Abstract
BackgroundStudying 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.MethodsThe 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.ResultsIn 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.ConclusionsOur 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.
Highlights
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
Study population and patient characteristics The University Clinical Hospital of Santiago de Compostela serves a catchment area of 447,699 people (16.5% of the total Galician population), plus 18–22% referred from other health centers
8.9% of patients were wake-up stroke (9.9% of ischemic stroke (IS) and 4.7% of intracerebral hemorrhage (ICH)), and in the rest, the latency time between the symptoms onset and hospital arrival was 218.9 ± 177.2 min (219.8 ± 168.1 min in IS and 215.0 ± 210.8 min in the ICH). 1.6% of patients were treated in another hospital by a telemedicine system
Summary
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. There have been important changes in the management of acute stroke. These changes include modifications in the care chain of these patients [1,2,3], due to better diagnostic processes [4] and new therapeutic targets [5,6,7,8]. In a context of deep demographic changes, the age-standardized incidence of stroke in Europe and developed countries is increasing and it seems that it will continue to do so in the decades [17,18,19]. Life expectancy at birth is 82.6 years and has increased by 5 years since 1981
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