Hospitalization rates, stroke unit care, and recurrence rates in Austria’s stroke cohort Epidemiologic analysis of 102,107 patients in a nation-wide acute stroke cohort between 2015 and 2019

Abstract

Introduction: Continuous analysis of key epidemiologic data is irremissible to adapt health-care systems to trends in stroke epidemiology. We present data from 2015 to 2019 on quality indicators of stroke care, including rates on hospitalization, stroke unit care and recurrence rates using medical record-linkage of in-patient routine documentation. Patients and methods: We included stroke/TIA patients admitted to Austrian hospitals between 2015 and 2019 aged ⩾20 years using medical record-linkage. Results: In our cohort of 102,107 patients with 107,055 treatment episodes, we could show a significant decrease in 1-year cumulative age-adjusted hospitalization rates per 100,000 in TIA (86.3 [95% CI 84.1–88.5] vs 75.4 [95% CI 73.4–77.4], RR 0.87 [95% CI 0.85–0.90]), ischemic stroke (187.3 [95% CI 184.0–190.5] vs 173.4 [95% CI 170.4–176.5], RR 0.93 [95% CI 0.91–0.94]), and intracerebral hemorrhage (28.5 [95% CI 27.3–29.8] vs 22.8 [95% CI 21.7–23.9], RR 0.80 [95% CI 0.76–0.84]). In ischemic stroke the rate of stroke unit care increased significantly (55.7% vs 69.3%; RR 1.14 [95% CI 1.12–1.17]), and acute 1-year recurrences decreased significantly. Discussion: We found a decline of the annual age-adjusted cumulative hospitalization rates in stroke/TIA, a higher age of disease manifestation and less severe strokes, which is probably attributable to improved primary and secondary prevention in Austria. The proportion of patients treated at stroke units increased significantly, however a geographical and age-dependency is still evident. Conclusion: Age-adjusted hospitalization rates of stroke/TIA patients decreased, and stroke unit care is increasing but the goal of the Stroke Action Plan for Europe is yet to be reached.