title: Trends in stroke treatment and outcome between 1995 and 2010: observations from Riks-Stroke, the Swedish stroke register.
abstract: BACKGROUND
  Continuous changes in stroke treatment and care, as well as changes in stroke characteristics, may alter stroke outcome over time. The aim of this paper is to describe time trends for treatment and outcome data, and to discuss if any such changes could be attributed to quality changes in stroke care.
  
  
  METHODS
  Data from Riks-Stroke, the Swedish stroke register, were analyzed for the time period of 1995 through 2010. The total number of patients included was 320,181. The following parameters were included: use of computed tomography (CT), stroke unit care, thrombolysis, medication before and after the stroke, length of stay in hospital, and discharge destination. Three months after stroke, data regarding walking, toileting and dressing ability, as well social situation, were gathered. Survival status after 7, 27 and 90 days was registered.
  
  
  RESULTS
  In 1995, 53.9% of stroke patients were treated in stroke units. In 2010 this proportion had increased to 87.5%. Fewer patients were discharged to geriatric or rehabilitation departments in later years (23.6% in 2001 compared with 13.4% in 2010), but more were discharged directly home (44.2 vs. 52.4%) or home with home rehabilitation (0 vs. 10.7%). The need for home help service increased from 18.2% in 1995 to 22.1% in 2010. Regarding prevention, more patients were on warfarin, antihypertensives and statins both before and after the stroke. The functional outcome measures after 3 months did improve from 2001 to 2010. In 2001, 83.8% of patients were walking independently, while 85.6% were independent in 2010. For toileting, independence increased from 81.2 to 84.1%, and for dressing from 78.0 to 80.4%. Case fatality (CF) rates after 3 months increased from 18.7% (2001) to 20.0% (2010). This trend is driven by patients with severe strokes.
  
  
  CONCLUSIONS
  Stroke outcomes may change over a relatively short time period. In some ways, the quality of care has improved. More stroke patients have CT, more patients are treated in stroke units and more have secondary prevention. Patients with milder strokes may have benefited more from these measures than patients with severe strokes. Increased CF rates for patients with severe stroke may be caused by shorter hospital stays, shorter in-hospital rehabilitation periods and lack of suitable care after discharge from hospital.
authors.affiliation: Department of Neurology, Örebro University Hospital, Örebro, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Appelros
authors.forename: Fredrik
authors.initials: F
authors.lastname: Jonsson
authors.forename: Signild
authors.initials: S
authors.lastname: Åsberg
authors.forename: Kjell
authors.initials: K
authors.lastname: Asplund
authors.forename: Eva-Lotta
authors.initials: EL
authors.lastname: Glader
authors.forename: Kerstin Hulter
authors.initials: KH
authors.lastname: Åsberg
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
authors.forename: Birgitta
authors.initials: B
authors.lastname: Stegmayr
authors.forename: Andreas
authors.initials: A
authors.lastname: Terént
mesh_terms: D000203:Activities of Daily Living; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001925:Brain Damage, Chronic / Q000209:etiology / Q000534:rehabilitation; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011787:Quality of Health Care; D020127:Recovery of Function; D012042:Registries / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055502:Secondary Prevention; D020521:Stroke / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D000071939:Stroke Rehabilitation; D013548:Sweden; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014859:Warfarin