What can we learn from RIKS-STROKE the national register for stroke care in Sweden

Professor Birgitta Stegmayr For the Riks-Stroke steering committe Medicine, Ume University Hospital Sweden

RIKS-STROKE IS A NATIONAL QUALITY REGISTER FOR STROKE CARE

Started April 1994 and since 1998 all hospitals participate Riks-Stroke is Internet-based and includes also a statistic package on-line

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- every hospital can use the statistic package to perform own tables and graphs Each hospital, can compare their own results with national data
(More than 90% of all stroke patients are treated in a hospital in Sweden)

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NUMBER OF PATIENTS IN RIKS-STROKE 1994 UP TILL 2007

30000

25000

20000

15000

10000

247 472 Stroke events

5000

0 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Finsp ng

Skene

Nyk ping

Mora

Falk ping

Alings s

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Uddevalla/Str ms.

Sk vde

Link ping

Akademiska

Varberg

Motala

UMAS

Enk ping

Karlstad/Kristineh/S ff.

Kalix

Vrnamo

K ping/Fagersta

Helsingborg

Arvika

Kullbergska

Hudiksvall

Kiruna

Karlskrona

Ludvika

Gllivare

ngelholm

Landskrona

Mariestad

Pite

Ryhov sjukh.

Torsby

NL

Sollefte

Kalmar

PROPORTION PATIENTS WITH A 3-MONTH FOLLOWUP

Halmstad

H ssleholm

Ljungby

Sundsvall/H rn sand

Skellefte

Kung lv

Lindesberg

Kristianstad

Vster s/Sala

stersund

M larsjukhuset

Norrk ping

Sunderbyn

Sahlgrenska

Riket
Lycksele

Vstervik

Karlshamn

Falun

Trelleborg

Ume

Bolln s/S derh.

M lndal

Vxj

S:t G ran

Avesta

rebro

Karlskoga

Gvle/Sandv.

rnskldsvik

Ystad

SS

Oskarshamn

Bor s

Lidk ping

Visby

Lund

Sdert lje

stra sjukh.

Hglandssjukhuset

Danderyd

Huddinge

Karolinska

Norrt lje

Results for 2006

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Simrishamn

MEAN AGE FOR STORKE PATIENTS IN SWEDEN

MEN
1500
Mean age 73.5 yrs Median 75 yrs

Women
Mean age 78,4 yrs Median 80 yrs

Number of strokes

1000

500

25

50

75

100

25

50

75

100
Results for 2006

PATIENTS TREATED AT STROKE UNITS

100

80

60 % 40

Proportion at stroke unit

20

0 1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Lycksele

Mariestad Falk ping

V rdavdelning
Annan v rdavdelning

Danderyd QuickTime och enGraphics-dekomprimerarekrvs fr att kunna se bilden.

Sk vde

Vanlig v rdavdelning
N L

Link ping Karlskrona

Strokeenhet

Visby

Ljungby M lndal

Kalix Torsby

Um e

Uddevalla/Str ms. Enk ping

K ping/Fagersta Sunderbyn

rnsk ldsvik

Lidk ping Sollefte

G llivare Huddinge

Norrk ping

Lund

Kullbergska

Trelleborg Hudiksvall

Sundsvall/H rn sand

PATIENTS TREATED AT STROKE UNITS

Lindesberg V rnamo

Pite Bolln s/S derh.

S dert lje

Varberg Arvika

Finsp ng

Kalmar

Karlskoga

Alings s Kung lv

rebro Kristianstad

Helsingborg

V stervik M larsjukhuset

V xj Ludvika

Skene Halmstad

UMAS H glandssjukhuset

Skellefte

Stroke unit General ward Other

Avesta Oskarshamn

S:t G ran Akademiska

Ryhov sjukh.

Karolinska Karlstad/Kristineh/S ff.

stersund Bor s

Karlshamn

Mora H ssleholm

Norrt lje G vle/Sandv.

