Adelaide Stroke Incidence Study: Declining Stroke Rates but Many Preventable Cardioembolic Strokes

James Leyden, Timothy Kleinig, Jonathan Newbury, Sally Castle, Jennifer Cranefield, Craig Anderson, Maria Crotty, Deirdre Whitford, Jim Jannes, Andrew Lee, Jennene Greenhill

    Research output: Contribution to journalArticlepeer-review

    90 Citations (Scopus)

    Abstract

    BACKGROUND AND PURPOSE-: Stroke incidence rates are in flux worldwide because of evolving risk factor prevalence, risk factor control, and population aging. Adelaide Stroke Incidence Study was performed to determine the incidence of strokes and stroke subtypes in a relatively elderly population of 148 000 people in the Western suburbs of Adelaide. METHODS-: All suspected strokes were identified and assessed in a 12-month period from 2009 to 2010. Standard definitions for stroke and stroke fatality were used. Ischemic stroke pathogenesis was classified by the Trial of ORG 10172 in Acute Stroke Treatment criteria. RESULTS-: There were 318 stroke events recorded in 301 individuals; 238 (75%) were first-in-lifetime events. Crude incidence rates for first-ever strokes were 161 per 100 000 per year overall (95% confidence interval [CI], 141-183), 176 for men (95% CI, 147-201), and 146 for women (95% CI, 120-176). Adjusted to the world population rates were 76 overall (95% CI, 59-94), 91 for men (95% CI, 73-112), and 61 for women (95% CI, 47-78). The 28-day case fatality rate for first-ever stroke was 19% (95% CI, 14-24); the majority were ischemic (84% [95% CI, 78-88]). Intracerebral hemorrhage comprised 11% (8-16), subarachnoid hemorrhage 3% (1-6), and 3% (1-6) were undetermined. Of the 258 ischemic strokes, 42% (95% CI, 36-49) were of cardioembolic pathogenesis. Atrial fibrillation accounted for 36% of all ischemic strokes, of which 85% were inadequately anticoagulated. CONCLUSIONS-: Stroke incidence in Adelaide has not increased compared with previous Australian studies, despite the aging population. Cardioembolic strokes are becoming a higher proportion of all ischemic strokes.

    Original languageEnglish
    Pages (from-to)1226-1231
    Number of pages6
    JournalStroke
    Volume44
    Issue number5
    DOIs
    Publication statusPublished - May 2013

    Keywords

    • acute cerebral hemorrhage
    • acute cerebral infarction
    • acute stroke syndromes
    • epidemiology

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