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Legasto-Mulvale JM, Inness EL, Thompson AN, Chandran N, Mathur S, Salbach NM. Adverse Events During Submaximal Aerobic Exercise Testing in People With Subacute Stroke: A Scoping Review. J Neurol Phys Ther 2024; 48:27-37. [PMID: 37184472 DOI: 10.1097/npt.0000000000000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND PURPOSE Concern for adverse cardiovascular events and limited guidance regarding how to conduct aerobic exercise (AEx) testing for individuals poststroke are key barriers to implementation by physical therapists in stroke rehabilitation. This study aimed to describe the nature and safety of submaximal AEx testing protocols for people with subacute stroke (PwSS) and the nature of comorbidity of PwSS who underwent submaximal AEx testing. METHODS We conducted a scoping review and searched MEDLINE, EMBASE, PsycINFO, CINAHL, and SPORTDiscus from inception to October 29, 2020. Studies involving submaximal AEx testing with PwSS, reporting on participant comorbidity and on adverse events during testing, were eligible. Two reviewers independently conducted title and abstract and full-text screening. One reviewer extracted data; a second reviewer verified data. RESULTS Thirteen studies involving 452 participants and 19 submaximal AEx testing protocols (10 field test, 7 incremental, and 2 constant load) were included. Hypertension (41%), diabetes (31%), and dyslipidemia (27%) were the most common comorbidities reported. No protocols resulted in a serious adverse event. The most common test termination criterion was a heart rate (HR) limit (9 protocols); a limit of 85% age-predicted maximal HR (APM-HR) most frequently reported. Average APM-HR achieved, computed using mean age and mean peak HR, ranged from 59% to 88% across 13 protocols. DISCUSSION AND CONCLUSION Diverse submaximal AEx testing protocols with conservative test termination criteria can be safely implemented with PwSS. Results can inform clinical practice guidelines and address physical therapists' concerns with the occurrence of serious adverse events during submaximal AEx testing.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A430 ).
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Affiliation(s)
- Jean Michelle Legasto-Mulvale
- Rehabilitation Sciences Institute (J.M.L.M., E.L.I., A.N.T., N.C., S.M., N.M.S.) and Department of Physical Therapy (J.M.L.M., E.L.I., S.M., N.M.S), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; The KITE Research Institute, Toronto Rehabilitation Institute (E.L.I., N.M.S), University Health Network, Toronto, Ontario, Canada; and School of Rehabilitation Therapy (S.M.), Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
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Rhein J, Charbonnier G, Nacher M, Gaudron M, Moulin T, Rochemont DR, Cottier JP, Montagnac C, Sabbah N, de Toffol B. Prospective observational study of stroke in Cayenne, Tours and Besançon: The BECATOUR study. Rev Neurol (Paris) 2023; 179:975-982. [PMID: 37487805 DOI: 10.1016/j.neurol.2023.02.068] [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: 07/26/2022] [Revised: 12/13/2022] [Accepted: 02/25/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Stroke is a major public health issue. Its epidemiology is still poorly known in French Guiana. METHOD We conducted a prospective observational study including 100 consecutive patients hospitalized for stroke in Cayenne (in French Guiana), and Tours and Besançon (in metropolitan France). We compared their age, medical history, cardiovascular risk factors, pre-admission Rankin score, Glasgow and NIHSS scores, usual treatments, acute phase management, type of stroke, duration of hospitalization, mechanism of stroke according to TOAST classification, NIHSS and Rankin scores at discharge, discharge treatments, and mode of discharge. RESULTS In French Guiana, the average age of patients was 7years lower (62 y), patients were more frequently affected by hypertension (75%) and diabetes (31%). Lacunar strokes were overrepresented (16.1%), and infarctions of cardioembolic origin were underrepresented (12%). NIHSS entry and Glasgow scores were similar between French Guiana and mainland France. Acute management was different: thrombolysis rate (9.3%) was 3 to 4 times lower, thrombectomy was not available. Fewer patients were transferred to rehabilitation centers and more patients were transferred to home hospitalization. DISCUSSION In Tours and Besançon, patients eligible for thrombectomy were overrepresented. This bias explains the overrepresentation of more severe infarctions and probably the overrepresentation of strokes of cardioembolic origin. Infarctions of undetermined origin were more numerous in French Guiana because patients were often discharged from hospital with an incomplete cardiological workup. CONCLUSION Despite some caveats, the profile of patients admitted for stroke in French Guiana is different from mainland France. The establishment of a stroke unit and an information campaign on the symptoms of stroke would allow better management.
