title: Trends of the Incidence of Ischemic Stroke Thrombolysis over Seven Years and One-Year Outcome: A Population-Based Study in Joinville, Brazil.
abstract: BACKGROUND
  In a population-based setting, we aimed to measure the incidence trends of ischemic stroke (IS) thrombolysis, thrombolysis times, proportion of symptomatic intracerebral hemorrhage (sICH), 30-day case fatality and functional outcomes. We also compared the 12-month functional status between thrombolyzed and nonthrombolyzed patients.
  
  
  METHODS
  Using data from the Joinville Population-Based Stroke Registry, we prospectively ascertained a cohort of all thrombolyses done in Joinville citizens, Southern Brazil, from 2005 to 2011. For the definition of sICH we used European Cooperative Acute Stroke Study (ECASS) II criteria.
  
  
  RESULTS
  Over 7 years, 6% (220/3,552) of all IS were thrombolyzed. The thrombolysis incidence increased from 1.4 [95% confidence interval (CI), 0.6-2.9] in 2005 to 9.8 (7.3-12.9) per 100,000 population in 2011 (p < 0.0001). The thrombolysis incidence age-adjusted to the world population in 2011 was 11 (8.2-14.3) per 100,000. Only 30% (50/165) were thrombolyzed within 1 h of arrival at hospital. In 7 days, 6.4% (14/220) had sICH and 57% (8/14) of those died. In the 2009-2011 period, a favorable functional outcome [modified Rankin scale (mRS) 0-1] at 12 months among patients who received thrombolysis was more frequent [mRS 0-1; 36% (38/107)] than among patients who did not receive thrombolysis [mRS 0-1; 24% (131/544); p = 0.016]. The logistic regression showed that thrombolyzed IS patients had a more favorable outcome (mRS 0-1; HR 2.13; 95% CI, 1.2-3.7; p < 0.016) than nonthrombolyzed patients.
  
  
  CONCLUSIONS
  In a population setting of a middle income country, the thrombolysis incidence and outcomes were similar to those of other well-structured services. After 1 year, patients thrombolyzed in the 4.5-hour time window had a better outcome. More than proportions, rates provide additional information and could be used to benchmark services against others.
authors.affiliation: Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region-Univille, Joinville, Brazil.
authors.forename: Carla H C
authors.initials: CH
authors.lastname: Moro
authors.affiliation: Joinville Stroke Registry, University of Joinville Region-Univille, Joinville, Brazil.
authors.forename: Anderson R R
authors.initials: AR
authors.lastname: Gonçalves
authors.affiliation: Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region-Univille, Joinville, Brazil.
authors.forename: Alexandre L
authors.initials: AL
authors.lastname: Longo
authors.affiliation: Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region-Univille, Joinville, Brazil.
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Fonseca
authors.affiliation: University of Joinville Region-Univille, Joinville, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Harger
authors.affiliation: University of Joinville Region-Univille, Joinville, Brazil.
authors.forename: Débora B
authors.initials: DB
authors.lastname: Gomes
authors.affiliation: University of Joinville Region-Univille, Joinville, Brazil.
authors.forename: Mariana C
authors.initials: MC
authors.lastname: Ramos
authors.affiliation: University of Joinville Region-Univille, Joinville, Brazil.
authors.forename: Aline L G
authors.initials: AL
authors.lastname: Estevam
authors.affiliation: University of Joinville Region-Univille, Joinville, Brazil.
authors.forename: Cristiane S
authors.initials: CS
authors.lastname: Fissmer
authors.affiliation: Joinville Stroke Registry, Hospital Municipal São José, Joinville, Brazil.
authors.forename: Adriana C
authors.initials: AC
authors.lastname: Garcia
authors.affiliation: Joinville Stroke Registry, Hospital Municipal São José, Joinville, Brazil.
authors.forename: Vivian
authors.initials: V
authors.lastname: Nagel
authors.affiliation: Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region-Univille, Joinville, Brazil.
authors.forename: Norberto L
authors.initials: NL
authors.lastname: Cabral
keywords: Epidemiology; Incidence; Ischemic stroke; Middle income country; Outcome; Population-based study; Thrombolysis