ABSTRACT
ObjetivoDeterminar la incidencia de la enfermedad cerebrovascular (ECV) y su tendencia en el área sanitaria de Lleida.Material y métodosEstudio de cohortes de base poblacional que incluyó a toda la población del área sanitaria de Lleida (440.000 personas). Se utilizaron los listados del Conjunto Mínimo Básico de Datos (CMBD) de urgencias y de las altas hospitalarias en el periodo comprendido entre enero de 2010 y diciembre de 2014. Se seleccionaron todos los episodios de ictus. Se evaluaron las tasas brutas y las tasas estandarizadas por edad utilizando la población mundial como referencia. Se excluyeron aquellos casos sin confirmación diagnóstica por neuroimagen.ResultadosSe incluyeron 4.397 casos, de los cuales 1.617 (36,8%) fueron ≥ 80 años; 3.969 (90,3%) sujetos sufrieron un ictus isquémico, mientras que 1.741 (39,6%) casos correspondieron a mujeres. La tasa de incidencia cruda osciló entre los 192 (intervalo de confianza [IC] del 95%: 179-205) en 2012 y los 211 (IC 95%: 197-224) en 2013 casos cada 100.000 habitantes. Las tasas estandarizadas por edad oscilaron entre los 93 (IC 95%: 86-100) en 2012 y los 104 (IC 95%: 96-111) en 2013 casos por cada 100.000 habitantes. En todos los años, las tasas de incidencia fueron significativamente mayores entre los varones en comparación con las mujeres; y se incrementaron con la edad.ConclusionesEl impacto de la ECV en Lleida es equiparable a otras regiones europeas, pero que el envejecimiento de la población se traduce en una incidencia bruta elevada que se mantiene estable en los 5 años analizados. (AU)
ObjectivesThis study aimed to determine the incidence and trends of cerebrovascular disease (CVD) in the healthcare district of Lleida.Material and methodsWe performed a population-based prospective cohort study including the entire population of the healthcare district of Lleida (440 000 people). Information was gathered from the minimum basic data set from the emergency department and hospital discharges for the period from January 2010 to December 2014. All types of stroke were included. We evaluated crude and age-standardised rates using the world population as a reference. Patients without neuroimaging confirmation of the diagnosis were excluded.ResultsWe identified 4397 patients: 1617 (36.8%) were aged 80 years or over; 3969 (90.3%) presented ischaemic stroke, and 1741 (39.6%) were women. The crude incidence rate ranged from 192 (95% confidence interval [CI], 179-205) to 211 (95% CI, 197-224) cases per 100 000 population, in 2012 and 2013, respectively. Age-standardised rates ranged from 93 (95% CI, 86-100) to 104 (95% CI, 96-111) cases per 100 000 population, in 2012 and 2013, respectively. For all years, incidence rates increased with age, and were significantly higher among men than among women.ConclusionThe impact of CVD in Lleida is comparable to that observed in other European regions. However, population ageing induces a high crude incidence rate, which remained stable over the five-year study period. (AU)
Subject(s)
Humans , Catchment Area, Health , Incidence , Stroke , Mortality , Aged , SpainABSTRACT
OBJECTIVES: This study aimed to determine the incidence and trends of cerebrovascular disease (CVD) in the healthcare district of Lleida. MATERIAL AND METHODS: We performed a population-based prospective cohort study including the entire population of the healthcare district of Lleida (440 000 people). Information was gathered from the minimum basic data set from the emergency department and hospital discharges for the period from January 2010 to December 2014. All types of stroke were included. We evaluated crude and age-standardised rates using the world population as a reference. Patients without neuroimaging confirmation of the diagnosis were excluded. RESULTS: We identified 4397 patients: 1617 (36.8%) were aged 80 years or over; 3969 (90.3%) presented ischaemic stroke, and 1741 (39.6%) were women. The crude incidence rate ranged from 192 (95% confidence interval [CI], 179-205) to 211 (95% CI, 197-224) cases per 100 000 population, in 2012 and 2013, respectively. Age-standardised rates ranged from 93 (95% CI, 86-100) to 104 (95% CI, 96-111) cases per 100 000 population, in 2012 and 2013, respectively. For all years, incidence rates increased with age, and were significantly higher among men than among women. CONCLUSION: The impact of CVD in Lleida is comparable to that observed in other European regions. However, population ageing induces a high crude incidence rate, which remained stable over the five-year study period.
