Decline In Stroke Mortality Research Articles

Prevention of cardiovascular disease, a major non-communicable disease, in a super-aging society: Health success and unsolved issues in Japan.

As far as non-communicable disease is concerned, Japan is unique in showing a substantial decline in stroke mortality and the lowest and declining mortality from ischemic heart disease during the past half century, which contributed to the elongation of a 4-year average life expectancy, leading to top longevity in the world. However, several issues have remained in the prevention of cardiovascular disease with super-aging: i) how to manage the screening and lifestyle modification for both individuals with metabolic syndrome and those with non-overweight/ obesity plus metabolic risk factors, and ii) how to enhance the referral of very high-risk individuals screened at health checks to physicians for seeking treatment and examine whether an early clinical visit was associated with a lower risk of cardiovascular disease and total mortality. Health counseling is needed for both persons with metabolic syndrome and high-risk individuals with non-obese/overweight because the population attributable risk fraction of ischemic cardiovascular disease was similar for both high-risk individuals. Standardized counseling for very high-risk individuals accelerated clinical visits and reduced levels of risk factors. In health counseling, public health nurses were more effective in increasing clinic visits. Furthermore, the earlier clinic visit after the counseling suggested a lower risk of hospitalization for stroke, coronary heart disease, heart failure, and all-cause mortality. This article reviews these epidemiological findings for health practitioners and policymakers to perform further prevention and control for cardiovascular disease in Japan and other Asian and African countries with emerging cardiovascular burden and aging.

Analysis of in-hospital mortality among ischemic stroke patients in Veresaev City Clinical Hospital

Background. Ischemic stroke (IS) is one of the most common cause of death in the world. The decline in stroke mortality is an important aim of medicine. The introduction of clinical guidelines for the management of patient with IS and transient ischemic attacks in adults in 2020 has made it possible to improve treatment for stroke patients in the Russian Federation. However, it is not completely understood whether the impact of introduction of clinical guidelines for decrease of stroke mortality.
 Aim. To compare and discuss causes of differences between stroke mortality rates in 2019 and 2022 in Veresaev City Clinical Hospital.
 Materials аnd methods. We compare the rates of in-hospital mortality among IS, frequency of thrombolytic therapy, mechanical thrombectomy, intermitted pneumatic compression, the incidence of pneumonia, hemorrhagic transformation, pulmonary thromboembolism and early activation in stroke between patients in 2019 and 2022 in Veresaev City Clinical Hospital. The study involved 1609 patients with IS in 2019, and 1429 patients with IS in 2022 in Veresaev City Clinical Hospital. We assessesed NIHSS to objectively rate severity of stroke and the modified Rankin Scale for measuring the degree of disability.
 Results. Initial stroke severity on NIHS scale was 9.6 in 2019 and 8.0 in 2022 (p0.05), stroke severity on NIHS scale at discharge was 7.8 in 2019 and 5.3 in 2022. Modified Rankin Scale at discharge was 1.95 in 2019 and 2.2 in 2022 (p0.05). Frequency of thrombolytic therapy was 8.6% in 2019 and 14.1% in 2022 (p0.05); 3.7% of patients undergone of mechanical thrombectomy in 2019 and 6.7% patients in 2022 (p0.05). In 2019 patients werent undergone of mechanical thrombectomy from 6 to 24 hours after stroke; 14 patients in 24-hour therapeutic window undergone of mechanical thrombectomy in 2022 (15.5%). There are no intermitted pneumatic compression in 2019; 18% of patients undergone intermitted pneumatic compression in 2022 (p0.05). Early activation used in 30% of patients in 2019 and 96% of patients in 2022 (p0.05). Pulmonary thromboembolism frequency was 26% in 2019 and 1% (p0.05). In-hospital mortality from IS was 19.9% in 2019 and 5.7% in 2022 (p0.001).
 Conclusion. Accurate adherence to clinical guidelines demonstrated decline of in-hospital mortality rate from IS.

Epidemiology and trends in stroke mortality in the USA, 1975-2019.

