Supplementary Methodological and Clinical Aspects
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Relapse and mortality rates were methodically evaluated on the basis of health insurance data, which—in contrast to purely register-based approaches—record individual courses even after inpatient treatment (1). As data from 2010/2011 were used, the frequency of recurrence over five years can be determined in an observation period up to December 2016. The definition that was used only records a relapse if the location is coded. However, as this is not revenue-relevant, it will not always take place and will lead to an underestimation. No differentiation is made for recurrence and mortality rates after a specific diagnosis, and the classification of I62 as a stroke is generally viewed critically.
The results here are not unexpected and are relatively unspecific. Significantly lower mortality is reported for patients treated in a stroke unit (SU). In 2017, however, the SU rate (OPS8–981.0/–1, 98b.*0/–1) differed between 19% (I60), 43% (I61), and 74% (I63) (2). Here, stratification after diagnosis as well as differentiation after intensive care stay (ICU, OPS8–980/98f) would also be interesting. Unfortunately, however, the influence of SU treatment on the frequency of recurrence is not reported.
Indicators of qualitative stroke treatment include the type of care in specialized wards (SU / ICU) and the rate of recanalization therapies (thrombolysis, thrombectomy), among others. Therefore, an analysis of these factors with respect to mortality and frequency of recurrence would be of particular interest to clinicians and care planners. Increases in the nationwide SU rate of ischemic strokes, from 53% and 74% in 2010–2017, as well as in the rates of thrombolysis (8.9% to 15.9%) and thrombectomy (0.8% to 5.8%) were seen (3, 4). Accordingly, we believe that an additional analysis of the changes in early recurrence and mortality rates, for instance of 2010/2011 and 2015/2016, with a follow-up period up to December 2012 and December 2017, respectively, would have been significantly more meaningful. This can possibly serve as motivation for a follow-up analysis.
Prof. Dr. med. Jens Eyding
Neurologische Klinik, Klinikum Dortmund gGmbH
Dr. rer. nat. Dirk Bartig
DRG Market, Osnabrück
PD Dr. med. Ralph Weber
Neurologische Klinik, Alfried Krupp Krankenhaus Essen
Prof. Dr. med. Dr. h.c. Dipl. Psych. Werner Hacke
Neurologie und Poliklinik, Universität Heidelberg
Prof. Dr. med. Christos Krogias
Neurologische Klinik, St. Josef-Hospital Bochum, Universitätsklinik der Ruhr Universität Bochum
Conflict of interest statement
Prof. Eyding has received reimbursement for conference participation fees, travel expenses, and hotel expenses, as well as honoraria for preparing scientific continuing educational events, from Bayer Vital and Boehringer Ingelheim.
Prof. Krogias has received reimbursement for conference participation fees, travel expenses, and hotel expenses from Bayer Vital and Daiichi-Sankyo, and honoraria for preparing scientific continuing educational events from Daiichi-Sankyo and Bayer Hellas.
The remaining authors declare that no conflict of interest exists.
|1.||Stahmeyer JT, Stubenrauch S, Geyer S, Weissenborn K, Eberhard S: The frequency and timing of recurrent stroke—an analysis of routine health insurance data. Dtsch Arztebl Int 2019; 116: 711–7 VOLLTEXT|
|2.||Eyding J, Bartig D, Weber R, et al.: Inpatient TIA and stroke care in adult patients in Germany—retrospective analysis of nationwide administrative data sets of 2011 to 2017. Neurol Res Pract 2019, 1: 39 CrossRef|
|3.||Weber R, Krogias C, Eyding J, et al.: Age and sex differences in ischemic stroke treatment in a nationwide analysis of 1.11 million hospitalized cases. Stroke 2019, doi: 10.1161/STROKEAHA.119.026723. [Epub ahead of print] CrossRef MEDLINE|
|4.||Weber R, Eyding J, Kitzrow M, et al.: Distribution and evolution of acute interventional ischemic stroke treatment in Germany from 2010 to 2016. Neurol Res Pract 2019; 1: 4 CrossRef|