Stroke is a leading cause of death, accounting for 7% of all deaths across the EU in 2021 (see indicator “Main causes of mortality” in Chapter 3). Stroke is a serious life‑threatening event that occurs when the blood supply to a part of the brain is interrupted. Of the two types of stroke, about 85% are ischaemic and 15% are haemorrhagic.
Figure 6.16 shows mortality rates within 30 days of hospital admission for ischaemic stroke where the death occurred in the same hospital as the initial admission (unlinked data), whereas Figure 6.17 shows mortality rates where deaths are recorded regardless of where they occurred, including in another hospital or outside the hospital (linked data).
Using unlinked data, the mortality rates within 30 days of hospital admission for ischaemic stroke were highest in Latvia, Lithuania and Malta, with mortality rates above 15% in 2021. Iceland, Norway, the Netherlands and Denmark reported the lowest rates, below 5%. Generally, countries with lower 30‑day mortality rates for ischaemic stroke than the EU average also had lower 30‑day mortality rates for acute myocardial infarction (AMI) (see indicator “Mortality following acute myocardial infarction”). This suggests that certain characteristics of acute care delivery have an impact on both stroke and AMI patients’ outcomes.
Across countries that reported linked data, the case fatality rates were highest in Latvia, with more than 25% of patients dying within 30 days of being admitted to hospital for stroke. They were lowest in the Netherlands and Norway, where case fatality rates were less than 8%. Case fatality rates using linked data are higher than those based on unlinked data because they capture all deaths, regardless of where they occurred. Generally, countries that show 30‑day mortality rates for ischaemic stroke lower than the EU average also tend to show lower 1‑year mortality rates for ischaemic stroke (see indicator “Integrated Care”).
Treatment for ischaemic stroke has advanced substantially over the last decades, with systems and processes now in place in many European countries to identify suspected stroke patients and to deliver acute reperfusion therapy quickly. Countries can improve the quality of stroke care further through timely transportation of patients and access to high-quality specialised facilities such as stroke units (OECD, 2015[1]). Advances in technology are leading to new models of care to deliver reperfusion therapy even more quickly and efficiently, whether through pre‑hospital triage by telephone or administering the therapy in the ambulance.
However, between 2019 and 2021, case fatality rates following ischaemic stroke increased on average across EU countries. For same‑hospital deaths, the increase was pronounced in Lithuania and Malta, and a substantial increase was also observed for deaths in and out of hospital in Lithuania, Malta and the Slovak Republic. They remained stable in other countries such as the Netherlands, Sweden, Denmark and Finland. During this period, hospital admissions following ischaemic stroke also decreased in most countries. These reductions have been attributed to stroke patients not seeking or receiving hospital care immediately due to a fear of becoming infected with COVID‑19, or because pre‑hospital triage and ambulance systems did not function as well and as promptly due to surges in demand. A systematic review of evidence found that the ambulance intervals from call to arrival at hospital increased during the pandemic (Burton et al., 2023[2]). As with heart attack (see indicator “Mortality following acute myocardial infarction”), a number of studies conducted in EU and other OECD countries have found that the severity of presentation of stroke patients was higher during the COVID‑19 pandemic than beforehand.