Whether changes in stroke mortality are affected by age distribution and birth cohorts, and if the decline in stroke mortality exhibits heterogeneity by stroke type, remains uncertain. We undertook a sequential time series analysis to examine stroke mortality trends in the USA among people aged 18-84 years between 1975 and 2019 (n = 4 332 220). Trends were examined for overall stroke and by ischaemic and haemorrhagic subtypes. Mortality data were extracted from the US death files, and age-sex population data were extracted from US census. Age-standardized stroke mortality rates and incidence rate ratio (IRR) with 95% confidence interval [CI] were derived from Poisson regression models. Age-standardized stroke mortality declined for females from 87.5 in 1975 to 30.9 per 100 000 in 2019 (IRR 0.27, 95% CI 0.26, 0.27; average annual decline -2.78%, 95% CI -2.79, -2.78). Among males, age-standardized mortality rate declined from 112.1 in 1975 to 38.7 per 100 000 in 2019 (RR 0.26, 95% CI 0.26, 0.27; average annual decline -2.80%, 95% CI -2.81, -2.79). Stroke mortality increased sharply with advancing age. Decline in stroke mortality was steeper for ischaemic than haemorrhagic strokes. Stroke mortality rates have substantially declined, more so for ischaemic than haemorrhagic strokes.

Abstract TMP21: Impact Of COVID-19 State-level Hospital Capacity On Overall Stroke Mortality In 2020 In The United States

Background: Although hospital admissions for stroke declined in 2020 during the COVID-19 pandemic, patients with comorbid COVID-19 and stroke had increased mortality. We explored stroke mortality in 2020 and its association with COVID-19 prevalence and state-level hospital capacities. Methods: We analyzed CDC National Vital Statistics System and COVID Data Tracker data from 2017-2020. The primary outcome was age-adjusted stroke (ischemic and hemorrhagic) mortality rate per 100,000. The secondary outcome was % change in state-level stroke mortality rates in 2020 (vs. 2017-19); we report its correlation with state-level 1) prevalence of confirmed COVID-19 infections by 12/31/2021, 2) total COVID mortality by 12/31/20, and the 2020 average state-level % of 3) hospital and 4) ICU beds occupied by COVID-19 patients. Results: Figure 1A shows the typical seasonal decline in stroke mortality in quarters 2/3 was attenuated in 2020. The % change in state-level stroke mortality in 2020 (Figure 1B) was not correlated with prevalence of COVID-19 infection (rho=0.05, p=0.74), mortality (rho=0.10, p=0.49), or the % of ICU beds occupied by COVID-19 patients (rho=0.24, p=0.09). There was a correlation with % of hospital beds occupied by COVID-19 patients (rho=0.35, p=0.01) (Figure 2). Conclusion: Overall stroke mortality increased in 2020, particularly in Q2/3, the early-to-mid phase of the COVID-19 pandemic. At the state level, the average % of all hospital beds occupied by COVID-19 patients in 2020 was the only COVID-19 metric associated with change in stroke mortality. Future work should determine if this association was due to decreased hospital capacity to deliver standard stroke care.

Abstract 11637: Decline in Stroke Mortality in the United States, 1975-2019: Impact of Obesity Among Women and Men

Introduction: The extent to which shifting age distributions, changes in stroke subtypes, and increases in obesity rates have impacted stroke mortality remain uncertain. Hypothesis: We hypothesize strong age and period effects on trends in stroke mortality, with obesity playing an important role in these trends. Methods: We designed a sequential time series analysis of 4,060,259 stroke deaths among women and men aged 18-84 years in the US, 1975-2019. The US annual mortality data, and US mid-year population data were accessed from Our World in Data and the CDC. Mortality rates were examined for overall stroke, and ischemic and hemorrhagic strokes. Trends in stroke mortality based on changes in the distribution of age, period, and birth cohorts (APC) were evaluated from Poisson models. We also aimed to quantify how much of the temporal increase in obesity rates explain the variance in stroke mortality trends. Results: Age-standardized stroke mortality declined for women (87.5 [95% confidence interval , CI, 86.8, 88.1] per 100,000 in 1975 to 30.9 [95% CI, 30.6, 31.2] in 2019) and men (112.1 [95% CI, 111.3, 113.0] per 100,000 in 1975 to 38.7 [95% CI, 38.3, 39.0] in 2019). In an APC analysis, stroke mortality increased sharply with advancing age (Figure). Ischemic and hemorrhagic strokes declined by period. There was a cohort effect for ischemic, but not hemorrhagic stroke. In 2019, the rate ratio (RR) of mortality for men versus women was 1.30 (95% CI, 1.27, 1.33) for ischemic stroke and 1.12 (95% CI, 1.09, 1.15) for hemorrhagic stroke. Increasing rates of obesity accounted for 86% and 80% of the temporal decline in stroke mortality rates among women and men, respectively. Conclusions: In the US, mortality rates from stroke have declined over the last 45 years. While men are more likely to die from stroke, the gender difference has narrowed for ischemic stroke, but widened for hemorrhagic strokes. Obesity appears to have contributed substantially to the decline in stroke mortality.

