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Declining 1-year case-fatality of stroke and increasing coverage of vascular risk management: population-based cohort study.

Gulliford MC, Charlton J, Rudd A, Wolfe CD, Toschke AM - J. Neurol. Neurosurg. Psychiatr. (2010)

Bottom Line: In men, the decline was from 29.2% in 1997 to 22.2% in 2005.The rate ratio for 1-year mortality in 2005, compared with 1997-1998, adjusted for age group, sex, prevalent coronary heart disease, prevalent hypertension and deprivation quintile was 0.79 (0.74 to 0.86, p<0.001).After adjustment for antihypertensive, statin and antiplatelet prescribing, the rate ratio was 1.29 (1.17 to 1.42).

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health Sciences, King's College London, Capital House, 42 Weston Street, London SE1 3QD, UK. martin.gulliford@kcl.ac.uk

ABSTRACT

Background: The authors estimated trends in 1-year case-fatality of stroke in relation to changes in vascular risk management from 1997 to 2005.

Methods: A cohort study was implemented using data for 407 family practices in the UK General Practice Research Database, including subjects with first acute strokes between 1997 and 2005. One-year case-fatality was estimated by year and sex. Rate ratios were estimated using Poisson regression.

Results: There were 19 143 women and 16 552 men who had first acute strokes between 1997 and 2005. In women, the 1-year case-fatality declined from 41.2% in 1997 to 29.2% in 2005. In men, the decline was from 29.2% in 1997 to 22.2% in 2005. The proportion of general practices that prescribed antihypertensive drugs to two-thirds or more of new patients with stroke increased from 6% in 1997 to 48% in 2005, for statins from 1% to 39% and for antiplatelet drugs from 11% to 39%. The rate ratio for 1-year mortality in 2005, compared with 1997-1998, adjusted for age group, sex, prevalent coronary heart disease, prevalent hypertension and deprivation quintile was 0.79 (0.74 to 0.86, p<0.001). After adjustment for antihypertensive, statin and antiplatelet prescribing, the rate ratio was 1.29 (1.17 to 1.42).

Conclusions: Reducing 1-year case-fatality after acute stroke may be partly explained by increased prescribing of antihypertensive, statin and antiplatelet drugs to patients with recent strokes. However, these analyses did not include measures of possible changes over time in stroke severity or acute stroke management.

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Related in: MedlinePlus

Prescription of antihypertensive drugs, statins or antiplatelet drugs ever prescribed before stroke or in the first year after stroke by year and sex. AHT, antihypertensive drugs; APL, antiplatelet drugs. Circles, women; triangles, men.
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fig1: Prescription of antihypertensive drugs, statins or antiplatelet drugs ever prescribed before stroke or in the first year after stroke by year and sex. AHT, antihypertensive drugs; APL, antiplatelet drugs. Circles, women; triangles, men.

Mentions: Figure 1 shows the proportion of men and women in whom the three classes of medications for vascular risk management were prescribed by study year. Upper panels show the percentage ever prescribed the drug class before stroke, while the lower panels show the percentage prescribed drug class in the first 12 months after stroke. The proportion of subjects who were prescribed antihypertensive medicines before stroke increased from 65% in women and 54% in men in 1997, to 74% in women and 64% in men in 2005. Prescribing of antihypertensive drugs in the first 12 months after stroke increased from 53% of women and 54% of men in 1997 to 74% of men and women in 2005. Statin prescribing before stroke increased, between 1997 and 2005, from 1% to 28% in women and from 4% to 30% in men. Statin prescribing after stroke increased from 6% to 67% in women and from 10% to 75% in men. Prescribing of antiplatelet drugs before stroke increased from 33% to 49% in women and from 35% to 48% in men. After stroke, prescribing of antiplatelet drugs increased from 58% to 72% in women and from 62% to 73% in men. There was strong evidence of an increasing linear trend for each drug class, in both sexes, before and after stroke (p=0.001 or smaller).


