Changes in the in-hospital mortality due to stroke and factors affecting its reduction in the European Union, Middle East, USA, Canada, Ethiopia and China

Abstract

Introduction. While a specialized healthcare system is being developed for patients with stroke, early in-hospital mortality has been rightly chosen as a target indicator. It integrally reflects the correctness of organizational decisions, the completeness and quality of the diagnostic process, the availability of help, and factors relating to patient comorbidities.

Aim. To gather information reflecting the level of the in-hospital mortality due to stroke and factors leading to its reduction.

Materials and methods. PubMed was used to search the Medline database with the keywords ‘mortality rate’, ‘in-hospital mortality’, ‘stroke’, and ‘prediction’. The review included sources in any language from the year 2000 to the present if the full text was available online. Most of the statistical data were obtained from national stroke registries. 

Results. Direct indicators of the percentage of in-hospital mortality varied significantly between different countries, precluding direct comparison. In-hospital mortality varied significantly and depended on clinical features and healthcare administration, including hospitals’ size and their level. A change in the in-hospital mortality was reported in 9 out of 22 reports and enabled us to track the degree of its reduction. The mean rate of reduction was 0.36% per year. Faster changes in this parameter were typical for ischaemic stroke and accompanied the implementation and expansion of cerebrovascular surgery centers with dedicated stroke units. We identified ‘modifiable’ and ‘non-modifiable’ factors that influence in-hospital mortality in stroke patients.

Conclusion. To more accurately evaluate the role of factors affecting in-hospital mortality in different countries, a meta-analysis is required, which would consider the regional organizational features, the availability of trained specialists at cerebrovascular surgery centers, and the degree of population awareness. The most consistent predictors of the in-hospital mortality were age, stroke type, stroke location, level of consciousness according to the Glasgow Coma Scale, stroke severity as measured by the NIHSS, and comorbidities. Factors that can reduce in-hospital mortality rates include population awareness, increased availability of ICU beds for stroke patients, telehealth, monitoring for late complications, and primary prevention.

For citation: Vozniuk I.A., Morozova E.M., Prokhorova M.V. [Changes in the in-hospital mortality due to stroke and factors affecting its reduction in the European Union, Middle East, USA, Canada, Ethiopia, and China]. Annals of clinical and experimental neurology. 2021; 15(1): 13–20. (In Russ.). https://doi.org/10.25692/ACEN.2021.1.2

About the authors

Igor A. Vozniuk

S.M. Kirov Military Medical Academy, St. Petersburg; Saint Petersburg I.I. Dzhanelidze Research Institute оf Emergency Medicine, St. Petersburg

Author for correspondence.
Email: platonova@neurology.ru
Russian Federation

E. M. Morozova

Saint Petersburg I.I. Dzhanelidze Research Institute оf Emergency Medicine, St. Petersburg

Email: platonova@neurology.ru
Russian Federation

Maria V. Prokhorova

Saint Petersburg I.I. Dzhanelidze Research Institute оf Emergency Medicine, St. Petersburg

