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Time trends in stroke severity in the years 2005 to 2020: results from the Austrian Stroke Unit Registry

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Abstract

Background and purpose

With aging population, there is an increase of atrial fibrillation (AF) and other vascular risk factors. We investigated trends in stroke severity at hospital admission with respect to AF and other risk factors in a prospective national stroke registry from 2005 to 2020.

Methods

Data from the prospective Austrian Stroke Unit Registry were used to study demographic and clinical factors associated with the change in admission stroke severity over years. Time trends in admission stroke severity of patients with pre-stroke modified Rankin Score ≤ 3 were investigated with respect to clinical variables and predefined age groups 18–54, 55–64, 65–74, 75–84 and ≥ 85 years. Time trends were studied using robust generalized linear models assuming normal distribution with a log link. Stroke severity on admission was assessed according to the National Institutes of Health Stroke Scale Score (NIHSS).

Results

In total, 140,312 patients with acute ischemic stroke were included in the analysis. Within the study period, mean patients’ age increased from 70 to 72 years (p < 0.001) and median NIHSS at admission decreased from 4 to 3 (p < 0.001). The frequency of AF increased from 25 to 32% (p < 0.001). The decrease in median admission NIHSS was evident in all relevant subgroups but more pronounced in patients with risk factors including AF, diabetes, hypercholesterolemia, smoking, elderly patients and those with pre-stroke disability.

Conclusion

Despite an aging population and generally increasing AF frequency, we observed a consistent trend towards less disabling strokes on admission.

