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Ansari U, Brachmann J, Lewalter T, Zeymer U, Sievert H, Ledwoch J, Geist V, Hochadel M, Schneider S, Senges J, Akin I, Fastner C. LAA occlusion is effective and safe in very high-risk atrial fibrillation patients with prior stroke: results from the multicentre German LAARGE registry. Clin Res Cardiol 2024; 113:1451-1462. [PMID: 38294498 PMCID: PMC11420338 DOI: 10.1007/s00392-024-02376-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Interventional left atrial appendage occlusion (LAAO) mitigates the risk of thromboembolic events in nonvalvular atrial fibrillation (AF) patients with contraindication for long-term oral anticoagulation (OAC). Patients with prior stroke have a relevantly increased risk of recurrent stroke, so the effectiveness of LAAO could be reduced in this specific very high-risk patient group. AIM This sub-study of the LAARGE registry investigates the effectiveness and safety of LAAO for secondary prevention in nonvalvular AF patients with a history of stroke. METHODS LAARGE is a prospective, non-randomised registry on the clinical reality of LAAO. The current sub-study employs data from index procedure and 1-year follow-up. Effectiveness and safety were assessed by documentation of all-cause mortality, non-fatal thromboembolism, procedure-related complications, and bleeding events. RESULTS A total of 638 patients were consecutively included from 38 hospitals in Germany and divided into two groups: 137 patients with a history of stroke (21.5%) and 501 patients without. Successful implantation was consistent between both groups (98.5% vs. 97.4%, p = NS), while peri-procedural MACCE and other complications were rare (0% vs. 0.6% and 4.4% vs. 4.0%, respectively; each p = NS). Kaplan-Meier estimate showed no significant difference in primary effectiveness outcome measure (freedom from all-cause death or non-fatal stroke) between both groups at follow-up (87.8% vs. 87.7%, p = NS). The incidence of transient ischemic attack or systemic embolism at follow-up was low (0% vs. 0.5% and 0.9% vs. 0%, respectively; each p = NS). Severe bleeding events after hospital discharge were rare (0% vs. 0.7%, p = NS). CONCLUSIONS Patients with prior stroke demonstrated similar effectiveness and safety profile for LAAO as compared to patients without prior stroke. LAAO could serve as a feasible alternative to OAC for secondary stroke prevention in this selected group of nonvalvular AF patients. CLINICALTRIALS GOV IDENTIFIER NCT02230748.
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Affiliation(s)
- Uzair Ansari
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Johannes Brachmann
- Department of Cardiology, Angiology, and Pneumology, Second Medical Clinic, Coburg Hospital, Coburg, Germany
- University of Split School of Medicine, Split, Croatia
| | - Thorsten Lewalter
- Department of Medicine, Cardiology, and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | - Uwe Zeymer
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Horst Sievert
- CardioVascular Center (CVC) Frankfurt, Frankfurt am Main, Germany
| | - Jakob Ledwoch
- Isar Herz Zentrum München, ISAR Klinikum, Munich, Germany
- Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, München Klinik Neuperlach, Munich, Germany
| | - Volker Geist
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Matthias Hochadel
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Steffen Schneider
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Fastner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Plaitano EG, Scharf RA, Aboutaleb PE, Glennon AL, Melkumova E, Green-LaRoche DM. Informing future randomized controlled trials of amantadine hydrochloride in neurocritical care and post-neurocritical care stroke patients through a retrospective study. BMC Neurol 2024; 24:338. [PMID: 39261794 PMCID: PMC11389468 DOI: 10.1186/s12883-024-03854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 09/06/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Amantadine hydrochloride has been increasingly prescribed as a neurostimulant for neurocritical care stroke patients to promote wakefulness during inpatient recovery. However, a lack of guidelines makes it difficult to decide who may benefit from this pharmacotherapy and when amantadine should be initiated during the hospital stay. This study aims to determine some factors that may be associated with favorable response to amantadine to inform future randomized controlled trials of amantadine in critical care or post-critical care stroke patients. METHODS Retrospective chart review for this study included neurocritical care and post-neurocritical care patients with acute ischemic or hemorrhagic stroke who were started on amantadine (N = 34) in the years 2016-2019. Patients were labeled as either responders or nonresponders of amantadine within 9 days of initiation using novel amantadine scoring criteria utilized and published in Neurocritical Care in the year 2021, which included spontaneous wakefulness and Glasgow Coma Scale (GCS). Amantadine response status and predictive variables were analyzed using nonparametric tests and adjusted multivariable regression models. RESULTS There were large but nonsignificant variations in the median total milligrams of amantadine received in the first 9 days (IQR = 700-1,450 mg, p = 0.727). GCS on the day before amantadine initiation was significantly higher for responders (median = 12, IQR = 9-14) than nonresponders (median = 9, IQR = 8-10, p = 0.009). Favorable responder status was significantly associated with initiation in the critical care unit versus the step-down unit or the general medical/surgical floor [𝛃=1.02, 95% CI (0.10, 1.93), p = 0.031], but there was no significant associations with hospital day number started [𝛃=-0.003, 95% CI (-0.02, 0.02), p = 0.772]. CONCLUSIONS Future randomized controlled trials of amantadine in hospitalized stroke patients should possibly consider examining dose-dependent relationships to establish stroke-specific dosing guidelines, minimum GCS threshold for which amantadine is efficacious, and the impact of patients' determined level of acuity on clinical outcomes instead of solely examining the impact of earlier amantadine initiation by hospital day number. Future research with larger sample sizes is needed to further examine these relationships and inform future clinical trials.
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Affiliation(s)
- Enzo G Plaitano
- Department of Neurology, Tufts Medical Center, 800 Washington Street #314, Boston, MA, 02111, USA.
- Undergraduate Program in Neuroscience, Boston University, Boston, MA, USA.
| | - Rebecca A Scharf
- Department of Neurology, Tufts Medical Center, 800 Washington Street #314, Boston, MA, 02111, USA
| | - Pakinam E Aboutaleb
- Department of Neurology, Tufts Medical Center, 800 Washington Street #314, Boston, MA, 02111, USA
| | | | - Emiliya Melkumova
- Department of Neurology, Tufts Medical Center, 800 Washington Street #314, Boston, MA, 02111, USA
| | - Deborah M Green-LaRoche
- Department of Neurology, Tufts Medical Center, 800 Washington Street #314, Boston, MA, 02111, USA
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Jaracz K, Grabowska-Fudala B, Jaracz J, Moczko J, Kleka P, Pawlicka A, Górna K. Caregiver burden after stroke: a 10-year follow-up study of Polish caregivers for stroke patients. BMC Nurs 2024; 23:589. [PMID: 39183261 PMCID: PMC11346017 DOI: 10.1186/s12912-024-02251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 08/09/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND A long-term assessment of stroke outcomes from the perspectives of patients and their caregivers is important for optimising long-term post-stroke care. The extended effects of stroke caregiving, particularly caregiver burden beyond 5 years since stroke, remain to be determined. Hence, this study aimed to determine caregiver burden at 10 years after stroke, compare the burden severity at 10 years with its levels at 5 years and 6 months after stroke, and identify predictors of the burden severity at 10 years post-stroke. METHODS A longitudinal follow-up study including a group of first-ever stroke patients/informal continuous caregivers pairs was followed for 10 years and interviewed face-to face at their home setting. Caregiver burden was evaluated with the Caregiver Burden Scale. Potential predictors were examined using standardised measures and identified by applying the Classification and Regression Tree. RESULTS A total of 40 caregiver/patient pairs participated in the study. At 10 years, 47.5% of the caregivers experienced a considerable burden. This was more than after 5 years (17.5%) and comparable to that after 6 months (37.5%), p < 0.003. Longer time spent caregiving, caregivers' weaker sense of coherence, more severe stroke, and caregivers' anxiety were the independent predictors of considerable burden 10 years after stroke. CONCLUSIONS Caregivers' burden in the late chronic post-stroke phase is a significant problem, as nearly half of the caregivers experience a substantial burden. This problem mainly concerns individuals who spend at least 7 h daily caregiving and have a lower Sense of Coherence. The long-term evaluation of stroke consequences reported by stroke patients and their caregivers can be an important source of information for healthcare professionals in order to optimise the care and support they provide at various stages of life after stroke.
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Affiliation(s)
- Krystyna Jaracz
- Department of Neurological Nursing, Poznan University of Medical Sciences, 2 A, Rokietnicka Str, 60-806, Poznań, Poland.
| | - Barbara Grabowska-Fudala
- Department of Neurological Nursing, Poznan University of Medical Sciences, 2 A, Rokietnicka Str, 60-806, Poznań, Poland.
| | - Jan Jaracz
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznań, Poland
| | - Jerzy Moczko
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznań, Poland
| | - Paweł Kleka
- Faculty of Psychology and Cognitive Sciences, Adam Mickiewicz University, Poznań, Poland
| | | | - Krystyna Górna
- Department of Psychiatric Nursing, Poznan University of Medical Sciences, Poznań, Poland
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Ganga A, Jayaraman MV, E Santos Fontánez S, Moldovan K, Torabi R, Wolman DN. Population analysis of ischemic stroke burden and risk factors in the United States in the pre- and post-mechanical thrombectomy eras. J Stroke Cerebrovasc Dis 2024; 33:107768. [PMID: 38750836 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/11/2024] [Accepted: 05/10/2024] [Indexed: 06/11/2024] Open
Abstract
OBJECTIVES To provide an updated analysis of the burden of ischemic stroke in the United States. MATERIALS AND METHODS Using the Global Burden of Disease database, we estimated age-standardized, population-adjusted rates of incidence, prevalence, mortality, and disability-adjusted life years from 2010 to 2019, with regional comparisons. Deaths and disability-adjusted life years were compared in 2010-2014 and 2015-2019 to assess the potential effect of increased mechanical thrombectomy use. The attributable, disability-adjusted life years for twenty risk factors were estimated, ranked, and trended. RESULTS Incident ischemic strokes decreased by 11.4 % across the study period from 65.7 (55.9-77.3) to 58.2 (49.0-69.5) per 100,000. Prevalence (-8.2 %), mortality (-1.9 %), and disability-adjusted life years (-4.4 %) all declined. All regions showed reductions in all burden measures, with the South consistently having the highest burden yet the largest reduction in incidence (-12.6 %) and prevalence (-10.5 %). Deaths (p < 0.0001) and DALYs (p < 0.0001) significantly differed between the pre- and post-mechanical thrombectomy eras. Total attributable disability-adjusted life years for all risk factors decreased from 304.7 (258.5-353.2) in 2010 to 288.9 (242.2-337.2) in 2019. In 2019, the risk factors with the most disability-adjusted life years were hypertension, hyperglycemia, and obesity with no state-based differences. Across the study period, disability-adjusted life years attributable to leading risk factors decreased among men but decreased less or increased among women. CONCLUSIONS The burden of ischemic stroke decreased during the study period. Declines in deaths and disability-adjusted life years suggest a mitigating impact of mechanical thrombectomy. While disability-adjusted life years attributable to leading risk factors decreased, sex-based disparities were observed.
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Affiliation(s)
- Arjun Ganga
- Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, United States
| | - Mahesh V Jayaraman
- Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, United States
| | - Santos E Santos Fontánez
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, United States
| | - Krisztina Moldovan
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, United States
| | - Radmehr Torabi
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, United States
| | - Dylan N Wolman
- Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, United States.
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Rivier CA, Acosta JN, Leasure AC, Forman R, Sharma R, de Havenon A, Spatz ES, Inzucchi SE, Kernan WN, Falcone GJ, Sheth KN. Secondary Prevention in Patients With Stroke Versus Myocardial Infarction: Analysis of 2 National Cohorts. J Am Heart Assoc 2024; 13:e033322. [PMID: 38639369 PMCID: PMC11179946 DOI: 10.1161/jaha.123.033322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The implementation of preventive therapies among patients with stroke remains inadequately explored, especially when compared with patients with myocardial infarction (MI), despite sharing similar vascular risk profiles. We tested the hypothesis that participants with a history of stroke have a worse cardiovascular prevention profile in comparison to participants with MI. METHODS AND RESULTS In cross-sectional analyses within the UK Biobank and All of Us Research Program, involving 14 760 (9193 strokes, 5567 MIs) and 7315 (2948 strokes, 4367 MIs) participants, respectively, we evaluated cardiovascular prevention profiles assessing low-density lipoprotein (<100 mg/dL), blood pressure (systolic, <140 mm Hg; and diastolic, <90 mm Hg), statin and antiplatelet use, and a cardiovascular prevention score that required meeting at least 3 of these criteria. The results revealed that, within the UK Biobank, patients with stroke had significantly lower odds of meeting all the preventive criteria compared with patients with MI: low-density lipoprotein control (odds ratio [OR], 0.73 [95% CI, 0.68-0.78]; P<0.001), blood pressure control (OR, 0.63 [95% CI, 0.59-0.68]; P<0.001), statin use (OR, 0.45 [95% CI, 0.42-0.48]; P<0.001), antiplatelet therapy use (OR, 0.30 [95% CI, 0.27-0.32]; P<0.001), and cardiovascular prevention score (OR, 0.42 [95% CI, 0.39-0.45]; P<0.001). Similar patterns were observed in the All of Us Research Program, with significant differences across all comparisons (P<0.05), and further analysis suggested that the odds of having a good cardiovascular prevention score were influenced by race and ethnicity as well as neighborhood deprivation levels (interaction P<0.05 in both cases). CONCLUSIONS In 2 independent national cohorts, patients with stroke showed poorer cardiovascular prevention profiles and lower adherence to guideline-directed therapies compared with patients with MI. These findings underscore the need to explore the reasons behind the underuse of secondary prevention in vulnerable stroke survivors.
