Case fatality, the mortality due to stroke within the first month, is an important measure of the severity of stroke and, importantly, acute care.
Table 2 and 3 show wide variations in stroke fatality between countries as well as within countries e.g. between hospitalised and non-hospitalised patients (Ukraine[43]) or urban and rural populations (Bulgaria[44], Portugal[15]). Comparisons are limited because some of the reported rates date further back than others or refer to slightly different stroke patient populations.
Table 3: Case fatality rates reported in european studies, ranked by magnitude of fatality rate
|
Country / Region or town |
Study period |
Case fatality rate |
| Bulgaria / Varna[44] | 2000-2001 | 35% (aged 45-85, 48% for rural population) |
| UK / East Lancashire[45] | 1995 | 34% |
| Italy / Belluno[46] | 1992-1993 | 33% |
| Greece / Arcadia[47] | 1993-1995 | 27% |
| Estonia / Tartu[14] | 2001-2003 | 26% |
| Italy / Sicily[18] | 1999-2000 | 24% |
| Italy / Vibo Valentia[48] | 1996 | 24% |
| Croatia / North-West[12] | 2007-2009 | 24% |
| Ukraine / Uzhgorod[43] | 1999-2000 | 23% (15% hospitalised,
37% non-hospitalised) |
| Ireland / North Dublin[27] | 2005-2006 | 21% |
| Italy / Udine[30] | 2007-2009 | 21% |
| Germany / Erlangen | 1994-1996 | 19.% |
| Norway / Innherred[49] | 1994-1996 | 19% |
| Sweden / Orebro[11] | 1999-2000 | 19% |
| Poland / Zabrze[24] | 2005-2006 | 18% |
| Italy / Puglia[19] | 2001-2002 | 18% |
| Iceland / Reykjavik[50] | 1996-1997 | 17% (hospitalised only) |
| Hungary, Romania, Ukraine /
Mures-Uzhgorod-Debrecen[51] |
Not reported | 16% ♂, 17% ♀ (hospitalised only) |
| UK / Scotland[28] | 1998-2000 | 16% |
| Hungary / Debrecen[52] | 1994-2006 | 15% (hospitalised only) |
| Portugal / Porto[15] | 1998-2000 | 15% in rural areas, 16.9% in urban areas |
| Sweden / national audit[53] | 2010 | 14% (hospitalised only, 84-92% hospitalised rate) |
| Finland / national audit[54] | 1999-2007 | 14% (hospitalised only, 95-98% hospitalised rate) |
| UK / national audit[55] | 2015/16 | 14% (hospitalised only) |
| Germany / Ludwigshafen[22] | 2006-2007 | 14% |
| Croatia / Zagreb[33] | 2001-2006 | 13%, was 20.% in 1995-2000
(hospitalised only, before and after introduction of stroke units) |
The Organisation for Economic Co-operation and Development (OECD) [56] released hospital-based case fatality rates for several European countries. Figure 1 shows those fatality rates stratified by stroke subtype. These rates are generally lower than those listed in table 2 and 3, which could be due to referring to data from more recent years, but also to only including hospitalised patients. Although not many Eastern European countries are included in this dataset, an East-West difference seems to emerge.
Figure 1: Case fatality rates per 100 discharges (adults ≥45 years, age- and sex-adjusted, 2009-11)
Over the last few years, stroke fatality rates have generally improved, as reported in hospital-based and population-based studies (Table 2 and 3,[56]). This could be due to people having less severe strokes; better risk factor control; and also as a result of earlier and more intensive acute treatment. There are significant inequalities in fatality rates across Europe and SAFE member countries. The vast majority of fatality rates reported from population-based registers are significantly higher than the target set in the Helsingborg 2006 declaration[57], which states that by 2015 85% of stroke patients should survive the first month. More up- to-date rates are needed from population- based registers to compare the current situation against the Helsingborg target.