Nyk ping

Kiruna Motala

ngelholm V ster s/Sala

Ystad

Falun

Landskrona

Sahlgrenska stra sjukh.

Simrishamn

Results for 2006

S S 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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Mean stay at hospital (days)

1996 Acute care 11.6 days Total care 18.9 days 2001 12.5 days 17.9 days 2006 12.6 days 17.3 days

Results for 2006

Karolinska

IN och UT
Ystad Alings s

ej IN, UT
Sdert lje

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Norrt lje

Uppgift saknas

Huddinge

SS rebro

IN, ej UT

ej IN, ej UT
Lund

S:t G ran

Landskrona

Helsingborg

Lindesberg

Avesta

Torsby

Kalix

Mariestad

Sahlgrenska

Pite

Danderyd

Norrk ping

Vrnamo

Karlshamn

THE USE OF ANTIHYPERTENSIVE DRUGS

Mlndal

Link ping

Varberg

Trelleborg

UMAS

Uddevalla/Str ms.

Falun

Kristianstad

Karlstad/Kristineh/S ff. Kung lv

Nyk ping

Lidk ping

Vster s/Sala stra sjukh.

Gvle/Sandv.

stersund

Bor s

All patients who died <7 days after onset are excluded

Karlskrona

Sunderbyn

Halmstad

NL

Skene

Sollefte

Mora

Hssleholm

ngelholm

Ryhov sjukh.

Hglandssjukhuset

Visby

Sk vde

Ljungby

Kullbergska

Mlarsjukhuset

Enk ping

Finsp ng

Ume Sundsvall/H rn sand

Kping/Fagersta

Oskarshamn

Kalmar

Ludvika

Gllivare

Arvika Bolln s/S derh.

Falk ping

Simrishamn

Akademiska

Kiruna Vxj

Karlskoga

Hudiksvall

In and Out Not In but Out Data missing In, not Out Not In, not Out
Results for 2006
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

rnskldsvik

Vstervik

Skellefte

Motala

Lycksele

Norrt lje

IN och UT
Uddevalla/Str ms.

Ystad

ej IN, UT
Alings s

Falk ping

Uppgift saknas

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Mariestad

Torsby

IN, ej UT

Huddinge

ej IN, ej UT
Hglandssjukhuset

Danderyd

Vstervik

S:t G ran

Bor s

Trelleborg

Visby

stra sjukh.

Avesta

rebro

Karolinska

Finsp ng

Lindesberg

UMAS

Vrnamo

Halmstad

Ludvika

Kalix

Ljungby

Kung lv

Sundsvall/H rn sand

The use of antitrombotic treatment (ASA, Clopidogrel, Dipyriamol) or Waran in patients with ischemic stroke
-

Sollefte

Kullbergska

Arvika

Karlshamn

Hssleholm

Sahlgrenska

Landskrona

Oskarshamn

Hudiksvall

Mora

Karlstad/Kristineh/S ff.

SS

Sunderbyn

Ume

Simrishamn

Kristianstad

Link ping

NL

All patients who died <7 days after onset are excluded In and Out Not In but Out Data missing In, not Out Not In, not Out
Results for 2006
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Helsingborg

Falun

Akademiska

Lund

Lycksele

stersund

Mlarsjukhuset

rnskldsvik

Sk vde

ngelholm

Skene

Pite M lndal

Ryhov sjukh.

Vxj

Vster s/Sala

Varberg

Enk ping

Lidk ping Sdert lje

Kalmar

Karlskoga

Kping/Fagersta

Nyk ping Gvle/Sandv.

Bolln s/S derh.