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Affiliation(s)
- J Rhein
- Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - G Charbonnier
- Neurology Department, University Hospital Centre Besançon, 25000 Besançon, France
| | - M Nacher
- Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - M Gaudron
- Neurology Department, CHU Bretonneau, 37044 Tours cedex, France
| | - T Moulin
- Neurology Department, University Hospital Centre Besançon, 25000 Besançon, France
| | - D R Rochemont
- Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - J-P Cottier
- Neuroradiology Department, CHU Bretonneau, 37044 Tours cedex, France
| | - C Montagnac
- Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - N Sabbah
- Endocrinology Department, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - B de Toffol
- Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana.
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Teodoro RS, Sampaio Silva G, Modolo GP, Trivellato SDA, de Souza JT, Luvizutto GJ, Nunes HRDC, Martin LC, Bazan R, Zanati Bazan SG. The Role of Transthoracic Echocardiography in the Evaluation of Patients With Ischemic Stroke. Front Cardiovasc Med 2021; 8:710334. [PMID: 34513953 PMCID: PMC8432611 DOI: 10.3389/fcvm.2021.710334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Ischemic stroke can be classified into five etiological types, according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and its adequate investigation and characterization can aid in its clinical management and in preventing new events. Transthoracic echocardiography (TTE) plays a key role in investigating its etiology; approximately one-third of the patients remain without an adequate definition of the etiology or are classified as the undetermined TOAST type. Objectives: To evaluate if the percentage of patients with indeterminate etiology according to the TOAST classification decreased after transthoracic echocardiography, to determine whether or not the prognosis after ischemic stroke is worse among patients classified as the undetermined TOAST type, and to verify the predictive capacity of echocardiography on the prognosis after ischemic stroke. Methods: In this retrospective cohort study, clinical, neurological, and echocardiographic examinations were conducted when the patient was hospitalized for stroke. In-hospital mortality and functional capacity were evaluated at hospital discharge and 90 days thereafter. Multiple linear regression and multiple logistic regression models were adjusted for confounding factors. The level of significance was 5%. Results: A total of 1,100 patients (men = 606; 55.09%), with a mean age of 68.1 ± 13.3 years, were included in this study. Using TTE, 977 patients (88.82%) were evaluated and 448 patients (40.7%) were classified as the undetermined TOAST type. The patients who underwent TTE were 3.1 times less likely to classified as the undetermined TOAST type (OR = 0.32; p < 0.001). Echocardiography during hospitalization was a protective factor against poor prognosis, and reduced the odds of in-hospital death by 11.1 times (OR: 0.090; p < 0.001). However, the presence of the undetermined TOAST classification elevated the chance of mortality during hospitalization by 2.0 times (OR: 2.00; p = 0.013). Conclusions: Echocardiography during hospitalization for ischemic stroke reduces the chances of an undetermined TOAST classification and the risk of in-hospital mortality. However, being classified as the undetermined TOAST type increases the chance of mortality during hospitalization, suggesting that evaluating patients using echocardiography during hospitalization for acute ischemic stroke is important.
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Affiliation(s)
- Robson Sarmento Teodoro
- Department of Internal Medicine, Botucatu Medical School - Universidade Estadual Paulista "Julio de Mesquita Filho" (UNESP), São Paulo State University, Botucatu, Brazil
| | - Gisele Sampaio Silva
- Department of Vascular Neurology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Gabriel Pinheiro Modolo
- Department of Neurology, Botucatu Medical School - Universidade Estadual Paulista "Julio de Mesquita Filho" (UNESP), São Paulo State University, Botucatu, Brazil
| | - Stella De Angelis Trivellato
- Department of Neurology, Botucatu Medical School - Universidade Estadual Paulista "Julio de Mesquita Filho" (UNESP), São Paulo State University, Botucatu, Brazil
| | - Juli Thomaz de Souza
- Department of Internal Medicine, Botucatu Medical School - Universidade Estadual Paulista "Julio de Mesquita Filho" (UNESP), São Paulo State University, Botucatu, Brazil
| | - Gustavo José Luvizutto
- Department of Applied Physiotherapy, Triangulo Mineiro Federal University, Uberaba, Brazil
| | - Hélio Rubens de Carvalho Nunes
- Department of Biostatistics, Botucatu Medical School - Universidade Estadual Paulista "Julio de Mesquita Filho" (UNESP), São Paulo State University, Botucatu, Brazil
| | - Luis Cuadrado Martin
- Department of Internal Medicine, Botucatu Medical School - Universidade Estadual Paulista "Julio de Mesquita Filho" (UNESP), São Paulo State University, Botucatu, Brazil
| | - Rodrigo Bazan
- Department of Neurology, Botucatu Medical School - Universidade Estadual Paulista "Julio de Mesquita Filho" (UNESP), São Paulo State University, Botucatu, Brazil
