Background Up to date data on incidence, mortality, and case-fatality for stroke are important for setting the agenda for prevention and healthcare. Aims and/or hypothesis We aim to update the most current incidence and mortality data on stroke available by country, and to expand the scope to case-fatality and explore how registry data might be complementary. Methods Data were compiled using two approaches: (1) an updated literature review building from our previous review and (2) direct acquisition and analysis of stroke events in the World Health Organization (WHO) mortality database for each country providing these data. To assess new and/or updated data on incidence, we searched multiple databases to identify new original papers and review articles that met ideal criteria for stroke incidence studies and were published between 15 May 2013 and 31 May 2016. For data on case-fatality, we searched between 1980 and 31 May 2016. We further screened reference lists and citation history of papers to identify other studies not obtained from these sources. Mortality codes for ICD-8, ICD-9, and ICD-10 were extracted. Using population denominators provided for each country, we calculated both the crude mortality from stroke and mortality adjusted to the WHO world population. We used only the most recent year reported to the WHO for which both population and mortality data were available. Results Fifty-one countries had data on stroke incidence, some with data over many time periods, and some with data in more than one region. Since our last review, there were new incidence studies from 12 countries, with four meeting pre-determined quality criteria. In these four studies, the incidence of stroke, adjusted to the WHO World standard population, ranged from 76 per 100,000 population per year in Australia (2009-10) up to 119 per 100,000 population per year in New Zealand (2011-12), with the latter being in those aged at least 15 years. Only in Martinique (2011-12) was the incidence of stroke greater in women than men. In countries either lacking or with old data on stroke incidence, eight had national clinical registries of hospital based data. Of the 128 countries reporting mortality data to the WHO, crude mortality was greatest in Kazhakstan (in 2003), Bulgaria, and Greece. Crude mortality and crude incidence of stroke were both positively correlated with the proportion of the population aged ≥ 65 years, but not with time. Data on case-fatality were available in 42 studies in 22 countries, with large variations between regions. Conclusions In this updated review, we describe the current data on stroke incidence, case-fatality and mortality in different countries, and highlight the growing trend for national clinical registries to provide estimates in lieu of community-based incidence studies.

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Global Stroke Statistics

Objective We studied evolving antithrombotic therapy patterns in patients with newly diagnosed non-valvular atrial fibrillation (AF) and ?1 additional stroke risk factor between 2010 and 2015. Methods 39 670 patients were prospectively enrolled in four sequential cohorts in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF): cohort C1 (2010'2011), n=5500; C2 (20112013), n=11 662; C3 (2013-2014), n=11 462; C4 (2014- 2015), n=11 046. Baseline characteristics and antithrombotic therapy initiated at diagnosis were analysed by cohort. Results Baseline characteristics were similar across cohorts. Median CHA2DS2-VASc (cardiac failure, hypertension, age ?75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)) score was 3 in all four cohorts. From C1 to C4, the proportion of patients on anticoagulant (AC) therapy increased by almost 15% (C1 57.4%; C4 71.1%). Use of vitamin K antagonist (VKA)±antiplatelet (AP) (C1 53.2%; C4 34.0%) and AP monotherapy (C1 30.2%; C4 16.6%) declined, while use of non-VKA oral ACs (NOACs)±AP increased (C1 4.2%; C4 37.0%). Most CHA2DS2-VASc ?2 patients received AC, and this proportion increased over time, largely driven by NOAC prescribing. NOACs were more frequently prescribed than VKAs in men, the elderly, patients of Asian ethnicity, those with dementia, or those using non-steroidal antiinflammatory drugs, and current smokers. VKA use was more common in patients with cardiac, vascular, or renal comorbidities. Conclusions Since NOACs were introduced, there has been an increase in newly diagnosed patients with AF at risk of stroke receiving guideline-recommended therapy, predominantly driven by increased use of NOACs and reduced use of VKA±AP or AP alone.

https://heart.bmj.com/content/heartjnl/103/4/307.full.pdf

Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation

BackgroundData on stroke epidemiology and availability of hospital-based stroke services around the world are important for guiding policy decisions and healthcare planning.AimsTo provide the most ...

/pdf/global-stroke-statistics-2019-4dtwkaru8x.pdf

Global Stroke Statistics 2019

Energy Expenditure and Cost During Walking After Stroke: A Systematic Review

After experiencing a stroke in the right hemisphere, almost 50% of patients showed Unilateral Spatial Neglect (USN). In recent decades, Virtual Reality (VR) has been used as an effective tool both for the assessment and rehabilitation of USN. Indeed, this advanced technology allows post-stroke patients to interact with ecological and engaging environments similar to real ones, but in a safe and controlled way. To provide an overview of the most recent VR applications for the assessment and rehabilitation of USN, a systematic review has been carried out. Since 2010, 13 studies have proposed and tested innovative VR tools for USN. After a wide description of the selected studies, we discuss the main features of these VR tools in order to provide crucial indications for future studies, neurorehabilitation interventions, and clinical practice.