Karlskrona

Skellefte

Norrk ping

Motala

Gllivare

Kiruna

Proportion patients with ischemic stroke and atrial fibrillation and treatment with oral anticoagulant drugs at discharge

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% Alla <75 r -m n -kvinnor >75 r -m n -kvinnor

2000 26,8 50,3 52,2 47,4 20,4 25,5 17,0

2001 29,3 48 49,9 44,7 23,1 27,5 20,0

2002 29,2 52,1 52,9 51,0 22,2 26,0 19,6

2003 29 49,8 52,3 45,6 23,6 29,1 19,8

2004* 31 51,8 51,8 51,8 25,2 29,8 22,1

2005* 31,8 54,6 54,8 54,3 25 29,1 22

2006* 31,4 56,8 57,2 56,2 24,2 28,5 21

Results for 2006

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Proportion patients with ischemic stroke and atrial fibrillation and treatment with oral anticoagulant drugs at discharge

Lidk ping

IN och UT
Sollefte Alings s

ej IN, UT
Avesta

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Kalix

Uppgift saknas

H glandssjukhuset

V rnamo

IN, ej UT

Karolinska

ej IN, ej UT
Kalmar

Visby

N L

Falun

stersund

Akademiska

M lndal

S dert lje

S S

stra sjukh.

Torsby

Falk ping

Nyk ping

Hudiksvall

Arvika

M ora

Mariestad

Varberg

Bor s

THE USE OF STATINS IN STROKE PATINETS

-

Oskarshamn

rnsk ldsvik

rebro M larsjukhuset

Sk vde

Ludvika

Kung lv

G vle/Sandv.

Pite

Lindesberg

UMAS

Karlstad/Kristineh/S ff.

G llivare

Finsp ng

Uddevalla/Str ms.

Karlshamn

All patients who died <7 days after onset are excluded

Link ping

Sunderbyn

Halmstad

Kullbergska

Karlskrona

Norrt lje

Ljungby

Kristianstad

Ryhov sjukh.

Danderyd

Norrk ping

Simrishamn

Kiruna

H ssleholm

Sahlgrenska

Huddinge

Helsingborg

Skene

Enk ping

V xj

Lund

Ystad

K ping/Fagersta S:t G ran

Lycksele

V ster s/Sala

Bolln s/S derh.

Karlskoga

Motala

Landskrona

Sundsvall/H rn sand

In and Out Not In but Out Data missing In, not Out Not In, not Out
Results for 2006
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Ume

ngelholm

Skellefte

Trelleborg

V stervik

Alarm for a potential thrombolyse treatment

(In ADL independent patients with ischemic stroke in age group 18-80 yrs)
Uppsala

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Vsterbotten

Skne

Halland

Kalmar

Gotland

V. Gtaland

Dalarna

Sdermanland

Riket

Jnkping

Stockholm

rebro

Gvleborg

Norrbotten

Vsternorrland

stergtland

Vrmland

Kronoberg

Jmtland

Vstmanland

Blekinge

0%

10%

20%

30%

40%

Results for 2006

Use of Thrombolytic therapy

(In ADL independent patient with ischemic stroke in age group 18-80 yrs)
V s t e r b o t t e n

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r m

t o

i k

r e

t a

r n

r n

r r l

s t

r m

l a

r o

r g

l e

Results for 2006

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PROPORTION SMOKERS AT STROKE ONSET

MEN < 75 years > 75 years 24.4% 6.6%

WOMEN 24.8% 5.1%

Results for 2006

Karlskoga

Ystad

Slutat r ka?

Halmstad

Nej, rker fortfarande

Kalix

Lidkping

Uppgift saknas

At the 3 month follow-up

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Visby

Ja

Karlskrona

Ume

Landskrona

Vstervik

Skellefte

Skene

Ludvika

stra sjukh.

Karolinska

stersund

Varberg

Motala

Have you stopped smoking after the stroke? In patients that were smokers before the event
-

Akademiska

Bors

Trelleborg

Danderyd

Vsters/Sala

Sundsvall/Hrnsand

Kalmar

Ryhov sjukh.

Pite

Huddinge

Hglandssjukhuset

Vxj

NL

Sahlgrenska

Uddevalla/Strms.

