22. European Stroke Conference 512 Epidemiology of stroke 40-year perspective on trends in the risk of acute ischaemic stroke in patients hospitalised with atrial fibrillation: English record linkage studies O.O. Seminog1, M.J. Goldacre2 University of Oxford, Department of Public Health, Oxford, UNITED KINGDOM1, University of Oxford, Department of Public Health, Oxford, UNITED KINGDOM2 Background: Atrial fibrillation (AF) is a well established risk factor for ischaemic stroke. Anticoag-ulation therapy decreases the risk of ischaemic stroke in patients with AF by approximately 60%. However several studies have suggested that, anticoagulants have been under-prescribed in people with AF, mostly because of bleeding concerns. We aimed to document changes in stroke risks as-sociated with AF in an all-England dataset from 1999-2011 and in an English regional dataset from 1974-1998. Methods: We used English national linked Hospital Episode Statistics from 1999 to 2011 and data from the Oxford Record Linkage Study (ORLS) from 1974 to 1998. The risk of hospitalisation for, or death from, ischaemic stroke in patients hospitalised with AF was calculated and compared with that in a control cohort. Results were expressed as a rate ratio (RR), comparing the cohorts, stan-dardised for age and a range of other variables; and the data were subdivided into successive 6-year periods of admission for AF. Results: In the national dataset the RR (95% CI) for subsequent ischaemic stroke was 2.14 (2.10- 2.18) in people admitted with AF in 1999-2004 and 2.71 (2.63-2.79) for those admitted in 2005- 2011. In the ORLS the rate ratios for stroke in people admitted with AF in 1974-1979, 1980-1985, 1986-1991 and 1992-1998 were, respectively, 2.13(1.58-2.83) , 2.87 (2.05-3.93), 1.85 (1.29-2.59) and 2.22 (1.67-2.91). Conclusion: Patients with AF remain at higher risk of acute stroke than those without AF. There was no consistent decline in this excess risk throughout the period, during which anticoagulants became proven to prevent thromboembolic complications of AF. Possible explanations might be inadequate prescribing of anticoagulants, or a rise in other risk factors that avert any decline in the risk of acute stroke in AF patients in England. These findings underline the importance of improving prevention of acute ischaemic complications in AF patients. 616 © 2013 S. Karger AG, Basel Scientific Programme 513 Epidemiology of stroke Increase of national intravenous thrombolysis rates for ischaemic stroke in the Netherlands between 2005 and 2011 S. Scherf1, M. Limburg2, T. van de Laar3, G. Beusmans4, J. Courlander5, E. van Gorp6, D. Raymak-ers7, R. Wimmers8, I. Middelkoop9, H. Lingsma10 Stroke Knowledge Network Netherlands, Maastricht, THE NETHERLANDS1, Stroke Knowl-edge Network Netherlands, Maastricht, THE NETHERLANDS2, Stroke Knowledge Network Neth-erlands, Maastricht, THE NETHERLANDS3, Stroke Knowledge Network Netherlands, Maastricht, THE NETHERLANDS4, Stroke Knowledge Network Netherlands, Maastricht, THE NETHER-LANDS5, Stroke Knowledge Network Netherlands, Maastricht, THE NETHERLANDS6, Stroke Knowledge Network Netherlands, Maastricht, THE NETHERLANDS7, Netherlands Heart Foun-dation, The Hague, THE NETHERLANDS8, Stroke Knowledge Network Netherlands, Maastricht, THE NETHERLANDS9, Erasmus University, Rotterdam, THE NETHERLANDS10 Background National thrombolysis rates are unknown but thought to be low 1. Our aim is to investigate trends in national thrombolysis rates in the Netherlands for ischaemic stroke between 2005 -2011. Methods We collected data on stroke, intravenous thrombolysis rates, outcome and patients characteristics per hospital from the Stroke Knowledge Network Netherlands dataset. Information is acquired through yearly surveys and contains retrospective information about stroke care in up to 63 hospitals be-tween January 2005 and December 2011. The network was installed in 2006 and has been gradually enlarged. Participating hospitals in 2011 include the majority of all 86 hospitals in the Netherlands. Results Information on 93.523 hospitalizations due to stroke were included, ranging from 7.393 in 2005 to 21.794 in 2011. Mean national thrombolysis rate increased from 6.83% in 2005 to 14.17% in 2011. Patient characteristics (mean age, gender, type of stroke, stroke severity) remained stable. Mean door-to-needle-time (DNT) decreased from 77.3 minutes in 2005 to 47 minutes in 2011. Conclusion The Stroke Knowledge Network Netherlands stroke registry developed significantly in the years be-tween 2005 to 2011, resulting in coverage of about 70% of all stroke patients in Netherlands. Intra-venous thrombolysis rates in the Netherlands more than doubled between 2005 and 2011. There was a large decline in mean DNT. There is significant uncertainty about the exact meaning of the results, due to the increase of participating hospitals. Further improvement of thrombolysis application in acute stroke care is needed, in the future more data in the registry will allow more detailed analysis. References 1. Kelly R. Evenson, Randi Foraker, Dexter L. Morris and Wayne D. Rosamond,. A Comprehen-sive Review of Prehospital and In-hospital Delay Times in Acute Stroke Care. .Int J Stroke. 2009 June ; 4(3): 187–199.
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