Number Of Stroke Deaths Research Articles

Emergency care and treatment of cerebral stroke at the stages of hospitalisation

According to the World Health Organization experts, about 7 million deaths due to cerebrovascular disease are recorded annually worldwide, and the number of stroke deaths is projected to reach 7.8 million by 2030. The main causes of stroke and its growth are population ageing, urbanisation, unhealthy lifestyles, insufficient control of risk factors (hypertension, atherosclerosis, diabetes, stressful situations, etc.). It is also associated with untimely provision of emergency medical care at the pre-hospital stage and ineffective treatment of strokes at the hospital stage, as well as a low efficiency of preventive treatment for recurrent stroke and rehabilitation measures. The lecture presents modern methods and techniques for treating patients with acute cerebrovascular accident at different stages: pre-hospital, hospital, and rehabilitation.

National- and State-Level Trends in Medicare Hospice Beneficiaries for Stroke During 2013 to 2019 in the United States.

Stroke is the fifth leading cause of death in the United States, one of the leading contributors to Medicare cost, including through Medicare hospice benefits, and the rate of stroke mortality has been increasing since 2013. We hypothesized that hospice utilization among Medicare beneficiaries with stroke has increased over time and that the increase is associated with trends in stroke death rate. Using Medicare Part A claims data and Centers for Disease Control mortality data at a national and state level from 2013 to 2019, we report the proportion and count of Medicare hospice beneficiaries with stroke as well as the stroke death rate (per 100 000) in Medicare-eligible individuals aged ≥65 years. From 2013 to 2019, the number of Medicare hospice beneficiaries with stroke as their primary diagnosis increased 104.1% from 78 812 to 160 884. The number of stroke deaths in the United States in individuals aged ≥65 years also increased from 109 602 in 2013 to 129 193 in 2019 (17.9% increase). In 2013, stroke was the sixth most common primary diagnosis for Medicare hospice, while in 2019 it was the third most common, surpassed only by cancer and dementia. The correlation between the change from 2013 to 2019 in state-level Medicare hospice for stroke and stroke death rate for Medicare-eligible adults was significant (Spearman ρ=0.5; P<0.001). In a mixed-effects model, the variance in the state-level proportion of Medicare hospice for stroke explained by the state-level stroke death rate was 48.2%. From 2013 to 2019, the number of Medicare hospice beneficiaries with a primary diagnosis of stroke more than doubled and stroke jumped from the sixth most common indication for hospice to the third most common. While increases in stroke mortality in the Medicare-eligible population accounts for some of the increase of Medicare hospice beneficiaries, over half the variance remains unexplained and requires additional research.

Ischemic stroke subtypes in subjects with and without diabetes: data from two hospitals in Mongolia

According to the World Health Organization report in 2020, the number of stroke deaths in Mongolia has reached 4,401, accounting for 19.84% of the total deaths, ranking as the second leading cause of death in Mongolia. Furthermore, the prevalence of diabetes has been steadily increasing for the last 20 years. In this case-control study (80 diabetic and 160 non-diabetic subjects), we analyzed data from two tertiary stroke centers over the past six months (June-December 2022). Inclusion criteria included patients over 18 years who presented to the emergency department with an acute ischemic stroke (I63 according to ICD 10). We reviewed and compared the data on clinical assessments such as the National Institutes of Health The Stroke Scale (NIHTSS), Glasgow Coma Scale and Modified Rankin Score, laboratory parameters, and TOAST classification of ischemic stroke between diabetic and non-diabetic patients in Mongolia. The mean age was 39.2±15.2, and 33.2% (n = 392) were male. The duration of diabetes in patients ranged from 0 to 23 years, and the median was 5.0. Mean glycated haemoglobin in subjects was 9.75±2.49%, and only 27.5% (n = 22) had HbA1c below 7.5%. Only BMI was significantly different in patients with diabetes compared to patients without diabetes (27.2±4.4 vs. 28.6±5.2). However, for other parameters, no significant difference was observed, but the NIHTSS at discharge was significantly higher in patients with diabetes. According to the TOAST classification, the risk of ischemic stroke caused by microangiopathy (18% vs 33.8%, p=0.142) and macroangiopathy (44.4% vs 57.5%, p=0.192) was 13-15% higher in people with diabetes than in people without diabetes. In regression analysis, patients with diabetes had a six times greater risk of ischemic stroke caused by atherosclerosis than non-diabetic patients. Most subtypes of stroke that occur in people with diabetes are caused by atherosclerosis, both large and small vessels.

