title: [Characteristics and prevention among patients with stroke: a study of 36,844 patients hospitalized in France].
abstract: BACKGROUND
  This study evaluates comorbidities, primary and secondary drug prevention and two years survival among patients hospitalized for stroke during the first half of 2008.
  
  
  METHODS
  First hospitalization with stroke diagnosis was identified by using the national hospital discharge database and linked to the reimbursement database of the beneficiaries covered by the general health insurance scheme (74% of the 64 million population). A medication was considered to be used when there were more than two reimbursements over the 6 months following or preceding hospitalization.
  
  
  RESULTS
  Among the 36,844 patients with stroke, 31.6% had a main diagnosis of transient ischemic attack (TIA), 53.6% a cerebral infarct (CI) and 14.8% a cerebral hemorrhage (CH). For the 8429 patients aged less than 60 years, high frequency of low-income and full health insurance coverage (11% of the covered population) was found for CI (17.6%) and CH (24.6%). Specific refund for invalidating stroke before hospitalization was found for 16% of patients with CI and 10.5% of those with CH. During the two previous years, around 7% of all patients were hospitalized for stroke, 30% for arterial hypertension, 13% for cardiac electric disorders, 10% for coronary disease and 12% for diabetes. Death rates one month after hospitalization were 11.3% for CI and 33.8% for CH, and two years after 22.5% for CI, 43% for CH and 7.7% for TIA. At least one antihypertensive drug treatment was found for 55.2% of patients with a TIA before hospitalization and 62.9% after and respectively 59.4% and 65.8% for CI and 51.1% and 57.7% for CH. Before hospitalization, beta-blocker was the most frequent antihypertensive class (21 to 25.6% according to stroke type). After hospitalization, frequency increased for angiotensin-converting enzyme inhibitors among CI patients (31% vs. 18.7%) and calcium-channel blockers among CH patients (27.1% vs. 13.7%). Antiplatelet drugs were used by 58% of the patients with CI after hospitalization (27.8% before). An anticoagulant drug was present for 74.8% of patients with CI, 69.5% for TIA and 19.2% for CH. Among patients with ischemic stroke, half of them had a lipid-lowering drug after hospitalization. A combination of antihypertensive, anticoagulant and lipid lowering drugs was found for 32.9% of patients with a TIA, 39.9% for CI and 7.6% for CH after hospitalization.
  
  
  CONCLUSIONS
  These patients presented frequently a history of stroke and comorbidities and their level of secondary prevention must be improved.
authors: Caisse nationale de l'assurance maladie des travailleurs salariés CNAMTS - direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France. philippe.tuppin@cnamts.fr
authors: P
authors: P
authors: Tuppin
authors: V
authors: V
authors: Moysan
authors: C
authors: C
authors: de Peretti
authors: A
authors: A
authors: Schnitzler
authors: E
authors: E
authors: Fery-Lemonnier
authors: F
authors: F
authors: Woimant
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015897:Comorbidity; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006769:Hospitals, General; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007297:Inpatients / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000145:classification / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D002317:Cardiovascular Agents; D005343:Fibrinolytic Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D011619:Psychotropic Drugs