Acute ischemic stroke trends in Slovenia, 2015-2022: declining admissions, rising reperfusion, uneven gains

INTRODUCTION: We assessed nationwide trends in administratively identified ischaemic stroke admissions, procedures, secondary prevention, and outcomes in Slovenia using linked national datasets in the absence of a dedicated stroke registry. METHODS: We conducted a nationwide longitudinal analysis of adult hospital admissions captured in linked administrative databases between 2015 and 2022. We report crude index-admission rates, acute procedures (intravenous thrombolysis [IVT], mechanical thrombectomy [MT], carotid thromboendarterectomy [CEA], carotid artery angioplasty with stenting [CAS]), discharge secondary-prevention prescriptions, and time-to-death analyses with a maximum follow-up of 5 years. RESULTS: We included 16,839 unique index patients (median age 74 years; 54% male). Admissions peaked in 2017 (2169) and crude rates decreased from 105 to 99 per 100,000 residents by 2022. Revascularisation increased (IVT 6.2% to 15%, MT 5.4% to 9.5%, CEA 9.1% to 14%), length of stay decreased, and discharge prevention therapy improved. Five-year mortality was higher with age and comorbidity and lower among patients receiving IVT and several secondary-prevention therapies. Care pathways differed by stroke aetiology; women were older and men underwent more CAS and CEA, while IVT and MT were similar. CONCLUSION: Crude admissions declined modestly while reperfusion and prevention improved, but the magnitude and pattern of improvement differed by care domain and patient subgroup, supporting continued monitoring and the development of a national stroke registry.