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Affiliation(s)
- Cyprien A. Rivier
- Department of Neurology, Center for Brain and Mind HealthYale School of MedicineNew HavenCT
| | - Julian N. Acosta
- Department of Neurology, Center for Brain and Mind HealthYale School of MedicineNew HavenCT
| | | | - Rachel Forman
- Department of Neurology, Center for Brain and Mind HealthYale School of MedicineNew HavenCT
| | - Richa Sharma
- Department of Neurology, Center for Brain and Mind HealthYale School of MedicineNew HavenCT
| | - Adam de Havenon
- Department of Neurology, Center for Brain and Mind HealthYale School of MedicineNew HavenCT
| | - Erica S. Spatz
- Section of Cardiovascular MedicineYale School of MedicineNew HavenCT
| | | | - Walter N. Kernan
- Department of Internal MedicineYale School of MedicineNew HavenCT
| | - Guido J. Falcone
- Department of Neurology, Center for Brain and Mind HealthYale School of MedicineNew HavenCT
| | - Kevin N. Sheth
- Department of Neurology, Center for Brain and Mind HealthYale School of MedicineNew HavenCT
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Meyer AC, Ebeling M, Modig K. Trajectories of Long-term Care after Stroke in Sweden: Nationwide Study Exploring Patterns and Determinants. J Am Med Dir Assoc 2024; 25:599-605.e5. [PMID: 38184296 DOI: 10.1016/j.jamda.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 01/08/2024]
Abstract
OBJECTIVES Stroke is a leading cause of mortality and disability worldwide. Although studies have primarily focused on health and functioning among stroke survivors, there is limited research on longitudinal patterns of long-term care use among older adults with stroke. This study explores long-term care trajectories among older men and women with stroke in the Swedish population. DESIGN Nationwide prospective cohort study. SETTING AND PARTICIPANTS All individuals aged ≥70 years hospitalized with a first stroke in 2015-2017 followed in the Swedish population registers for 3 years. METHODS Care trajectories among patients with strokes were visualized and compared to trajectories in 2 control groups: (1) same-aged peers randomly drawn from the general population and (2) older adults with health and sociodemographic characteristics similar to patients with strokes but without stroke identified through propensity score matching. Multivariable Cox regression and multistate models were used to identify determinants of mortality and care trajectories among patients with strokes. RESULTS We identified 31,560 individuals with stroke (mean age 82.9 years). Already before the stroke, these individuals had a higher comorbidity burden and received more long-term care than their same-aged peers. Compared with both control groups, patients with strokes were also more likely to enter long-term care. However, 38% of patients with strokes survived for 3 years without taking up long-term care. Sex, income, cohabitation, and comorbidities were associated with care trajectories. Care status was a more robust predictor of mortality after stroke than the established Charlson comorbidity index. CONCLUSIONS AND IMPLICATIONS Experiencing a stroke increases both mortality and long-term care utilization, and once formal long-term care is provided, exceedingly few patients with strokes return to living without care. However, a considerable part of care utilization and mortality after stroke is concentrated among those with preexisting care needs. Prestroke care utilization should thus be considered in future studies exploring stroke prognosis.
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Affiliation(s)
- Anna C Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Marcus Ebeling
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Skajaa N, Farkas DK, Laugesen K, Fuglsang CH, Henderson VW, Plana-Ripoll O, Gaist D, Sørensen HT. Mental Health Conditions in Partners and Adult Children of Stroke Survivors. JAMA Netw Open 2024; 7:e243286. [PMID: 38483386 PMCID: PMC10940969 DOI: 10.1001/jamanetworkopen.2024.3286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/29/2024] [Indexed: 03/17/2024] Open
Abstract
Importance Family caregiving after critical illness has been associated with several adverse health outcomes, including various aspects of mental health, but research focusing specifically on family members of stroke survivors is limited. Objectives To examine the associations of stroke in a partner or parent with the risk of depression, substance use disorders, anxiety disorders, and self-harm or suicide. Design, Setting, and Participants This nationwide, population-based cohort study used data from Danish nationwide administrative and clinical registries (2004-2021). Participants included partners and adult children of survivors of stroke. Data analysis was performed from March to December 2023. Exposure Having a partner or parent who survived stroke. Main Outcomes and Measures The Aalen-Johansen estimator was used to compute propensity score-weighted 3-year absolute risks, risk differences, and risk ratios for depression, substance use disorders, anxiety disorders, and self-harm or suicide among partners or children of survivors of stroke compared with partners or children of survivors of myocardial infarction (MI) and matched individuals from the general population. Results The study included a total of 1 923 732 individuals: 70 917 partners of stroke survivors (median [IQR] age, 68 [59-76] years; 46 369 women [65%]), 70 664 partners of MI survivors (median [IQR] age, 65 [55-73] years; 51 849 women [73%]), 354 570 partners of individuals from the general population (median [IQR] age, 68 [59-76] years; 231 833 women [65%]), 207 386 adult children of stroke survivors (median [IQR] age, 45 [36-52] years; 99 382 women [48%]), 183 309 adult children of MI survivors (median [IQR] age, 42 [33-49] years; 88 078 women [48%]), and 1 036 886 adult children of individuals from the general population (median [IQR] age, 45 [36-52] years; 496 875 women [48%]). Baseline characteristics were well balanced across cohorts after propensity score weighting. Among partners of stroke survivors, the 3-year absolute risk was 1.0% for depression, 0.7% for substance use disorders, 0.3% for anxiety disorders, and 0.04% for self-harm or suicide. Risk ratio point estimates for the assessed outcomes ranged from 1.14 to 1.42 compared with the general population and from 1.04 to 1.09 compared with partners of MI survivors. The elevated risk of depression in partners of stroke survivors was more pronounced after severe or moderate stroke than after mild stroke. Among adult children of stroke survivors, the 3-year absolute risk was 0.6% for depression, 0.6% for substance use disorders, 0.2% for anxiety disorders, and 0.05% for self-harm or suicide. Both absolute risks and risk ratios for adult children of stroke survivors were smaller than those reported in the partner analyses. Conclusions and Relevance In this cohort study of partners and adult children of stroke survivors, risks of several mental health conditions and self-harm or suicide were moderately higher compared with the general population and, to a lesser extent, partners and adult children of MI survivors. These findings highlight the potential consequences of stroke among family members, particularly partners, and its findings may possibly serve as a quantitative foundation for the development of future stroke rehabilitation services.
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Affiliation(s)
- Nils Skajaa
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Dóra Körmendiné Farkas
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Kristina Laugesen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Cecilia Hvitfeldt Fuglsang
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Victor W. Henderson
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
- Department of Epidemiology & Population Health, Stanford University, Stanford, California
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, California
| | - Oleguer Plana-Ripoll
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - David Gaist
- Research Unit for Neurology, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 182] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Kilkki M, Stolt M, Rannikko S, Pasanen M, Tarvonen-Schröder S. Patient- and proxy-perceptions on functioning after stroke rehabilitation using the 12-item WHODAS 2.0: a longitudinal cohort study. Disabil Rehabil 2024; 46:783-792. [PMID: 36786275 DOI: 10.1080/09638288.2023.2173813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE To analyse longitudinally patient- and proxy-perceptions on stroke survivors'(SSs') functioning using the 12-item WHO Disability Assessment Schedule 2.0 (WHODAS) after subacute inpatient stroke rehabilitation. METHODS Sixty-five SSs and their significant others(proxies) responded to WHODAS questionnaire at discharge and 9 to 50 months later. Self-WHODAS ratings were compared with corresponding proxy-perceptions and informal ratings on self-reported functional recovery. RESULTS On average, SSs' functioning improved after discharge, except according to self-WHODAS ratings of those with severe stroke. Individual changes were, however, notable. Association between time and change was statistically insignificant. SSs perceived greatest improvements in walking, household tasks, community life and working ability. The only items showing slight deterioration were emotions and relationships. In parallel, proxies rated all items except emotions and relationships improved. At discharge, proxies rated SSs' functioning more impaired than SSs themselves, mostly regarding those with severe stroke. Still, inter-rater reliability was very strong and increased significantly with time (ICC 0.799 vs. 0.979 at follow-up). Ninety percent of SSs with improved functioning according to self-WHODAS reported better functioning also in the informal questionnaire. CONCLUSION WHODAS showed improvements in SSs' functioning 9-50 months after discharge from subacute stroke rehabilitation. Improvements were in line with proxy-perception and self-reported functional recovery.IMPLICATIONS FOR REHABILITATIONStroke survivors' functioning improved significantly during the 9-50 months follow-up after subacute inpatient stroke rehabilitation.Stroke survivors perceived slightly less difficulties in their functioning compared to evaluations by proxies.Strong correlation between patient- and proxy-perceptions on stroke survivors' functioning strengthened from subacute to chronic phase of stroke recovery.The 12-item WHODAS 2.0 seems to be a valuable patient- and proxy-reported outcome measure to assess longitudinal changes in stroke survivors' functioning after stroke.
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Affiliation(s)
- Mia Kilkki
- Department of Nursing Science, University of Turku, Turku, Finland
- Masku Neurological Rehabilitation Center, Masku, Finland
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Sunna Rannikko
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Miko Pasanen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Sinikka Tarvonen-Schröder
- Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
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10
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Kodera R, Fujihara K, Koyama T, Shiozaki H, Mutsuma Y, Yagyuda N, Hatta M, Tsuruoka K, Takeda Y, Araki A, Sone H. Impact of a history of cardiovascular disease and physical activity habits on the incidence of functional disability. Sci Rep 2023; 13:20793. [PMID: 38012261 PMCID: PMC10682401 DOI: 10.1038/s41598-023-47913-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
We examined the impact of a history of coronary artery disease (CAD) or cerebrovascular disease (CVD) and physical activity habits on functional disability among community-dwelling Japanese adults. This population-based retrospective cohort study included 10,661 people aged 39-98 years in Japan (5054, men). Median follow-up was 3.7 years. During the study period, 209 functional disabilities occurred in the overall study population. In multivariable analysis, a history of CVD (hazard ratio [HR] 1.57 [95% CI: 1.00-2.45]) and no physical activity habit (HR 1.74 [1.27-2.39]) presented increased risks for functional disability. HRs for functional disability among patients with a CVD history with and without a physical activity habit were 1.68 (0.75-3.74) and 2.65 (1.49-4.71), respectively, compared with individuals without a history of CVD with a physical activity habit. Similar results were observed for CAD. We found no significant difference in the incidence of functional disability between the group with a history of CAD or CVD and physical activity habits and the group with no history of CAD or CVD and without physical activity habits. Physical activity habits had a favorable influence on avoiding functional disability regardless of a history of CAD or CVD. Future prospective studies are needed to clarify these associations.
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Affiliation(s)
- Remi Kodera
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2, Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan.
| | - Tetsuya Koyama
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Haruka Shiozaki
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Yurie Mutsuma
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Noriko Yagyuda
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Mariko Hatta
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Kahori Tsuruoka
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Yasunada Takeda
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2, Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
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11
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Tsubota-Utsugi M, Tanno K, Takahashi N, Onoda T, Yonekura Y, Ohsawa M, Takahashi S, Kuribayashi T, Itabashi R, Tanaka F, Asahi K, Omama S, Ogasawara K, Ishigaki Y, Takahashi F, Soma A, Takanashi N, Sakata K, Ohkubo T, Okayama A. Rapid weight change as a predictor of disability among community-dwelling Japanese older adults. Geriatr Gerontol Int 2023; 23:809-816. [PMID: 37770036 DOI: 10.1111/ggi.14687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 10/03/2023]
Abstract
AIM To fill the knowledge gap regarding weight change and the onset of disability in community-dwelling Japanese older adults, we investigated the potential effects of rapid weight change on disability risk as defined by Japan's long-term care insurance (LTCI) system. METHODS We analyzed data from a longitudinal study of 10 375 community-dwelling older Japanese adults (≥65 years) who were not LTCI needs certified at baseline and joined the study from 2002 to 2005. Weight change (percentage) was calculated by subtracting participants' weight in the previous year from that measured during a physical examination at study commencement. The five weight-change categories ranged from sizable weight loss (≤ -8.0%) to sizable weight gain (≥ +8.0%). Disability was defined according to LTCI certifications at follow-up. Hazard ratios (HRs) and 95% confidence intervals were calculated for new-onset disability using a Cox proportional hazards model that fitted the proportional subdistribution hazards regression model with weights for competing risks of death. RESULTS During the mean 10.5-year follow-up, 2994 participants developed a disability. Sizable weight loss (HR [95% confidence intervals], 1.41 [1.17-1.71]) and weight loss (1.20 [1.05-1.36]) were significant predictors of disability onset. Sizable weight gain (1.45 [1.07-1.97]) corresponded to severe disability. Stratified analyses by lifestyle and initial body mass index categories revealed more pronounced associations between weight change and disability risk in the unhealthy lifestyle and below initial normal body mass index groups. CONCLUSIONS Rapid and sizable weight gain could be additional criteria for disability risk in older adults. Geriatr Gerontol Int 2023; 23: 809-816.
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Grants
- JP17K09126 a grant-in-aid for Scientific Research (C) from the Japan Society for the Promotion of Science
- JP21K10477 a grant-in-aid for Scientific Research (C) from the Japan Society for the Promotion of Science
- 20FA1002 a grant-in-aid from the Ministry of Health, Labor and Welfare, Health and Labor Sciences Research Grants, Japan
- H23-Junkankitou [Seishuu]-Ippan-005 a grant-in-aid from the Ministry of Health, Labor and Welfare, Health and Labor Sciences Research Grants, Japan
- H26-Junkankitou [Seisaku]-Ippan-001 a grant-in-aid from the Ministry of Health, Labor and Welfare, Health and Labor Sciences Research Grants, Japan
- H29-Junkankitou-Ippan-003 a grant-in-aid from the Ministry of Health, Labor and Welfare, Health and Labor Sciences Research Grants, Japan
- Eli Lilly Japan K.K.
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Affiliation(s)
- Megumi Tsubota-Utsugi
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan
| | - Kozo Tanno
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan
| | - Naomi Takahashi
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan
| | | | - Yuki Yonekura
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Masaki Ohsawa
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Shuko Takahashi
- Division of Medical Education, Iwate Medical University, Morioka, Japan
| | - Toru Kuribayashi
- Faculty of Humanities and Social Sciences, Iwate University, Morioka, Japan
| | - Ryo Itabashi
- Stroke Center, Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Fumitaka Tanaka
- Division of Nephrology and Hypertension, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Koichi Asahi
- Department of General Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Shinichi Omama
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kuniaki Ogasawara
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Yasushi Ishigaki
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Fumiaki Takahashi
- Department of Information Science, Iwate Medical University, Morioka, Japan
| | - Akemi Soma
- Iwate Health Service Association, Morioka, Japan
| | - Nobuyuki Takanashi
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan
| | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
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12
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Gonçalves J, Filipe L, Van Houtven CH. Trajectories of Disability and Long-Term Care Utilization After Acute Health Events. J Aging Soc Policy 2023:1-24. [PMID: 37811807 DOI: 10.1080/08959420.2023.2267399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/11/2023] [Indexed: 10/10/2023]
Abstract
Hip fractures, strokes, and heart attacks are common acute health events that can lead to long-term disability, care utilization, and unmet needs. However, such impacts, especially in the long term, are not fully understood. Using data from the Health and Retirement Study, 1992-2018, this study examines the long-term trajectories of individuals suffering such health shocks, comparing with individuals not experiencing health shocks. Hip fracture, stroke, and heart attack are confirmed to have severe implications for disability. In most cases of stroke and heart attack, informal caregivers provide the daily support needed by survivors, whereas following hip fracture, nursing home care is more relevant. These health shocks put individuals on worse trajectories of disability, care utilization, and unmet needs. There is no long-term recovery or convergence with individuals who do not suffer shocks. Unmet need is prevalent, even pre-shock and among individuals who do not experience health shocks, emphasizing the importance of preventative care measures. These findings support policy action to ensure hospitalized individuals, especially those aged 50 and above, receive rehabilitative services and other post-acute care. Furthermore, hospitalization is an event that requires the detection and addressing of unmet care needs beyond the short run.