Rural-urban differences in stroke risk

Rural-urban health disparities in life expectancy are large and increasing, with the rural-urban disparity stroke mortality serving as a potential contributor. Data from Vital Statistics shows an unexplained temporal pattern in the rural-urban disparity in stroke-specific mortality, with the magnitude of the disparity increasing from 15% to 25% between 1999 and 2010, but subsequently decreasing to 8% by 2019. This recent decrease in the magnitude of the rural-urban disparity in stroke mortality appears to be driven by a previously unreported plateauing of stroke mortality in urban areas and a continued decline of stroke mortality in rural areas. There is a need to better understand the contributors to these temporal changes; however, a general lack of temporal data on potential contributors prevents this investigation. However considering contributors to the rural-urban differences pooled across time, an overall a higher stroke incidence in rural areas appears to be a contributor to the higher rural stroke mortality, with this higher incidence potentially associated with a higher prevalence of stroke risk factors in rural areas. Conversely, studies assessing rural-urban disparities in stroke case fatality show smaller and inconsistent associations. To the extent that disparities in case fatality do exist, there are many studies showing rural-urban disparities in stroke care could be contributing. While these data offer insights to the overall rural-urban disparities in stroke mortality, additional data are needed to help understand temporal changes in the magnitude of the rural-urban stroke mortality disparity.

Abstract TP375: Using Characteristics of Secondary Ischemic Stroke Events to Improve Stroke Education Initiatives

Purpose: While it is common practice for nursing to perform the duty of stroke education,it is not common to use secondary stroke event data to determine what aspect of stroke education should be emphasized for the greatest impact on secondary stroke prevention. The purpose of this descriptive study is to exam the characteristics of secondary stroke events using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria so future educational initiatives can be customized to the needs of the local high risk population. Methods: The team collected data characteristics on all ischemic stroke admissions with previous admitting diagnosis of acute ischemic stroke. The strokes were further characterized using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification to determine any emerging patterns of both risk factors and etiological types. Conclusions: A total of n=51 admissions were previous adult stroke survivors, (M=30, F=21). Pre-morbid risk factors were as follows: hypertension=78%, type 2 diabetes=39%, hyperlipidemia =54%, smoking=8%, atrial fibrillation=24%. TOAST classification results: Large Vessel Atherosclerosis=14%, Cardioembolic =17%, Small Vessel Disease=3%, Other Known Cause=2%, Cryptogenic=15%. Summary: The results reveal a striking pattern of the presence of premorbid hypertension. While the TOAST classification did not have a single dominant type, but nearly equal distribution of large vessel atherosclerosis, cardioembolic, and small vessel disease etiologies. Not surprising, the decline in stroke mortality is felt to be due to improved blood pressure control, but in discharge stroke education, hypertension is not necessarily emphasized over other perhaps less impactful risk factors. Yet, the most recent acute ischemic stroke clinical guidelines gave providers a first-time recommendation to start or restart antihypertensive therapy in stable patients with BP > 140/90. Nursing has enough encouragement to take the lead on hypertension prevention education in appropriate stable patients ready for discharge. The next goal will be to develop a multimedia educational effort in patient stroke education on hypertension as a risk factor for secondary stroke prevention in this Comprehensive Stroke Center.

