Mai Roose

The Third Stroke Registry in Tartu, Estonia: Decline of Stroke Incidence and 28-Day Case-Fatality Rate Since 1991

Background and Purpose— The purpose of the present study was to estimate the time trends of stroke during the last 10 years in an Estonian population by comparison of the results from the 2 previous stroke registries from Tartu. Methods— The Third Stroke Registry in Tartu was conducted from January 12, 2001, to November 30, 2003. The previous registry was composed from January 1, 1991, to December 31, 1993. The design of both studies is similar, using the same study criteria and classification schemes. Results— A total of 1280 patients with first-ever stroke were registered during the 5-year study period. The overall incidence rate of 230 per 100 000 declined between the studies to 188 per 100 000 age-standardized to the European standard population. The age-adjusted incidence rate for women decreased from 204 to 164 per 100 000 between the 2 periods. In most of the age groups, the overall case-fatality rates declined during the second period; the trend in the age group 75 to 84 years was statistically significant. Conclusions— The incidence of first-ever stroke in Tartu has declined significantly during the past decade and reached the level of the first registry. The 28-day case-fatality rate has declined from 30% to 26%. The prevalence of cardiovascular risk factors, incidence of stroke, and ischemic heart disease has been high in Eastern European countries. Our data show that the situation has improved.

Lifestyle and late effects after poliomyelitis. A risk factor study of two populations

Background – Patients with polio often experience new symptoms (muscle weakness, pain, fatigue and respiratory problems) many years after the acute disease. This study examined possible interactions between lifestyle factors (overweight, physical inactivity, smoking) and late polio with new symptoms.

One‐year outcome after first‐ever stroke according to stroke subtype, severity, risk factors and pre‐stroke treatment. A population‐based study from Tartu, Estonia

The aim of the current study was to evaluate the outcome at 1 year following a first‐ever stroke based on a population‐based registry from 2001 to 2003 in Tartu, Estonia. The outcome of first‐ever stroke was assessed in 433 patients by stroke risk factors, demographic data and stroke severity at onset using the Barthel Index (BI) score and the modified Rankin Score (mRS) at seventh day, 6 months and 1 year. Female sex, older age, blood glucose value >10 mmol/l on admission and more severe stroke on admission were the best predictors of dependency 1 year following the first‐ever stroke. At 1 year, the percentage of functionally dependent patients was 20% and the survival rate was 56%. The use of antihypertensive/antithrombotic medication prior to stroke did not significantly affect the outcome. The survival rate of stroke patients in Tartu is lower compared with other studied populations. The outcome of stroke was mainly determined by the initial severity of stroke and by elevated blood glucose value on admission. Patients with untreated hypertension had more severe stroke and trend for unfavourable outcome compared with those who were on treatment.

Changed Incidence and Case-Fatality Rates of First-Ever Stroke Between 1970 and 1993 in Tartu, Estonia

BACKGROUND AND PURPOSE The incidence of stroke has stabilized or increased in several developed countries recently, but few data about the trends are available from Eastern Europe. The study was designed to evaluate the possible changes of stroke incidence in Estonia. METHODS A population-based stroke registry was conducted in Tartu during 1991 through 1993 (mean population, 110,631) to compare it with the study of 1970 through 1973 (population, 90,459). The majority of stroke patients were recorded prospectively, and most were hospitalized and evaluated by a neurologist. All available medical records were reviewed. Only first-ever stroke cases were registered. RESULTS A total of 667 patients in 1970 through 1973 and 829 patients in 1991 through 1993 were recorded. The total annual incidence per 100,000 rose from 221 to 250 (P = .0173). The total rate for men increased nonsignificantly from 183 to 209 and for women from 258 to 284. Significant increases were observed for men aged 50 to 59 years and for women aged 50 to 69 years; for persons over 70 years, the rates slightly declined. The case-fatality rate at 1 month declined significantly, from 49% to 30%. CONCLUSIONS A remarkable increase in the incidence and decline in the case-fatality rate of first-ever stroke was observed in Tartu, Estonia. The increase of incidence for those younger than 70 years could be due to the increased prevalence of risk factors. The decline in case fatality could theoretically be related to better management of secondary complications.

Acute phase proteins and oxidised low-density lipoprotein in association with ischemic stroke subtype, severity and outcome.

Objectives: The goal of our study was to investigate the associations of oxidized LDL (apoB100 aldehyde-modified form) and acute phase proteins (fibrinogen, CRP) with acute ischemic stroke severity and outcome. Materials and Methods: The study included 61 ischemic stroke patients and 64 controls. Strokes were subtyped according to TOAST criteria, the severity and outcome of stroke (at 1 year) were measured. Results: The mean triglyceride, fibrinogen, CRP and glucose values were significantly higher among cases. The median oxLDL value for patients with large artery atherosclerosis (LAA) type of stroke was significantly higher than for other subtypes. The oxLDL values did not correlate with age, stroke severity and outcome. Conclusions: Inflammatory markers (fibrinogen and CRP) predicted the stroke severity and outcome whereas elevation of oxLDL levels did not. Our data refer to possibility that there may exist some links between the LAA subtype of stroke and elevated oxLDL (apoB100 aldehyde-modified form).