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Affiliation(s)
- Judite Gonçalves
- School of Public Health, Imperial College London, London, UK
- NOVA School of Business and Economics, NOVA University Lisbon, Carcavelos, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Luís Filipe
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
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13
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Johansen MC, Ye W, Gross A, Gottesman RF, Han D, Whitney R, Briceño EM, Giordani BJ, Shore S, Elkind MSV, Manly JJ, Sacco RL, Fohner A, Griswold M, Psaty BM, Sidney S, Sussman J, Yaffe K, Moran AE, Heckbert S, Hughes TM, Galecki A, Levine DA. Association Between Acute Myocardial Infarction and Cognition. JAMA Neurol 2023; 80:723-731. [PMID: 37252710 PMCID: PMC10230369 DOI: 10.1001/jamaneurol.2023.1331] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/08/2023] [Indexed: 05/31/2023]
Abstract
Importance The magnitude of cognitive change after incident myocardial infarction (MI) is unclear. Objective To assess whether incident MI is associated with changes in cognitive function after adjusting for pre-MI cognitive trajectories. Design, Setting, and Participants This cohort study included adults without MI, dementia, or stroke and with complete covariates from the following US population-based cohort studies conducted from 1971 to 2019: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study. Data were analyzed from July 2021 to January 2022. Exposures Incident MI. Main Outcomes and Measures The main outcome was change in global cognition. Secondary outcomes were changes in memory and executive function. Outcomes were standardized as mean (SD) T scores of 50 (10); a 1-point difference represented a 0.1-SD difference in cognition. Linear mixed-effects models estimated changes in cognition at the time of MI (change in the intercept) and the rate of cognitive change over the years after MI (change in the slope), controlling for pre-MI cognitive trajectories and participant factors, with interaction terms for race and sex. Results The study included 30 465 adults (mean [SD] age, 64 [10] years; 56% female), of whom 1033 had 1 or more MI event, and 29 432 did not have an MI event. Median follow-up was 6.4 years (IQR, 4.9-19.7 years). Overall, incident MI was not associated with an acute decrease in global cognition (-0.18 points; 95% CI, -0.52 to 0.17 points), executive function (-0.17 points; 95% CI, -0.53 to 0.18 points), or memory (0.62 points; 95% CI, -0.07 to 1.31 points). However, individuals with incident MI vs those without MI demonstrated faster declines in global cognition (-0.15 points per year; 95% CI, -0.21 to -0.10 points per year), memory (-0.13 points per year; 95% CI, -0.22 to -0.04 points per year), and executive function (-0.14 points per year; 95% CI, -0.20 to -0.08 points per year) over the years after MI compared with pre-MI slopes. The interaction analysis suggested that race and sex modified the degree of change in the decline in global cognition after MI (race × post-MI slope interaction term, P = .02; sex × post-MI slope interaction term, P = .04), with a smaller change in the decline over the years after MI in Black individuals than in White individuals (difference in slope change, 0.22 points per year; 95% CI, 0.04-0.40 points per year) and in females than in males (difference in slope change, 0.12 points per year; 95% CI, 0.01-0.23 points per year). Conclusions This cohort study using pooled data from 6 cohort studies found that incident MI was not associated with a decrease in global cognition, memory, or executive function at the time of the event compared with no MI but was associated with faster declines in global cognition, memory, and executive function over time. These findings suggest that prevention of MI may be important for long-term brain health.
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Affiliation(s)
| | - Wen Ye
- University of Michigan Medical School, Ann Arbor
| | - Alden Gross
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Dehua Han
- University of Michigan Medical School, Ann Arbor
| | | | | | | | | | | | | | | | | | - Michael Griswold
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | | | | | | | - Timothy M. Hughes
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
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14
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Pouplin S, Bonnyaud C, Bouchigny S, Mégard C, Bertholier L, Goulamhoussen R, Foulon P, Bensmail D, Barbot F, Roche N. Feasibility of a serious game system including a tangible object for post stroke upper limb rehabilitation: a pilot randomized clinical study. Front Neurol 2023; 14:1176071. [PMID: 37360348 PMCID: PMC10289014 DOI: 10.3389/fneur.2023.1176071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/03/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Serious games can be used to provide intensive rehabilitation through attractive exercises as part of post-stroke rehabilitation. However, currently available commercial and serious games systems primarily train shoulder and elbow movements. These games lack the grasping and displacement components that are essential to improve upper limb function. For this reason, we developed a tabletop device that encompassed a serious game with a tangible object to rehabilitate combined reaching and displacement movements: the Ergotact system. Objectives The aim of this pilot study was to assess the feasibility and the short-term effects of a training program using the Ergotact prototype in individuals with chronic stroke. Methods Participants were assigned to one of two groups: a serious game training group (Ergotact) or a control training group (Self). Results Twenty-eight individuals were included. Upper limb function increased after the Ergotact training program, although not statistically significantly, and the program did not induce pain or fatigue, demonstrating its safety. Conclusion The Ergotact system for upper limb rehabilitation was well accepted and induced participant satisfaction. It complies with current recommendations for people with stroke to autonomously perform intensive active exercises in a fun context, in addition to conventional rehabilitation sessions with therapists. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT03166020?term=NCT03166020&draw=2&rank=1, identifier NCT03166020.
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Affiliation(s)
- Samuel Pouplin
- New Technologies Platform, Raymond-Poincaré Hospital, AP–HP, Université Paris Saclay, Garches, France
- Paris-Saclay University, UVSQ, Research Unit ERPHAN, Versailles, France
| | - Céline Bonnyaud
- Paris-Saclay University, UVSQ, Research Unit ERPHAN, Versailles, France
- Physiology and Functional Exploration Department, Raymond-Poincaré Hospital, AP–HP, Université Paris Saclay, Garches, France
| | | | | | | | | | - Pierre Foulon
- Genious Healthcare, Groupe MindMaze, Montpellier, France
| | - Djamel Bensmail
- Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, AP–HP, Université Paris Saclay, Garches, France
- End: icap Laboratory, Inserm Unit 1179, UVSQ, Montigny-le-Bretonneux, France
| | - Frédéric Barbot
- CIC 1429 INSERM, Raymond-Poincaré Hospital, AP–HP, Université Paris Saclay, Garches, France
| | - Nicolas Roche
- Physiology and Functional Exploration Department, Raymond-Poincaré Hospital, AP–HP, Université Paris Saclay, Garches, France
- CIC 1429 INSERM, Raymond-Poincaré Hospital, AP–HP, Université Paris Saclay, Garches, France
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15
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Cao SY, Yang D, Huang ZQ, Lin YH, Wu HY, Chang L, Luo CX, Xu Y, Liu Y, Zhu DY. Cerebral organoids transplantation repairs infarcted cortex and restores impaired function after stroke. NPJ Regen Med 2023; 8:27. [PMID: 37253754 DOI: 10.1038/s41536-023-00301-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/16/2023] [Indexed: 06/01/2023] Open
Abstract
Stroke usually causes prolonged or lifelong disability, owing to the permanent loss of infarcted tissue. Although a variety of stem cell transplantation has been explored to improve neuronal defect behavior by enhancing neuroplasticity, it remains unknown whether the infarcted tissue can be reconstructed. We here cultured human cerebral organoids derived from human pluripotent stem cells (hPSCs) and transplanted them into the junction of the infarct core and the peri-infarct zone of NOD-SCID mice subjected to stroke. Months later, we found that the grafted organoids survived well in the infarcted core, differentiated into target neurons, repaired infarcted tissue, sent axons to distant brain targets, and integrated into the host neural circuit and thereby eliminated sensorimotor defect behaviors of stroke mice, whereas transplantation of dissociated single cells from organoids failed to repair the infarcted tissue. Our study offers a new strategy for reconstructing infarcted tissue via organoids transplantation thereby reversing stroke-induced disability.
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Affiliation(s)
- Shi-Ying Cao
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
- Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, 210008, China
| | - Di Yang
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Zhen-Quan Huang
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Yu-Hui Lin
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Hai-Yin Wu
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Lei Chang
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Chun-Xia Luo
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Yun Xu
- Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, 210008, China
| | - Yan Liu
- Institution of Stem Cells and Neuroregeneration, Nanjing Medical University, Nanjing, 211166, China.
| | - Dong-Ya Zhu
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China.
- Institution of Stem Cells and Neuroregeneration, Nanjing Medical University, Nanjing, 211166, China.
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16
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Lin YH, Yang D, Ni HY, Xu XM, Wu F, Lin L, Chen J, Sun YY, Huang ZQ, Li SY, Jiang PL, Wu HY, Chang L, Hu B, Luo CX, Wu J, Zhu DY. Ketone bodies promote stroke recovery via GAT-1-dependent cortical network remodeling. Cell Rep 2023; 42:112294. [PMID: 36947544 DOI: 10.1016/j.celrep.2023.112294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 01/31/2023] [Accepted: 03/04/2023] [Indexed: 03/23/2023] Open
Abstract
Stroke is a leading cause of adult disability worldwide, and better drugs are needed to promote functional recovery after stroke. Growing evidence suggests the critical role of network excitability during the repair phase for stroke recovery. Here, we show that β-hydroxybutyrate (β-HB), an essential ketone body (KB) component, is positively correlated with improved outcomes in patients with stroke and promotes functional recovery in rodents with stroke during the repair phase. These beneficial effects of β-HB depend on HDAC2/HDAC3-GABA transporter 1 (GAT-1) signaling-mediated enhancement of excitability and phasic GABA inhibition in the peri-infarct cortex and structural and functional plasticity in the ipsilateral cortex, the contralateral cortex, and the corticospinal tract. Together with available clinical approaches to elevate KB levels, our results offer a clinically translatable means to promote stroke recovery. Furthermore, GAT-1 can serve as a pharmacological target for developing drugs to promote functional recovery after stroke.
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Affiliation(s)
- Yu-Hui Lin
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China.
| | - Di Yang
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Huan-Yu Ni
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Xiu-Mei Xu
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Feng Wu
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Long Lin
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Jie Chen
- Department of Neurology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China
| | - Yan-Yu Sun
- Department of Neurology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China
| | - Zhen-Quan Huang
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Shi-Yi Li
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Pei-Lin Jiang
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Hai-Yin Wu
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Lei Chang
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chun-Xia Luo
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Jin Wu
- Department of Neurology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China.
| | - Dong-Ya Zhu
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China; Institution of Stem Cells and Neuroregeneration, Nanjing Medical University, Nanjing 211166, China.
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Savelieva I, Fumagalli S, Kenny RA, Anker S, Benetos A, Boriani G, Bunch J, Dagres N, Dubner S, Fauchier L, Ferrucci L, Israel C, Kamel H, Lane DA, Lip GYH, Marchionni N, Obel I, Okumura K, Olshansky B, Potpara T, Stiles MK, Tamargo J, Ungar A. EHRA expert consensus document on the management of arrhythmias in frailty syndrome, endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA). Europace 2023; 25:1249-1276. [PMID: 37061780 PMCID: PMC10105859 DOI: 10.1093/europace/euac123] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 04/17/2023] Open
Abstract
There is an increasing proportion of the general population surviving to old age with significant chronic disease, multi-morbidity, and disability. The prevalence of pre-frail state and frailty syndrome increases exponentially with advancing age and is associated with greater morbidity, disability, hospitalization, institutionalization, mortality, and health care resource use. Frailty represents a global problem, making early identification, evaluation, and treatment to prevent the cascade of events leading from functional decline to disability and death, one of the challenges of geriatric and general medicine. Cardiac arrhythmias are common in advancing age, chronic illness, and frailty and include a broad spectrum of rhythm and conduction abnormalities. However, no systematic studies or recommendations on the management of arrhythmias are available specifically for the elderly and frail population, and the uptake of many effective antiarrhythmic therapies in these patients remains the slowest. This European Heart Rhythm Association (EHRA) consensus document focuses on the biology of frailty, common comorbidities, and methods of assessing frailty, in respect to a specific issue of arrhythmias and conduction disease, provide evidence base advice on the management of arrhythmias in patients with frailty syndrome, and identifies knowledge gaps and directions for future research.
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Affiliation(s)
- Irina Savelieva
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Stefano Fumagalli
- Department of Experimental and Clinical Medicine, Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, University of Florence and AOU Careggi, Florence, Italy
| | - Rose Anne Kenny
- Mercer’s Institute for Successful Ageing, Department of Medical Gerontology, St James’s Hospital, Dublin, Ireland
| | - Stefan Anker
- Department of Cardiology (CVK), Germany
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Germany
- German Centre for Cardiovascular Research (DZHK) partner site Berlin, Germany
- Charité Universitätsmedizin Berlin, Germany
| | - Athanase Benetos
- Department of Geriatric Medicine CHRU de Nancy and INSERM U1116, Université de Lorraine, Nancy, France
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Jared Bunch
- (HRS representative): Intermountain Medical Center, Cardiology Department, Salt Lake City,Utah, USA
- Stanford University, Department of Internal Medicine, Palo Alto, CA, USA
| | - Nikolaos Dagres
- Heart Center Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - Sergio Dubner
- (LAHRS representative): Clinica Suizo Argentina, Cardiology Department, Buenos Aires Capital Federal, Argentina
| | - Laurent Fauchier
- Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | | | - Carsten Israel
- Evangelisches Krankenhaus Bielefeld GmbH, Bielefeld, Germany
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, General Cardiology Division, University of Florence and AOU Careggi, Florence, Italy
| | - Israel Obel
- (CASSA representative): Milpark Hospital, Cardiology Unit, Johannesburg, South Africa
| | - Ken Okumura
- (APHRS representative): Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Brian Olshansky
- University of Iowa Hospitals and Clinics, Iowa CityIowa, USA
- Covenant Hospital, Waterloo, Iowa, USA
- Mercy Hospital Mason City, Iowa, USA
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Serbia
- Cardiology Clinic, Clinical Center of Serbia, Serbia
| | - Martin K Stiles
- (APHRS representative): Waikato Clinical School, University of Auckland and Waikato Hospital, Hamilton, New Zealand
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, CIBERCV, Universidad Complutense, Madrid, Spain
| | - Andrea Ungar
- Department of Experimental and Clinical Medicine, Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, University of Florence and AOU Careggi, Florence, Italy
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18
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Acosta JN, Both CP, Demarais ZS, Conlon CJ, Leasure AC, Torres-Lopez VM, de Havenon A, Petersen NH, Gill TM, Sansing LH, Sheth KN, Falcone GJ. Polygenic Susceptibility to Hypertension and Blood Pressure Control in Stroke Survivors. Neurology 2023; 100:e1587-e1597. [PMID: 36690452 PMCID: PMC10103110 DOI: 10.1212/wnl.0000000000206763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 11/16/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Blood pressure (BP) is often not at goal in stroke survivors, leaving individuals vulnerable to additional vascular events. Given that BP is a highly heritable trait, we hypothesize that a higher polygenic susceptibility to hypertension (PSH) leads to worse BP control in stroke survivors. METHODS We conducted a study within the UK Biobank evaluating persons of European ancestry who survived an ischemic or hemorrhagic stroke. To model the PSH, we created polygenic risk scores (PRSs) for systolic and diastolic BP using 732 genetic variants. We divided the PRSs into quintiles and used linear/logistic regression to test whether higher PSH led to higher observed BP, uncontrolled BP (systolic BP > 140 mm Hg or diastolic BP > 90 mm Hg), and resistant BP (uncontrolled BP despite being on ≥3 antihypertensive drugs). We conducted an independent replication using data from the Vitamin Intervention for Stroke Prevention (VISP) trial. RESULTS We analyzed 5,940 stroke survivors. When comparing stroke survivors with very low vs very high PSH, the mean systolic BP was 137 (SD 18) vs 143 (SD 20, p < 0.001), the mean diastolic BP was 81 (SD 10) vs 84 (SD 11, p < 0.001), the prevalence of uncontrolled BP was 42.8% vs 57.2% (p < 0.001), and the prevalence of resistant hypertension was 3.9% vs 11% (p < 0.001). Results remained significant using multivariable models (p < 0.001) and were replicated in the VISP study (all tests with p < 0.05). DISCUSSION A higher PSH is associated with worse BP control in stroke survivors. These findings point to genetic predisposition as an important determinant of poorly controlled BP in this population.
