A Comparison of the Care and Outcomes of Patients with Stroke or Transient Ischemic Attack in Beijing, China and Ontario, Canada

Abstract

Abstract:

Objective To compare baseline characteristics, key performance in stroke care and outcomes for stroke or transient ischemic attack (TIA) in China, Beijing with those in Ontario, Canada. Methods The China National Stroke Registry (CNSR)-Beijing consecutively recruited 1775 patients with acute stroke or TIA from 11 stroke centers in Beijing between September 2007 and August 2008. We analyzed data from the CNSR-Beijing and compared the results with the data from the Ontario Stroke Registry, which contained 3551 stroke or TIA patients from 11 stroke Objective To compare baseline characteristics, key performance in stroke care and outcomes for stroke or transient ischemic attack (TIA) in China, Beijing with those in Ontario, Canada. Methods The China National Stroke Registry (CNSR)-Beijing consecutively recruited 1775 patients with acute stroke or TIA from 11 stroke centers in Beijing between September 2007 and August 2008. We analyzed data from the CNSR-Beijing and compared the results with the data from the Ontario Stroke Registry, which contained 3551 stroke or TIA patients from 11 stroke

Key words: Stroke; Stroke care; Outcome

摘要：

目的旨在比较中国北京和加拿大安大略省卒中/短暂性脑缺血发作（transient ischemic attack，TIA）住院患者的基线特征、卒中治疗和住院结局的差异。方法中国国家卒中登记于2007年9月～2008年8月在北京地区的11个研究中心连续收集了1775例急性卒中及TIA患者。加拿大安大略省的数据来源于2007年4月～2008年3月安大略省的11个卒中中心的 3551例卒中及TIA患者。本研究对北京地区患者的基线特征、卒中治疗和住院结局的数据进行了分析，并与加拿大卒中登记研究中安大略省的数据进行比较。结果 ①基线信息：北京地区的患者较安大略省的患者年轻（64.5±12.9 vs 70.2±15.3，P＜0.001），并且男性较多（64.8% vs 51.6%，P＜0.001）；既往史有吸烟、饮酒、卒中、高血压的比例北京地区均高于安大略省（P均＜0.001），而既往史有TIA、高脂血症、心房颤动的人数安大略省高于北京地区（P 均＜0.001）。②院前信息：与安大略省的患者相比，北京地区的患者使用救护车到达急诊的比率较低（33.5% vs 78.4%，P＜0.001），并且2.5 h内到达急诊的比例较低（21.0% vs 42.4%，P＜0.001）。③ 治疗情况：北京地区的患者中，进行影像学检查的比例低于安大略省（93.9% vs 99.2%，P＜0.001），并且进入卒中单元治疗的比例较低（23% vs 64.7%，P＜0.001）。在缺血性卒中的患者中，北京地区的患者进行溶栓治疗的比例较低（8.1% vs 17.4%，P＜0.001），然而伴有心房颤动的患者中，给与抗凝治疗的比例两者无明显的差异（75.9% vs 75.5%，P =0.945）。北京地区和安大略省地区缺血性卒中患者出院给予抗栓治疗的比例相近（77.0% vs 77.9%，P =0.544）。④结局事件：与安大略省地区相比，北京地区患者住院期间新发卒中的比例较低（3.4% vs 5.1%，P＜0.001），然而住院期间肺炎的发生率较高（12.5% vs 7.6%，P＜0.001）。北京地区患者的住院死亡率、7 d死亡率和30 d死亡率均显著低于安大略省地区（7.7% vs 14.7%，5.7% vs 9.3%，7.9% vs 15.9%，P均＜0.001）。结论北京和安大略地区的卒中/TIA住院患者在基线信息、住院治疗和结局方面有较大的差异。认识到这些差异将有助于提高中国卒中住院治疗的质量，有助于更好地制订卒中的控制和预防策略。

关键词: 卒中; 卒中治疗; 结局事件

LIU Gai-Fen, FANG Ji-Ming, SONG Yan-Li, et al.. A Comparison of the Care and Outcomes of Patients with Stroke or Transient Ischemic Attack in Beijing, China and Ontario, Canada[J]. Chinese Journal of Stroke, 2014, 9(09): 724-730.

刘改芬，房继明，宋彦丽，等. 北京和加拿大安大略省卒中/短暂性脑缺血发作基线和住院治疗的比较[J]. 中国卒中杂志, 2014, 9(09): 724-730.

References

1 Johnston SC, Mendis S, Mathers CD. Global variation

in stroke burden and mor tality:estimates from

monitoring, surveillance, and modelling[J]. Lancet

Neurol, 2009, 8:345-354.

2 Thrift AG, Cadilhac DA, Thayabaranathan T, et al.

Global stroke statistics[J]. Int J Stroke, 2014, 9:6-18.