Declining Stroke Mortality in Singapore and The Challenges Ahead

Declining Stroke Mortality in Singapore and The Challenges Ahead

Decline in Stroke Mortality Between 1997 and 2012 by Sex: Ecological Study in Brazilians Aged 15 to 49 Years

This study aimed to analyse the time trends of stroke mortality between 1997 and 2012 according to sex in Brazilians aged 15 to 49 years. This ecological study used data obtained from the Mortality Information System, which is available from the National Health System Department of Informatics - DATASUS and maintained by the Brazilian Ministry of Health. Stroke definition included International Classification of Disease version 10 (ICD-10) codes I60, I61, I63, and I64. Crude and age-standardized mortality rates and respective 95% confidence intervals were estimated per 100,000 inhabitants and stratified by age, region, year, and sex. Linear regression models were used to analyse the time trends with a confidence level of 95%. The statistical program used was Stata 11.0. Between 1997 and 2012, there were 124,866 deaths due to stroke in Brazilians aged 15 to 49 years. There was a decreasing linear trend in stroke mortality among men (β = −0.46, p < 0.001, R2 = 0.95) and women (β = −0.40, p < 0.001, R2 = 0.98) during this period. Overall there was no significant difference in stroke mortality trends by sex, except with respect to the age group of 40 to 49 years where there was a difference in the decrease of stroke mortality between men and women (interaction sex * year: β = 0.238, p = 0.012, R² = 0.96). Mortality rates decrease significantly over time in men and women in the age group 15 to 49 years old, but there is only significant difference in the decrease of rates by sex only in the age group from 40 to 49 years old.

Global Implications of Blood Pressure Thresholds and Targets: Guideline Conversations From the World Hypertension League.

See related article, pp e13–e115 Global high blood pressure control and prevention is a major goal of the World Hypertension League (WHL), which strives to support and promote population strategies for the reduction in risks of hypertension-related outcomes. The implementation of hypertension management protocols and recommendations based on evidence from clinical studies is associated with the risk reduction in stroke, as well as cardiovascular and renal disease.1 The impact of the structured hypertension guidelines can be seen in the Figure where the risks of elevated blood pressure identified in the 1920s and the benefit of blood pressure reduction from the Veterans Administration studies was associated with declines in population stroke mortality.2–5 As evidence in the Table, the decline in stroke mortality coincides with the reduction of population blood pressure pressures which was consistent with the lowered blood pressure thresholds and targets described in the sequential recommendations from the Guidelines.6–12 View this table: Table. Mean and 90th …

Implications of Recent Clinical Trials and Hypertension Guidelines on Stroke and Future Cerebrovascular Research.

The decline in stroke mortality observed over the past 50 years has been attributed, in part, to improved implementation of high blood pressure (BP) treatment and control strategies based on the most current evidence from clinical research studies and randomized controlled trials (RCTs).1 The reduction in stroke risks coincides with the shift to lower systolic BP (SBP) distributions in the US adult population for all age groups.1 However, critical clinical questions remain about the treatment, control, and prevention of high BP. New evidence from RCTs and meta-analyses2–6 is expected to have an important positive impact on hypertension guidelines, clinical practice, and future research. Because stroke risk is substantially associated with BP levels and hypertension treatment and control, raised BP and stroke reduction is so heavily tied to BP control, stroke prevention is a key driving force for clinical practice decisions. As a component of the 2017 International Stroke Conference, the American Heart Association, American Stroke Association, and World Hypertension League cosponsored session focused on impact of recent hypertension studies, meta-analyses and new clinical guidelines on stroke risk reduction, and implications for future research. The Prospective Studies Collaboration7 showed a log-linear relationship between BP and stroke declining with lower BP values right down to <120 mm Hg systolic and <70 mm Hg diastolic. Further, a meta-analysis of 147 RCTs of antihypertensive therapy the percentage reduction in stroke with BP reduction down to a mean of 110/70 mm Hg regardless of their BP before treatment.8 Another systematic review in patients with diabetes mellitus reported a decrease of 13% in the risk of stroke for each 5 mm Hg reduction in SBP, and by 11.5% for each 2 mm Hg reduction in diastolic BP.9 In another meta-analysis of 123 studies, Ettehad et al4 provided support for lowering SBP to …

Abstract WMP50: A Shift in the Population Distribution of Systolic Blood Pressure as a Contributor to the Decline in Stroke Mortality