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Affiliation(s)
- Julián N Acosta
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Cameron P Both
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Zachariah S Demarais
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Carolyn J Conlon
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Audrey C Leasure
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Victor M Torres-Lopez
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Adam de Havenon
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Nils H Petersen
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Thomas M Gill
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Lauren H Sansing
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Kevin N Sheth
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Guido J Falcone
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
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19
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1433] [Impact Index Per Article: 1433.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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20
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Abstract
Stroke recovery therapeutics include many classes of intervention and numerous treatment targets. Stroke is a very heterogeneous disease. As such, stroke recovery therapeutics benefit from a personalized medicine approach that considers intersubject differences, such as in infarct location or stroke severity, when assigning treatment. Prediction of treatment responders can be improved by incorporating biological measures, such as neural injury and neural function, as the bedside behavioral phenotype has an incomplete relationship with the biological events underlying stroke recovery. Another ramification of high variability between patients is the need to examine effects of restorative therapies in relation to dose, time poststroke, and stroke severity in clinical trials. For example, enrollment across a wide time interval poststroke or in a population with a very broad range of deficits means high variance across patients in the biological state of the brain. The doses of rehabilitation therapy being studied are often low; it takes substantial practice to acquire a skill in the healthy brain; this is more, not less, pronounced after a stroke. Recognition and treatment of poststroke depression represents a major unmet need. These points are considered in the context of a review of recent advances in stroke recovery therapeutics.
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Affiliation(s)
- Lorie G Richards
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City (L.G.R.)
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles (S.C.C.).,California Rehabilitation Institute, Los Angeles (S.C.C.)
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21
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Blöchl M, Nestler S. Long-term Changes in Depressive Symptoms Before and After Stroke. Neurology 2022; 99:e720-e729. [PMID: 35831179 DOI: 10.1212/wnl.0000000000200756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 04/05/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To determine the trajectory of depressive symptoms several years before and after incident stroke. METHODS We analyzed data from 10,797 participants from the English Longitudinal Study of Ageing without a history of stroke at baseline (wave 1). We matched participants with first-ever stroke during the 12-year follow-up (waves 2-7) to stroke-free individuals using propensity scores accounting for age, sex, education, ethnicity, and vascular risk factors. Trajectories of depressive symptoms before and after stroke were analyzed using multilevel models. RESULTS Among the 10,797 participants (mean age 64.6 ± 9.9 years, 54.8% women), we identified 425 individuals with incident stroke. At the assessment before stroke, these individuals demonstrated an increase in depressive symptoms when compared with matched controls. There was a further increase in depressive symptoms in stroke survivors after the acute event, which persisted for several years. Symptom-level analyses revealed that differences in depressive symptoms between stroke survivors and stroke-free controls before and after stroke were most pronounced for mood-related and fatigue-related symptoms. DISCUSSION Incident stroke is associated with long-term increases in depressive symptoms. A small part of this increase occurs in the years before stroke, perhaps indicating the incipient pathologic process. Particular attention should be paid to depressive symptoms in the long-term care of patients, and especially to fatigue-related symptoms.
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Affiliation(s)
- Maria Blöchl
- From the Department of Psychology (M.B., S.N.), University of Münster; Department for Neurology (M.B.), Max Planck Institute for Human Cognitive and Brain Sciences; and International Max Planck Research School on Neuroscience of Communication: Structure, Function, and Plasticity (M.B.), Leipzig, Germany.
| | - Steffen Nestler
- From the Department of Psychology (M.B., S.N.), University of Münster; Department for Neurology (M.B.), Max Planck Institute for Human Cognitive and Brain Sciences; and International Max Planck Research School on Neuroscience of Communication: Structure, Function, and Plasticity (M.B.), Leipzig, Germany
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22
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Yang F, Li N, Yang L, Chang J, Yan A, Wei W. Association of Pre-stroke Frailty With Prognosis of Elderly Patients With Acute Cerebral Infarction: A Cohort Study. Front Neurol 2022; 13:855532. [PMID: 35711265 PMCID: PMC9196308 DOI: 10.3389/fneur.2022.855532] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Frailty is a state of cumulative degradation of physiological functions that leads to adverse outcomes such as disability or mortality. Currently, there is still little understanding of the prognosis of pre-stroke frailty status with acute cerebral infarction in the elderly. Objective We investigated the association between pre-stroke frailty status, 28-day and 1-year survival outcomes, and functional recovery after acute cerebral infarction. Methods Clinical data were collected from 314 patients with acute cerebral infarction aged 65–99 years. A total of 261 patients completed follow-up in the survival cohort analysis and 215 patients in the functional recovery cohort analysis. Pre-stroke frailty status was assessed using the FRAIL score, the prognosis was assessed using the modified Rankin Scale (mRS), and disease severity using the National Institutes of Health Stroke Scale (NIHSS). Results Frailty was independently associated with 28-day mortality in the survival analysis cohort [hazard ratio (HR) = 4.30, 95% CI 1.35–13.67, p = 0.014]. However, frailty had no independent effect on 1-year mortality (HR = 1.47, 95% CI 0.78–2.79, p = 0.237), but it was independently associated with advanced age, the severity of cerebral infarction, and combined infection during hospitalization. Logistic regression analysis after adjusting for potential confounders in the functional recovery cohort revealed frailty, and the NIHSS score was significantly associated with post-stroke severe disability (mRS > 2) at 28 days [pre-frailty adjusted odds ratio (aOR): 8.86, 95% CI 3.07–25.58, p < 0.001; frailty aOR: 7.68, 95% CI 2.03–29.12, p = 0.002] or 1 year (pre-frailty aOR: 8.86, 95% CI 3.07–25.58, p < 0.001; frailty aOR: 7.68, 95% CI 2.03–29.12, p = 0.003). Conclusions Pre-stroke frailty is an independent risk factor for 28-day mortality and 28-day or 1-year severe disability. Age, the NIHSS score, and co-infection are likewise independent risk factors for 1-year mortality.
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Affiliation(s)
- Fuxia Yang
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Nan Li
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Lu Yang
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Jie Chang
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Aijuan Yan
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Wenshi Wei
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
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23
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Gu HQ, Yang KX, Lin JX, Jing J, Zhao XQ, Wang YL, Liu LP, Meng X, Jiang Y, Li H, Wang YJ, Li ZX. Association between high-sensitivity C-reactive protein, functional disability, and stroke recurrence in patients with acute ischaemic stroke: A mediation analysis. EBioMedicine 2022; 80:104054. [PMID: 35576642 PMCID: PMC9118507 DOI: 10.1016/j.ebiom.2022.104054] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Post-stroke inflammation biomarker high-sensitivity C-reactive protein (hsCRP) increases cerebral infarct size and results in functional disability directly, it also contributes to the formation and maturation of atherosclerotic plaques, which increase the risk of stroke recurrence and results in functional disability indirectly. However, no study has quantified how much functional disability was mediated by stroke recurrence. Methods Patients with acute ischaemic stroke within 7 days and admitted to 169 hospitals in the Third China National Stroke Registry were analyzed. Blood samples were collected within 24 h of admission. Stroke recurrence and functional disability (defined as a modified Rankin scale score ≥ 2) were assessed via face-to-face interviews at three months. Mediation analysis under the counterfactual framework was performed to examine the potential causal chain in which stroke recurrence may mediate the relationship between hsCRP and functional outcome. Sensitivity analyses were performed across different subgroups and on different scales of hsCRP measurement. Findings Of the 7603 analyzed patients (mean [SD] age, 62.3 [11.3] years; 2392 [31.5%] women), the median (interquartile range [IQR]) of NIHSS score was 3.0 (1.0–6.0). The median (IQR) level of hsCRP was 1.73 (0.81–4.38) mg/L. A total of 496 (6.5%) cases of stroke recurrence and 1884 (24.8%) cases of functional disability were observed at the 90-day follow-up. Each SD increase in the concentration of hsCRP was associated with an increased risk of stroke recurrence (adjusted odds ratio [aOR], 1.11; 95% CI, 1.04–1.18) and disability (aOR, 1.14; 95% CI, 1.08–1.20) within 90 days. Of 1884 functionally disabled patients, only 16.0 % (n = 302) of patients experienced stroke recurrence before functional disability. Stroke recurrence during follow-up explained 16.52% (95% CI, 5.79%–27.25%) of the relationship between hsCRP and functional disability. Sensitivity analyses in different subgroups and on different scales of hsCRP measurement showed comparable results. Interpretation Stroke recurrence mediates less than 20% of the association between hsCRP and functional disability at 90 days among patients with acute ischaemic stroke. In addition to typical secondary prevention strategies for preventing stroke recurrence, more attention should be paid to novel anti-inflammatory therapy to improve functional outcomes. Funding Beijing Natural Science Foundation, the National Key R&D Program of China, the National Natural Science Foundation of China, and the Beijing Municipal Science & Technology Commission.
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24
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Wang J, Wang J, Li X, Wang Z, Qi X, Dove A, Bennett DA, Xu W. Association of Pulmonary Function With Motor Function Trajectories and Disability Progression Among Older Adults: A Long-Term Community-Based Cohort Study. J Gerontol A Biol Sci Med Sci 2022; 77:2524-2531. [PMID: 35512113 PMCID: PMC9799204 DOI: 10.1093/gerona/glac085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The association of pulmonary function (PF) with motor function and disability remains unclear. We investigate the association of PF with motor function trajectories and disability progression, and explore the role of social activity, cognitive function, and cardiovascular diseases (CVDs) in this relationship. METHODS Within the Rush Memory and Aging Project, 1 403 disability-free participants (mean age: 79.28 years) were followed for up to 22 years. PF was measured with a composite score based on peak expiratory flow, forced expiratory volume in 1 second, and forced vital capacity at baseline. Global motor function including dexterity, gait, and hand strength was assessed annually using 10 motor tests. Disability was evaluated according to the basic activities of daily living. Social activity was defined as the frequency of common types of social interaction. Global cognitive function was assessed using a battery of 19 cognitive performance tests. CVDs (including stroke, congestive heart failure, and heart diseases) were ascertained at baseline. Linear mixed-effects models were used. RESULTS Compared to high PF, low PF was related to faster decline in global motor function (β = -0.005, 95% confidence interval [CI]: -0.008 to -0.001) and all 3 specific motor abilities (p < .05), as well as faster progression of disability (β = 0.012, 95% CI: 0.009 to 0.014). There was a statistically significant interaction between PF and social activity/cognitive function on disability progression (β = 0.005, 95% CI: 0.001 to 0.009, p = .010/β = 0.004, 95% CI: 0.001 to 0.009, p = .025). CONCLUSION Poor PF accelerates motor function decline and the progression of disability. A high level of social activity and cognitive function appear to decelerate disability progression related to poor PF.
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Affiliation(s)
| | | | - Xuerui Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China,Center for International Collaborative Research on Environment, Nutrition, and Public Health, Tianjin, China
| | - Zhangyu Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China,Center for International Collaborative Research on Environment, Nutrition, and Public Health, Tianjin, China
| | - Xiuying Qi
- Address correspondence to: Xiuying Qi, PhD, Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, 300070, Tianjin, China. E-mail: ; Weili Xu, PhD, Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Tomtebodavägen 18A Floor 10, SE-171 65 Solna, Stockholm, Sweden. E-mail: ;
| | - Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Weili Xu
- Address correspondence to: Xiuying Qi, PhD, Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, 300070, Tianjin, China. E-mail: ; Weili Xu, PhD, Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Tomtebodavägen 18A Floor 10, SE-171 65 Solna, Stockholm, Sweden. E-mail: ;
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Skajaa N, Adelborg K, Horváth-Puhó E, Rothman KJ, Henderson VW, Thygesen LC, Sørensen HT. Stroke and Risk of Mental Disorders Compared With Matched General Population and Myocardial Infarction Comparators. Stroke 2022; 53:2287-2298. [PMID: 35317610 DOI: 10.1161/strokeaha.121.037740] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accurate estimates of risks of poststroke outcomes from large population-based studies can provide a basis for public health policy decisions. We examined the absolute and relative risks of a spectrum of incident mental disorders following ischemic stroke and intracerebral hemorrhage. METHODS During 2004 to 2018, we used Danish registries to identify patients (≥18 years and with no hospital history of mental disorders), with a first-time ischemic stroke (n=76767) or intracerebral hemorrhage (n=9344), as well as age-,sex-, and calendar year-matched general population (n=464 840) and myocardial infarction (n=92 968) comparators. We computed risk differences, considering death a competing event, and hazard ratios adjusted for income, occupation, education, and history of cardiovascular and noncardiovascular comorbidity. RESULTS Compared with the general population, following ischemic stroke, the 1-year risk difference was 7.3% (95% CI, 7.0-7.5) for mood disorders (driven by depression), 1.4% (95% CI, 1.3-1.5) for organic brain disorders (driven by dementia and delirium), 0.8% (95% CI, 0.7-0.8) for substance abuse disorders (driven by alcohol and tobacco abuse), and 0.5% (95% CI, 0.4-0.5) for neurotic disorders (driven by anxiety and stress disorders). For suicide, risk differences were near null. Hazard ratios were particularly elevated in the first year of follow-up, ranging from a 2- to a 4-fold increased hazard, decreasing thereafter. Compared with myocardial infarction patients, the 1-year risk difference was 4.9% (95% CI, 4.6 to 5.3) for mood disorders, 1.0% (95% CI, 0.8 to 1.1) for organic brain disorders, 0.1% (95% CI, 0.0 to 0.2) for substance abuse disorders, but -0.2% (95% CI, -0.2 to -0.1) for neurotic disorders. Hazard ratios during the first year of follow-up were elevated 1.1- to 1.8-fold for mood, organic brain, and neurotic disorders, while decreased 0.8-fold for neurotic disorders. CONCLUSIONS The considerably greater risks of mental disorders following a stroke, particularly mood disorders, underline the importance of mental health evaluation after stroke.
