur.2018.00134

Abstract

Ischemic stroke (IS) still constitutes a serious problem for public health worldwide. The data on its burden in Poland before 2009 is limited and came only from a few metropolitan areas. To assess temporal trends in the hospital admissions, treatment, and outcomes of IS in Poland in 2009-2013, to identify risk factors for IS mortality and to compare the results with other countries. The data from the Polish Stroke Registry were analyzed. The data concerned all subjects hospitalized due to IS (classified according to the ICD10 classification as I63.0-I63.9) as primary diagnosis in Poland in 2009-2013. Temporal trends in treatment and outcome were analyzed. Hospital admissions rates as well as case fatality and 12-month mortality rates were calculated. Altogether, 360,556 patients (47.5% of males) were hospitalized due to IS in Poland in 2009-2013. The median of age was 75 years, IQR 18 (Women 78, IQR 14 vs. Men 70, IQR 17; p < 0.001). The hospital admissions age-standardized annual rate for IS in Poland in 2013 was 8% lower than in 2009 (169 vs. 157/100,000; p for trend < 0.001). In-hospital case fatality has slightly decreased (from 13.6% in 2009 to 12.9% in 2013; p for trend < 0.001). One-year posthospital mortality rate has not changed (19.3% in 2009 and 2013). The percentage of IS subjects treated with intravenous thrombolysis was low but increased from 1.7% in 2009 to 6.3% in 2013 (p for trend <0.001). Since 2009, Poland has had national epidemiological data on the hospital admissions, treatment, and outcomes in IS. The data indicate a slow improvement of in-hospital survival and suggest the need for better stroke prevention and further dissemination of reperfusion therapy.

Highlights

Ischemic stroke (IS) is one of the major clinical and social problems in the world
Annual crude (CAR) and standardized by age (SAR) hospital admissions rates of IS patients in Poland, calculated on the basis of the data obtained from Pol-Stroke Registry, are presented in Figure 1 and Table S1 in Supplementary Material
The highest percentage (54%) of diagnoses according to ICD10 classification was constituted by the least precise diagnoses: I63.5—cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery, I63.8—other cerebral infarction, I63.9—cerebral infarction, unspecified

Summary

Introduction

Ischemic stroke (IS) is one of the major clinical and social problems in the world. It is the second cause of death after coronary heart disease and the main cause of disability among adults [1,2,3]. According to the Global Burden of Disease study, in the years 1990–2010, around 70% of all strokes took place in lowand middle-income countries (LMIC), with Poland included until 2008 [3]. Global stroke incidence decreased over the past three decades by 12% in high-income countries, whereas in LMIC, it increased by 12% [3]. Data on IS mortality were more extensive and showed only a small declining trend [12]

Methods

Results

Conclusion