The Third Stroke Registry in Tartu, Estonia, from 2001 to 2003

Objectives –  The main goal of the Third Stroke Registry in Tartu was to determine the incidence and 28‐day case‐fatality of first‐ever stroke in an Estonian population.

First-Year Results of the Third Stroke Registry in Tartu, Estonia

Background: The main goal of the Third Stroke Registry in Tartu was to determine the incidence and 28-day case-fatality rates for first-ever stroke in an Estonian population. Methods: The data collection started on 01.12.2001. All patients with first-ever stroke living in Tartu were registered. Results: During the first year, 234 first-ever stroke cases were registered. The incidence rate of first-ever stroke age-standardised to the European population was 195/100,000, 214 (95% CI, 185–243) for men and 181 (95% CI, 155–208) per 100,000 for women. Sixty-eight patients (29%) died within 28 days of stroke onset. Conclusions: The incidence and 28-day case-fatality rate of stroke in Estonia are high compared to other countries. It might be related to higher risk factor prevalence, stress and socioeconomic status.

The Mannheim Declaration of Stroke in Eastern Europe

Accessible online at: www.karger.com/ced Stroke is the most devastating cause of morbidity and mortality in the Eastern European countries. In this region, stroke is more frequent and the victims are younger than in Western Europe. Moreover, the incidence of stroke is significantly higher in social classes with low income, which represents a higher percentage of the Eastern European populations. Stroke is still one of the most important contributors to the mortality gap between East and West. The socioeconomic impact of stroke further weakens the economic development of these societies. The frequency of stroke is partly dependent on modifiable risk factors. In Eastern Europe, relatively more high-risk patients (hypertension + diabetes + smoking) live in worse environmental conditions compared with Western individuals. The positive tendency of decreasing mortality and morbidity could not be seen in the majority of Eastern countries, therefore urgent and efficient steps should be done to improve the situation. To avoid death and permanent disability caused by stroke in Eastern Europe, a specialised action plan has been established. This action plan is based on the Helsingborg Declaration and the 10-Point Action Plan to Tackle Stroke summarised by the European Parliament in June, 2003. The governments of these countries should elaborate a countryspecific programme based on the following elements. 1 Highlight the link between stroke and risk factors to physicians, emergency medical personnel, other health care professionals and the general public by facilitating education programmes. Recognition of symptoms of stroke is the cornerstone of successful stroke management. 2 Health care budgets should be allocated considering stroke prevention and therapy as a priority. 3 In specialised stroke units, widespread application of diagnostic interventions, pharmacological and surgical treatments should be available for all patients with stroke. The prevention and treatment of stroke should be based on the principle of evidence-based medicine. There is a pressing need for further randomised and placebo-controlled trials. 4 Stroke patients should receive an individual, patient-centred rehabilitation treatment carried out by an interdisciplinary team and involving the family. 5 Ensure the timely prevention of stroke by adequately treated modifiable risk factors such as hypertension, diabetes, hyperlipidaemia and atrial fibrillation by helping physicians making their treatment decisions using swiftly adoptable guidelines. 6 Because stroke is an emergency and efficient therapy is possible only in a limited time window, simplify the transport of acute stroke patients from their home to the stroke units and try to shorten the stroke-to-needle time. 7 Persuade people of the importance of changing their lifestyle including smoking, heavy alcohol and calorie intake, lack of physical activity, mental and emotional stress, which are very common, but also modifiable risk factors of stroke in Eastern Europe. 8 Encourage active and establish new patients’ associations. Patient groups play an important role in health policy and are able to coordinate actions to promote better rehabilitation and social support for people with stroke and their families. 9 Set realistic, time-based targets for stroke management and produce population-based monitoring systems covering incidence, prevalence, mortality and disability to provide an Eastern European picture of stroke management. 10 Foundation of an East and West European Stroke Forum to share all information between Western and Eastern European stroke professionals by identifying and disseminating the best practices in stroke prevention and treatment.

Registry of first‐ever stroke in Tartu, Estonia, 1991 through 1993: outcome of stroke

ObjectivesTo provide information about the functional ability of the survivors of first‐ever stroke in Estonia. Patients and methods – A population based epidemiological study 1991 through 1993 in Tartu. Herewith the data for 1991 and 1993 are presented. A total of 519 persons were registered; 82% of them were admitted (mean length 14 days), 66% were discharged home. Results – During 6 months 41% of the patients died, the remaining 305 patients were interviewed about their living conditions, and functional ability using the Barthel ADL Index. Although 58% of patients responded to the questionnaire, no significant differences in several factors between the respondents and non‐respondents were found. Thirty‐eight percent of the patients were totally independent in ADL. Conclusion – The case‐fatality rate at 6 months was high in Estonia and the proportion of totally independent patients 6 months after stroke is slightly lower compared to other studies. The short length of hospital treatment was possibly compensated by sufficient support by relatives after discharge.