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Affiliation(s)
- Nils Skajaa
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Denmark (N.S., K.A., E.H.-P., K.J.R., V.W.H., H.T.S.).,National Institute of Public Health, University of Southern Denmark, Copenhagen (N.S., L.C.T.)
| | - Kasper Adelborg
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Denmark (N.S., K.A., E.H.-P., K.J.R., V.W.H., H.T.S.).,Department of Clinical Biochemistry, Thrombosis and Haemostasis Research Unit, Aarhus University Hospital, Denmark (K.A.)
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Denmark (N.S., K.A., E.H.-P., K.J.R., V.W.H., H.T.S.)
| | - Kenneth J Rothman
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Denmark (N.S., K.A., E.H.-P., K.J.R., V.W.H., H.T.S.).,Department of Epidemiology, Boston University School of Public Health, MA (K.J.R., H.T.S.).,RTI Health Solutions, Research Triangle Institute, Research Triangle Park, NC (K.J.R.)
| | - Victor W Henderson
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Denmark (N.S., K.A., E.H.-P., K.J.R., V.W.H., H.T.S.).,Department of Epidemiology and Population Health, Stanford University, CA (V.W.H., H.T.S.).,Department of Neurology and Neurological Sciences, Stanford University, CA (V.W.H)
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen (N.S., L.C.T.)
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Denmark (N.S., K.A., E.H.-P., K.J.R., V.W.H., H.T.S.).,Department of Epidemiology, Boston University School of Public Health, MA (K.J.R., H.T.S.).,Department of Epidemiology and Population Health, Stanford University, CA (V.W.H., H.T.S.)
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26
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2610] [Impact Index Per Article: 1305.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Zhao WY, Zhang L, Wan Y, Chen X, Jin Y, Zhang L, Sum G, Katar A, Song L, Anderson CS. The association between functional status and physical pain with depressive symptoms after a stroke event: A cross-sectional analysis of the China Health and Retirement Longitudinal Study 2018. Front Psychiatry 2022; 13:927856. [PMID: 36172512 PMCID: PMC9512144 DOI: 10.3389/fpsyt.2022.927856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stroke is a major cause of mortality and long-term physical and cognitive impairment. This study aims to: (1) examine the prevalence of depressive symptoms, disability and pain among Chinese adults with stroke; (2) test the associations of functional limitations and body pain with occurrence of depressive symptoms; (3) investigate gender and urban-rural disparities in these associations. METHODS This study utilized the data from the China Health and Retirement Longitudinal Study in 2018, involving 969 patients with stroke among 17,970 participants aged ≥ 45 years. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression (CES-D) Scale. We performed multivariable logistic regression models to estimate the associations between activities of daily life (ADL), instrumental activities of daily life (IADL) and pain with depressive symptoms. RESULTS Depressive symptoms were found among 40.2% of stroke patients, with a higher prevalence in females (48.2%) than males (32.7%). Prevalence of ADL limitations, IADL limitations and pain among stroke patients were 39.2, 49.8 and 14.0%, respectively. ADL and IADL limitations and pain were more prevalent among females and residents in rural areas. Multivariable regression analyses showed a significant association between ADL limitation (OR = 1.535, 95% CI = 1.168, 2.018), IADL limitation (OR = 1.666, 95% CI = 1.260, 2.203) and pain (OR = 2.122, 95% CI = 1.466, 3.073) with depressive symptoms. Stratified analyses revealed stronger associations among urban residents. Females had a higher association of ADL and IADL with depressive symptoms but similar in that of pain to the males. The impact of ADL and IADL in male patients is higher than in females, but the impact of pain on depressive symptoms is higher in female patients. CONCLUSION Depressive symptoms are common amongst post-stroke patients in China and are significantly associated with functional disability and physical pain. Our findings have implications for practitioners on the early assessment of pain and depression after stroke. Future research should explore effective intervention measures for physical-mental stroke complications.
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Affiliation(s)
- William Yang Zhao
- The George Institute for Global Health, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Luwen Zhang
- School of Health Services Management, Southern Medical University, Guangzhou, China
| | - Yingfeng Wan
- Department of Neurology, University of California, Davis, Davis, CA, United States
| | - Xiaoying Chen
- The George Institute for Global Health, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, China.,Institute for Global Health and Development, Peking University, Beijing, China
| | - Lin Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Grace Sum
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ameera Katar
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Lili Song
- The George Institute for Global Health, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Craig S Anderson
- The George Institute for Global Health, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Li J, Lin S, Yan X, Pei L, Wang Z. Adverse Childhood Experiences and Trajectories of ADL Disability among Middle-Aged and Older Adults in China: Findings from the CHARLS Cohort Study. J Nutr Health Aging 2022; 26:1034-1041. [PMID: 36519765 DOI: 10.1007/s12603-022-1863-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES There is little evidence on the association between adverse childhood experiences (ACEs) and disability trajectories among middle-aged and older adults. This study aimed to investigate the association between ACEs and activities of daily living (ADL) trajectories over eight years of follow-up and the mediation role of different chronic diseases on this relationship. DESIGN Prospective cohort study, eight-year follow-up. SETTING China Health and Retirement Longitudinal Study(CHARLS). PARTICIPANTS A total of 10651 participants age 45 and over from CHARLS 2011 to 2018 were included in this study. MEASUREMENTS Five ACEs exposure groups were formed based on the cumulative ACE scores. A 6-item ADL score was used, including bathing, dressing, eating, getting in/out of bed, using the toilet, and controlling urination, to measure the ADL disability, and the group-based trajectory model (GBTM) was used to identify the ADL disability trajectories. Multinomial logistic regression was performed to investigate the association between ACEs and ADL disability trajectory memberships, and KHB-method was used to estimate the contribution of different chronic diseases on this relationship. RESULTS Of the 10651 participants, 9.64% showed a mild-increasing trajectory in terms of change in ADL score during follow-up, followed by the low-mild trajectory (32.00%) and low-low trajectory (58.36%). Compared with those without ACEs exposure, participants who had ≥4 ACEs were associated with an increased risk of being on low-mild trajectory (OR 1.32, 95%CI:1.11-1.57) and mild-increasing trajectory (OR 1.41, 95%CI: 1.06-1.89), respectively. Besides, mediation analysis revealed chronic diseases had a mediation effect in this association, with the largest effect from arthritis or rheumatism (over 60%), followed by digestive system disease (around 14%), respiratory disease (around 12%), and cardio-metabolic disease (around 5%). CONCLUSION This study suggested that exposure to ACEs was associated with a higher risk of being worse ADL disability trajectories. Moreover, chronic disease accounts for a meaningful proportion of this association. Further studies are needed to clarify how chronic diseases mediate the association between ACEs and ADL disability trajectories.
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Affiliation(s)
- J Li
- Lijun Pei, PhD, Institute of Population Research/China Center on Population Health and development, Peking University, No.5 Yiheyuan Road, Haidian District, Beijing 100871, China, ; Tel and fax: +86 010-62751974
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Neurologic Complications in Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2021; 10:519-529. [PMID: 34593114 DOI: 10.1016/j.iccl.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become the mainstay of treatment for severe symptomatic aortic stenosis. Although many TAVR complication rates including mortality and aortic regurgitation have decreased, stroke rates have remained stable for years. TAVR-related strokes are devastating to patients and their families, and very costly for health care systems. The predictors of stroke in TAVR are not yet well defined, although older age, female gender, carotid and peripheral arterial disease, bicuspid aortic valve anatomy, and atrial fibrillation are emerging as risk factors across studies.
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30
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Liu X, Yu HJ, Gao Y, Zhou J, Zhou M, Wan L, Xiong F, Zhao J, He QQ, Wang Y. Combined association of multiple chronic diseases and social isolation with the functional disability after stroke in elderly patients: a multicenter cross-sectional study in China. BMC Geriatr 2021; 21:495. [PMID: 34530729 PMCID: PMC8447675 DOI: 10.1186/s12877-021-02439-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background Multiple chronic diseases (MCDs) and social isolation are independent risk factors related to stroke and disability, but it is unknown whether the combination of these two conditions resulted from aging-related to functional disability in stroke patients. This study aimed to probe the relationship between the combination of MCDs, social isolation, and functional disability after stroke in elderly patients. Methods A multicenter and cross-sectional study was conducted in the Departments of Rehabilitation of 103 hospitals located in 23 cities across China. Stroke patients aged 60–90 years were selected for analysis. Demographic characteristics, lifestyles, and clinical information were investigated by questionnaires and medical records. MCDs (hypertension/ diabetes/ hyperlipidemia/heart disease/kidney disease) were categorized into three levels: 0, 1, and ≥ 2. Functional disability was assessed by the Barthel Index and categorized into four groups: no, mild, moderate, and severe disability. The multi-nominal logistic regression model was used to explore the independent and combined association of MCDs and social isolation with functional disability. Results A total of 4046 elderly stroke patients (55 % males) were included in the final analysis. The prevalence of social isolation, MCDs ≥ 2, and severe disability increased with aging. In the fully adjusted model, patients with social isolation or MCDs had a higher risk of functional disability significantly than those without. Patients with social isolation combined MCDs ≥ 2 were 35 times (95 % CI: 18.89–64.69) more likely to suffer severe disability after stroke, and 8 times (95 % CI: 18.89–64.69) for moderate disability than those without social isolation and MCDs. Conclusions MCDs, social isolation, and their combination were associated with a higher risk of functional disability after stroke in Chinese elderly patients. The elderly population should be encouraged to participate in more social activities, particularly in those with MCDs. Future secondary prevention and rehabilitation treatments to the functional ability of elderly stroke patients should underscore both social activity and the combined treatments of MCDs. Trial registration NO: ChiCTR2000034067. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02439-9.
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Affiliation(s)
- Xiangxiang Liu
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 518035, Shenzhen, China.,Shenzhen Dapeng New District Nan'ao People's Hospital, 518121, Shenzhen, China
| | - Hong-Jie Yu
- School of Health Sciences, Wuhan University, 430071, Wuhan, China
| | - Yan Gao
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 518035, Shenzhen, China
| | - Jing Zhou
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 518035, Shenzhen, China
| | - Mingchao Zhou
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 518035, Shenzhen, China
| | - Li Wan
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 518035, Shenzhen, China
| | - Feng Xiong
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 518035, Shenzhen, China
| | - Jingpu Zhao
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 518035, Shenzhen, China
| | - Qi-Qiang He
- School of Health Sciences, Wuhan University, 430071, Wuhan, China
| | - Yulong Wang
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 518035, Shenzhen, China. .,Shenzhen Dapeng New District Nan'ao People's Hospital, 518121, Shenzhen, China.
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Psioda MA, Jones SB, Xenakis JG, D’Agostino RB. Methodological Challenges and Statistical Approaches in the COMprehensive Post-Acute Stroke Services Study. Med Care 2021; 59:S355-S363. [PMID: 34228017 PMCID: PMC8263146 DOI: 10.1097/mlr.0000000000001580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The COMprehensive Post-Acute Stroke Services study was a cluster-randomized pragmatic trial designed to evaluate a comprehensive care transitions model versus usual care. The data collected during this trial were complex and analysis methodology was required that could simultaneously account for the cluster-randomized design, missing patient-level covariates, outcome nonresponse, and substantial nonadherence to the intervention. OBJECTIVE The objective of this study was to discuss an array of complementary statistical methods to evaluate treatment effectiveness that appropriately addressed the challenges presented by the complex data arising from this pragmatic trial. METHODS We utilized multiple imputation combined with inverse probability weighting to account for missing covariate and outcome data in the estimation of intention-to-treat effects (ITT). The ITT estimand reflects the effectiveness of assignment to the COMprehensive Post-Acute Stroke Services intervention compared with usual care (ie, it does not take into account intervention adherence). Per-protocol analyses provide complementary information about the effect of treatment, and therefore are relevant for patients to inform their decision-making. We describe estimation of the complier average causal effect using an instrumental variables approach through 2-stage least squares estimation. For all preplanned analyses, we also discuss additional sensitivity analyses. DISCUSSION Pragmatic trials are well suited to inform clinical practice. Care should be taken to proactively identify the appropriate balance between control and pragmatism in trial design. Valid estimation of ITT and per-protocol effects in the presence of complex data requires application of appropriate statistical methods and concerted efforts to ensure high-quality data are collected.