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Acknowledgements

We thank all Austrian Stroke Unit Registry collaborators. Austrian Stroke Unit Registry Collaborators (Co-Investigators) Johannes Sebastian Mutzenbach, MD (Christian-Doppler-Clinic, Salzburg); Nele Bubel, MD (Christian-Doppler-Clinic, Salzburg); Katharina Millesi, MD (Christian-Doppler-Clinic, Salzburg); Regina Katzenschlager, MD (Donauspital, Vienna); Sabine Torma, MD (Donauspital, Vienna); Miroslav Krstic, MD (Donauspital, Vienna); Franz Gruber, MD (General Hospital, Linz); Milan R.Vosko, MD (General Hospital, Linz); Cornelia Brunner, MD (General Hospital, Linz), Michael Brainin, MD (Hospital Donauregion, Tulln); Karl Matz, MD (Hospital Donauregion, Tulln); Yvonne Teuschl, MD (Hospital Donauregion); Omid Hosseiny, MD (Hospital Göttlicher Heiland ,Vienna); Wolf Muellbacher, MD (Hospital Göttlicher Heiland,Vienna); Dietlind Resch, MD (Hospital Hietzing, Vienna); Martina Mayr, MD (Hospital Hietzing, Vienna) Robert Paur, MD (Hospital Hietzing, Vienna); Otto Berger, MD (Hospital Kaiser Franz-Josef, Vienna);Vera Nussgruber,MD (Hospital Kaiser Franz-Josef, Vienna);Wolfgang Grisold, MD (Hospital Kaiser Franz-Josef, Vienna); Joerg Weber, MD (Hospital Klagenfurt); Heinz Kohlfuerst, MD ( Hospital Klagenfurt); Klaus Berek, MD (Hospital Kufstein); Maertin Sawires, MD (Hospital Kufstein);Stefan Haaser, MD (Hospital Kufstein); Susanne Asenbaum-Nan, MD (Hospital Mostviertel, Amstetten); Awini Barwari, MD (Hospital Mostviertel, Amstetten); Sarah Doerfler, MD (Hospital Mostviertel, Amstetten); Stefan Oberndorfer (Hospital St. Poelten); Andreas Gatterer (Hospital St. Poelten); Alexander Tinchon (Hospital St. Poelten);Alexandra Herbst, MD (Hospital Oberwart);Barbara Muellauer, MD (Hospital Oberwart); Eva Schubert-Vadon, MD (Hospital Oberwart); Christian Eggers, MD (Hospital of the Mercy Friars Linz);Christof Bocksrucker, MD (Hospital of the Mercy Friars Linz);Andrea Hackenbuchner, MD (Hospital Otto Wagner, Vienna); Martin Krichmayr, MD (Hospital Rudolfstiftung, Vienna);Peter Sommer, MD (Hospital Rudolfstiftung, Vienna); Elisabeth Fertl, MD (Hospital Rudolfstiftung, Vienna); Herbert Koller, MD (Hospital LSF Graz); Franz-Stefan Höger, MD (Hospital LSF, Graz); Nenad Mitrovic, MD (Hospital Vöcklabruck); Thomas Salletmayr, MD (Hospital Vöcklabruck); Monika Grunenberg, MD (Hospital Vöcklabruck);Hanspeter Haring, MD (Hospital Wagner-Jauregg, Linz); Nakajima Takeshi, MD (Hospital Waldviertel Horn);Alexandra Rieseneder, MD (Hospital Waldviertel Horn); Martin Gabler (Hospital Waldviertel Horn); Andreas Doppelbauer, MD (Hospital Weinviertel Mistelbach); Stefan Pingitzer, MD (Hospital Weinviertel Mistelbach); Manfred Eder; MD (Hospital Weinviertel Mistelbach);Peter Schnider, MD (Hospital Wiener Neustadt); Isabelle Csmarich, MD(Hospital Wiener Neustadt); Andrea Hager-Seifert,MD (Hospital Wiener Neustadt); Franz Fazekas, MD (Medical University of Graz); Kurt Niederkorn, MD (Medical University of Graz), Thomas Gattringer, MD (Medical University of Graz); Johann Willeit, MD (Medical University of Innsbruck); Michael Knoflach, MD (Medical University of Innsbruck); Stefan Kiechl, MD (Medical University of Innsbruck); Claude Alf, MD (Neurological Center Rosenhügel, Hospital Hietzing Vienna -1st Dept. of Neurology);Georg Dimitriadis, MD (Neurological Center Rosenhügel, Hospital Hietzing Vienna -1st Dept. of Neurology); Manfred Schmidbauer, MD (Neurological Center Rosenhügel, Hospital Hietzing Vienna -1st Dept. of Neurology); Elsa Fröschl, MD (Neurological Center Rosenhügel, Hospital Hietzing Vienna -2nd Dept. of Neurology);Christoph Baumgartner, MD (Neurological Center Rosenhügel, Hospital Hietzing Vienna -2nd Dept. of Neurology); Judith Stanek, MD (Wilhelminen Hospital, Vienna); Gerhard Daniel, MD (Wilhelminen Hospital, Vienna);Silvia Parigger , MD (Wilhelminen Hospital, Vienna);Josef Grossmann, MD (Hospital Lienz);Martin Kosco, MD (Hospital Lienz); Robert Perfler, MD (Hospital Lienz);Sylvia Promisch, MD (Hospital LKH Villach); Peter Kapeller, MD (Hospital LKH Villach);Magret Niederkorn-Duft, MD (Hospital LKH Knittelfeld); Philipp Werner, MD (LKH Feldkirch); Wolfgang Serles (Medical University of Vienna); Eduard Auff (Medical UniversityofVienna); Martin Heine, MD (Hospital Feldbach); Harald Wurzinger, MD(Hospital Feldbach); Gesundheit Österreich GmbH/BIQG (M. Moritz, A. Gollmer,R. Kern,), Steering Group at the GÖG/BIQG