3 Liu L, Wang D, Wong KS, et al. Stroke and stroke

care in China:huge burden, significant workload, and

a national priority[J]. Stroke, 2011, 42:3651-3654.

4 Li u M, Wu B, Wa n g WZ , e t a l . St r o k e i n

China:epidemiology, prevention, and management

strategies[J]. Lancet Neurol, 2007, 6:456-464.

5 陈竺. 中国人民共和国全国第三次人口调查[D]. 北京

大学医学部出版社, 2008.

6 Kapral MK, Hall RE, Silver FL, et al. The Registry of

the Canadian Stroke Network Report on the 2004/05

Ontario Stroke Audit. Toronto, Institute for Clinical

Evaluative Sciences; 2009[EB/OL]. http://www.ices.

on.ca/file/RCSN_2004-05%20Ontario%20Stroke%20

Audit%20Report_Final_April%2006.pdf. 2013-01-01.

7 Wang YL, Wu D, Liao X, et al. Burden of stroke in

China[J]. Int J Stroke, 2007, 2:211-213.

8 Wang Y, Cui L, Ji X, et al. The China National Stroke

Registry for patients with acute cerebrovascular

events:design, rationale, and baseline patient

characteristics[J]. Int J Stroke, 2011, 6:355-361.

9 Fang J, Kapral MK, Richards J, et al. The Registry of

Canadian Stroke Network:an evolving methodology[J].

Acta Neurol Taiwan, 2011, 20:77-84.

10 Aho K, Harmsen P, Hatano S, et al. Cerebrovascular

dise a se i n the commu nit y:re sult s of a WHO

collaborative study[D]. Bull World Health Organ,

1980, 58:113-130.

11 Go AS, Mozaffarian D, Roger VL, et al. Heart

Disease and Stroke Statistics--2014 Update:A Report

From the American Heart Association[J]. Circulation.

2014, 129:e28-e292.

12 北京公共卫生信息中心. 20 09年北京市卫生工作

统计资料简编[EB/OL]. ht tp://www.phic.org.cn/

tonjixinxi/weishengtongjijianbian/2009nianjianbi

an/qsjmcsjbsswyyqk/201008/t20100817_12790.htm,

2010-08-13?.

13 刘改芬, 王伊龙, 周永, 等. 2007-2009年北京市脑血管

病住院病例的流行特征及医疗现状[J]. 中国卒中杂

志, 2011, 6:938-942.

14 Tissue plasminogen activator for acute ischemic

st roke. The National Institute of Neurological

Disorders and Stroke rt-PA Stroke Study Group[J]. N

Engl J Med, 1995, 333:1581-1587.

15 Kleindor fer D, Kissela B, Schneider A, et al.

Eligibility for recombinant tissue plasminogen

activator in acute ischemic stroke:a population-based

study[J]. Stroke, 2004, 35:e27-e29.

16 Reeves MJ, Arora S, Broderick JP, et al. Acute stroke

care in the US:results from 4 pilot prototypes of the

Paul Coverdell National Acute Stroke Registry[J].

Stroke, 2005, 36:1232-1240.

17 Wang Y, Liao X, Zhao X, et al. Using recombinant

tissue plasminogen activator to treat acute ischemic

stroke in China:analysis of the results from the

Chinese National Stroke Registry (CNSR)[J]. Stroke,

2011, 42:1658-1664.

18 Jin H, Zhu S, Wei JW, et al. Factors associated with

prehospital delays in the presentation of acute stroke

in urban China[J]. Stroke, 2012, 43:362-370.

19 Maestroni A, Mandelli C, Manganaro D, et al. Factors

influencing delay in presentation for acute stroke in an

emergency department in Milan, Italy[J]. Emerg Med

J, 2008, 25:340-345.

20 Derex L, Adeleine P, Nighoghossian N, et al. Factors

influencing early admission in a French stroke unit[J].

Stroke, 2002, 33:153-159.

21 孙海欣, 王文志. 卒中患者就诊延误的影响因素及其

干预措施[J]. 中国卒中杂志, 2010, 5:758-762.

22 Wang C, Yang Z, Wang C, et al. Significant underuse

of warfarin in patients with nonvalvular atrial

fibrillation:Results from the China National Stroke

Registry[J]. J Stroke Cerebrovasc Dis, 2014, 23:1157-1163.

23 Wang PL, Zhao XQ, Yang ZH, et al. Effect of inhospital

medical complications on case fatality

post-acute ischemic stroke:data from the China

National Stroke Registry[J]. Chin Med J (Engl), 2012,

125:2449-2454.

24 Zhang N, Liu GF, Zhang GH, et al. External validation

of the iScore for predicting ischemic stroke mortality

in patients in China[J]. Stroke, 2013, 44:1924-1929.

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