/pdf/assessment-and-rehabilitation-of-neglect-using-virtual-19qh371tvf.pdf

Assessment and rehabilitation of neglect using virtual reality: a systematic review.

Background. Although the burden of stroke in terms of mortality and disability has been well documented in previous years, data after 2000 are limited. Therefore, the aim of this paper was to identify the epidemiology of stroke in the US and EU5 nations from data published in 2000 and later. Methods. Data from literature databases and online sources were collated to identify information relating to the incidence, prevalence, and mortality of stroke from the year 2000 onwards. Results and Conclusions. Twenty-three data sources were identified. The incidence of and mortality due to stroke both increase with age and are greater in males compared to females. Stroke is a common problem and likely to worsen in the US and EU5 as their populations age. However, pre-2000 trends of decreasing stroke mortality over time have continued after 2000, reflecting a consistent improvement in the treatment and care of patients with stroke.

/pdf/the-incidence-prevalence-and-mortality-of-stroke-in-france-4mvnc8tpcz.pdf

The Incidence, Prevalence, and Mortality of Stroke in France, Germany, Italy, Spain, the UK, and the US: A Literature Review

Economic impact of using additional diagnostic tests to better select patients with stroke for intravenous thrombolysis in the United Kingdom.

Objective:Transient ischemic attack (TIA) is a serious condition which should be considered on the same spectrum as other conditions involving brain ischemia. Efficient management of these patients is therefore critical. The aim of this research was to gain insights into ‘real-world’ global trends of the current management approaches for patients with suspected and diagnosed TIA, and highlight the unmet need and areas of improvement to ensure effective management of this patient group.Research design and methods:Tele-interviews were conducted with 120 physicians and five operational managers across France, Germany, Italy, Spain, UK, and the US including stakeholders from primary care group practice, those with hospital responsibilities (ER physician and Neurologists), or from home health agencies. Information from the interviewees regarding the management of patients with TIA (including entrance into the clinical pathway, diagnosis, and treatment) were obtained and analyzed qualitatively.Results:T...

Management of patients with transient ischemic attack: insight from real-life clinical practice in Europe and the United States.

Updated treatment guidelines for atrial fibrillation (AF) have been released by the National Institute for Health and Care Excellence (NICE) in the UK, and highlight a current shortfall in the prescription of anticoagulants to patients with AF for stroke prevention. To design a budget impact model as a planning tool for UK Clinical Commissioning Groups (CCGs) looking to budget for greater use of anticoagulants in the AF population. An Excel® model was developed to estimate the five-year impact of gradually treating all eligible patients with AF who are currently not being prescribed anticoagulants, both in terms of the effect on key clinical outcomes (strokes, major bleeds and mortality) and the associated financial impact. For a population of 251,693 (average CCG size) with an estimated 2626 prevalent patients and an additional 546 incident cases annually, the model estimated that increasing the proportion of the eligible AF patient population receiving anticoagulation by a fraction would require an additional budget of GBP139,961 in Year 1 to treat an additional 314 patients. This would rise to GBP1,004,900 in Year 5 to treat an additional 2242 patients, with all eligible patients treated by this year. The price year was 2014. Over the 5-year timeframe, this could lead to the prevention of 24 strokes and 29 deaths, with an increase of 31 major bleeds. The clinical benefits of appropriate anticoagulation are widely recognised; however, full implementation can be difficult and costly. Therefore, the development of models can support the planning process by facilitating discussion among stakeholders on how best they can reach full implementation. The model is flexible and can be adapted to suit different payers.

Ann-Marie Chapman

Papers

The Incidence, Prevalence, and Mortality of Stroke in France, Germany, Italy, Spain, the UK, and the US: A Literature Review

Economic impact of using additional diagnostic tests to better select patients with stroke for intravenous thrombolysis in the United Kingdom.

Management of patients with transient ischemic attack: insight from real-life clinical practice in Europe and the United States.

Implementing Guidelines: The Cost and Clinical Impact of Anticoagulants in the UK Atrial Fibrillation Population

The Budget Impact Of New Generation Ct Scanners For Difficult-To-Image, Low-Risk Patients With Suspected Cad