Email: platonova@neurology.ru
Russian Federation

References

  1. Piradov M.A., Gulevskaya T.S., Gnedovskaya E.V., et al. [Multiple organ dysfunction syndrome after severe stroke (clinical and pathomorphological study)]. Nevrologicheskiy zhurnal. 2006; 5: 9–13. (In Russ.)
  2. Rumjantseva S.A., Oganov R.G., Silina E.V., et al. [Cardiovascular pathology in acute stroke (issues on prevalence, prevention and treatment)]. Kardiovaskulyarnaya terapiya i profilaktika. 2014; 13(4): 47–53. doi: 10.15829/1728-8800-2014-4-47-53. (In Russ.)
  3. Sidyakina I.V., Tsarenko S.V., Dobrushina O.R., et al. [Prognostic model of evaluation of lethality and functional recovery after severe and extremely severe stroke]. Mediko-sotsial'naya ekspertiza i reabilitatsiya. 2012; (3): 49–52. (In Russ.)
  4. Ovbiagele B. Nationwide trends in in-hospital mortality among patients with stroke. Stroke. 2010; 41(8): 1748–1754. doi: 10.1161/strokeaha.110.585455. PMID: 20558829.
  5. Metsker О., Vozniuk I., Kopanitsa G., et al. Stroke ICU patient mortality day prediction. In: Krzhizhanovskaya V.V. et al. (eds.) Computational Science – ICCS 2020. Cham, 2020: 390–405, 2020. doi: 10.1007/978-3-030-50423-6_29.
  6. Sun S., Pan Y., Bai L., et al. GWTG Risk model for all stroke types predicts in-hospital and 3-month mortality in chinese patients with acute stroke. J Stroke Cerebrovasc Dis. 2018; 28(3): 800–806. doi: 10.1016/j.jstrokecerebrovasdis.2018.11.02. PMID: 30553646.
  7. Fekadu G., Chelkeba L., Kebede A. Burden, clinical outcomes and predictors of time to in hospital mortality among adult patients admitted to stroke unit of Jimma university medical center: a prospective cohort study. BMC Neurol. 2019; 19(1): 213. doi: 10.1186/s12883-019-1439-7. PMID: 31470811.
  8. Chen H., Shi L., Wang N., et al. Analysis on geographic variations in hospital deaths and endovascular therapy in ischaemic stroke patients: an observational cross-sectional study in China. BMJ Open. 2019; 9(6): e029079. doi: 10.1136/bmjopen-2019-029079. PMID: 31239305.
  9. Gebreyohannes E.A., Bhagavathula A.S., Abebe T.B., et al. In-hospital mortality among ischemic stroke patients in gondar university hospital: a retrospective cohort study. Stroke Res Treat. 2019; 2019: 7275063. doi: 10.1155/2019/7275063. PMID: 30693082.
  10. Heuschmann P.U. Predictors of in-hospital mortality and attributable risks of death after ischemic stroke: the German Stroke Registers Study Group. Arch Intern Med. 2004; 164(16): 1761–1768. doi: 10.1001/archinte.164.16.1761. PMID: 15364669.
  11. Koennecke H.C., Belz W., Berfelde D., et al. Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit. Neurology. 2011; 77(10): 965–972. doi: 10.1212/wnl.0b013e31822dc795. PMID: 21865573.
  12. Minnerup J., Wersching H., Unrath M., Berger K. Explaining the decrease of in-hospital mortality from ischemic stroke. PLоS One. 2015; 10(7): e0131473. doi: 10.1371/journal.pone.0131473. PMID: 26154704.
  13. Smith E.E., Shobha N., Dai D., et al. Risk score for in-hospital ischemic stroke mortality derived and validated within the get with the guidelines-stroke program. Circulation. 2010; 22(15): 1496–1504. doi: 10.1161/circulationaha.109.932822. PMID: 20876438.
  14. Cadilhac D.A., Kilkenny M.F., Levi C.R., et al. Risk-adjusted hospital mortality rates for stroke: evidence from the Australian Stroke Clinical Registry (AuSCR). Med J Aust. 2017; 206(8): 345–350. doi: 10.5694/mja16.00525. PMID: 28446116.
  15. Steiner M.M., Brainin M. The quality of acute stroke units on a nation-wide level: the Austrian Stroke Registry for acute stroke units. Eur J Neurology. 2003; 10(4): 353–360. doi: 10.1046/j.1468-1331.2003.00609.x. PMID: 12823485.
  16. Gattringer T., Posekany A., Niederkorn K., et al. Predicting early mortality of acute ischemic stroke. Stroke. 2018; 50(2): 349–356. doi: 10.1161/strokeaha.118.022863. PMID: 30580732.
  17. Stepanova M., Venkatesan C., Altaweel L., et al. Recent trends in inpatient mortality and resource utilization for patients with stroke in the United States: 2005–2009. J Stroke Cerebrovasc Dis. 2013; 22(4),: 491–499. doi: 10.1016/j.jstrokecerebrovasdis.2013.03.00. PMID: 23545319.
