Strokec Neurol: Our stroke prevention and treatment has short boards! Wang Congjun and other BMJ sub-publications published a national registration study.

Recently, Beijing Tiantan Hospital Professor Wang Congjun and others published a national registered study shows that China's stroke-related mortality rate is significantly lower than in Western countries, but China's stroke patients stay in hospital for a longer period of time, and lysotic drugs, lipid-lowering drugs, anti-hypertensive drugs and other evidence-based drugs are obviously inadequate, while some drugs (including neuroprotective drugs and Chinese medicine) are widely used.
the results of the study show that there is still a lot of room for improvement in the management of stroke patients in China The study shows that in patients with ischemic stroke, cerebral hemorrhage and cobweb subcavity hemorrhage, the mortality rate during hospitalization was 3.2%, 9.3%, 10.1%, and the mortality rate was 8.6%, 18.2% and 22.0% in 6 months.
in Western countries, the mortality rate for ischemic stroke patients during hospitalization and at 6 months was 5.6% and about 20%, respectively, and in patients with cerebral hemorrhage at 6 months.
researchers said this was related to the relatively mild inpatients of stroke in China (NIHS scores were 4 and 9 for patients with ischemic stroke and cerebral hemorrhage).
Despite the relatively low mortality rate of stroke patients in China, the recurrence rate of 6 months among survivors was 7.2%, significantly higher than in Western countries (5%).
in patients with ischemic stroke, cerebral hemorrhage and cobweb hypocranial hemorrhage in China, the recurrence rate during hospitalization was 2.6%, 1.9%, 7.2%, and the recurrence rate was 8.0%, 5.1%, 7.5% in 6 months, and the incidence of major vascular events (vascular death, stroke recurrence, myocardial infarction) was 16.5%, 23.1% and 28.4%, respectively.
researchers pointed out that the high rate of stroke recurrence in China is related to the lack of application of secondary preventive drugs that have been proven efficacy.
only 1.3% of patients with ischemic stroke received thrombolytic treatment within 3 h of symptoms, but the rate of application of unproven neuroprotective drugs (e.g., intravenous idarafon, neurocosine GM1, cytophosphacholine) and Chinese medicine (including Herbal medicine and supplements) were as high as 69.7% and 70.6%. During
hospitalization, the application rate of platelet therapy in ischemic stroke patients was 88.4%, but the application rate of antiplatelet therapy in combination between aspirin and clopidogrel was only 8%.
in patients with cerebral hemorrhage, the rates of neuroprotective drugs and Chinese medicine were 63.3% and 36.3%, respectively. In patients with subcavity bleeding in
cobweb membrane, the rate of neuroprotective drugs and Chinese medicine application was 59% and 20%, respectively.
were discharged from hospital, 70.7 percent and 38.0 percent of patients with ischemic stroke were treated with antiplatelet drugs and statins, respectively, but the application rate of these two drugs decreased to 64.8 percent and 23.9 percent, respectively, at 6 months.
only 1.5% of ischemic stroke patients were discharged from the hospital with anticoagulant drugs.
is the most important drug in secondary prevention for patients with cerebral hemorrhage and cobweb subcavity bleeding.
but only 51% and 18% of patients with cerebral hemorrhage and cobweb subcavity bleeding were prescribed antihypertensive drugs.
, only 20 per cent of stroke patients in China are treated in specialist stroke centres, and only 23 per cent are transferred by ambulance to hospitals.
the hospital stay of stroke patients in China is significantly longer than in Western countries.
the average hospital stay of patients who survived stroke when discharged from hospital in China was 18 days, of which the average hospitalization time for patients with cerebral hemorrhage was 21 days, about twice that of Western countries.
researchers pointed out that the long hospital stay of stroke patients in China may be related to factors such as the main coverage of hospitalization and the lack of rehabilitation facilities in the community.
the study included 14,244 first-time stroke hospitalizations diagnosed by imaging examination from 132 hospitals in 31 provinces, municipalities and autonomous regions of China from 2007 to 2008, with an average age of 62.5 years and 60.6% for men.
, ischemic stroke accounted for 68.7%, cerebral hemorrhage and cobweb subcavity hemorrhage accounted for 26.9% and 4.4%, respectively.
more than one-third of patients with ischemic stroke and cerebral hemorrhage were given antihypertensive drugs before their first hospitalization, but only 1.8 percent of ischemic stroke patients were given statins. The most common complication in hospital
stroke patients was pneumonia, with the highest incidence (16.1%) among brain haemorrhage patients.
researchers say that while the study, which mainly covers large and medium-sized urban hospitals and was included 10 years ago, does not reflect the current state of stroke management across the country, the largest registration study to date covering all regions of the country helps to estimate the extent to which the quality of care needs to be improved in the future and the reform of the health care system.
they believe that a stratified, multi-stage sampling method is needed in the future to further monitor changes in stroke treatment patterns in China.
another important thing to do is to conduct large-scale randomized clinical trials to assess the effectiveness and safety of drugs widely used in clinical use but with unproven efficacy, especially neuroprotective drugs and Chinese medicine.
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