Temporal Trends in Stroke Management and Outcomes between 2011 and 2020: Results from a Nationwide Multicenter Registry
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Abstract
Background There have been significant advancements in the treatment of ischemic stroke including stent retrievers for endovascular thrombectomy, new oral anticoagulants for atrial fibrillation, dual antiplatelet therapy for stroke prevention, and statins for atherosclerotic stroke. This study aims to evaluate temporal trends of these treatments and related clinical outcomes through a decade-long trend analysis, utilizing data from a comprehensive, national, multicenter stroke registry. We also seek to identify areas in need of improvement. Methods This analysis involved patients with ischemic stroke or transient ischemic attack registered prospectively in the Clinical Research Center for Stroke-Korea-National Institute of Health (CRCS-K-NIH) registry between 2011 and 2020. We examined temporal trends in risk factors, etiologic subtypes, acute management strategies, and outcomes for up to one year post-stroke. Generalized linear mixed models were employed to account for center clustering. Results Among 77,662 patients over 10 years, the average age increased by 2.2 years in men and 2.4 years in women. Notably, in-hospital neurological deterioration, 3-month and 1-year mortality, and cumulative incidence of recurrent stroke within one year showed significant decreases over time after adjustments for age, sex, and initial stroke severity ( P trend ’s < 0.01). However, functional outcomes at 3 months and 1 year remained unchanged. The use of endovascular thrombectomy increased from 5.4% in 2011 to 10.6% in 2020. There was also an increase in the prescription of anticoagulants for atrial fibrillation, dual antiplatelet therapy, statins, and stroke unit care. Contrarily, the rate of intravenous thrombolysis showed a slight decline. Conclusions This study points to a reduction in mortality and risk of recurrent stroke over the past decade, paralleling enhancement in acute and preventive stroke management. Nevertheless, the decline in use of intravenous thrombolysis and the stagnation of functional outcomes may signal the need for further investigation to identify underlying causes of these trends and counterstrategies to mitigate risks.
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Abstract
Background There have been significant advancements in the treatment of ischemic stroke including stent retrievers for endovascular thrombectomy, new oral anticoagulants for atrial fibrillation, dual antiplatelet therapy for stroke prevention, and statins for atherosclerotic stroke. This study aims to evaluate temporal trends of these treatments and related clinical outcomes through a decade-long trend analysis, utilizing data from a comprehensive, national, multicenter stroke registry. We also seek to identify areas in need of improvement.
Methods
This analysis involved patients with ischemic stroke or transient ischemic attack registered prospectively in the Clinical Research Center for Stroke-Korea-National Institute of Health (CRCS-K-NIH) registry between 2011 and 2020. We examined temporal trends in risk factors, etiologic subtypes, acute management strategies, and outcomes for up to one year post-stroke. Generalized linear mixed models were employed to account for center clustering.
Results
Among 77,662 patients over 10 years, the average age increased by 2.2 years in men and 2.4 years in women. Notably, in-hospital neurological deterioration, 3-month and 1-year mortality, and cumulative incidence of recurrent stroke within one year showed significant decreases over time after adjustments for age, sex, and initial stroke severity (Ptrend’s < 0.01). However, functional outcomes at 3 months and 1 year remained unchanged. The use of endovascular thrombectomy increased from 5.4% in 2011 to 10.6% in 2020. There was also an increase in the prescription of anticoagulants for atrial fibrillation, dual antiplatelet therapy, statins, and stroke unit care. Contrarily, the rate of intravenous thrombolysis showed a slight decline.
Conclusions
This study points to a reduction in mortality and risk of recurrent stroke over the past decade, paralleling enhancement in acute and preventive stroke management. Nevertheless, the decline in use of intravenous thrombolysis and the stagnation of functional outcomes may signal the need for further investigation to identify underlying causes of these trends and counterstrategies to mitigate risks.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
Source of Funding: This research was supported by a fund (2023-ER1006-00) by Research of Korea Centers for Disease Control and Prevention.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
Ethics committee/IRB of Seoul National University Bundang Hospital gave ethical approval for this work.
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
Yes
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