Norrkping

Lund

Kunglv

Vrnamo

rebro

Enkping

Linkping

SS

Karlstad/Kristineh/Sff.

Mora

Bollns/Sderh.

UMAS

Hudiksvall

Alingss

Kristianstad

Falun

No, still smoking No data Yes

Karlshamn

Kullbergska

Nykping

Lycksele

Arvika

Kping/Fagersta

Sdertlje

Sunderbyn

S:t Gran

Lindesberg

ngelholm

Gvle/Sandv.

Mlarsjukhuset

Skvde

Hssleholm

Helsingborg

Results for 2006

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Proportion patients very satisfied, depending if they were treated on SU vs. GW

70 60 Stroke unit 50 General ward 40 30 20 10 0 Care
BS - 2005 rs data

Personnel

Rehabilitation

Information
p<0.0001

At the 3 month follow-up

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Proportion patients that were ADL dependent

Only in patients ADL indepentent and without support at onset
25

22,4

22,1

22,4

21,6

21,2

19,9

20

15 % 10

0 2001 2002 2003 2004 2005 2006

Results for 2006

WHAT DOES RIKS-STROKE PROVIDE?

Providing hospitals with tools for monitoring and improvement of stroke care It provides an evidence base for routine stroke-specific care It also pinpoints areas of care that requiring improvements Results available for national inquires of stroke care and for development of National Guidelines for stroke care Riks-Stroke has become a useful tool for professions and decisions makers

http://www.riks-stroke.org

T lle o re b rg

T mo ro b cyth./a ntiko g a.
H lsin b rg e go

A rvika

U gift sa a pp kn s
re ro b

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K rlsk g a oa

E da A A n st S

n e olm g lh

L nb ju g y

In n tro bo ge m cyth ntiko g ./a a.

H ssle olm h

A g lin s s

S lle o fte

L d sb rg in e e

K tia sta ris n d

L n sk a a d ron

U A MS

M ora

L k g id p in

Kin /F g rsta p g ae

Ek g n p in

Ld a u vik

M d l ln a

Ln ud

A a e isk kdm a V j x

K rlsh m a a n

K rlsta /K a d ristin h e /S ff. stra sju h k.

V rn m a o

K rlsk n a ro a

B lln s/S d rh o . e

Treatment with antithrombotic drugs at discharge in patients with ischemic strokes

All patients who died <7 days after onset are excluded

Hla d k u t g n ssju h se N g yk p in

K ro sk a lin a

Y d sta

N L

H d sva u ik ll

S S

F lk g a p in

A sta ve

V r /S la ste s a

K lix a

F lu a n

S G :t ra n

Se e kn

S rish m im a n

K lm r a a

K llb rg a u e sk

M la ju h se rs k u t

G vle a d /S n v.

N rrt o lje

Br o s

P ite

D ne a d ryd

V rb rg a e

H lm d a sta

M ta o la

S n e yn u d rb

H d in e ud g

O a a n sk rsh m

S e k v d

T rsb o y

V y isb

L se yck le

U d va /S m d e lla tr s.

S e fte k lle

R o sju h yh v k .

N orrk g p in L k g in p in

S d rt e lje

ste n rsu d

F sp in n g

Kn u g lv

S h re sk a lg n a

M rie d a sta

K n iru a

Antithrombotic, other than ASA Data missing Only ASA Nothing at discharge
Results for 2006
0 % 1% 0 2% 0 3% 0 4% 0 5% 0 6% 0 7% 0 8% 0 9% 0 10 0%

G lliva re

U e m

V ste rvik

S n sva u d ll/H rn sa d n

rn ld sk svik

Proportion patients living at home at 3 month

In patients ADL indepentent and without support at onset

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100

90

82,9
80 % 70

83,7

83

84,4

85

84,8

60

50 2001 2002 2003 2004 2005 2006

Results for 2006