Abstract 1122‐000221: High School Student Stroke Awareness in Rio De Janeiro

Introduction : The ultimate purpose of this study was to assess the extent of stroke awareness within high school students in several countries in Latin America. Stroke awareness and prevention is the best way to minimize the risks of a stroke. Strokes resulted in 195,661 deaths in 2016 in high‐income regions within North America. In Brazil alone, there were 107,258 deaths by stroke in 2016 that could have been caused by improper treatment and lack of awareness. Methods : The focus of the study quickly shifted to within Brazil, due to its concerning status. Quantitative data provided by secondary and primary research through an anonymous survey shows a critical need for more awareness in high school students. A Google Form survey was conducted in 2020 with various multiple choice, checkbox, and multiple‐choice grid questions on 124 high school students in Brazil was passed out through several students in the area. Of these students, 83% were from a private high school with excellent academics, student life, and club activities, in the city of Rio de Janeiro. The impact of Covid‐19 has resulted in fewer responses from schools and officials as many were not taking any messages, making it difficult to attain survey responses. Results : Regardless, 26.61% of all survey participants were unaware of what a stroke is, and a majority thought it had to do with the heart. Less than half of the participants knew what FAST stood for, a well‐known acronym for identifying symptoms of a stroke. Even if a student identified a stroke, 25% did not know that the first step is calling an emergency hotline, crucial knowledge that could lead to a decrease in the high rate of stroke deaths. When asked where their knowledge of strokes came from, further concerns arose with more than half learning from social media, 12.39% not knowing anything, and 6.45% even citing Grey’s Anatomy, a popular television series. Only 37.1% of participants got any of their knowledge on stroke from the news and less than half learned from a credible source, such as their school. Conclusions : Lack of education about stroke among a significant number of students in Rio de Janeiro may lead to an increase in the number of stroke deaths that could have been prevented had communities been educated. The research marks the beginning of an ongoing assessment that will expand to all of Latin America. The assessment will reveal the extent of stroke awareness among the youth in the entire region and may provide a blueprint for educating them, ultimately improving the treatment rates for stroke in the region.

Disparities in the Burden of Stroke in Mexico: A National and Subnational Analysis of the Global Burden of Disease 1990–2017

Background: Stroke burden has been decreasing in high-income countries while increasing in low- to middle-income nations where ischaemic and haemorrhagic stroke are major causes of death and disability. The lack of updated epidemiological information on stroke in Mexico has motivated the development of new estimations based on available data sources and published research. Methods: Data of incidence, prevalence, deaths, premature mortality, disability, and DALYs due to cerebrovascular disease included in the Global Burden of Disease (GBD) 2017 study were analysed to identify differences on the burden of stroke types (i.e., ischaemic stroke [IS], intracerebral haemorrhage [ICH] and subarachnoid haemorrhage [SAH]), sex, age groups, and federal states from 1990 to 2017. To explore disparities due to social and health system variables, the federal states were classified using GBD’s Sociodemographic Index (SDI) and Health Access and Quality (HAQ) Index. Sources available from Mexico included vital registration data and information on stroke incidence, prevalence, and mortality from scientific literature, inpatient hospital data, population surveys, and mortality registries for the period 1990–2017. Findings: In the last 27 years, the number of stroke deaths in Mexico increased from 21,456 in 1990 to 36,653 in 2017, while the age-standardised mortality rate declined 35.8% during the period. Significant reductions in incidence, prevalence, disability, and mortality rates occurred from 1990 to 2005, with no significant changes in the declining trends from 2006 to 2017. Age-standardised mortality rates for IS and ICH were significantly reduced by 46.6% and 30%, respectively, mainly in the period 1990-2005, but not afterwards, while mortality from SAH showed non-significant changes during the whole period. DALYs and premature mortality (YLLs) age-standardised rates exhibited important decreases during the period (41.4% and 48.6%), respectively, also mainly during 1990-2005. The magnitude of decline in all metrics for ICH was more pronounced in women than men. In the case of SAH, females had higher differences in age-standardised mortality, DALYs, YLLs, YLDs, and prevalence rates at the beginning of the study (1990), but men presented higher increases during the whole period. Haemorrhagic stroke presented significantly higher age-standardised mortality, DALYs, YLLs, and incidence rates for ICH than SAH, as well as more important reductions accounted during the period. Stroke burden metrics varied widely by federal state, with less developed states (according to SDI) exhibiting the lowest improvements during the period. Interpretation: Stroke mortality in Mexico showed a decreasing trend without meaningful changes for incidence and prevalence. Reductions in DALYs were mostly explained by decrements in premature mortality and not by changes in disability burden, probably due to a precariously organised acute stroke care. During the last decade a modest declining trend on stroke burden was observed in comparison with the major reduction that occurred in the period 1900-2005. The less developed states showed the lowest reduction in stroke burden. These findings reveal the health disparities in the burden of stroke within the fragmented Mexican Healthcare System. Funding: Funding was provided by The Bill & Melinda Gates Foundation. Declaration of Interests: Vanessa De la Cruz-Gongora, D.Sc: none. Erwin Chiquete, MD, PhD: none. Hector Gomez–Dantes M.D., M.Sc: none. Lucero Cahuana-Hurtado Ph.D: none. Alejandra Montoya-Rodriguez, M.Sc: none. Carlos Cantu-Brito, M.D, Ph.D: none.

