title: Trends in management and outcome of hospitalized patients with acute stroke and transient ischemic attack: the National Acute Stroke Israeli (NASIS) registry.
abstract: OBJECTIVE
  Improving stroke management, guideline adherence, and outcome is a global priority. Our aim was to examine trends in nationwide use of reperfusion therapy, stroke in-hospital management, and outcome.
  
  
  METHODS
  Data were based on the triennial 2-month period of the National Acute Stroke Israeli registry (February to March 2004, March to April 2007, April to May 2010). The registry includes unselected patients admitted to all hospitals nationwide. There were in total 6279 patients: ischemic stroke, 4452 (70.9%); intracerebral hemorrhage, 485 (7.7%); undetermined stroke, 97 (1.6%); and transient ischemic attacks, 1245 (19.8%).
  
  
  RESULTS
  Overall use of reperfusion therapy for acute ischemic stroke increased from 0.4% in 2004% to 5.9% in 2010 (P<0.001; adjusted OR, 17.0; 95% CI, 7.5-38.7). Use of CT or MR angiography for ischemic events increased from 2.1% in 2004% to 16.6% in 2010 (P<0.001; adjusted OR, 9.7; 95% CI, 6.8-13.9). Overall use of antithrombotics and anticoagulation for atrial fibrillation did not differ between periods, whereas clopidogrel use increased nearly 3-fold to 41% and statin use nearly 2-fold to 68%. The relative odds of providing reperfusion therapy, using CT or MR angiography, and prescribing anticoagulants for atrial fibrillation were higher among hospitals with large as compared with small stroke patient volumes. In-hospital mortality after acute ischemic stroke decreased from 7.2% in 2004 to 3.9% in 2010 (P<0.001; adjusted OR, 0.7; 95% CI, 0.4-1.0), whereas there was no significant change in odds of poor functional outcome.
  
  
  CONCLUSIONS
  Based on a nationwide stroke registry, use of reperfusion therapy, vascular imaging, and statins is steadily increasing, whereas in-hospital mortality is decreasing.
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. tanne@post.tau.ac.il
authors.forename: David
authors.initials: D
authors.lastname: Tanne
authors.forename: Silvia
authors.initials: S
authors.lastname: Koton
authors.forename: Noa
authors.initials: N
authors.lastname: Molshazki
authors.forename: Uri
authors.initials: U
authors.lastname: Goldbourt
authors.forename: Tamar
authors.initials: T
authors.lastname: Shohat
authors.forename: Rakefet
authors.initials: R
authors.lastname: Tsabari
authors.forename: Ehud
authors.initials: E
authors.lastname: Grossman
authors.forename: Natan M
authors.initials: NM
authors.lastname: Bornstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D003627:Data Interpretation, Statistical; D004363:Drug Utilization; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000628:therapy*; D007557:Israel; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000379:methods*; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D000960:Hypolipidemic Agents; D010959:Tissue Plasminogen Activator