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Stroke mortality decline – credit where it’s due

The decline of stroke from third to fourth leading cause of death represents a major public health and clinical medicine success story, attributable to research studies and the application of their findings in developing intervention programmes, according to a study1 published recently in Stroke.

The writing group members were approved by the American Heart Association Stroke Council’s Scientific Statements Oversight Committee and the American Heart Association Manuscript Oversight Committee. They used systematic literature reviews, references to published clinical and epidemiological studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarise evidence and to indicate gaps in current knowledge.

The decline in stroke mortality over the past decades represents a major improvement in population health and is observed for both sexes and for all racial/ethnic and age groups, the authors find. In addition to the overall impact on fewer lives lost to stroke, the major decline in stroke mortality seen among people <65 years of age represents a reduction in years of potential life lost. The decline in mortality results from reduced incidence of stroke and lower case-fatality rates, according to the report.

These significant improvements in stroke outcomes are concurrent with cardiovascular risk factor control interventions, the authors say. They highlight efforts in hypertension control initiated in the 1970s as having had the most substantial influence on the accelerated decline in stroke mortality. Although implemented later, diabetes mellitus and dyslipidaemia control and smoking cessation programmes, particularly in combination with treatment of hypertension, also appear to have contributed to the decline in stroke mortality.

The potential effects of telemedicine and stroke systems of care appear to be strong but have not been in place long enough to indicate their influence on the decline. Other factors had probable effects, but additional studies are needed to determine their contributions, the authors say. The continued application of aggressive evidence-based public health programs and clinical interventions is expected to result in further declines in stroke mortality, they conclude.

References

1. Lackland DT, Roccella EJ, Deutsch AF, et al. Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke 2013. Online ahead of print http://dx.doi.org/10.1161/​01.str.0000437068.30550.cf

Published on: December 20, 2013

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