Article Text
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.
- Stroke
- mortality
- survival rate
- primary healthcare
- hypertension
- Hydroxymethylglutaryl-CoA reductase inhibitors
- platelet aggregation inhibitors
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Footnotes
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Funding This research was supported by the Wellcome Trust and Research Councils' Joint Initiative in Electronic Patient Records and Databases in Research. AR is supported by the Guy's and St Thomas' NHS Trust/King's Health Partners research programmed activities scheme. The authors acknowledge financial support from the Department of Health via the NIHR comprehensive Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London. AMT was partly supported by the Munich Center of Health Sciences (LMUinnovativ) subproject II ‘Evidence Based Prevention and Modelling of Chronic Diseases.’ However, the hypothesis development, analysis, interpretation and conclusions contained in this study are those of the authors alone.
Competing interest None.
Ethics approval Ethics approval was provided by the Independent Scientific Advisory Committee (ISAC) of the Medicines and Healthcare products Regulatory Agency (MHRA) (ISAC Protocol No 07_027R).
Provenance and peer review Not commissioned; externally peer reviewed.