Introduction: Between 1960 and 2006, stroke mortality in the U.S. has declined a remarkable 65% for white men (123.4 ◊ 42.8 per 100,000), 61% for white women (108.6 ◊42.3 per 100,000), 67% for non-white men (178.4 ◊ 59.5 per 100,000) and 70% for non-white women (175.2 ◊ 52.0 per 100,000). With hypertension being the predominant risk factor for stroke, we examined the population shift in systolic blood pressure (SBP) levels over this period. Methods: The Charleston Heart Study (CHS) and Evan County Study (EC) were population-based cohorts recruiting black and white participants in the early 1960’s, conducted in the coastal plain regions of SC and GA respectively. REasons for Geographic And Racial Differences in Stroke (REGARDS) is a population-based study recruiting black and white participants in the contiguous U.S. For purposes of this report, CHS/EC participants were limited to those over 45 years, and REGARDS participants were restricted to residents of the coastal plain of NC/SC/GA. Results: SBP data are available on 1,988 whites and 1,172 blacks from CHS/EC, and from 4,057 whites and 2,237 blacks from REGARDS. Dramatic changes in the distribution of SBP have occurred over these 40+ years, with the 25 th percentile of CHS/EC being consistently above the 75 th percentile for REGARDS (see figure). For example, for whites aged 65-74, the 25 th , 50 th , and 75 th percentile of SBP in CHS/EC was 144-162-184 mmHg, compared to 118-126-137 mmHg in REGARDS. For blacks, the corresponding percentiles were 158-180-204 mmHg in CHS/EC, and 119-129-140 mmHg in REGARDS. In CHS/EC, 125 of 1988 (6%) whites, and 245 of 1172 (20%) blacks had a SBP of 200+ mmHg; compared to only 4 of 4057 (0.1%) whites and 3 of 2235 (0.1%) blacks in REGARDS. Discussion: A dramatic shift in the distribution of systolic blood pressure, likely related to both population shifts in blood pressure and the advent of antihypertensive therapy, is likely a major contributor to the steep decline in stroke mortality.

Trend of declining stroke mortality in China: reasons and analysis

IntroductionThere is a downward trend of stroke-related mortality in the USA. By reviewing all published articles on stroke mortality in China, we analysed its trend and possible factors that have...

Urban and rural stroke mortality rates in China between 1988 and 2013: An age-period-cohort analysis.

ObjectiveTo evaluate effects attributable to age, time period and birth cohort, on stroke mortality data from urban and rural regions in China between 1988 and 2013.MethodsMortality data were obtained from the Chinese Health Statistics Annual Report (1987–2001) and Chinese Health Statistics Yearbooks (2003–2014). Population data were obtained from population censuses (i.e. 1982, 1990, 2000 and 2010). Data were analysed using an age-period-cohort (APC) model and intrinsic estimation (IE) method.ResultsThe age effect suggested that all older residents had higher stroke mortality risk than younger residents. Period effect showed that compared with figures for 1988, stroke mortality in 2013 was 1.8 times higher for urban regions and 2.4 times higher for rural regions. After controlling for age and period effects, cohorts born before the Chinese economic reform had a steady decline in stroke mortality. However, mortality rates increased and fluctuated in post-reform cohorts.ConclusionsThis APC-IE analysis identified a modest period effect with large age and cohort contributions to both the overall mortality and the disparity between urban and rural stroke mortality. Identifying early life and cumulative risk factors for stroke, improving equality in stroke prevention and care are needed to reduce the stroke mortality in China.

Trends in one-year mortality for stroke in a tertiary academic center in Saudi Arabia: a 5-year retrospective analysis.