ABSTRACT
OBJECTIVES: This study aimed to determine the incidence and trends of cerebrovascular disease (CVD) in the healthcare district of Lleida. MATERIAL AND METHODS: We performed a population-based prospective cohort study including the entire population of the healthcare district of Lleida (440 000 people). Information was gathered from the minimum basic data set from the emergency department and hospital discharges for the period from January 2010 to December 2014. All types of stroke were included. We evaluated crude and age-standardised rates using the world population as a reference. Patients without neuroimaging confirmation of the diagnosis were excluded. RESULTS: We identified 4397 patients: 1617 (36.8%) were aged 80 years or over; 3969 (90.3%) presented ischaemic stroke, and 1741 (39.6%) were women. The crude incidence rate ranged from 192 (95% confidence interval [CI], 179-205) to 211 (95% CI, 197-224) cases per 100 000 population, in 2012 and 2013, respectively. Age-standardised rates ranged from 93 (95% CI, 86-100) to 104 (95% CI, 96-111) cases per 100 000 population, in 2012 and 2013, respectively. For all years, incidence rates increased with age, and were significantly higher among men than among women. CONCLUSION: The impact of CVD in Lleida is comparable to that observed in other European regions. However, population ageing induces a high crude incidence rate, which remained stable over the five-year study period.
Subject(s)
Brain Ischemia , Cerebrovascular Disorders , Stroke , Brain Ischemia/epidemiology , Cerebrovascular Disorders/epidemiology , Delivery of Health Care , Female , Humans , Incidence , Male , Prospective Studies , Spain/epidemiology , Stroke/epidemiologyABSTRACT
INTRODUCTION: The concept of embolic stroke of undetermined source (ESUS) has recently appeared to better characterise patients with cryptogenic stroke. PATIENTS AND METHODS: A systematic review of studies published since 2014 was performed to evaluate the epidemiology, clinical features and prognosis of patients with ESUS and their proportion among patients with cryptogenic stroke. RESULTS: Ten studies were identified with a total of 14,810 patients. The frequency of ESUS varied between 6% and 42%. We observed a high percentage of patients with cryptogenic stroke who met ESUS criteria (37-82%). The mean age of these patients was 65-68 years. The mean severity of the stroke, as measured using the National Institutes of Health Stroke Scale, was found to be 3-7 points. A high degree of variability was seen in the proportion of atrial fibrillation (detected during follow-up) related to the electrocardiogram monitoring technique. In five studies, some minor source of cardioembolism was observed in one out of every two patients, the most frequent being the persistence of patent foramen ovale. The risk of recurrence was 5-14.5%. CONCLUSION: The application of the new ESUS criteria provides a better definition of patients with cryptogenic stroke. Applying the concept of ESUS requires not only adequate electrocardiogram monitoring, but also routine complementary examinations to rule out the presence of minor sources of cardioembolism and other sources of embolism other than atrial fibrillation.
TITLE: Revision sistematica de las caracteristicas y pronostico de los sujetos que sufren un ictus criptogenico no lacunar de mecanismo embolico.Introduccion. Recientemente ha surgido el concepto de ictus criptogenico no lacunar de mecanismo embolico del ingles embolic stroke of undetermined source (ESUS) para caracterizar mejor a los pacientes con ictus criptogenico. Pacientes y metodos. Se realiza una revision sistematica de los estudios publicados desde 2014 hasta la actualidad, valorando la epidemiologia, las caracteristicas clinicas y el pronostico de los pacientes con ESUS y su proporcion entre los pacientes con ictus criptogenico. Resultados. Se identificaron 10 estudios con un total de 14.810 pacientes. La frecuencia de ESUS vario entre el 6 y el 42%. Se observo un porcentaje elevado de pacientes con ictus criptogenico que cumplian los criterios de ESUS (37-82%). La edad media de estos pacientes era de 65-68 años. La gravedad media del ictus, medida por la National Institutes of Health Stroke Scale, se establecio en 3-7 puntos. Se observo una alta variabilidad en la proporcion de fibrilacion auricular (detectada durante el seguimiento) relacionada con la tecnica de monitorizacion del electrocardiograma. En cinco estudios, hasta en uno de cada dos pacientes se observo alguna fuente de cardioembolismo menor, la mas frecuente, la persistencia del foramen oval permeable. El riesgo de recurrencia fue del 5-14,5%. Conclusion. La aplicacion de los nuevos criterios de ESUS define mejor a los pacientes con ictus criptogenico. La aplicacion del concepto de ESUS exige no solo una monitorizacion de electrocardiograma adecuada, sino exploraciones complementarias de rutina para descartar la presencia de fuentes de cardioembolismo menor y de otras fuentes de embolismo diferentes a la fibrilacion auricular.
