Introduction: Significant advances have been made in the prevention and treatment of acute ischemic stroke (AIS) in the last decade.
Hypothesis: The incidence of AIS, its management patterns are changing and its associated mortality is improving over time.
Methods: We utilized the national inpatient sample to examine temporal trends in the utilization of thrombolytics and mechanical thrombectomy, in-hospital morbidity and mortality, and resource utilization in patients admitted with AIS.
Results: Between 2003-2014, 930,010 patients were admitted with AIS representing a national estimate of 4,579,487 patients. The overall incidence of AIS decreased from 136 per 100000 in 2003 to 127 per 100000 in 2014 (p=0.45). The prevalence of hypertension, diabetes, atrial fibrillation, and smoking among AIS patients increased by 15%, 32%, 24%, and 104%, respectively (p<0.001). The use of thrombolytics and mechanical thrombectomy increased from 1.1% to 7.2% and from 0% to 1.1%, respectively (p<0.001) and this was associated with an increase in secondary hemorrhagic conversion from 0.5% to 2.1% (p<0.001). AIS-associated in-hospital mortality, however, decreased significantly from 6.2% to 4.2% (p<0.001) (Figure-1). Although length of stay deceased, cost of hospitalization increased overtime.
Conclusions: The management of AIS has evolved in the last decade. Despite the increasing prevalence of cardiovascular comorbidities in AIS patients, their in-hospital mortality decreased by ~50%. Further research is needed to examine the impact of the large expected increase in mechanical thrombectomy utilization on the outcomes of these patients.