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| Large variations in stroke mortality among Western countries |
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22 February 2006
Study findings revealing marked variability in mortality and functional outcome after ischemic stroke in Western countries have led to calls for the establishment of an international stroke registry.
Dr L Gray (University of Nottingham, UK) and co-workers analysed the outcomes of 1484 patients from 11 countries who were recruited to the Tinzaparin in Acute Ischemic Stroke Trial (TAIST), which compared the safety and efficacy of the low molecular weight heparin tinzaparin with aspirin in patients with acute ischaemic stroke.
The number of fatalities at day 10 ranged from none of 36 patients enrolled in Germany to 19 (6.7%) of 283 stroke patients in the UK. By day 180, all of the German patients were still alive, whereas 58 (20.5%) UK patients had died. Less variability was found for the outcome of dependency; the proportion of patients with a modified Rankin Scale score of more than 2 points ranged from 44% of German patients to 67.2% of those enrolled in Ireland. In Finland, 81% of patients were discharged to an institution, compared with 37% of UK patients, the results, published in the Journal of Neurology, Neurosurgery, and Psychiatry, show.
Compared with patients in the UK, those in Canada, Germany, and The Netherlands were about half as likely to be dead or dependent after 3 months. These variations remained after adjustments for clinical variables including diabetes, atrial fibrillation, and stroke severity, and treatment variables including diagnostic procedure, physiotherapy, and speech therapy.
In an accompanying editorial Dr Diederik Dippel, from Erasmus Medical Centre in Rotterdam, The Netherlands, asks: "Should we take these figures at face value, and specifically worry about British stroke care?" He notes: "The disproportionably large variation in mortality, as compared to the variation in the composite outcome of death and dependency, is difficult to explain in terms of differences in stroke management processes." The fact that the study authors were unable to explain this variation suggests "systematic bias," Dr Dippel says, pointing out that the study was not designed to address the issue of international variations in stroke mortality. "What should worry us more," he suggests, "is that there is cause for alarm, and we do not have the data to check this in any way." Dr Dippel therefore recommends the establishment of large, representative, international stroke registries to provide a clear picture of international stroke mortality rates.
Reference:
J Neurol Neurosurg Psychiatry 2006; 77 (3): 327-333.
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