Functional Outcomes Improving in Patients With Ischemic Stroke

Lisa Rapaport

January 12, 2022

Over the past two decades, stroke onset has been at older ages and stroke severity has become milder for both sexes and for both ischemic and hemorrhagic stroke, a Japanese study suggests.

Researchers examined records from the Japan Stroke Data Bank on 183,080 patients who developed acute stroke between 2000 and 2019. They assessed initial stroke severity based on the National Institutes of Health Stroke Scale for ischemic stroke and intracerebral hemorrhage and by the World Federation of Neurological Surgeons grading for subarachnoid hemorrhage. Symptoms at discharge were assessed based on modified Rankin Scale scores and considered "favorable" with scores of 0-2 and "unfavorable" with scores of 5-6.

Overall, the study included 135,266 patients with ischemic stroke, 36,014 with intracerebral hemorrhage, and 11,800 with subarachnoid hemorrhage. During the study period, the median age at onset increased for all three types of stroke and the severity based on the National Institutes of Health Stroke Scale and World Federation of Neurological Surgeons scores decreased, researchers report in JAMA Neurology.

With hemorrhagic strokes, the proportion of patients with favorable outcomes didn't significantly increase over time. However, unfavorable outcomes and in-hospital deaths decreased in both sexes.

For intracerebral hemorrhage in particular, the study found that favorable outcomes decreased in both sexes, and unfavorable outcomes and deaths decreased only in women. With subarachnoid hemorrhage, the analysis found no significant change in the proportion of favorable outcomes, but there was a decline in the proportion of patients of both sexes who died or had unfavorable outcomes.

With ischemic stroke, the proportion of women with scores indicating favorable outcomes increased over time in analysis adjusted for age, while scores were little changed for men. Once researchers adjusted for reperfusion therapy, however, there was no longer a significant change in scores for women or men.

"It seems to clearly indicate differences in development of therapeutic techniques between acute ischemic stroke and acute hemorrhagic strokes in the last 20 years," said lead study author Dr. Kazunori Toyoda of the National Cerebral and Cardiovascular Center, Suita, in Osaka, Japan.

"We have not yet obtained decisively effective acute therapeutic strategies for hemorrhagic strokes just as powerful as reperfusion therapy for ischemic stroke," Dr. Toyoda said by email.

One limitation of the study is that several sites included in the registry either joined or dropped out from participation during the study period, researchers note. Another drawback is that functional outcomes were assessed at discharge, around a median of 20 days after the stroke, without longer-term data to determine future functional outcomes.

SOURCE: https://bit.ly/3FdjQiX JAMA Neurology, online December 6, 2021.

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