National trends in outcomes of ischemic stroke and prognostic influence of stroke center capability in Japan, 2010–2016

on behalf of the J-ASPECT Study Collaborators

Research output: Contribution to journalArticle

Abstract

Background: Limited national-level information on temporal trends in comprehensive stroke center capabilities and their effects on acute ischemic stroke patients exists. Aims: To examine trends in in-hospital outcomes of acute ischemic stroke patients and the prognostic influence of temporal changes in comprehensive stroke center capabilities in Japan. Methods: This retrospective study used the J-ASPECT Diagnosis Procedure Combination database and identified 372,978 acute ischemic stroke patients hospitalized in 650 institutions between 2010 and 2016. Temporal trends in patient outcomes and recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy usage were examined. Facility comprehensive stroke center capabilities were assessed using a validated scoring system (comprehensive stroke center score: 1–25 points) in 2010 and 2014. The prognostic influence of temporal comprehensive stroke center score changes on in-hospital mortality and poor outcomes (modified Rankin Scale: 3–6) at discharge were examined using hierarchical logistic regression models. Results: Over time, stroke severity at admission decreased, whereas median age, sex ratio, and comorbidities remained stable. The median comprehensive stroke center score increased from 16 to 17 points. After adjusting for age, sex, comorbidities, consciousness level, and facility comprehensive stroke center score, proportion of in-hospital mortality and poor outcomes at discharge decreased (from 7.6% to 5.0%, and from 48.7% to 43.1%, respectively). The preceding comprehensive stroke center score increase (in 2010–2014) was independently associated with reduced in-hospital mortality and poor outcomes, and increased rt-PA and mechanical thrombectomy use (odds ratio (95% confidence interval): 0.97 (0.95–0.99), 0.97 (0.95–0.998), 1.07 (1.04–1.10), and 1.21 (1.14–1.28), respectively). Conclusions: This nationwide study revealed six-year trends in better patient outcomes and increased use of rt-PA and mechanical thrombectomy in acute ischemic stroke. In addition to lesser stroke severity, preceding improvement of comprehensive stroke center capabilities was an independent factor associated with such trends, suggesting importance of comprehensive stroke center capabilities as a prognostic indicator of acute stroke care.

Original languageEnglish
JournalInternational Journal of Stroke
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Japan
Stroke
Thrombectomy
Tissue Plasminogen Activator
Hospital Mortality
Comorbidity
Logistic Models
Sex Ratio
Consciousness
Retrospective Studies
Odds Ratio
Databases
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Neurology

Cite this

National trends in outcomes of ischemic stroke and prognostic influence of stroke center capability in Japan, 2010–2016. / on behalf of the J-ASPECT Study Collaborators.

In: International Journal of Stroke, 01.01.2019.

Research output: Contribution to journalArticle

@article{00c8e731839e4700a17e4ca20cd7d17c,
title = "National trends in outcomes of ischemic stroke and prognostic influence of stroke center capability in Japan, 2010–2016",
abstract = "Background: Limited national-level information on temporal trends in comprehensive stroke center capabilities and their effects on acute ischemic stroke patients exists. Aims: To examine trends in in-hospital outcomes of acute ischemic stroke patients and the prognostic influence of temporal changes in comprehensive stroke center capabilities in Japan. Methods: This retrospective study used the J-ASPECT Diagnosis Procedure Combination database and identified 372,978 acute ischemic stroke patients hospitalized in 650 institutions between 2010 and 2016. Temporal trends in patient outcomes and recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy usage were examined. Facility comprehensive stroke center capabilities were assessed using a validated scoring system (comprehensive stroke center score: 1–25 points) in 2010 and 2014. The prognostic influence of temporal comprehensive stroke center score changes on in-hospital mortality and poor outcomes (modified Rankin Scale: 3–6) at discharge were examined using hierarchical logistic regression models. Results: Over time, stroke severity at admission decreased, whereas median age, sex ratio, and comorbidities remained stable. The median comprehensive stroke center score increased from 16 to 17 points. After adjusting for age, sex, comorbidities, consciousness level, and facility comprehensive stroke center score, proportion of in-hospital mortality and poor outcomes at discharge decreased (from 7.6{\%} to 5.0{\%}, and from 48.7{\%} to 43.1{\%}, respectively). The preceding comprehensive stroke center score increase (in 2010–2014) was independently associated with reduced in-hospital mortality and poor outcomes, and increased rt-PA and mechanical thrombectomy use (odds ratio (95{\%} confidence interval): 0.97 (0.95–0.99), 0.97 (0.95–0.998), 1.07 (1.04–1.10), and 1.21 (1.14–1.28), respectively). Conclusions: This nationwide study revealed six-year trends in better patient outcomes and increased use of rt-PA and mechanical thrombectomy in acute ischemic stroke. In addition to lesser stroke severity, preceding improvement of comprehensive stroke center capabilities was an independent factor associated with such trends, suggesting importance of comprehensive stroke center capabilities as a prognostic indicator of acute stroke care.",
author = "{on behalf of the J-ASPECT Study Collaborators} and Akiko Kada and Kuniaki Ogasawara and Takanari Kitazono and Kunihiro Nishimura and Nobuyuki Sakai and Daisuke Onozuka and Yoshiaki Shiokawa and Shigeru Miyachi and Izumi Nagata and Kazunori Toyoda and Yoichiro Hashimoto and Yasuhiro Hasegawa and Haruhiko Hoshino and Shinichi Yoshimura and Michiyasu Suzuki and Akira Tsujino and Shinya Matsuda and Ryota Kurogi and Ai Kurogi and Nice Ren and Ataru Nishimura and Koichi Arimura and Akihito Hagihara and Teiji Tominaga and Takamasa Kayama and Hajime Arai and Norihiro Suzuki and Susumu Miyamoto and Akira Ogawa and Koji Iihara",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/1747493019884526",
language = "English",
journal = "International Journal of Stroke",
issn = "1747-4930",
publisher = "Wiley-Blackwell",