BACKGROUNDNumerous studies have reported a decline in stroke-related mortality in developed countries.OBJECTIVETo assess trends in one-year mortality following a stroke diagnosis in Saudi Arabia.DESIGNRetrospective longitudinal cohort study.SETTINGSingle tertiary care center from 2010 through 2014.PATIENTSAll patients admitted with a primary admitting diagnosis of stroke.METHODSDemographic data (age, gender, nationality), risk factor profile, stroke subtypes, in-hospital complications and mortality data as well as cause of death were collected for all patients. A multivariable logistic regression model was used to assess factors associated with one-year mortality following a stroke admission.MAIN OUTCOME MEASURE(S)One-year mortality.RESULTSIn 548 patients with a mean age of 62.9 years (SD 16.9), the most frequent vascular risk factors were hypertension (90.6%), diabetes (65.5%), and hyperlipidemia (27.2%). Hemorrhagic stroke was diagnosed in 9.9%. The overall mortality risk was 26.9%. Non-Saudis had a significantly higher one-year mortality risk compared with Saudis (25% vs. 16.8%, respectively; P=.025). The most frequently reported causes of mortality were neurological and related to the underlying stroke (32%), sepsis (30%), and cardiac or other organ dysfunction-related (each 9%) in addition to other etiologies (collectively 9.5%) such as pulmonary embolism or an underlying malignancy. Significant predictors in the multivariate model were age (P<.0001), non-Saudi nationality (OR 1.8, CI 95 1.1 to 2.9; P=.019), and hospital length of stay (OR 1.01, CI 95 1 to 1.004; P=.001).CONCLUSIONWe observed no decline in stroke mortality in our center over the 5-year span. The establishment of stroke systems of care, use of thrombolytic agents, and opening of a stroke unit should play an important role in a decline in stroke mortality.LIMITATIONSRetrospective single center study. Mortality data were available only for patients who died in our hospital.

New hope for ameliorating stroke-induced deficits?

This scientific commentary refers to ‘Electrical stimulation of the motor cortex enhances treatment outcome in post-stroke aphasia’ by Meinzer et al . (doi:10.1093/brain/aww002). The overall decline in stroke mortality observed over the past decades is due to both a reduction in stroke incidence, primarily resulting from cardiovascular risk factor interventions, and substantial progress in the acute treatment of stroke (e.g. recanalization due to thrombolysis and thrombectomy, decompressive therapy) as well as patient care (stroke units) (Mozaffarian et al. , 2016). These improvements (in particular among people older than 65 years) are mirrored, however, by an increasing number of stroke survivors, who are left with persistent neurological deficits. Despite intensive rehabilitation, at least in countries with well developed healthcare systems, many stroke survivors are left with motor, language, spatial or other neuropsychological sequelae, all of which result in reduced functional independence. Consequently, stroke is the leading cause of acquired long-term disability and globally produces immense health, social and economic burdens (Mozaffarian et al. , 2016). While physiotherapy, language therapy and occupational therapy are widely accepted elements of rehabilitation medicine that aim to restore functioning and quality of life in those with physical disabilities or cognitive impairments, novel approaches to rehabilitation are urgently needed. Such therapies may comprise behavioural, pharmacological or technical approaches, the latter including the use of robotic devices as well as non-invasive neuromodulatory techniques [i.e. transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS)]. In this issue of Brain , Meinzer and colleagues raise new hope for the treatment of post-stroke aphasia by showing that electrical stimulation of the motor cortex [sic!] enhances treatment outcomes (Meinzer et al. , 2016). Meinzer and colleagues performed a registered, randomized, sham-controlled, parallel-group, double-blind clinical trial of 26 chronic aphasic patients with anomia [>12 months after stroke …

Transitions of Care for Stroke Patients: Opportunities to Improve Outcomes.

The last 30 years have seen tremendous progress in primary and secondary stroke prevention in the United States with better control of hypertension, decreasing smoking rates, antithrombotic treatment for atrial fibrillation, use of statins, and blood transfusions for children with sickle cell disease.1 In 1996, intravenous tissue-type plasminogen activator was approved for treatment of acute ischemic stroke,2 and in 2014 to 2015, endovascular treatment of major arterial occlusion, primarily by stent retrievers, was demonstrated to result in better outcomes for patients with ischemic stroke when compared with patients treated with intravenous tissue-type plasminogen activator alone.3 During this same time period, the field of neurocritical care grew tremendously in terms of physician and nurse training, standardization of care, and technology. Finally, standardization and certification of primary and comprehensive stroke centers have improved the quality of acute stroke care and the use of secondary prevention medications when patients are hospitalized for acute stroke.4,5 These cumulative advances have resulted in the decline in stroke mortality rates from the third to the fifth cause of death in the United States.6 The bulk of these advances have occurred in 2 settings—the office of primary care physicians who manages stroke risk factors in persons with and without a prior stroke; and the acute care hospital. Yet, the stroke patient follows a complex path from first onset of symptoms to the years after the onset of stroke, and the transitions between the respective places of care along the path represent major challenges and opportunities. ### Transition From Place of Stroke Onset to Acute Hospital One of the first major transitions of care is when emergency medical services (EMS) respond to a 911 call for a potential stroke. EMS personnel assess …