Declining 1-year case-fatality of stroke and increasing coverage of vascular risk management: population-based cohort study.

Gulliford MC, Charlton J, Rudd A, Wolfe CD, Toschke AM - J. Neurol. Neurosurg. Psychiatr. (2010)

Prescription of antihypertensive drugs, statins or antiplatelet drugs ever prescribed before stroke or in the first year after stroke by year and sex. AHT, antihypertensive drugs; APL, antiplatelet drugs. Circles, women; triangles, men.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2921278&req=5

fig1: Prescription of antihypertensive drugs, statins or antiplatelet drugs ever prescribed before stroke or in the first year after stroke by year and sex. AHT, antihypertensive drugs; APL, antiplatelet drugs. Circles, women; triangles, men.
Mentions: Figure 1 shows the proportion of men and women in whom the three classes of medications for vascular risk management were prescribed by study year. Upper panels show the percentage ever prescribed the drug class before stroke, while the lower panels show the percentage prescribed drug class in the first 12 months after stroke. The proportion of subjects who were prescribed antihypertensive medicines before stroke increased from 65% in women and 54% in men in 1997, to 74% in women and 64% in men in 2005. Prescribing of antihypertensive drugs in the first 12 months after stroke increased from 53% of women and 54% of men in 1997 to 74% of men and women in 2005. Statin prescribing before stroke increased, between 1997 and 2005, from 1% to 28% in women and from 4% to 30% in men. Statin prescribing after stroke increased from 6% to 67% in women and from 10% to 75% in men. Prescribing of antiplatelet drugs before stroke increased from 33% to 49% in women and from 35% to 48% in men. After stroke, prescribing of antiplatelet drugs increased from 58% to 72% in women and from 62% to 73% in men. There was strong evidence of an increasing linear trend for each drug class, in both sexes, before and after stroke (p=0.001 or smaller).

Bottom Line: In men, the decline was from 29.2% in 1997 to 22.2% in 2005.The rate ratio for 1-year mortality in 2005, compared with 1997-1998, adjusted for age group, sex, prevalent coronary heart disease, prevalent hypertension and deprivation quintile was 0.79 (0.74 to 0.86, p<0.001).After adjustment for antihypertensive, statin and antiplatelet prescribing, the rate ratio was 1.29 (1.17 to 1.42).

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health Sciences, King's College London, Capital House, 42 Weston Street, London SE1 3QD, UK. martin.gulliford@kcl.ac.uk

ABSTRACT

Background: The authors estimated trends in 1-year case-fatality of stroke in relation to changes in vascular risk management from 1997 to 2005.

Methods: A cohort study was implemented using data for 407 family practices in the UK General Practice Research Database, including subjects with first acute strokes between 1997 and 2005. One-year case-fatality was estimated by year and sex. Rate ratios were estimated using Poisson regression.

Results: There were 19 143 women and 16 552 men who had first acute strokes between 1997 and 2005. In women, the 1-year case-fatality declined from 41.2% in 1997 to 29.2% in 2005. In men, the decline was from 29.2% in 1997 to 22.2% in 2005. The proportion of general practices that prescribed antihypertensive drugs to two-thirds or more of new patients with stroke increased from 6% in 1997 to 48% in 2005, for statins from 1% to 39% and for antiplatelet drugs from 11% to 39%. The rate ratio for 1-year mortality in 2005, compared with 1997-1998, adjusted for age group, sex, prevalent coronary heart disease, prevalent hypertension and deprivation quintile was 0.79 (0.74 to 0.86, p<0.001). After adjustment for antihypertensive, statin and antiplatelet prescribing, the rate ratio was 1.29 (1.17 to 1.42).

Conclusions: Reducing 1-year case-fatality after acute stroke may be partly explained by increased prescribing of antihypertensive, statin and antiplatelet drugs to patients with recent strokes. However, these analyses did not include measures of possible changes over time in stroke severity or acute stroke management.

Show MeSH
Related in: MedlinePlus