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TY - JOUR

T1 - National trends in outcomes of ischemic stroke and prognostic influence of stroke center capability in Japan, 2010–2016

AU - on behalf of the J-ASPECT Study Collaborators

AU - Kada, Akiko

AU - Ogasawara, Kuniaki

AU - Kitazono, Takanari

AU - Nishimura, Kunihiro

AU - Sakai, Nobuyuki

AU - Onozuka, Daisuke

AU - Shiokawa, Yoshiaki

AU - Miyachi, Shigeru

AU - Nagata, Izumi

AU - Toyoda, Kazunori

AU - Hashimoto, Yoichiro

AU - Hasegawa, Yasuhiro

AU - Hoshino, Haruhiko

AU - Yoshimura, Shinichi

AU - Suzuki, Michiyasu

AU - Tsujino, Akira

AU - Matsuda, Shinya

AU - Kurogi, Ryota

AU - Kurogi, Ai

AU - Ren, Nice

AU - Nishimura, Ataru

AU - Arimura, Koichi

AU - Hagihara, Akihito

AU - Tominaga, Teiji

AU - Kayama, Takamasa

AU - Arai, Hajime

AU - Suzuki, Norihiro

AU - Miyamoto, Susumu

AU - Ogawa, Akira

AU - Iihara, Koji

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Limited national-level information on temporal trends in comprehensive stroke center capabilities and their effects on acute ischemic stroke patients exists. Aims: To examine trends in in-hospital outcomes of acute ischemic stroke patients and the prognostic influence of temporal changes in comprehensive stroke center capabilities in Japan. Methods: This retrospective study used the J-ASPECT Diagnosis Procedure Combination database and identified 372,978 acute ischemic stroke patients hospitalized in 650 institutions between 2010 and 2016. Temporal trends in patient outcomes and recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy usage were examined. Facility comprehensive stroke center capabilities were assessed using a validated scoring system (comprehensive stroke center score: 1–25 points) in 2010 and 2014. The prognostic influence of temporal comprehensive stroke center score changes on in-hospital mortality and poor outcomes (modified Rankin Scale: 3–6) at discharge were examined using hierarchical logistic regression models. Results: Over time, stroke severity at admission decreased, whereas median age, sex ratio, and comorbidities remained stable. The median comprehensive stroke center score increased from 16 to 17 points. After adjusting for age, sex, comorbidities, consciousness level, and facility comprehensive stroke center score, proportion of in-hospital mortality and poor outcomes at discharge decreased (from 7.6% to 5.0%, and from 48.7% to 43.1%, respectively). The preceding comprehensive stroke center score increase (in 2010–2014) was independently associated with reduced in-hospital mortality and poor outcomes, and increased rt-PA and mechanical thrombectomy use (odds ratio (95% confidence interval): 0.97 (0.95–0.99), 0.97 (0.95–0.998), 1.07 (1.04–1.10), and 1.21 (1.14–1.28), respectively). Conclusions: This nationwide study revealed six-year trends in better patient outcomes and increased use of rt-PA and mechanical thrombectomy in acute ischemic stroke. In addition to lesser stroke severity, preceding improvement of comprehensive stroke center capabilities was an independent factor associated with such trends, suggesting importance of comprehensive stroke center capabilities as a prognostic indicator of acute stroke care.

AB - Background: Limited national-level information on temporal trends in comprehensive stroke center capabilities and their effects on acute ischemic stroke patients exists. Aims: To examine trends in in-hospital outcomes of acute ischemic stroke patients and the prognostic influence of temporal changes in comprehensive stroke center capabilities in Japan. Methods: This retrospective study used the J-ASPECT Diagnosis Procedure Combination database and identified 372,978 acute ischemic stroke patients hospitalized in 650 institutions between 2010 and 2016. Temporal trends in patient outcomes and recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy usage were examined. Facility comprehensive stroke center capabilities were assessed using a validated scoring system (comprehensive stroke center score: 1–25 points) in 2010 and 2014. The prognostic influence of temporal comprehensive stroke center score changes on in-hospital mortality and poor outcomes (modified Rankin Scale: 3–6) at discharge were examined using hierarchical logistic regression models. Results: Over time, stroke severity at admission decreased, whereas median age, sex ratio, and comorbidities remained stable. The median comprehensive stroke center score increased from 16 to 17 points. After adjusting for age, sex, comorbidities, consciousness level, and facility comprehensive stroke center score, proportion of in-hospital mortality and poor outcomes at discharge decreased (from 7.6% to 5.0%, and from 48.7% to 43.1%, respectively). The preceding comprehensive stroke center score increase (in 2010–2014) was independently associated with reduced in-hospital mortality and poor outcomes, and increased rt-PA and mechanical thrombectomy use (odds ratio (95% confidence interval): 0.97 (0.95–0.99), 0.97 (0.95–0.998), 1.07 (1.04–1.10), and 1.21 (1.14–1.28), respectively). Conclusions: This nationwide study revealed six-year trends in better patient outcomes and increased use of rt-PA and mechanical thrombectomy in acute ischemic stroke. In addition to lesser stroke severity, preceding improvement of comprehensive stroke center capabilities was an independent factor associated with such trends, suggesting importance of comprehensive stroke center capabilities as a prognostic indicator of acute stroke care.

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U2 - 10.1177/1747493019884526

DO - 10.1177/1747493019884526

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JO - International Journal of Stroke

JF - International Journal of Stroke

SN - 1747-4930

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