Stroke and Hypertension: Recent Trends of High Blood Pressure and the Decline in Stroke Mortality

High blood pressure has long been recognized as associated with increased risk of stroke. Basically, the higher the systolic blood pressure, the greater the risk of stroke. The high blood pressure risks are evident in both genders, all ages and all population. Since the 1970s, evidence has been generated deter mining that lowering the blood pressure reduces the risks of stroke. At the population level, the blood pressure distri butions in the United States have shifted to the left, i.e. current population blood pressure levels are lower than previous decades. These lower blood pressures are associated with lower stroke risks. The lower blood pressures are attributed to structured programs implemented specifically to lower blood pressure in the population, clinical guidelines detailed to pharmacologically lower pressures, hypertension prevention efforts and programs, and additional resources devoted to lower blood pressure. These intervention and prevention have been effective in lowering blood pressures and stroke risk reduction. While additional improvements remain to be accomplished globally, the models of lower blood pressures and hypertension should be considered one of the major public health success stories in the past 50 years and a major objective for population risk reduction throughout the world.

Organizational update: American Heart Association Stroke Council.

This report represents the Spring 2014 update of the Stroke Council. Much has happened in the past 6 months, and we want to particularly focus on the new strategic plan for the American Heart Association (AHA)/American Stroke Association (ASA) and new research opportunities within the AHA/ASA. Each Stroke Council Update starts with restating our 2020 Goals: By 2020 to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%. To reach this goal, the AHA/ASA has worked hard, with input from throughout the organization, to craft the next detailed strategic plan for the entire AHA/ASA, including the strategic plan for the ASA that will be distributed throughout the organization in the upcoming months. One issue became apparent while reviewing the strategic plan for AHA/ASA: stroke rehabilitation and recovery are not emphasized currently in the Strategic Plan for the AHA as they deserve. In part, this reflects more limited research data and metrics available for assessing the effect of various approaches to stroke recovery compared with extensive research and public data about cardiac rehabilitation. Our stroke strategic plan must prioritize increasing engagement and advocacy for stroke recovery and rehabilitation. For example, in March, Congress passed another temporary fix to the Medicare therapy caps. They extended the exceptions process for 1 additional year (through March 31, 2015). This process allows stroke survivors on Medicare to get more outpatient therapy than the $1920 caps allow but only if their healthcare provider jumps through additional hoops to get those services covered. Although this short-term fix is good and is a direct result of advocacy from many stroke-related organizations, a long-term fix to Medicare therapy caps is paramount, and advocacy by all of us will be needed to ensure a long-term solution. …

Executive Summary: Heart Disease and Stroke Statistics—2014 Update

Author(s): Go, Alan S; Mozaffarian, Dariush; Roger, Veronique L; Benjamin, Emelia J; Berry, Jarett D; Blaha, Michael J; Dai, Shifan; Ford, Earl S; Fox, Caroline S; Franco, Sheila; Fullerton, Heather J; Gillespie, Cathleen; Hailpern, Susan M; Heit, John A; Howard, Virginia J; Huffman, Mark D; Judd, Suzanne E; Kissela, Brett M; Kittner, Steven J; Lackland, Daniel T; Lichtman, Judith H; Lisabeth, Lynda D; Mackey, Rachel H; Magid, David J; Marcus, Gregory M; Marelli, Ariane; Matchar, David B; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Mussolino, Michael E; Neumar, Robert W; Nichol, Graham; Pandey, Dilip K; Paynter, Nina P; Reeves, Matthew J; Sorlie, Paul D; Stein, Joel; Towfighi, Amytis; Turan, Tanya N; Virani, Salim S; Wong, Nathan D; Woo, Daniel; Turner, Melanie B; American Heart Association Statistics Committee and Stroke Statistics Subcommittee