| | - Silméia Garcia Zanati Bazan
- Department of Internal Medicine, Botucatu Medical School - Universidade Estadual Paulista "Julio de Mesquita Filho" (UNESP), São Paulo State University, Botucatu, Brazil
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Savsin M, Dubourg D, Coppieters Y, Collart P. [Analysis of comorbidities in hospitalized patients for ischemic stroke and their effects on lethality]. Ann Cardiol Angeiol (Paris) 2020; 69:31-36. [PMID: 31542203 DOI: 10.1016/j.ancard.2019.07.008] [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: 09/27/2018] [Revised: 03/07/2019] [Accepted: 07/22/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of the study consists of analyzing the comorbidities of acute ischemic stroke and those influencing its hospital lethality. METHODS We considered patients from Wallonia aged 25 years or more and admitted to a Belgian hospital for an acute ischemic stroke in 2013 and 2014. The analyzed medico-administrative data are taken from the Minimum Hospital Summary. A factorial correspondence analysis (FCA) was used to demonstrate the comorbidities profiles. A logistic regression was used to analyse the comorbidities influencing hospital lethality by ischemic stroke. RESULTS The stroke risk factors vary according to the age. Cardiac problems are more common in older people aged 85 years or more. High blood pressure, hypercholesterolemia and diabetes are more present between 65- and 84-year-olds. Overweight is more present between 55 and 74-year-olds. People who are addicted to alcohol or tobacco are often 65 years or younger. The logistic regression showed that age and heart problems are the risk factors that increase lethality. However there is a lethality diminution in the presence of high blood pressure, hypercholesterolemia, overweight and addiction to alcohol or tobacco. CONCLUSION This study demonstrates that medico-administrative databases and factorial statistical methods are perfectly adapted to confirm the ischemic stroke risk factors. This type of study will allow to target with more precision the secondary and tertiary prevention actions of stroke.
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Affiliation(s)
- M Savsin
- Centre de recherche épidémiologie, biostatistiques et recherche clinique, école de santé publique, université libre de Bruxelles (U.L.B.), Route de Lennik 808, CP 596, 1070 Brussels, Belgique.
| | - D Dubourg
- Agence pour une vie de qualité, rue de la Rivelaine 21, 6061 Charleroi, Belgique.
| | - Y Coppieters
- Centre de recherche épidémiologie, biostatistiques et recherche clinique, école de santé publique, université libre de Bruxelles (U.L.B.), Route de Lennik 808, CP 596, 1070 Brussels, Belgique.
| | - P Collart
- Centre de recherche épidémiologie, biostatistiques et recherche clinique, école de santé publique, université libre de Bruxelles (U.L.B.), Route de Lennik 808, CP 596, 1070 Brussels, Belgique; Agence pour une vie de qualité, rue de la Rivelaine 21, 6061 Charleroi, Belgique.
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The prevalence of disability among people with cancer, cardiovascular disease, chronic respiratory disease and/or diabetes: a systematic review. INT J EVID-BASED HEA 2019; 16:154-166. [PMID: 29608458 DOI: 10.1097/xeb.0000000000000138] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD), cancer, diabetes and chronic respiratory disease are noncommunicable diseases (NCDs) that cause extensive social and economic burden worldwide, particularly in low-income and middle-income countries. There is growing recognition of the importance of the disabilities that individuals experience as a consequence of these NCDs. OBJECTIVES This systematic review examined the prevalence of disabilities associated with cancer, CVD, chronic respiratory disease and diabetes. METHODS A comprehensive literature search was conducted in PubMed, CINAHL, Embase, Web of Science, PsycINFO, CIRRIE, WHO database, LILACS and AIM. Studies were included if their samples were representative of people with at least one of these four conditions and if prevalence estimates of disability were provided. As random sampling was not feasible in the majority of cases, studies were included where they offered evidence that their sample was representative of the general population being investigated. RESULTS A total of 105 articles were included in the review. Most studies were conducted in high-income countries. The prevalence of difficulties with activities of daily living (i.e. eating, bathing, dressing) was reported to be 10.4-34.5% amongst cancer survivors, 21.1-64.1% in those with CVD, 7.4-49.8% in those with chronic respiratory disease and 12.2-54.5% for those with diabetes. The prevalence of a range of other physical, cognitive and psychological impairments (systemic or structural) was additionally described for each disease. CONCLUSION Substantial proportions of people with cancer, CVD, chronic respiratory disease or diabetes experience some form of disability - although there was great variance in prevalence and definitions. The findings of this review support the evidence base of global impact associated with NCD, indicate frequency measures for specific disabilities and inabilities associated with each NCD and provide direction for future systematic reviews. WHAT IS KNOWN ABOUT THE TOPIC WHAT THIS ARTICLE ADDS.
