I have no conflicts of interest

Transcription

1 Alan Barber Valery Feigin, Rita Krishnamurthi, Varsha Parag, Suzanne Barker-Collo, Kathryn McPherson, Bruce Arroll, Ruth Bonita for the ARCOS investigators

2 I have no conflicts of interest

3 I have no conflicts of interest I m a clinician and not an epidemiologist

4 Get as many points across as you can rather than dwelling on airy fairy research statistics

5 Get as many points across as you can rather than dwelling on airy fairy research statistics If there HAVE to be statistics, make them short clear & pleasant

6 Four ideal population-based stroke incidence studies

7 Four ideal population-based stroke incidence studies Consistent methods / standard definitions multiple overlapping sources of participants

8 All new strokes aged 16 years WHO criteria Data collected baseline, 1, 6 & 12 months

9 Auckland hospitals & EDs Hospital discharges & outpatient clinics Rest homes, community health services GP referrals & urgent medical clinics Private hospitals MoH database of all strokes Death certificates; coroner; autopsy records daily weekly monthly quarterly quarterly yearly yearly

10 Insights into trends in risk factors, incidence and outcomes over time where we are where we re going right and where we re not Few recent studies reporting burden of stroke and TIA informs healthcare planning

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12 2,829 people with Stroke 2096 TIA 785 TIA & stroke 52

13 Stroke n=2096 Age years 72 Female % 52

14 Stroke n=2096 Age years 72 Female % 52 Ethnicity % European 68 Maori 7 Pacific 13 Asian 12

15 Stroke n=2096 Age years 72 Female % 52 Admitted % 93

16 Prior history Stroke n=2096 Hypertension % 67 Myocardial infarct 24 Previous stroke 21 Previous TIA 18 Diabetes 23 Atrial fibrillation 29

17 Prior medications Stroke n=2096 BP lowering meds 63 Anti-platelet meds 48 Lipid lowering 41 Anti-coagulants 8

18 Prior medications Stroke n=2096 BP lowering meds 63 Anti-platelet meds 48 Lipid lowering 41 Anti-coagulants 8

19 ARCOS IV 2011/12 36% ischemic stroke patients had AF

20 ARCOS IV 2011/12 36% ischemic stroke patients had AF Swedish registry study % ischemic stroke patients had AF L Friberg Stroke 2014;45:2599

21 Stroke patients with known atrial fibrillation taking anti-coagulants

22 Stroke patients with known atrial fibrillation taking anti-coagulants Auckland % J Somerfield Stroke 2007

23 Stroke patients with known atrial fibrillation taking anti-coagulants Auckland % J Somerfield Stroke 2007 Northland % Bang & McGrath NZMJ 124;28

24 Stroke patients with known atrial fibrillation taking anti-coagulants Auckland % J Somerfield Stroke 2007 Northland % Bang & McGrath NZMJ 124;28 Sweden % L Friberg Stroke 2014;45:2599

25 Stroke patients with known atrial fibrillation taking anti-coagulants Auckland % J Somerfield Stroke 2007 Northland % Bang & McGrath NZMJ 124;28 Sweden % L Friberg Stroke 2014;45:2599 Auckland % Feigin V

26 Medical practitioners reluctant to anticoagulate patients with atrial fibrillation

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28 Stroke n=2096 Overall 119

29 Stroke n=2096 Overall 119 Male 129 Female 110

30 TIA Stroke Stroke & TIA n=785 n=2096 n=2829 Total

31 TIA n=785 Stroke n=2096 Stroke & TIA n=2829 Total Ethnic group European Maori Pacific

32 TIA n=785 Stroke n=2096 Stroke & TIA n=2829 Total Ethnic group European Maori Pacific

33 Maori aren t presenting with TIAs have a higher incidence of stroke

34 Maori aren t presenting with TIAs have a higher incidence of stroke Age at first stroke Maori Pacific Europeans 60 years 62 years 75 years

35 ARCOS I to ARCOS IV

36 Population 16 yr ARCOS I ARCOS II ARCOS III ARCOS IV , , ,882 1,119,192

37 ARCOS I ARCOS II ARCOS III ARCOS IV Population 596, , ,882 1,119,192 Strokes

38 ARCOS I ARCOS II ARCOS III ARCOS IV Population 596, , ,882 1,119,192 Strokes European, %

39 ARCOS I ARCOS II ARCOS III ARCOS IV Population 596, , ,882 1,119,192 Strokes European, % Hospital admit, %

40 ARCOS I ARCOS II ARCOS III ARCOS IV Population 596, , ,882 1,119,192 Strokes European, % Hospital admit, % Brain imaging %

41 ARCOS I ARCOS II ARCOS III ARCOS IV Total * * p for trend <0.0001

42 Total Male Female

43 European Maori Pacific

44 30 ARCOS III ARCOS IV 28-day case fatality (%) Total Male Female European Maori Pacific Asian/Other

45 Likely due to higher rates of hospitalisation development of stroke units better acute management & prevention

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47 Over a 12 month period, for every 100,000 people there were 63 TIAs 149 strokes 212 strokes & TIAs These figures will inform health service planning

48 Declines in first ever or all stroke

49 Declines in first ever or all stroke These declines seen in all major ethnic groups European, Maori, Pacific & Asian

50 Declines in first ever or all stroke These declines seen in all major ethnic groups European, Maori, Pacific & Asian Due to better management of vascular risk factors

51 We re still not serving Maori well Strokes 15 years earlier than Europeans Not seeking medical attention for TIA

52 We re still not serving Maori well Strokes 15 years earlier than Europeans Not seeking medical attention for TIA Ongoing barriers to accessing health care

53 We re still not serving Maori well Strokes 15 years earlier than Europeans Not seeking medical attention for TIA Ongoing barriers to accessing health care Targeted vascular risk factor strategies required

54 Medical practitioners reluctant to anticoagulate patients with atrial fibrillation

55 Medical practitioners reluctant to anticoagulate patients with atrial fibrillation Reduces stroke risk by two thirds

56 Medical practitioners reluctant to anticoagulate patients with atrial fibrillation Reduces stroke risk by two thirds Risks (hassles) often exaggerated

57 Medical practitioners reluctant to anticoagulate patients with atrial fibrillation Reduces stroke risk by two thirds Risks (hassles) often exaggerated Please don t find reasons not to anticoagulate patients with appropriate CHADS