Trends in 10-Year Survival of Patients With Stroke Hospitalized Between 1980 and 2000 - Minnesota

This really doesn't help much because we have no objective damage diagnoses from the stroke so we could compare year by year whether our stroke teams are doing better in applying tPA and stopping the neuronal cascade of death.  This reduction probably has almost nothing to do with doctor interventions.  If you don't know what the problem is, you'll never be able to solve it.
http://stroke.ahajournals.org/content/45/9/2575.abstract?etoc

The Minnesota Stroke Survey

1. Kamakshi Lakshminarayan, MD, PhD;
2. Alan K. Berger, MD, MS;
3. Candace C. Fuller, PhD, MPH;
4. David R. Jacobs Jr, PhD;
5. David C. Anderson, MD;
6. Lyn M. Steffen, PhD;
7. Arthur Sillah, MPH;
8. Russell V. Luepker, MD, MS

+ Author Affiliations

1. From the Division of Epidemiology and Community, School of Public Health (K.L., D.R.J., L.M.S., R.V.L.), Department of Medicine, Division of Interventional Cardiology (A.K.B.), and Department of Neurology, Medical School (D.C.A.), University of Minnesota, Minneapolis; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim HealthCare Institute, Boston, MA (C.C.F.); and Division of Applied Research, Allina Health, Minneapolis, MN (A.S.).

1. Correspondence to Kamakshi Lakshminarayan, MD, PhD, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S Second St, Suite 300, Minneapolis, MN 55454-1015. E-mail laksh004@umn.edu

Abstract

Background and Purpose—We report on trends in poststroke survival, both in the early period after stroke and over the long term. We examine these trends by stroke subtype.

Methods—The Minnesota Stroke Survey is a study of all hospitalized patients with acute stroke aged 30 to 74 years in the Minneapolis–St Paul metropolis. Validated stroke events were sampled for survey years 1980, 1985, 1990, 1995, and 2000 and subtyped as ischemic or hemorrhagic by neuroimaging for survey years 1990, 1995, and 2000. Survival was obtained by linkage to vital statistics data through the year 2010.

Results—There were 3773 acute stroke events. Age-adjusted 10-year survival improved from 1980 to 2000 (men 29.5% and 46.5%; P<0.0001; women 32.6% and 50.5%; P<0.0001). Ten-year ischemic stroke survival (n=1667) improved from 1990 to 2000 (men 35.3% and 50%; P=0.0001; women 38% and 55.3%; P<0.0001). Ten-year hemorrhagic stroke survival showed a trend toward improvement, but this (n=489) did not reach statistical significance, perhaps because of their smaller number (men 29.7% and 45.8%; P=0.06; women 39.2% and 49.6%; P=0.2). Markers of stroke severity including unconsciousness or major neurological deficits at admission declined from 1980 to 2000 while neuroimaging use increased.

Conclusions—These poststroke survival trends are likely because of multiple factors, including more sensitive case ascertainment shifting the case mix toward less severe strokes, improved stroke care and risk factor management, and overall improvements in population health and longevity.