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More people are surviving after acute stroke

BMJ 2019; 365 doi: (Published 22 May 2019) Cite this as: BMJ 2019;365:l2150

Linked research

Determinants of the decline in mortality from acute stroke in England

  1. Amy Y X Yu, assistant professor12,
  2. Moira K Kapral, professor23
  1. 1Department of Medicine (Neurology), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
  2. 2ICES, Toronto, ON, Canada
  3. 3Department of Medicine (General Internal Medicine) and Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto General Hospital, 200 Elizabeth St 14EN-215, Toronto, ON M5G 2C4, Canada
  1. Correspondence to: M K Kapral moira.kapral{at}

But prevention remains a key priority

Deaths from stroke have been decreasing worldwide for several decades, but it is unclear to what extent this is due to a decrease in stroke incidence, stroke case fatality, or a combination of the two.12 In this issue, using national administrative health datasets from England, Seminog and colleagues (doi:10.1136/bmj.l1778) identified 795 869 people with ischaemic stroke or intracranial haemorrhage who were admitted to hospital between January 2001 and December 2010, and they confirmed that age standardised stroke mortality decreased over time for men and women in all age groups.3 This was mainly attributable to a decrease in case fatality rather than stroke incidence, with stroke rates actually on the increase in younger adults.

Reductions in stroke case fatality over time have been seen in other jurisdictions, and potential explanations include the establishment of integrated regional stroke systems, stroke unit care to prevent and manage complications, and decreases in stroke severity as a result of improved risk factor management.2456 Improved survival after stroke …

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