Spuścizna badania ASCOT — obserwacja odległa ASCOT-Legacy

The ASCOT trial was a breakthrough observation where the newer hypotensive drugs proved superior to the older generation drugs in reducing cardio-vascular complications. Large clinical trials results, despite their influence on everyday practice, do not answer the question on long term benefits of a certain therapeutic approach. This question was raised in ASOCT-Legacy trial where the authors searched the answer if the initially started therapy influences the long term prognosis and if discovered amlodipine/perindopril combination advantage will persist for the long time and result in reducing patients’ mortality. The mortality analysis in ASCOT-Legacy trial patients, after on average of 16 years of observation, indicated to 29% reduction in number of stroke deaths in newer drugs group. At the same time the patients not included in the LLA arm benefited with 21% reduction in cardiovascular deaths and 24% reduction in coronary disease mortality.

Abstract 188: The Burden of Stroke in Mexico: An Analysis of the Global Burden of Disease 1990-2015

Background and purpose: Stroke incidence, prevalence and mortality have decreased in high-income countries, while in the last decades there has been an increasing trend in low- to middle-income nations, where ischemic (IS) and hemorrhagic stroke (HS) are still major causes of death and disability. The lack of updated epidemiological information of stroke in Mexico has motivated the performance of current estimations based on available direct data sources and published research. Methods: We analyzed available information cases related with cerebrovascular disease included in the Global Burden of Disease (GBD) 2015 data source. Sources available from Mexico included vital registration data and information on stroke incidence, prevalence and mortality from the scientific literature about inpatient hospital data, population surveys and mortality registries for the period 1990-2015. Results: The absolute number of stroke deaths increased substantially in the last 25 years. In 1990 there were 10,572 IS and 11,158 HS deaths, compared with 18,649 and 21,396 respectively in 2015. Conversely, age-standardized mortality rates for IS were significantly reduced by 27.8%, from 30.1 per 100,000 in 1990 to 21.8 in 2015; while the decrease for HS in the same period was 12.4%, from 26.8 to 23.5 per 100,000. However, the decrease trend in mortality for both types of stroke was observed only during the 1990-2005 period, and remained stable from 2005-2015. The age-standardized IS prevalence diminished (-27.6%) from 116.3 per 100,000 in 1990 to 84.2 in 2015, while HS decreased (-23%) from 88.6 to 68.3. Age-standardized IS incidence diminished (-34%) from 37.4 per 100,000 in 1990 to 24.6 in 2015. For HS, incidence rate decreased (-32%) from 23.2 to 15.7 per 100,000. Nevertheless, incident cases for both conditions did not show any decrease after 2005. Conclusion: Mexico exhibit an epidemiological pattern of transition, characterized by both low mortality and prevalence, which contrasts with findings for high and low- to middle-income countries. This study provides a unique insight on epidemiological trends associated with a transition towards development in a Latin American country.

Urokinase-type Plasminogen Activator (uPA) and its Receptor (uPAR) Promote Neurorepair in the Ischemic Brain

Despite the fact that ischemic stroke has been considered a leading cause of mortality in the world, recent advances in our understanding of the pathophysiological mechanisms underlying the ischemic injury and the treatment of acute ischemic stroke patients have led to a sharp decrease in the number of stroke deaths. However, this decrease in stroke mortality has also led to an increase in the number of patients that survive the acute ischemic injury with different degrees of disability. Unfortunately, to this date we do not have an effective therapeutic strategy to promote neurological recovery in these growing population of stroke survivors. Cerebral ischemia not only causes the destruction of a large number of axons and synapses but also activates endogenous mechanisms that promote the recovery of those neurons that survive its harmful effects. Here we review experimental evidence indicating that one of these mechanisms of repair is the binding of the serine proteinase urokinase-type plasminogen activator (uPA) to its receptor (uPAR) in the growth cones of injured axons. Indeed, the binding of uPA to uPAR in the periphery of growth cones of injured axons induces the recruitment of β1-integrin to the plasma membrane, β1-integrin-mediated activation of the small Rho GTPase Rac1, and Rac1-induced axonal regeneration. Furthermore, we found that this process is modulated by the low density lipoprotein receptor-related protein (LRP1). The data reviewed here indicate that the uPA-uPAR-LRP1 system is a potential target for the development of therapeutic strategies to promote neurological recovery in acute ischemic stroke patients.

