How has the outcome of cerebrovascular disease changed in 20 years?

Stroke incidence and mortality in Japan have declined sharply over the past half century, but this trend has slowed in recent decades
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In the long term, it remains unknown whether improvements in demographic characteristics and treatment techniques alter stroke severity and functional outcomes
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Professor Kazunori Toyoda's team from the Department of Cerebrovascular Medicine, National Cardiovascular and Cerebrovascular Center, Japan, recently used the Japanese Stroke Database to investigate long-term changes in initial neurological severity and short-term functional outcomes in ischemic and hemorrhagic stroke patients over a 20-year period with a large population.

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Compiled and organized by Yimaitong, please do not reprint without authorization
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STUDY INTRODUCTION This is a nationwide, hospital-based, multicenter, prospective registry cohort study using the Japanese Stroke Database, including patients with acute stroke from January 2000 to December 2019
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Stroke patients, including ischemic and hemorrhagic strokes, were enrolled within 7 days of symptom onset
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Modified Rankin Scale scores were assessed at discharge in all patients
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Results were judged favorable if the modified Rankin scale score was 0 to 2, and unfavorable if the score was 5 to 6
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Results ➤ Among 183,080 patients, 135,266 (53,800 women [39.
8%]; median [IQR] age, 74 [66-82] years) had ischemic stroke, 36,014 (15,365 women [42.
7%]) ]; median [IQR] age, 70 [59-79] years) with cerebral hemorrhage, 11,800 (7924 women [67.
2%]; median [IQR] age, 64 [53-75] years) with arachnoid Inferior hemorrhage
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Across all 3 stroke types, multivariate analysis showed an increase in median age at onset and a decrease in National Institutes of Health Stroke Scale and World Federation of Neurosurgeons scores over a 20-year period
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➤ For ischemic stroke, the proportion of favorable outcomes increased over time after age adjustment (odds ratio [OR], 1.
020; 95% CI, 1.
015-1.
024 for women and 1.
015 for men; 95% CI, 1.
011 -1.
018), but stagnated or even declined in men, multivariate adjustment including reperfusion therapy (OR, 0.
997 for women; 95% CI, 0.
991-1.
003, 0.
990 for men; 95% CI, 0.
985 -0.
994)
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Adverse outcomes and in-hospital mortality decreased for both men and women
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➤ In intracerebral hemorrhage, favorable outcomes decreased in both men and women, while unfavorable outcomes and mortality decreased only in women
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In subarachnoid hemorrhage, the proportion of favorable outcomes remained unchanged, while the proportions of unfavorable outcomes and death decreased in both sexes
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CONCLUSIONS: Functional outcomes have improved in patients with ischemic stroke in both sexes over the past 20 years, likely due to the development of acute reperfusion therapy
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The prognosis of patients with hemorrhagic stroke during the same period was not significantly improved
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Compiled from: Toyoda K, Yoshimura S, Nakai M, et al.
Twenty-Year Change in Severity and Outcome of Ischemic and Hemorrhagic Strokes.
JAMA Neurol.
2022;79(1):61–69.
doi:10.
1001/ jamaneurol.
2021.
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