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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...

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Autores principales: Minnerup, Jens, Wersching, Heike, Unrath, Michael, Berger, Klaus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
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.
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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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