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Management characteristics and prognosis after stroke in China: findings from a large nationwide stroke registry
  1. Haiqiang Qin1,2,3,4,
  2. Yiping Chen5,6,
  3. Gaifen Liu1,2,3,4,
  4. Iain Turnbull5,
  5. Runhua Zhang1,2,3,4,
  6. Zixiao Li1,2,3,4,
  7. Yilong Wang1,2,3,4,
  8. Liping Liu1,2,3,4,
  9. Xingquan Zhao1,2,3,4,
  10. Zhengming Chen5,
  11. Yongjun Wang1,2,3,4
  1. 1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  2. 2China National Clinical Research Center for Neurological Diseases, Beijing, China
  3. 3Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
  4. 4Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
  5. 5Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
  6. 6Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
  1. Correspondence to Dr Yongjun Wang; yongjunwang{at}ncrcnd.org.cn

Abstract

Background and purpose There is limited nationwide evidence about the standard management characteristics of stroke types and prognosis in China. This study aimed to assess clinical characteristics, in-hospital and after-discharge management characteristics and prognosis for stroke types in China.

Methods A nationwide registry recruited 14 244 imaging-confirmed first-ever incident strokes from 132 hospitals across 31 provinces of China during 2007–2008, recording presenting characteristics, diagnostic procedures and in-hospital treatment. After hospital discharge, patients were followed up for 6 months. Conventional statistical methods were used to examine the patterns of management and prognosis.

Results Overall, 68.7%, 26.9% and 4.4% were ischaemic stroke (IS), intracerebral haemorrhage (ICH), and subarachnoid haemorrhage (SAH), respectively. Only 20% were managed in a dedicated stroke unit. Among IS, 1.3% received thrombolysis within 3 hours after symptom onset, whereas the proportions of receiving in-hospital antiplatelet therapy, neuroprotective agents and traditional Chinese medicines (TCM) were 88.4%, 69.7% and 70.6%, respectively. For ICH, 63.3% and 36.3% received neuroprotective agents and TCM in hospital, respectively. At discharge, 70.7% and 38.0% of the patients with IS were given antiplatelet and statin therapies, respectively, decreasing to 64.8% and 23.9%, respectively, at 6 months. In-hospital mortality was 3.2%, 9.3% and 10.1% for IS, ICH and SAH, respectively, with a further 8.6%, 18.2% and 22.0%, respectively, died by 6 month. Meanwhile, in-hospital recurrence rate was 2.6%, 1.9% and 7.2% for IS, ICH and SAH, respectively, with a further 8.0%, 5.1% and 7.5%, respectively, recurred by 6 month.

Conclusions In China, the mortality rate of stroke is lower than that reported from west populations, though most strokes are not managed in specialised stroke unit. There is widespread use of some unproven therapies but limited proven treatments, especially after discharge, leading to unnecessary recurrent risks.

  • stroke
  • management characteristic
  • prognosis
  • registry
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Footnotes

  • ZC and YW are joint senior authors.

  • Twitter @yilong

  • Contributors YW, LL, XZ and YW designed the study. ZC conceived of this article. HQ drafted the article, with further contributions from YC, IT and ZC. HQ, RZ and GL managed and analysed the data. All authors interpreted data and approved the final version of the article.

  • Funding National Key R&D Plan of the Ministry of Science and Technology of China (2016YFC1301604, 2017YFC1307702); National Natural Science Foundation of China (81870907); Ministry of Science and Technology and the Ministry of Health of China (2006BA101A11 and 2009CB521905); Beijing Municipal Administration of Hospitals’ Mission Plan (SML20150502).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Central Ethics Committee at Beijing Tiantan Hospital affiliated to Capital Medical University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. None.

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