Estimating the Incidence of Stroke where Older People do not present to Hospital using a Large population-Representative Dataset

Abstract Background Recognition and investigation of stroke is important in determining aetiology and treating underlying risk factors to prevent reoccurrence. We propose the theory that there is a significant minority of older people with stroke that do not present to hospital or seek medical assessment. We examined stroke incidence data from a large longitudinal study to assess the likely number of older people with acute stroke that do not present to hospital. Methods Data was from a large population-representative longitudinal study was analysed, specifically for self-reported stroke or transient ischemic attack (TIA) in the past 2 years. Stroke/TIA incidence was compared to data on presentation to an emergency department (ED) and admission to hospital. Results 281 participants of 4,321 aged 50+ reported a history of stroke/TIA (6.5% of the cohort), with 36 (.08%) new or incident strokes and 61 (1.4%) new or incident TIAs reported in the last 2 years. Of the 36 older people with incident stroke, only 15 had an ED attendance and 12 reported they were admitted to hospital within the last 12 months. Of the 61 people with incident TIA only 30 reported an ED attendance and 25 reported they were admitted to hospital within the last 12 months. Conclusion Assuming a constant incidence of stroke/TIA over a 2-year period, it is possible that 17% of older people with acute stroke did not present to hospital after they developed stroke symptoms. These patients are potentially missing out on hyperacute stroke treatment and comprehensive workup of stroke aetiology with appropriate secondary prevention. A comprehensive strategy including public education would be useful in increasing public awareness of stroke symptoms and the need to present promptly to the ED.