Trends in acute care of cerebrovascular events – a joinpoint analysis with German hospital data from 2000 to 2021

TL;DR

This study examines changes in acute stroke care in Germany from 2000 to 2021, showing declining trends in some stroke types but increasing resource use in others.

Contribution

The paper provides a detailed joinpoint analysis of acute stroke care trends in Germany, highlighting subtype-specific changes over two decades.

Findings

Ischemic stroke case rates and inpatient burden declined significantly until 2006, followed by stabilization.

Stroke unit care expanded rapidly, reducing in-hospital mortality for ischemic stroke.

Intracerebral and subarachnoid hemorrhage showed falling case rates but longer hospital stays.

Abstract

Acute stroke care has evolved markedly in recent decades, yet long-term trends across stroke subtypes remain understudied. This study analyzed national trends in inpatient stroke care for ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in Germany from 2000 to 2021.

We conducted a retrospective analysis of nationwide hospital administrative data, assessing annual case counts, age-standardized rates, mean length of stay, and annual inpatient case days (AICD). Stroke unit (SU) treatments were analyzed from 2005 onward. Joinpoint regression identified changes in trends over time.

IS case rates, length of stay, and AICD declined significantly until 2005/2006, after which they stabilized at remarkably high levels. Paralleled by a rapid expansion of SU care, in-hospital mortality from IS decreased significantly. Coding of unspecified stroke (I64) declined steeply, suggesting shifts in diagnostic precision. In contrast, ICH and SAH showed falling case rates but increasing lengths of stay, particularly among deceased patients. SU treatments rose continuously from 2005 to 2021, with age-standardized rates increasing by 7.1% annually.

Over two decades, total inpatient burden from stroke has declined, primarily due to reductions in IS admissions and mortality. However, longer hospital stays in SAH and ICH and an overall rising SU care indicate shifting but consistently high resource requirements. Thus, continued efforts in optimizing healthcare infrastructure seem reasonable and should consider a subtype-specific resource allocation in acute stroke care.

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