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Gold-standard methods find high stroke rates in Dublin

Incidence rates of stroke in Dublin are high compared with those in similar high-income countries, due in part to high rates of subtype-specific risk factors, according to a study1 using gold-standard ascertainment methods published recently in Stroke.

The World Health Organization has emphasised the importance of international population-based data for unbiased surveillance of stroke incidence and outcome. To date, few such studies have been conducted using recommended gold-standard ascertainment methods.

Researchers identified individuals with stroke and transient ischaemic attack occurring over a 12-month period (December 1, 2005–November 30, 2006) in North Dublin. Disability was assessed using the modified Rankin score and stroke severity (<72 hours) by the National Institutes of Health Stroke Scale.

Stroke-related deaths were confirmed by review of medical files, death certificates, pathology, and coroner’s records. Crude and standardised (to European and World Health Organization standard populations) rates of incidence, risk factors, severity, and early outcome (mortality, case-fatality, disability) were calculated, assuming a Poisson distribution for the number of events.

701 patients with new stroke or transient ischaemic attack were ascertained (485 first-ever stroke patients, 83 recurrent stroke patients, 133 first-ever transient ischemic attack patients). Crude frequency rates (all rates per 1,000 person-years) were: 1.65 (95% CI, 1.5–1.79; first-ever stroke), 0.28 (95% CI, 0.22–0.35; recurrent stroke), and 0.45 (95% CI, 0.37–0.53; first-ever transient ischaemic attack). Age-adjusted stroke rates were higher than those in nine other recent population-based samples from high-income countries.

High rates of subtype-specific risk factors were observed (atrial fibrillation, 31.3% and smoking, 29.1% in ischaemic stroke; warfarin use, 21.2% in primary intracerebral haemorrhage; smoking, 53.9% in subarachnoid haemorrhage; p<0.01 for all compared with other subtypes). Compared with recent studies, 28-day case-fatality rates for primary intracerebral haemorrhage (41%; 95% CI, 29.2%–54.1%) and subarachnoid haemorrhage (46%; 95% CI, 28.8%–64.5%) were greater in Dublin.


1. Peter J. Kelly, MD; Gloria Crispino, PhD; Orla Sheehan, et al. Incidence, Event Rates, and Early Outcome of Stroke in Dublin, Ireland The North Dublin Population Stroke Study. Stroke 2012;43:2042–7.​STROKEAHA.111.645721

Published on: September 27, 2012

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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