Declining 1-year case-fatality of stroke and increasing coverage of vascular risk management: population-based cohort study.
BACKGROUND
The authors estimated trends in 1-year case-fatality of stroke in relation to changes in vascular risk management from 1997 to 2005.


METHODS
A cohort study was implemented using data for 407 family practices in the UK General Practice Research Database, including subjects with first acute strokes between 1997 and 2005. One-year case-fatality was estimated by year and sex. Rate ratios were estimated using Poisson regression.


RESULTS
There were 19 143 women and 16 552 men who had first acute strokes between 1997 and 2005. In women, the 1-year case-fatality declined from 41.2% in 1997 to 29.2% in 2005. In men, the decline was from 29.2% in 1997 to 22.2% in 2005. The proportion of general practices that prescribed antihypertensive drugs to two-thirds or more of new patients with stroke increased from 6% in 1997 to 48% in 2005, for statins from 1% to 39% and for antiplatelet drugs from 11% to 39%. The rate ratio for 1-year mortality in 2005, compared with 1997-1998, adjusted for age group, sex, prevalent coronary heart disease, prevalent hypertension and deprivation quintile was 0.79 (0.74 to 0.86, p<0.001). After adjustment for antihypertensive, statin and antiplatelet prescribing, the rate ratio was 1.29 (1.17 to 1.42).


CONCLUSIONS
Reducing 1-year case-fatality after acute stroke may be partly explained by increased prescribing of antihypertensive, statin and antiplatelet drugs to patients with recent strokes. However, these analyses did not include measures of possible changes over time in stroke severity or acute stroke management.
Gulliford
Martin C
MC
Department of Public Health Sciences, King's College London, Capital House, 42 Weston Street, London SE1 3QD, UK. martin.gulliford@kcl.ac.uk
Charlton
Judith
J
Rudd
Anthony
A
Wolfe
Charles D
CD
Toschke
André Michael
AM
D000959:Antihypertensive Agents / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000188:drug therapy* / Q000517:prevention & control*; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy / Q000517:prevention & control; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011159:Population Surveillance; D012307:Risk Factors; D040242:Risk Reduction Behavior; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality*; D015996:Survival Rate
D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors