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Explaining the Decrease of In-Hospital Mortality from Ischemic Stroke
BACKGROUND: Mortality from ischemic stroke has declined over time. However, little is known about the reasons for the decreased mortality. We therefore aimed to evaluate trends in in-hospital mortality and to identify factors associated with these trends. METHODS: This study was based on a prospecti...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4496086/ https://www.ncbi.nlm.nih.gov/pubmed/26154704 http://dx.doi.org/10.1371/journal.pone.0131473 |
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author | Minnerup, Jens Wersching, Heike Unrath, Michael Berger, Klaus |
author_facet | Minnerup, Jens Wersching, Heike Unrath, Michael Berger, Klaus |
author_sort | Minnerup, Jens |
collection | PubMed |
description | BACKGROUND: Mortality from ischemic stroke has declined over time. However, little is known about the reasons for the decreased mortality. We therefore aimed to evaluate trends in in-hospital mortality and to identify factors associated with these trends. METHODS: This study was based on a prospective database of 26 hospitals of the Stroke Register of Northwestern Germany, which included 73,614 patients admitted between 2000 and 2011. Time trends in observed (crude) and risk-adjusted in-hospital mortality were assessed. Independent factors associated with death after stroke were evaluated using multivariable logistic regression analysis. RESULTS: The observed in-hospital mortality decreased from 6.6% in 2000 to 4.6% in 2008 (P < 0.001 for trend) and then remained fairly stable. The risk-adjusted mortality decreased from 2.85% in 2000 to 1.86% in 2008 (P < 0.01 for trend) and then increased to 2.32% in 2011. Use of in-hospital treatments including antiplatelets within 48 hours, antihypertensive therapy, statins, antidiabetics, physiotherapy and anticoagulants increased over time and was significantly associated with a decrease in mortality. The association of the year of admission with mortality became insignificant after adjustment for antiplatelet therapy within 48 hours (from OR 0.96; 95% CI, 0.94-0.98, to OR 0.99; 95% CI, 0.97-1.01) and physiotherapy (from OR 0.96; 95% CI, 0.94-0.97, to OR 0.99; 95% CI, 0.97-1.00). CONCLUSIONS: In-hospital mortality decreased by approximately one third between 2000 and 2008. This decline was paralleled by improvements in different in-hospital managements, and we demonstrated that it was partly mediated by early antiplatelet therapy and physiotherapy use. |
format | Online Article Text |
id | pubmed-4496086 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-44960862015-07-15 Explaining the Decrease of In-Hospital Mortality from Ischemic Stroke Minnerup, Jens Wersching, Heike Unrath, Michael Berger, Klaus PLoS One Research Article BACKGROUND: Mortality from ischemic stroke has declined over time. However, little is known about the reasons for the decreased mortality. We therefore aimed to evaluate trends in in-hospital mortality and to identify factors associated with these trends. METHODS: This study was based on a prospective database of 26 hospitals of the Stroke Register of Northwestern Germany, which included 73,614 patients admitted between 2000 and 2011. Time trends in observed (crude) and risk-adjusted in-hospital mortality were assessed. Independent factors associated with death after stroke were evaluated using multivariable logistic regression analysis. RESULTS: The observed in-hospital mortality decreased from 6.6% in 2000 to 4.6% in 2008 (P < 0.001 for trend) and then remained fairly stable. The risk-adjusted mortality decreased from 2.85% in 2000 to 1.86% in 2008 (P < 0.01 for trend) and then increased to 2.32% in 2011. Use of in-hospital treatments including antiplatelets within 48 hours, antihypertensive therapy, statins, antidiabetics, physiotherapy and anticoagulants increased over time and was significantly associated with a decrease in mortality. The association of the year of admission with mortality became insignificant after adjustment for antiplatelet therapy within 48 hours (from OR 0.96; 95% CI, 0.94-0.98, to OR 0.99; 95% CI, 0.97-1.01) and physiotherapy (from OR 0.96; 95% CI, 0.94-0.97, to OR 0.99; 95% CI, 0.97-1.00). CONCLUSIONS: In-hospital mortality decreased by approximately one third between 2000 and 2008. This decline was paralleled by improvements in different in-hospital managements, and we demonstrated that it was partly mediated by early antiplatelet therapy and physiotherapy use. Public Library of Science 2015-07-08 /pmc/articles/PMC4496086/ /pubmed/26154704 http://dx.doi.org/10.1371/journal.pone.0131473 Text en © 2015 Minnerup et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Minnerup, Jens Wersching, Heike Unrath, Michael Berger, Klaus Explaining the Decrease of In-Hospital Mortality from Ischemic Stroke |
title | Explaining the Decrease of In-Hospital Mortality from Ischemic Stroke |
title_full | Explaining the Decrease of In-Hospital Mortality from Ischemic Stroke |
title_fullStr | Explaining the Decrease of In-Hospital Mortality from Ischemic Stroke |
title_full_unstemmed | Explaining the Decrease of In-Hospital Mortality from Ischemic Stroke |
title_short | Explaining the Decrease of In-Hospital Mortality from Ischemic Stroke |
title_sort | explaining the decrease of in-hospital mortality from ischemic stroke |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4496086/ https://www.ncbi.nlm.nih.gov/pubmed/26154704 http://dx.doi.org/10.1371/journal.pone.0131473 |
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