Socioeconomic Status and Stroke

Rates of stroke incidence and mortality vary across populations with important differences between socioeconomic groups worldwide. Knowledge of existing disparities in stroke risk is important for effective stroke prevention and management strategies. This review updates the evidence for associations between socioeconomic status and stroke. Summary of Review- Studies were identified with electronic searches of MEDLINE and EMBASE databases (January 2006 to July 2011) and reference lists from identified studies were searched manually. Articles reporting the association between any measure of socioeconomic status and stroke were included. The impact of stroke as measured by disability-adjusted life-years lost and mortality rates is >3-fold higher in low-income compared with high- and middle-income countries. The number of stroke deaths is projected to increase by >30% in the next 20 years with the majority occurring in low-income countries. Higher incidence of stroke, stroke risk factors, and rates of stroke mortality are generally observed in low compared with high socioeconomic groups within and between populations worldwide. There is less available evidence of an association between socioeconomic status and stroke recurrence or temporal trends in inequalities. Those with a lower socioeconomic status have more severe deficits and are less likely to receive evidence-based stroke services, although the results are inconsistent. Poorer people within a population and poorer countries globally are most affected in terms of incidence and poor outcomes of stroke. Innovative prevention strategies targeting people in low socioeconomic groups are required along with effective measures to promote access to effective stroke interventions worldwide.

Intra-arterial Stroke Therapy: Recanalization Strategies, Patient Selection and Imaging

With more than 700,000 strokes per year resulting in greater than 160,000 deaths per year, stroke remains the leading cause of disability and third leading cause of death in the United States. Despite an overall decline in stroke mortality over the past 40 years, the total number of stroke deaths continues to increase, suggesting an increase in stroke incidence. The last 20 years of neuroscience advances have moved stroke from a condition that is monitored clinically and imaged serially as it evolves to an entity that can be treated acutely, with remarkable alterations in its natural history.

Health minister highlights need for more specialist stroke nurses.

The Department of Health (DH) has begun a hard-hitting campaign to halve the number of stroke deaths in England.

Improvements in treatment of coronary heart disease and cessation of stroke mortality rate decline.

Many countries observed rapidly declining stroke mortality rates during 1970-1990, followed by a slowing or a cessation of this decline. This slowing was seen for both sexes and all ages. Here we test the hypothesis that improvements in coronary heart disease (CHD) survival can explain this slowing through an increase in the number of CHD survivors at an increased risk for stroke. We created multistate life-table models based on the survival experience of 46 years of follow-up of the Framingham Heart Study cohort. Improvements in survival after CHD were modeled by decreasing mortality rates for those with CHD. We analyzed whether improved CHD survival could result in a >3% increase in annual stroke mortality rates, which would be enough to eliminate the previously observed decline. CHD survival improvements led to an increase in the number of stroke deaths but also a concomitant increase in the total population size. Under no circumstances was there an annual increase in stroke mortality rates approaching 3% for both sexes and for younger and older age groups. The hypothesis that increases in the numbers of people with CHD, as a consequence of improvements in CHD survival, explain the observed slowing of the stroke mortality rate decline must be rejected. The true explanation is also likely to be a factor that changed markedly around 1990, but with more direct effects on stroke mortality.

Stroke mortality in blacks. Disturbing trends.

Despite long-term declines in US stroke mortality rates, declines have slowed in the past decade and targets for blacks for the years 2000 and 2010 seem attainable only by extraordinary measures, if at all. This review focuses attention on key aspects of this problem. Data from the US National Center for Health Statistics and reports of population-based studies of stroke mortality published since 1987 retrieved by computerized literature searches were reviewed. The third leading cause of death in black women and the sixth in black men in the United States in 1996, stroke accounted for 10 509 deaths in women and 7972 in men among blacks: 7.92% and 5.33%, respectively, of the total deaths. Age-adjusted death rates per 100 000 were black women, 39.2; white women, 22.9; black men, 50.9; and white men, 26.3. Available data indicate that compared with US whites, US blacks have greater mortality rates for every stroke subtype, with the likely exception of cerebral infarction due to extracranial carotid artery occlusion. These differences will persist into the 21st century. The number of stroke deaths in blacks increased by >8% between 1992 and 1996. Increased research on stroke in blacks is needed to develop more effective strategies for primary and secondary prevention of stroke to reduce the high burden of premature mortality and morbidity. Renewed efforts to prevent and control stroke risk factors (in particular elevated blood pressure, diabetes, and smoking) are needed among US blacks.