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Affiliation(s)
- Matthew A. Psioda
- Department of Biostatistics, Collaborative Studies Coordinating Center
| | - Sara B. Jones
- Department of Epidemiology, Gillings School of Global Public Health
| | - James G. Xenakis
- Department of Genetics, University of North Carolina, Chapel Hill
| | - Ralph B. D’Agostino
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
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32
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Bowling CB, Sloane R, Pieper C, Luciano A, Davis BR, Simpson LM, Einhorn PT, Oparil S, Muntner P. Association of Sustained Blood Pressure Control with Lower Risk for High-Cost Multimorbidities Among Medicare Beneficiaries in ALLHAT. J Gen Intern Med 2021; 36:2221-2229. [PMID: 33564944 PMCID: PMC8342657 DOI: 10.1007/s11606-021-06623-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Clustering of chronic conditions is associated with high healthcare costs. Sustaining blood pressure (BP) control could be a strategy to prevent high-cost multimorbidity clusters. OBJECTIVE To determine the association between sustained systolic BP (SBP) control and incident multimorbidity cluster dyads and triads. DESIGN Cohort study of Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) linked to Medicare claims. PARTICIPANTS ALLHAT included adults with hypertension and ≥1 coronary heart disease risk factor. This analysis was restricted to 5234 participants with ≥ 8 SBP measurements during a 48-month BP assessment period. MAIN MEASURES SBP control was defined as <140 mm Hg at <50%, 50 to <75%, 75 to <100%, and 100% of study visits during the BP assessment period. High-cost multimorbidity clusters included dyads (stroke/chronic kidney disease [CKD], stroke/chronic obstructive pulmonary disease [COPD], stroke/heart failure [HF], stroke/asthma, COPD/CKD) and triads (stroke/CKD/asthma, stroke/CKD/COPD, stroke/CKD/depression, stroke/CKD/HF, stroke/HF/asthma) identified during follow-up. KEY RESULTS Incident dyads occurred in 1334 (26%) participants and triads occurred in 481 (9%) participants over a median follow-up of 9.2 years. Among participants with SBP control at <50%, 50 to <75%, 75 to <100%, and 100% of visits, 32%, 23%, 23%, and 19% of participants developed high-cost dyads, respectively, and 13%, 9%, 8%, and 5% of participants developed high-cost triads, respectively. Compared to those with sustained BP control at <50% of visits, adjusted HRs (95% CI) for incident dyads were 0.66 (0.57, 0.75), 0.67 (0.59, 0.77), and 0.51 (0.42, 0.62) for SBP control at 50 to <75%, 75 to <100%, and 100% of visits, respectively. The corresponding HRs (95% CI) for incident triads were 0.69 (0.55, 0.85), 0.56 (0.44, 0.71), and 0.32 (0.22, 0.47). CONCLUSIONS Among Medicare beneficiaries in ALLHAT, sustained SBP was associated with a lower risk of developing high-cost multimorbidity dyads and triads.
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Affiliation(s)
- C Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, NC, USA. .,Department of Medicine, Duke University, Durham, NC, USA.
| | - Richard Sloane
- Center for Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Carl Pieper
- Center for Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Alison Luciano
- Center for Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Barry R Davis
- The University of Texas School of Public Health, Houston, TX, USA
| | - Lara M Simpson
- The University of Texas School of Public Health, Houston, TX, USA
| | - Paula T Einhorn
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, MD, USA
| | - Suzanne Oparil
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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33
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Schäfer SK, Fleischmann R, von Sarnowski B, Bläsing D, Flöel A, Wurm S. Relationship between trajectories of post-stroke disability and self-rated health (NeuroAdapt): protocol for a prospective observational study. BMJ Open 2021; 11:e049944. [PMID: 34187831 PMCID: PMC8245451 DOI: 10.1136/bmjopen-2021-049944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Stroke is the leading neurological cause of adult long-term disability in Europe. Even though functional consequences directly related to neurological impairment are well studied, post-stroke trajectories of functional health according to the International Classification of Functioning, Disability and Health are poorly understood. Particularly, no study investigated the relationship between post-stroke trajectories of activities of daily living (ADL) and self-rated health (SRH). However, such knowledge is of major importance to identify patients at risk of unfavourable courses. This prospective observational study aims to investigate trajectories of ADL and SRH, and their modifying factors in the course of the first year after stroke. METHODS AND ANALYSIS The study will consecutively enrol 300 patients admitted to a tertiary care hospital with acute ischaemic stroke or transient ischaemic attack (TIA; Age, Blood Pressure, Clinical Features, Duration of symptoms, Diabetes score ≥3). Patient inclusion is planned from May 2021 to September 2022. All participants will complete an interview assessing ADL, SRH, mental health, views on ageing and resilience-related concepts. Participants will be interviewed face-to-face 1-5 days post-stroke/TIA in the hospital; and will be followed up after 6 weeks, 3 months, 6 months and 12 months via telephone. The 12-month follow-up will also include a neurological assessment. Primary endpoints are ADL operationalised by modified Rankin Scale scores and SRH. Secondary outcomes are further measures of ADL, functional health, physical activity, falls and fatigue. Views on ageing, social support, resilience-related concepts, affect, frailty, illness perceptions and loneliness will be examined as modifying factors. Analyses will investigate the bidirectional relationship between SRH and ADL using bivariate latent change score models. ETHICS AND DISSEMINATION The study has been approved by the institutional review board of the University Medicine Greifswald (Ref. BB 237/20). The results will be disseminated through scientific publications, conferences and media. Moreover, study results and potential implications will be discussed with patient representatives. TRIAL REGISTRATION NUMBER NCT04704635.
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Affiliation(s)
- Sarah K Schäfer
- Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | | | - Dominic Bläsing
- Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
- German Centre for Neurodegenerative Diseases, Greifswald, Germany
| | - Susanne Wurm
- Institute for Community Medicine, Department of Social Medicine and Prevention, University of Greifswald Faculty of Medicine, Greifswald, Germany
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Wu H, Le Couteur DG, Hilmer SN. Mortality trends of stroke and dementia: Changing landscapes and new challenges. J Am Geriatr Soc 2021; 69:2888-2898. [PMID: 34133024 DOI: 10.1111/jgs.17322] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/28/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND/IMPORTANCE Stroke and dementia are important causes of death in the United States and may be interrelated as competing risks for mortality. No previous studies have simultaneously compared age- and sex-specific mortality trends between stroke and subtypes of dementia at a population level. Insights gained from this study can help identify high-risk populations and inform healthcare service requirements for managing stroke and dementia in the United States. OBJECTIVES To examine nationwide trends in mortality from stroke and subtypes of dementia in the United States by age group and sex. DESIGN Population-based cross-sectional study. SETTING U.S. mortality data from 2007 to 2016. PARTICIPANTS All U.S. residents whose primary cause of death was stroke, Alzheimer's disease, vascular dementia, or Lewy body dementia. MEASUREMENTS Age-adjusted mortality, mortality trends among men and women were analyzed separately using joinpoint regression. RESULTS From 2007 to 2016, age-adjusted stroke mortality fell by 21.6%. Age-adjusted mortality (per 1,000,000) for Alzheimer's disease, vascular dementia, and Lewy body dementia increased by 1.2-fold, 2-fold, and 3-fold, respectively. Annual age-adjusted stroke mortality decreased by an average rate of 2.67% per year, while annual age-adjusted mortality for Alzheimer's disease, vascular dementia, and Lewy body dementia increased by an average rate of 2.06%, 4.90%, and 12.13% per year, respectively. Mortality from stroke and dementia increased with age. Greater reductions in stroke mortality and greater increases in dementia mortality were seen in women than men; and in older than younger (<65 years) people. CONCLUSIONS There has been a striking rising trend in dementia mortality coincident with a reduction in stroke mortality in the United States. There are persistent age and sex disparities in stroke and dementia mortality trends. Our findings support the pathophysiological relationship between stroke and dementia, and have important implications for future research, healthcare planning, and provision.
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Affiliation(s)
- Harry Wu
- Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Laboratory of Ageing and Pharmacology, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - David G Le Couteur
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Ageing and Alzheimer's Institute (AAAI), Centre for Education and Research on Ageing (CERA) and ANZAC Research Institute, Concord Hospital, Concord, New South Wales, Australia.,Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah N Hilmer
- Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Laboratory of Ageing and Pharmacology, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Chou CY, Chiu CJ, Chang CM, Wu CH, Lu FH, Wu JS, Yang YC. Disease-related disability burden: a comparison of seven chronic conditions in middle-aged and older adults. BMC Geriatr 2021; 21:201. [PMID: 33757452 PMCID: PMC7986023 DOI: 10.1186/s12877-021-02137-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although previous studies have explored the effect of chronic conditions on physical disability, little is known about the levels and rates of change in physical disability after a chronic condition diagnosis in middle-aged and older adults in the Asian population. The aim of this study is to ascertain the average levels and rates of change in the development of disability after disease diagnosis, as well as to determine the influences of sociodemographic and health-related correlates in the development of disability. METHODS This is a retrospective cohort study analyzing data of nationally representative participants aged 50 and over with a chronic condition or having developed one during follow-ups based on data from the 1996-2011 Taiwan Longitudinal Study on Aging (TLSA) (n = 5131). Seven chronic conditions were examined. Covariates included age at initial diagnosis, gender, education level, number of comorbidities, and depression status. Physical disability was measured by combining self-reported ADL, IADL, and strength and mobility activities with 17 total possible points, further analyzed with multilevel modeling. RESULTS The results showed that (1) physical disability was highest for stroke, followed by cancer and diabetes at the time of the initial disease diagnosis. (2) The linear rate of change was highest for stroke, followed by lung disease and heart disease, indicating that these diseases led to higher steady increases in physical disability after the disease diagnosis. (3) The quadratic rate of change was highest in diabetes, followed by cancer and hypertension, indicating that these diseases had led to higher increments of physical disability in later stage disease. After controlling for sociodemographic and comorbidity, depression status accounted for 39.9-73.6% and 37.9-100% of the variances in the physical disability intercept and change over time, respectively. CONCLUSIONS Despite the fact that a comparison across conditions was not statistically tested, an accelerated increase in physical disabilities was found as chronic conditions progressed. While stroke and cancer lead to disability immediately, conditions such as diabetes, cancer, and hypertension give rise to higher increments of physical disability in later stage disease. Mitigating depressive symptoms may be beneficial in terms of preventing disability development in this population.
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Affiliation(s)
- Chieh-Ying Chou
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1, University Road, 70101, Tainan, Taiwan.,Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1, University Road, 70101, Tainan, Taiwan.
| | - Chia-Ming Chang
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1, University Road, 70101, Tainan, Taiwan.,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chih-Hsing Wu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1, University Road, 70101, Tainan, Taiwan.,Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Feng-Hwa Lu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1, University Road, 70101, Tainan, Taiwan.,Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Khalagi K, Ansarifar A, Fahimfar N, Sanjari M, Gharibzdeh S, Sharifi F, Shafiee G, Heshmat R, Nabipour I, Larijani B, Ostovar A. Cardio-metabolic and socio-demographic risk factors associated with dependency in basic and instrumental activities of daily living among older Iranian adults: Bushehr elderly health program. BMC Geriatr 2021; 21:172. [PMID: 33750321 PMCID: PMC7941716 DOI: 10.1186/s12877-021-02124-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background Iran’s population is aging. Disability is a major public health problem for older adults, not only in Iran but all over the world. The purpose of this study was to investigate the relationship between cardio-metabolic and socio-demographic risk factors and disability in people 60 years and older in Iran. Methods The baseline (cross-sectional) data of 2426 samples from the Bushehr Elderly Health (BEH) program was included in the analysis. The participants were selected through multi-stage random sampling in Bushehr, southern Iran. Socio-demographic characteristics, as well as the history of diabetes and other chronic diseases, and smoking were measured using standardized questionnaires. Anthropometric measurements and laboratory tests were performed under standard conditions. Dependency was determined by the questionnaires of basic activities of daily living (BADL) and instrumental activities of daily living (IADL) using Barthel and Lawton scales respectively. Multiple logistic regression was used in the analysis. Results Mean (Standard Deviation) of the participants’ age was 69.3 (6.4) years (range: 60 and 96 years), and 48.1% of the participants were men. After adjusting for potential confounders, being older, being female (OR (95%CI): 2.3 (1.9–2.9)), having a lower education level, a history of diabetes mellitus (OR: 1.4 (1.2–1.7)) and past smoking (OR: 1.3 (1.0–1.6)), and no physical activity (OR: 1.5 (1.2–1.9)) were significantly associated with dependency in IADL. Also, being older and female (OR: 2.4 (1.9–3.0)), having a lower education level, no physical activity (OR: 2.2 (1.6–2.9)) and daily intake of calories (OR: 0.99 (0.99–0.99)) were associated with dependency in BADL. Conclusion Dependency in older adults can be prevented by increasing community literacy, improving physical activity, preventing and controlling diabetes mellitus, avoiding smoking, and reducing daily calorie intake. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02124-x.
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Affiliation(s)
- Kazem Khalagi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Ansarifar
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Safoora Gharibzdeh
- Department of Epidemiology and Biostatistics, Pasteur Institute of Iran, Tehran, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj Nabipour
- The Persian Gulf Marine Biotechnology Research Center, the Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bagher Larijani
- Endocrinology Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3172] [Impact Index Per Article: 1057.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Lin Y, Yao M, Wu H, Wu F, Cao S, Ni H, Dong J, Yang D, Sun Y, Kou X, Li J, Xiao H, Chang L, Wu J, Liu Y, Luo C, Zhu D. Environmental enrichment implies GAT-1 as a potential therapeutic target for stroke recovery. Theranostics 2021; 11:3760-3780. [PMID: 33664860 PMCID: PMC7914370 DOI: 10.7150/thno.53316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/06/2021] [Indexed: 12/21/2022] Open
Abstract
Rationale: Stroke is a leading cause of adult disability worldwide, but no drug provides functional recovery during the repair phase. Accumulating evidence demonstrates that environmental enrichment (EE) promotes stroke recovery by enhancing network excitability. However, the complexities of utilizing EE in a clinical setting limit its translation. Methods: We used multifaceted approaches combining electrophysiology, chemogenetics, optogenetics, and floxed mice in a mouse photothrombotic stroke model to reveal the key target of EE-mediated stroke recovery. Results: EE reduced tonic gamma-aminobutyric acid (GABA) inhibition and facilitated phasic GABA inhibition in the peri-infarct cortex, thereby promoting network excitability and stroke recovery. These beneficial effects depended on GAT-1, a GABA transporter regulating both tonic and phasic GABA signaling, as EE positively regulated GAT-1 expression, trafficking, and function. Furthermore, GAT-1 was necessary for EE-induced network plasticity, including structural neuroplasticity, input synaptic strengthening in the peri-infarct cortex, output synaptic strengthening in the corticospinal tract, and sprouting of uninjured corticospinal axons across the midline into the territory of denervated spinal cord, and functional recovery from stroke. Moreover, restoration of GAT-1 function in the peri-infarct cortex by its overexpression showed similar beneficial effects on stroke recovery as EE exposure. Conclusion: GAT-1 is a key molecular substrate of the effects of EE on network excitability and consequent stroke recovery and can serve as a novel therapeutic target for stroke treatment during the repair phase.
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Abstract
PURPOSE OF REVIEW To review new evidence on links between poststroke dementia and inflammation. RECENT FINDINGS Although there are still no treatments for poststroke dementia, recent evidence has improved our understanding that stroke increases the risk of incident dementia and worsens cognitive trajectory for at least a decade afterwards. Within approximately the first year dementia onset is associated with stroke severity and location, whereas later absolute risk is associated with more traditional dementia risk factors, such as age and imaging findings. The molecular mechanisms that underlie increased risk of incident dementia in stroke survivors remain unproven; however new data in both human and animal studies suggests links between cognitive decline and inflammation. These point to a model where chronic brain inflammation, provoked by inefficient clearance of myelin debris and a prolonged innate and adaptive immune response, causes poststroke dementia. These localized immune events in the brain may themselves be influenced by the peripheral immune state at key times after stroke. SUMMARY This review recaps clinical evidence on poststroke dementia, new mechanistic links between the chronic inflammatory response to stroke and poststroke dementia, and proposes a model of immune-mediated neurodegeneration after stroke.