Author information

Authors and Affiliations

  1. Department of Neurology, St. John’s Hospital, Vienna, Austria

    Alexandra Bernegger, Stefan Krebs, Julia Ferrari, Wilfried Lang & Marek Sykora

  2. Gesundheit Österreich GmbH/BIQG, Vienna, Austria

    Dominika Mikšová & Alexandra Posekany

  3. Department of Neurology, Medical University of Vienna, Vienna, Austria

    Stefan Greisenegger

  4. Research Unit of Computational Statistics, University of Technology, Vienna, Austria

    Alexandra Posekany

  5. Department of Neurology, Medical University of Graz, Graz, Austria

    Thomas Gattringer

  6. Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria

    Thomas Gattringer

  7. Medical Faculty, Sigmund Freud University Vienna, Vienna, Austria

    Wilfried Lang & Marek Sykora

  8. Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

    Stefan Kiechl

  9. VASCage, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria

    Stefan Kiechl

Authors
  1. Alexandra Bernegger
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  2. Dominika Mikšová
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  3. Alexandra Posekany
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  4. Stefan Krebs
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  5. Julia Ferrari
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  6. Stefan Greisenegger
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  7. Thomas Gattringer
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  8. Wilfried Lang
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  9. Stefan Kiechl
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  10. Marek Sykora
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Consortia

the Austrian Stroke Unit Registry Collaborators

  • Johannes Sebastian Mutzenbach
  • , Nele Bubel
  • , Katharina Millesi
  • , Regina Katzenschlager
  • , Sabine Torma
  • , Miroslav Krstic
  • , Franz Gruber
  • , Milan R. Vosko
  • , Cornelia Brunner
  • , Michael Brainin
  • , Karl Matz
  • , Yvonne Teuschl
  • , Omid Hosseiny
  • , Wolf Muellbacher
  • , Dietlind Resch
  • , Martina Mayr
  • , Robert Paur
  • , Otto Berger
  • , Vera Nussgruber
  • , Wolfgang Grisold
  • , Joerg Weber
  • , Heinz Kohlfuerst
  • , Klaus Berek
  • , Maertin Sawires
  • , Stefan Haaser
  • , Susanne Asenbaum-Nan
  • , Awini Barwari
  • , Sarah Doerfler
  • , Stefan Oberndorfer
  • , Andreas Gatterer
  • , Alexander Tinchon
  • , Alexandra Herbst
  • , Barbara Muellauer
  • , Eva Schubert-Vadon
  • , Christian Eggers
  • , Christof Bocksrucker
  • , Andrea Hackenbuchner
  • , Martin Krichmayr
  • , Peter Sommer
  • , Elisabeth Fertl
  • , Herbert Koller
  • , Franz-Stefan Höger
  • , Nenad Mitrovic
  • , Thomas Salletmayr
  • , Monika Grunenberg
  • , Hanspeter Haring
  • , Nakajima Takeshi
  • , Alexandra Rieseneder
  • , Martin Gabler
  • , Andreas Doppelbauer
  • , Stefan Pingitzer
  • , Manfred Eder
  • , Peter Schnider
  • , Isabelle Csmarich
  • , Andrea Hager-Seifert
  • , Franz Fazekas
  • , Kurt Niederkorn
  • , Thomas Gattringer
  • , Johann Willeit
  • , Michael Knoflach
  • , Stefan Kiechl
  • , Claude Alf
  • , Georg Dimitriadis
  • , Manfred Schmidbauer
  • , Elsa Fröschl
  • , Christoph Baumgartner
  • , Judith Stanek
  • , Gerhard Daniel
  • , Silvia Parigger
  • , Josef Grossmann
  • , Martin Kosco
  • , Robert Perfler
  • , Sylvia Promisch
  • , Peter Kapeller
  • , Magret Niederkorn-Duft
  • , Philipp Werner
  • , Wolfgang Serles
  • , Eduard Auff
  • , Martin Heine
  • , Harald Wurzinger
  •  & Gesundheit Österreich

Corresponding author

Correspondence to Marek Sykora.

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None.

Additional information

The members of the the Austrian Stroke Unit Registry Collaborators are mentioned "Acknowledgments section".

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Bernegger, A., Mikšová, D., Posekany, A. et al. Time trends in stroke severity in the years 2005 to 2020: results from the Austrian Stroke Unit Registry. J Neurol 269, 4396–4403 (2022). https://doi.org/10.1007/s00415-022-11079-x

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  • DOI: https://doi.org/10.1007/s00415-022-11079-x

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