This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Numminen, H. Articles by Kotila, M. Search for Related Content PubMed PubMed Citation Articles by Numminen, H. Articles by Kotila, M. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Health policy and outcome research Acute Cerebral Hemorrhage Acute Cerebral Infarction Cerebral Aneurysm, AVM, & Subarachnoid hemorrhage Other Stroke Treatment - Medical

(Stroke. 2000;31:651.)
© 2000 American Heart Association, Inc.

Original Contributions

Decreased Severity of Brain Infarct Can in Part Explain the Decreasing Case Fatality Rate of Stroke

Heikki Numminen, MD; Markku Kaste, MD; Kari Aho, MD; Olli Waltimo, MD Mervi Kotila, MD

From the Department of Clinical Neuroscience (H.N., M.K., O.W., M.K.), Helsinki University Central Hospital, Helsinki, Finland; and Department of Neurology (K.A.), Jorvi Hospital, Espoo, Finland.

Correspondence to Dr Heikki Numminen, Department of Clinical Neuroscience, Helsinki University Central Hospital, PL 300, 00029 HYKS, Helsinki, Finland. E-mail h.numminen{at}kimpinen.fimnet.fi

Background and Purpose—Case fatality rates for stroke has declined in most Western industrialized countries during recent decades. One possible explanation for this is a decrease in the severity of stroke symptoms. We therefore sought evidence for a change in stroke severity and its relationship with case fatality rates.

Methods—We compared the severity of symptoms among first-ever stroke patients in 2 population-based prospective stroke registers maintained during 1972 to 1973 and 1989 to 1991 in Finland. Patients who were evaluated by study assistants or the investigator during the first week after the onset of symptoms were included in the study, and their severity of symptoms was assessed with the use of comparable scales modified from the Scandinavian Stroke Scale.

Results—A total of 244 and 594 patients were registered, and a portion of them (155 [63.5%] and 360 [60.6%]) were included in the analyses in the registers for Espoo-Kauniainen from 1972 to 1973 and for 4 separate districts in Finland from 1989 to 1991, respectively. The death rates during the first week among those who were not included did not differ between the registers. The severity of symptoms decreased significantly between the registers in both patients with brain infarct or intracerebral hemorrhage but not in those with subarachnoid hemorrhage. The severity of symptoms was an independent factor of case fatality at 1 month.

Conclusions—The severity of symptoms of brain infarcts has decreased and can in part explain the decreased case fatality rate of stroke in Finland. However, the change in patients with intracerebral hemorrhage may be overestimated due to undiagnosed intracerebral hemorrhages in the first register resulting from the lack of brain CT.

Key Words: Keys words: cerebrovascular disorders • treatment outcome • mortality • prospective studies

This article has been cited by other articles:

				J. D. Lewsey, M. Gillies, P. S. Jhund, J. W.T. Chalmers, A. Redpath, A. Briggs, M. Walters, P. Langhorne, S. Capewell, J. J.V. McMurray, et al. Sex Differences in Incidence, Mortality, and Survival in Individuals With Stroke in Scotland, 1986 to 2005 Stroke, April 1, 2009; 40(4): 1038 - 1043. [Abstract] [Full Text] [PDF]

				A. Rautio, M. Eliasson, and B. Stegmayr Favorable Trends in the Incidence and Outcome in Stroke in Nondiabetic and Diabetic Subjects: Findings From the Northern Sweden MONICA Stroke Registry in 1985 to 2003 Stroke, December 1, 2008; 39(12): 3137 - 3144. [Abstract] [Full Text] [PDF]

				N. E. Mayo, L. Nadeau, S. S. Daskalopoulou, and R. Cote The evolution of stroke in Quebec: A 15-year perspective Neurology, April 3, 2007; 68(14): 1122 - 1127. [Abstract] [Full Text] [PDF]

				P. Pajunen, R. Paakkonen, H. Hamalainen, I. Keskimaki, T. Laatikainen, M. Niemi, H. Rintanen, and V. Salomaa Trends in Fatal and Nonfatal Strokes Among Persons Aged 35 to >=85 Years During 1991-2002 in Finland Stroke, February 1, 2005; 36(2): 244 - 248. [Abstract] [Full Text] [PDF]

				P. Appelros, I. Nydevik, and M. Viitanen Poor Outcome After First-Ever Stroke: Predictors for Death, Dependency, and Recurrent Stroke Within the First Year Stroke, January 1, 2003; 34(1): 122 - 126. [Abstract] [Full Text] [PDF]

				B. Hallstrom, B. Norrving, and A. Lindgren Stroke in Lund-Orup, Sweden: Improved Long-Term Survival Among Elderly Stroke Patients Stroke, June 1, 2002; 33(6): 1624 - 1629. [Abstract] [Full Text] [PDF]

				A. Hartmann, T. Rundek, H. Mast, M. C. Paik, B. Boden-Albala, J. P. Mohr, and R. L. Sacco Mortality and causes of death after first ischemic stroke: The Northern Manhattan Stroke Study Neurology, December 11, 2001; 57(11): 2000 - 2005. [Abstract] [Full Text] [PDF]