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Duncan PW, Bushnell C, Sissine M, Coleman S, Lutz BJ, Johnson AM, Radman M, Pvru Bettger J, Zorowitz RD, Stein J. Comprehensive Stroke Care and Outcomes: Time for a Paradigm Shift. Stroke 2020; 52:385-393. [PMID: 33349012 DOI: 10.1161/strokeaha.120.029678] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Worldwide, stroke is prevalent, costly, and disabling in >80 million survivors. The burden of stroke is increasing despite incredible progress and advancements in evidence-based acute care therapies and despite the substantial changes being made in acute care stroke systems, processes, and quality metrics. Although there has been increased global emphasis on the importance of postacute stroke care, stroke system changes have not expanded to include postacute care and outcome follow-up. Our objectives are to describe the gaps and challenges in postacute stroke care and suboptimal stroke outcomes; to report on stroke survivors' and caregivers' perceptions of current postacute stroke care and their call for improvements in follow-up services for recovery and secondary prevention; and, ultimately, to make the case that a paradigm shift is needed in the definition of comprehensive stroke care and the designation of Comprehensive Stroke Center. Three recommendations are made for a paradigm shift in comprehensive stroke care: (1) criteria should be established for designation of rehabilitation readiness for Comprehensive Stroke Centers, (2) The American Heart Association/American Stroke Association implement an expanded Get With The Guidelines-Stroke program and criteria for comprehensive stroke centers to be inclusive of rehabilitation readiness and measure outcomes at 90 days, and (3) a public health campaign should be launched to offer hopeful and actionable messaging for secondary prevention and recovery of function and health. Now is the time to honor the patients' and caregivers' strongest ask: better access and improved secondary prevention, stroke rehabilitation, and personalized care.
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Affiliation(s)
- Pamela W Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC (P.W.D., C.B., M.S., S.C., M.R.)
| | - Cheryl Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC (P.W.D., C.B., M.S., S.C., M.R.)
| | - Mysha Sissine
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC (P.W.D., C.B., M.S., S.C., M.R.)
| | - Sylvia Coleman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC (P.W.D., C.B., M.S., S.C., M.R.)
| | - Barbara J Lutz
- School of Nursing, University of North Carolina at Wilmington (B.J.L.)
| | - Anna M Johnson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (A.M.J.)
| | - Meghan Radman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC (P.W.D., C.B., M.S., S.C., M.R.)
| | | | - Richard D Zorowitz
- Department of Rehabilitation Medicine, MedStar National Rehabilitation Network and Georgetown University School of Medicine, Washington, DC (R.D.Z.)
| | - Joel Stein
- Department of Rehabilitation Medicine, Cornell University, Weill Cornell Medical College, New York, NY (J.S.)
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Maulet T, Pouplin S, Bensmail D, Zory R, Roche N, Bonnyaud C. Self-rehabilitation combined with botulinum toxin to improve arm function in people with chronic stroke. A randomized controlled trial. Ann Phys Rehabil Med 2020; 64:101450. [PMID: 33152520 DOI: 10.1016/j.rehab.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/06/2020] [Accepted: 10/11/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Botulinum toxin injection (BTI) reduces muscle hyperactivity, but its effect on active upper-limb function is limited. Intensive rehabilitation could optimize the effects; however, outpatient post-stroke rehabilitation is usually not intensive. One solution could be self-rehabilitation. OBJECTIVES The aim of this randomized controlled trial was to determine the effect of a self-rehabilitation program combined with BTI on upper-limb function in individuals with chronic hemiparesis. METHODS In total, 33 outpatients were randomly allocated to receive BTI+self-rehabilitation (R group: n=17) or BTI alone (C group: n=16). Outcomes evaluated just before the BTI and 4 weeks later included the Wolf Motor Function Test (WMFT time: primary outcome), Action Research Arm Test, fatigue and quality of life. RESULTS Change in WMFT did not differ between groups at 4 weeks (WMFT time: -14% for R group, -4% for C group. WFMT score: +12% for R group, 0% in C group). WFMT time and score improved significantly in the R group only (-14%, P=0.01, and +12%, P=0.02). In addition, the proportion of patients with improved WMFT time and score was higher in the R than C group (R group: 71% improved score, 77% improved time; C group: 43% improved score, 50% improved time). Also, passive range of shoulder flexion (P=0.03) and wrist extension (P=0.01) improved only in the R group. No other variables changed significantly. Compliance was excellent; average daily training time was greater than that prescribed. CONCLUSIONS The addition of a self-rehabilitation program to BTI did not significantly improve functional outcomes more than BTI alone; however, movement quality and speed improved only in the self-rehabilitation group. Participants in the self-rehabilitation group trained more than they were asked to, which suggests that they found the program worthwhile. These clinically relevant findings justify larger-scale studies of the effects of self-rehabilitation to enhance the effects of BTI. CLINICAL TRIAL NCT02699762.
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Affiliation(s)
- Théo Maulet
- Physiology and Functional Exploration Department, Raymond-Poincaré Hospital, AP-HP, Garches, France; End: icap laboratory, Inserm Unit 1179, UVSQ, Montigny-le-Bretonneux, France; Paris-Saclay University, UVSQ, Research Unit ERPHAN, 78000 Versailles, France.
| | - Samuel Pouplin
- Paris-Saclay University, UVSQ, Research Unit ERPHAN, 78000 Versailles, France; New Technologies Platform, Raymond-Poincaré Hospital, APHP, Garches, France
| | - Djamel Bensmail
- End: icap laboratory, Inserm Unit 1179, UVSQ, Montigny-le-Bretonneux, France; Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, AP-HP, Garches, France
| | | | - Nicolas Roche
- Physiology and Functional Exploration Department, Raymond-Poincaré Hospital, AP-HP, Garches, France; End: icap laboratory, Inserm Unit 1179, UVSQ, Montigny-le-Bretonneux, France; Côte d'Azur University, LAMHESS, Nice, France
| | - Celine Bonnyaud
- Physiology and Functional Exploration Department, Raymond-Poincaré Hospital, AP-HP, Garches, France; Paris-Saclay University, UVSQ, Research Unit ERPHAN, 78000 Versailles, France
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Cui K, Song R, Xu H, Shang Y, Qi X, Buchman AS, Bennett DA, Xu W. Association of Cardiovascular Risk Burden With Risk and Progression of Disability: Mediating Role of Cardiovascular Disease and Cognitive Decline. J Am Heart Assoc 2020; 9:e017346. [PMID: 32869681 PMCID: PMC7726997 DOI: 10.1161/jaha.120.017346] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cardiovascular risk burden has been linked to cardiovascular disease (CVD) and cognitive decline, but its association with disability is unclear. We aimed to examined the association of cardiovascular risk burden assessed by the Framingham general cardiovascular risk score (FGCRS) with the risk and progression of disability and estimated the extent to which CVD and cognitive decline mediate this association. Methods and Results A total of 1480 older adults with no disabilities (mean age=79.32±7.38 years) from the Rush Memory and Aging Project were followed for up to 21 years. FGCRS at baseline was calculated and categorized into tertiles. Disability was assessed annually with activities of daily living. The number of CVDs was calculated by summing up the CVD events. Global cognitive function was assessed annually with a battery of 19 tests. Data were analyzed using the Cox model, linear mixed effects model, and mediation analysis. At the end of the follow-up, 713 (48.2%) participants developed disability. Compared with the lowest tertile of the FGCRS, the multiadjusted hazards ratios of disability were 1.34 (95% CI, 1.11-1.62) for the highest tertile. In addition, the highest FGCRS was associated with a change in activities of daily living score over time (β=0.057; 95% CI, 0.021-0.093). The association between FGCRS and change in activities of daily living was 13.8% mediated by the accumulation of CVDs and 25.1% by cognitive decline, respectively. Conclusions Higher cardiovascular risk burden increased the risk of disability and accelerated its progression over time. CVD accumulation and cognitive decline may partially mediate the association.
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Affiliation(s)
- Kaiwang Cui
- Department of Epidemiology and BiostatisticsSchool of Public HealthTianjin Medical UniversityTianjinChina
- Tianjin Key Laboratory of Environment, Nutrition and Public HealthTianjinChina
- Center for International Collaborative Research on Environment, Nutrition and Public HealthTianjinChina
| | - Ruixue Song
- Department of Epidemiology and BiostatisticsSchool of Public HealthTianjin Medical UniversityTianjinChina
- Tianjin Key Laboratory of Environment, Nutrition and Public HealthTianjinChina
- Center for International Collaborative Research on Environment, Nutrition and Public HealthTianjinChina
| | - Hui Xu
- Department of Epidemiology and BiostatisticsSchool of Public HealthTianjin Medical UniversityTianjinChina
- Tianjin Key Laboratory of Environment, Nutrition and Public HealthTianjinChina
- Center for International Collaborative Research on Environment, Nutrition and Public HealthTianjinChina
| | - Ying Shang
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Xiuying Qi
- Department of Epidemiology and BiostatisticsSchool of Public HealthTianjin Medical UniversityTianjinChina
- Tianjin Key Laboratory of Environment, Nutrition and Public HealthTianjinChina
- Center for International Collaborative Research on Environment, Nutrition and Public HealthTianjinChina
| | - Aron S. Buchman
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
| | - David A. Bennett
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
| | - Weili Xu
- Department of Epidemiology and BiostatisticsSchool of Public HealthTianjin Medical UniversityTianjinChina
- Tianjin Key Laboratory of Environment, Nutrition and Public HealthTianjinChina
- Center for International Collaborative Research on Environment, Nutrition and Public HealthTianjinChina
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
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Kim M, Yun SM, Jeong J, Jo C, Koh YH. Association between blood lead level and risk of stroke in Korean adults: a cross-sectional study in the Korea National Health and Nutrition Examination Survey 2008-2013. BMJ Open 2020; 10:e035725. [PMID: 32907895 PMCID: PMC7482501 DOI: 10.1136/bmjopen-2019-035725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Although lead is a potential risk factor for cardiovascular diseases such as stroke, research on this association in the Korean population remains limited. Therefore, we aimed to investigate the association between lead level and stroke in Korean adults. DESIGN A population-based cross-sectional study. SETTING The Korea National Health and Nutrition Examination Survey 2008-2013, which enrolled a representative sample of the Korean population. PARTICIPANTS We excluded participants younger than 20 years, missing weight data, pregnant or lactating, and missing blood lead and stroke data. A total of 11 510 participants were included in this analysis. PRIMARY AND SECONDARY OUTCOME MEASUREMENT The participants were classified by blood lead concentration into the low-level (≤2.189 µg/dL, n=5756) and high-level (>2.189 µg/dL, n=5754) groups. The main outcome, stroke, was assessed by information from physician diagnosis, prevalence of stroke or treatment for stroke. The ORs and 95% CIs were calculated to evaluate the association between blood lead level and stroke using multivariate logistic regression analysis. RESULTS Although blood lead level was not significantly associated with stroke (OR: 1.30, 95% CI: 0.66-2.58) in the multivariate-adjusted model, in individuals with hypertension, the high-level group was 2.36-fold higher odds of stroke (OR: 2.36, 95% CI: 1.02-5.44) compared to that in the low-level group. No association was observed in individuals with normotension (OR: 0.42, 95% CI: 0.13-1.38, p for interaction=0.007). CONCLUSION The association between blood lead concentration and stroke may be influenced by hypertension status. Our findings suggest the need for closer attention to lead exposure in patients with hypertension.
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Affiliation(s)
- Minkyeong Kim
- Division of Brain Diseases, Korea National Institute of Health, Cheongju, South Korea
| | - Sang-Moon Yun
- Division of Brain Diseases, Korea National Institute of Health, Cheongju, South Korea
| | - Jihyun Jeong
- Division of Brain Diseases, Korea National Institute of Health, Cheongju, South Korea
| | - Chulman Jo
- Division of Brain Diseases, Korea National Institute of Health, Cheongju, South Korea
| | - Young Ho Koh
- Division of Brain Diseases, Korea National Institute of Health, Cheongju, South Korea
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Fukuda-Doi M, Yamamoto H, Koga M, Palesch YY, Durkalski-Mauldin VL, Qureshi AI, Yoshimura S, Okazaki S, Miwa K, Okada Y, Ueda T, Okuda S, Nakahara J, Suzuki N, Toyoda K. Sex Differences in Blood Pressure-Lowering Therapy and Outcomes Following Intracerebral Hemorrhage: Results From ATACH-2. Stroke 2020; 51:2282-2286. [PMID: 32623977 DOI: 10.1161/strokeaha.120.029770] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Evidence regarding sex differences in clinical outcomes and treatment effect following intracerebral hemorrhage is limited. Using the ATACH-2 trial (Antihypertensive Treatment in Intracerebral Hemorrhage-2) data, we explored whether sex disparities exist in outcomes and response to intensive blood pressure (BP)-lowering therapy. METHODS Eligible intracerebral hemorrhage subjects were randomly assigned to intensive (target systolic BP, 110-139 mm Hg) or standard (140-179 mm Hg) BP-lowering therapy within 4.5 hours after onset. Relative risk of death or disability corresponding to the modified Rankin Scale score of 4 to 6 was calculated, and interaction between sex and treatment was explored. RESULTS In total, 380 women and 620 men were included. Women were older, more prescribed antihypertensive drugs before onset, and had more lobar intracerebral hemorrhage than men. Hematoma expansion was observed less in women. After multivariable adjustment, the relative risk of death or disability in women was 1.19 (95% CI, 1.02-1.37, P=0.023). The relative risk of death or disability between intensive versus standard BP-lowering therapy was 0.91 (95% CI, 0.74-1.13) in women versus 1.13 (95% CI, 0.92-1.39) in men (P for interaction=0.11), with inconclusive Gail-Simmon test (P=0.16). CONCLUSIONS Women had a higher risk of death or disability following intracerebral hemorrhage. The benefit of intensive BP-lowering therapy in women is inconclusive, consistent with the overall results of ATACH-2. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01176565.