  18. Keller K., Geyer M., Münzel T., et al. Impact of atrial fibrillation on in-hospital mortality of ischemic stroke patients and identification of promoting factors of atrial thrombi — Results from the German nationwide inpatient sample and a single-center retrospective cohort. Observational Study Medicine (Baltimore). 2019; 98(4): e14086. doi: 10.1097/MD.0000000000014086. PMID: 30681566.
  19. Arboix A., García-Eroles L., Comes E., et al. Importance of cardiovascular risk profile for in-hospital mortality due to cerebral infarction. Rev Esp Cardiol. 2008; 61(10): 1020–1029. doi: 10.1016/s1885-5857(09)60005-0. PMID: 18817678.
  20. Lee J., Morishima T., Kunisawa S., et al. Derivation and validation of in-hospital mortality prediction models in ischaemic stroke patients using administrative data. Cerebrovasc Dis. 2013; 35(1): 73–80. doi: 10.1159/000346090. PMID: 23429000.
  21. Saposnik G., Hill M.D., O’Donnell M., et al. Variables associated with 7-day, 30-day, and 1-year fatality after ischemic stroke. Stroke. 2008; 39(8): 2318–2324. doi: 10.1161/strokeaha.107.510362. PMID: 18566303.
  22. Ohinmaa A., Zheng Y., Jeerakathil T., et al. Trends and regional variation in hospital mortality, length of stay and cost in hospital of ischemic stroke patients in Аlberta accompanying the provincial reorganization of stroke care. J Stroke Cerebrovasc Dis. 2016; 25(12): 2844–2850. doi: 10.1016/j.jstrokecerebrovasdis.2016.07.046. PMID: 27663512.
  23. Ganesh A., Lindsay P., Fang J., et al. Integrated systems of stroke care and reduction in 30-day mortality. Neurology. 2016; 86(10): 898–904. doi: 10.1212/wnl.0000000000002443. PMID: 26850979.
  24. Roussot A., Cottenet J., Gadreau M., et al. The use of national administrative data to describe the spatial distribution of in-hospital mortality following stroke in France, 2008–2011. Int J Health Geogr. 2016; 15(1): 2. doi: 10.1186/s12942-015-0028-2. PMID: 26754188.
  25. Tanne D., Koton S., Molshazki N., et al. Trends in management and outcome of hospitalized patients with acute stroke and transient ischemic attack: The National Acute Stroke Israeli (NASIS) Registry. Stroke. 2012; 43(8): 2136–2141. doi: 10.1161/strokeaha.111.647610. PMID: 22569935.
  26. Rodríguez Lucci F., Pujol Lereis V., Ameriso S., et al. In-hospital mortality due to stroke. Medicina (B Aires). 2013; 73(4): 331–334. PMID: 23924531.
  27. The 2018 National (Irish) Stroke Register Annual Report
  28. Counsell C., Dennis M., McDowall M., Warlow C. Predicting outcome after acute and subacute stroke: development and validation of new prognostic models. Stroke. 2002; 33(4): 1041–1047. doi: 10.1161/hs0402.105909. PMID: 11935058.
  29. Counsell C., Dennis M. Systematic review of prognostic models in patients with acute stroke. Cerebrovascular Diseases. 2001; 12(3): 159–170. doi: 10.1159/000047699. PMID: 11641579.
  30. Ho W.M., Lin J.R., Wang H.H., et al. Prediction of in-hospital stroke mortality in critical care unit. Springerplus. 2016; 5(1): 1051. doi: 10.1186/s40064-016-2687-2. PMID: 27462499.
  31. Weimar C. Age and National Institutes of Health Stroke Scale Score within 6 hours after onset are accurate predictors of outcome after cerebral ischemia: development and external validation of prognostic models. Stroke. 2003; 35(1): 158–162. doi: 10.1161/01.str.0000106761.94985.8b. PMID: 14684776.
  32. Viana Baptista M., van Melle G., Bogousslavsky J. Prediction of in-hospital mortality after first-ever stroke: the Lausanne Stroke Registry. J Neurol Sci. 1999; 166(2): 107–114. doi: 10.1016/s0022-510x(99)00117-3. PMID: 10475103
  33. Wang Y., Lim L.L., Levi C., et al. A prognostic index for 30-day mortality after stroke. J Clin Epidemiol. 2001; 54(8): 766–773. doi: 10.1016/s0895-4356(01)00338-9. PMID: 11470384.
  34. Weimar C., Ziegler A., König I.R., Diener H.C. Predicting functional outcome and survival after acute ischemic stroke. J Neurol. 2002; 249(7): 888–895. doi: 10.1007/s00415-002-0755-8. PMID: 12140674.

Statistics

Views

Abstract: 131

PDF (Russian): 89

Article Metrics

Metrics Loading ...

Dimensions

PlumX


Copyright (c) 2021 Vozniuk I.A., Morozova E.M., Prokhorova M.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies