Future demographic trends decrease the proportion of ischemic stroke patients receiving thrombolytic therapy: a call to set-up therapeutic studies in the very old.

BACKGROUND AND PURPOSE Thrombolytic therapy with tissue plasminogen activator (tPA) is rarely applied to ischemic stroke patients aged 80 years and above. As future demographic trends will increase the proportion of older stroke patients, the overall tPA treatment rate may decrease. The aim of the present analysis was to provide an estimate of the future number of ischemic stroke patients and the fraction thereof receiving tPA. METHODS In 2005, n=12 906 hospitalized ischemic stroke patients were included into a large registry covering the Federal State of Hesse, Germany. Age- and gender-specific frequency rates for ischemic stroke and tPA therapy were calculated based on the registry and the respective population data. Population projections until 2050 were derived from the Hessian Bureau of Statistics. RESULTS Assuming constant age- and gender-specific stroke incidence rates and treatment strategies, the total number of ischemic stroke patients will rise by approximately 68% until 2050, whereas the proportion of tPA-treated ischemic stroke patients will decrease from 4.5% to 3.8% in the same time frame (relative decrease 16%; chi(2) P<0.001). CONCLUSIONS Future demographic changes will reduce tPA treatment rates. Therapeutic studies focusing on very old stroke patients are necessary to counteract this trend.