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Affiliation(s)
- Mayumi Fukuda-Doi
- Department of Cerebrovascular Medicine (M.F.-D., M.K., S.Y., K.M., K.T.), National Cerebral and Cardiovascular Center, Suita, Japan.,Center for Advancing Clinical and Translational Sciences (M.F.-D., H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan.,Department of Neurology, Keio University School of Medicine, Tokyo, Japan (M.F.-D., J.N., N.S., K.T.)
| | - Haruko Yamamoto
- Center for Advancing Clinical and Translational Sciences (M.F.-D., H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine (M.F.-D., M.K., S.Y., K.M., K.T.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuko Y Palesch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston (Y.Y.P., V.L.D.-M.)
| | | | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute, St. Cloud, MN (A.I.Q.).,Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine (M.F.-D., M.K., S.Y., K.M., K.T.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shuhei Okazaki
- Department of Neurology (S. Okazaki), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine (M.F.-D., M.K., S.Y., K.M., K.T.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center Clinical Research Institute, Fukuoka, Japan (Y.O.)
| | - Toshihiro Ueda
- Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Japan (T.U.)
| | - Satoshi Okuda
- Department of Neurology, National Hospital Organization Nagoya Medical Center, Japan (S. Okuda)
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan (M.F.-D., J.N., N.S., K.T.)
| | - Norihiro Suzuki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan (M.F.-D., J.N., N.S., K.T.)
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine (M.F.-D., M.K., S.Y., K.M., K.T.), National Cerebral and Cardiovascular Center, Suita, Japan.,Department of Neurology, Keio University School of Medicine, Tokyo, Japan (M.F.-D., J.N., N.S., K.T.)
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Duncan PW, Bushnell CD, Jones SB, Psioda MA, Gesell SB, D'Agostino RB, Sissine ME, Coleman SW, Johnson AM, Barton-Percival BF, Prvu-Bettger J, Calhoun AG, Cummings DM, Freburger JK, Halladay JR, Kucharska-Newton AM, Lundy-Lamm G, Lutz BJ, Mettam LH, Pastva AM, Xenakis JG, Ambrosius WT, Radman MD, Vetter B, Rosamond WD. Randomized Pragmatic Trial of Stroke Transitional Care: The COMPASS Study. Circ Cardiovasc Qual Outcomes 2020; 13:e006285. [PMID: 32475159 DOI: 10.1161/circoutcomes.119.006285] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The objectives of this study were to develop and test in real-world clinical practice the effectiveness of a comprehensive postacute stroke transitional care (TC) management program. Methods and Results The COMPASS study (Comprehensive Post-Acute Stroke Services) was a pragmatic cluster-randomized trial where the hospital was the unit of randomization. The intervention (COMPASS-TC) was initiated at 20 hospitals, and 20 hospitals provided their usual care. Hospital staff enrolled 6024 adult stroke and transient ischemic attack patients discharged home between 2016 and 2018. COMPASS-TC was patient-centered and assessed social and functional determinates of health to inform individualized care plans. Ninety-day outcomes were evaluated by blinded telephone interviewers. The primary outcome was functional status (Stroke Impact Scale-16); secondary outcomes were mortality, disability, medication adherence, depression, cognition, self-rated health, fatigue, care satisfaction, home blood pressure monitoring, and falls. The primary analysis was intention to treat. Of intervention hospitals, 58% had uninterrupted intervention delivery. Thirty-five percent of patients at intervention hospitals attended a COMPASS clinic visit. The primary outcome was measured for 59% of patients and was not significantly influenced by the intervention. Mean Stroke Impact Scale-16 (±SD) was 80.6±21.1 in TC versus 79.9±21.4 in usual care. Home blood pressure monitoring was self-reported by 72% of intervention patients versus 64% of usual care patients (adjusted odds ratio, 1.43 [95% CI, 1.21-1.70]). No other secondary outcomes differed. Conclusions Although designed according to the best available evidence with input from various stakeholders and consistent with Centers for Medicare and Medicaid Services TC policies, the COMPASS model of TC was not consistently incorporated into real-world health care. We found no significant effect of the intervention on functional status at 90 days post-discharge. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02588664.
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Affiliation(s)
- Pamela W Duncan
- Department of Neurology (P.W.D., C.D.B., M.E.S., S.W.C., M.D.R.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Cheryl D Bushnell
- Department of Neurology (P.W.D., C.D.B., M.E.S., S.W.C., M.D.R.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Sara B Jones
- Department of Epidemiology, Gillings School of Global Public Health (S.B.J., A.M.J., A.M.K.-N., L.H.M., W.D.R.), University of North Carolina at Chapel Hill
| | - Matthew A Psioda
- Department of Biostatistics, Collaborative Studies Coordinating Center (M.A.P.), University of North Carolina at Chapel Hill
| | - Sabina B Gesell
- Social Sciences and Health Policy, Division of Public Health Sciences (S.B.G.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Ralph B D'Agostino
- Division of Public Health Sciences, Department of Biostatistics and Data Science (R.B.D., W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Mysha E Sissine
- Department of Neurology (P.W.D., C.D.B., M.E.S., S.W.C., M.D.R.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Sylvia W Coleman
- Department of Neurology (P.W.D., C.D.B., M.E.S., S.W.C., M.D.R.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Anna M Johnson
- Department of Epidemiology, Gillings School of Global Public Health (S.B.J., A.M.J., A.M.K.-N., L.H.M., W.D.R.), University of North Carolina at Chapel Hill
| | | | | | - Adrienne G Calhoun
- Area Agency on Aging, Piedmont Triad Regional Council, Kernersville, NC (B.F.B.-P., A.G.C.)
| | - Doyle M Cummings
- Brody School of Medicine, East Carolina University, Greenville, NC (D.M.C.)
| | - Janet K Freburger
- Department of Physical Therapy School of Health and Rehabilitation Science, University of Pittsburgh, PA (J.K.F.)
| | - Jacqueline R Halladay
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill (J.R.H.)
| | - Anna M Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health (S.B.J., A.M.J., A.M.K.-N., L.H.M., W.D.R.), University of North Carolina at Chapel Hill
| | | | - Barbara J Lutz
- University of North Carolina at Wilmington School of Nursing (B.J.L.)
| | - Laurie H Mettam
- Department of Epidemiology, Gillings School of Global Public Health (S.B.J., A.M.J., A.M.K.-N., L.H.M., W.D.R.), University of North Carolina at Chapel Hill
| | - Amy M Pastva
- Duke University School of Medicine, Durham, NC (J.P.-B., A.M.P.)
| | - James G Xenakis
- Department of Biostatistics, Gillings School of Global Public Health (J.G.X.), University of North Carolina at Chapel Hill
| | - Walter T Ambrosius
- Division of Public Health Sciences, Department of Biostatistics and Data Science (R.B.D., W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Meghan D Radman
- Department of Neurology (P.W.D., C.D.B., M.E.S., S.W.C., M.D.R.), Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Wayne D Rosamond
- Department of Epidemiology, Gillings School of Global Public Health (S.B.J., A.M.J., A.M.K.-N., L.H.M., W.D.R.), University of North Carolina at Chapel Hill
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46
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4927] [Impact Index Per Article: 1231.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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47
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5401] [Impact Index Per Article: 1080.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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48
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Tsai AS, Berry K, Beneyto MM, Gaudilliere D, Ganio EA, Culos A, Ghaemi MS, Choisy B, Djebali K, Einhaus JF, Bertrand B, Tanada A, Stanley N, Fallahzadeh R, Baca Q, Quach LN, Osborn E, Drag L, Lansberg MG, Angst MS, Gaudilliere B, Buckwalter MS, Aghaeepour N. A year-long immune profile of the systemic response in acute stroke survivors. Brain 2019; 142:978-991. [PMID: 30860258 DOI: 10.1093/brain/awz022] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/18/2018] [Accepted: 12/14/2018] [Indexed: 02/07/2023] Open
Abstract
Stroke is a leading cause of cognitive impairment and dementia, but the mechanisms that underlie post-stroke cognitive decline are not well understood. Stroke produces profound local and systemic immune responses that engage all major innate and adaptive immune compartments. However, whether the systemic immune response to stroke contributes to long-term disability remains ill-defined. We used a single-cell mass cytometry approach to comprehensively and functionally characterize the systemic immune response to stroke in longitudinal blood samples from 24 patients over the course of 1 year and correlated the immune response with changes in cognitive functioning between 90 and 365 days post-stroke. Using elastic net regularized regression modelling, we identified key elements of a robust and prolonged systemic immune response to ischaemic stroke that occurs in three phases: an acute phase (Day 2) characterized by increased signal transducer and activator of transcription 3 (STAT3) signalling responses in innate immune cell types, an intermediate phase (Day 5) characterized by increased cAMP response element-binding protein (CREB) signalling responses in adaptive immune cell types, and a late phase (Day 90) by persistent elevation of neutrophils, and immunoglobulin M+ (IgM+) B cells. By Day 365 there was no detectable difference between these samples and those from an age- and gender-matched patient cohort without stroke. When regressed against the change in the Montreal Cognitive Assessment scores between Days 90 and 365 after stroke, the acute inflammatory phase Elastic Net model correlated with post-stroke cognitive trajectories (r = -0.692, Bonferroni-corrected P = 0.039). The results demonstrate the utility of a deep immune profiling approach with mass cytometry for the identification of clinically relevant immune correlates of long-term cognitive trajectories.
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Affiliation(s)
- Amy S Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
| | - Kacey Berry
- Stanford Stroke Center, Stanford School of Medicine, CA, USA.,Department of Neurology and Neurological Sciences, Stanford School of Medicine, CA, USA
| | - Maxime M Beneyto
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
| | - Dyani Gaudilliere
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, CA, USA
| | - Edward A Ganio
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
| | - Anthony Culos
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
| | - Mohammad S Ghaemi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
| | - Benjamin Choisy
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
| | - Karim Djebali
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
| | - Jakob F Einhaus
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
| | - Basile Bertrand
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
| | - Athena Tanada
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
| | - Natalie Stanley
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
| | - Ramin Fallahzadeh
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
| | - Quentin Baca
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
| | - Lisa N Quach
- Stanford Stroke Center, Stanford School of Medicine, CA, USA.,Department of Neurology and Neurological Sciences, Stanford School of Medicine, CA, USA
| | - Elizabeth Osborn
- Stanford Stroke Center, Stanford School of Medicine, CA, USA.,Department of Neurology and Neurological Sciences, Stanford School of Medicine, CA, USA
| | - Lauren Drag
- Department of Neurology and Neurological Sciences, Stanford School of Medicine, CA, USA
| | - Maarten G Lansberg
- Stanford Stroke Center, Stanford School of Medicine, CA, USA.,Department of Neurology and Neurological Sciences, Stanford School of Medicine, CA, USA
| | - Martin S Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
| | - Marion S Buckwalter
- Stanford Stroke Center, Stanford School of Medicine, CA, USA.,Department of Neurology and Neurological Sciences, Stanford School of Medicine, CA, USA.,Department of Neurosurgery, Stanford School of Medicine, CA, USA
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, CA, USA
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49
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Blöchl M, Meissner S, Nestler S. Does depression after stroke negatively influence physical disability? A systematic review and meta-analysis of longitudinal studies. J Affect Disord 2019; 247:45-56. [PMID: 30654265 DOI: 10.1016/j.jad.2018.12.082] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/11/2018] [Accepted: 12/24/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Depression after stroke is common and has been proposed to negatively affect disability by preventing optimal physical rehabilitation and recovery. However, the nature of this influence remains poorly understood. Here, we synthesise longitudinal studies to examine the hypotheses that depression after stroke (i) hampers physical rehabilitation, (ii) prevents functional improvement during recovery, and (iii) is associated with poor functional outcomes. METHODS A systematic literature search was conducted using the databases PubMed and Web of Science. A total of 5672 studies were screened; 28 met criteria for inclusion. The quality of included studies was assessed using the Newcastle-Ottawa Scale. RESULTS Individual studies showed no consistent effects of depression post-stroke on (i) the effectiveness of physical rehabilitation and (ii) functional improvements during recovery. In contrast, random-effects models revealed that (iii) depression after stroke was associated with an increased risk for poor long-term disability (OR: 2.16, 95% CI 1.70-2.77). Overall, the quality of studies was moderate and there was evidence for publication bias. LIMITATIONS The number of included studies was small. There was considerable methodological heterogeneity between studies, prohibiting meta-analyses for all effects of interest. Few studies examined the influence of antidepressants. CONCLUSIONS Depressed stroke patients are generally more disabled. However, depressed mood might not restrict improvements in physical disability during rehabilitation and recovery, although it seems to be linked to a delayed increase in the risk of poor functional outcome. High-quality evidence from longitudinal studies is needed to clarify the precise mechanisms and temporal dynamics underlying these associations.
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Affiliation(s)
- Maria Blöchl
- Department for Psychology, University of Leipzig, Germany; International Max Plank Research School: Neuroscience of Communication: Structure, Function, and Plasticity, Leipzig, Germany.
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50
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Musa KI, Keegan TJ. The change of Barthel Index scores from the time of discharge until 3-month post-discharge among acute stroke patients in Malaysia: A random intercept model. PLoS One 2018; 13:e0208594. [PMID: 30571691 PMCID: PMC6301695 DOI: 10.1371/journal.pone.0208594] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 11/20/2018] [Indexed: 02/05/2023] Open
Abstract
Background Acute stroke results in functional disability measurable using the well-known Barthel Index. The objectives of the study are to describe the change in the Barthel Index score and to model the prognostic factors for Barthel Index change from discharge up to 3 months post-discharge using the random intercept model among patients with acute first ever stroke in Kelantan, Malaysia. Methods A total 98 in-hospital first ever acute stroke patients were recruited, and their Barthel Index scores were measured at the time of discharge, at 1 month and 3 months post-discharge. The Barthel Index was scored through telephone interviews. We employed the random intercept model from linear mixed effect regression to model the change of Barthel Index scores during the three months intervals. The prognostic factors included in the model were acute stroke subtypes, age, sex and time of measurement (at discharge, at 1 month and at 3 month post-discharge). Results The crude mean Barthel Index scores showed an increased trend. The crude mean Barthel Index at the time of discharge, at 1-month post-discharge and 3 months post-discharge were 35.1 (SD = 39.4), 64.4 (SD = 39.5) and 68.8 (SD = 38.9) respectively. Over the same period, the adjusted mean Barthel Index scores estimated from the linear mixed effect model increased from 39.6 to 66.9 to 73.2. The adjusted mean Barthel Index scores decreased as the age increased, and haemorrhagic stroke patients had lower adjusted mean Barthel Index scores compared to the ischaemic stroke patients. Conclusion Overall, the crude and adjusted mean Barthel Index scores increase from the time of discharge up to 3-month post-discharge among acute stroke patients. Time after discharge, age and stroke subtypes are the significant prognostic factors for Barthel Index score changes over the period of 3 months.
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Affiliation(s)
- Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kbg Kerian, Kelantan, Malaysia
- * E-mail:
| | - Thomas J. Keegan
- The Centre for Health Informatics, Computing, and Statistics (CHICAS), Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
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