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Sánchez-Larsen Á, García-García J, Ayo-Martín O, Hernández-Fernández F, Díaz-Maroto I, Fernández-Díaz E, Monteagudo M, Segura T. Has the aetiology of ischaemic stroke changed in the past decades? Analysis and comparison of data from current and historical stroke databases. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Polese JC, Faria-Fortini ID, Basílio ML, Faria GSE, Teixeira-Salmela LF. Recruitment rate and retention of stroke subjects in cross-sectional studies. CIENCIA & SAUDE COLETIVA 2017; 22:255-260. [DOI: 10.1590/1413-81232017221.14262015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/10/2015] [Indexed: 11/21/2022] Open
Abstract
Abstract This article aimed to determine the recruitment rate of chronic stroke survivors to cross-sectional studies and to determine their retention at the two days of assessments. Participants after six months of a unilateral stroke were screened for eligibility and invited to participate in two cross-sectional studies, by telephone. The number of people who were screened, eligible, and successfully recruited was recorded. Retention at the two days of assessments was also recorded. From a list of 654 individuals, 87 were ineligible. Of the 567 left, 216 had wrong contact numbers, 144 refused to participate, and 12 had died. A total of 165 subjects participated in both studies. Out of the 56 who agreed to attend to the second day of assessment, eight did not return. The results showed that individuals with chronic stroke had low rates of recruitment and retention.
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Satue E, Vila-Corcoles A, Ochoa-Gondar O, de Diego C, Forcadell MJ, Rodriguez-Blanco T, Barnes L, Jariod M. Incidence and risk conditions of ischemic stroke in older adults. Acta Neurol Scand 2016; 134:250-7. [PMID: 26592375 DOI: 10.1111/ane.12535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this study was to investigate incidence and mortality from ischemic stroke in older adults with specific underlying chronic conditions, evaluating the influence of these conditions in developing stroke. MATERIALS & METHODS Population-based cohort study involving 27,204 individuals ≥60 years old in Southern Catalonia, Spain. All cases of hospitalization from ischemic stroke (confirmed by neuro-imaging) were collected from 01/12/2008 until 30/11/2011. Incidence rates and 30-day mortality were estimated according to age, sex, chronic illnesses, and underlying conditions. Multivariable Cox regression analysis was used to calculate Hazards Ratio (HR) and estimate the association between baseline conditions and risk of developing stroke. RESULTS Mean incidence rate reached 453 cases per 100,000 person-years. Maximum rates appeared among individuals with history of prior stroke (2926 per 100,000), atrial fibrillation (1815 per 100,000), coronary artery disease (1104 per 100,000), nursing-home residence (1014 per 100,000), and advanced age ≥80 years (1006 per 100,000). Thirty-day mortality was 13% overall, reaching 21% among patients over 80 years. Age [HR: 1.06; 95% confidence interval (CI): 1.04-1.07], history of prior stroke (HR: 5.08; 95% CI: 3.96-6.51), history of coronary artery disease (HR: 1.65; 95% CI: 1.21-2.25), atrial fibrillation (HR: 2.96; 95% CI: 2.30-3.81), diabetes mellitus (HR: 1.55; 95% CI: 1.23-1.95), and smoking (HR: 1.64; 95% CI: 1.15-2.34) emerged independently associated with an increased risk of ischemic stroke. CONCLUSION Incidence and mortality from ischemic stroke remains considerable. Apart from age and history of atherosclerosis (prior stroke or coronary artery disease), atrial fibrillation, diabetes, and smoking were the underlying conditions most strongly associated with an increased risk.
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Affiliation(s)
- E. Satue
- Primary Care Service ‘Camp de Tarragona’; Institut Catala de la Salut; Tarragona Spain
| | - A. Vila-Corcoles
- Primary Care Service ‘Camp de Tarragona’; Institut Catala de la Salut; Tarragona Spain
| | - O. Ochoa-Gondar
- Primary Care Service ‘Camp de Tarragona’; Institut Catala de la Salut; Tarragona Spain
| | - C. de Diego
- Primary Care Service ‘Camp de Tarragona’; Institut Catala de la Salut; Tarragona Spain
| | - M. J. Forcadell
- Primary Care Service ‘Camp de Tarragona’; Institut Catala de la Salut; Tarragona Spain
| | | | - L. Barnes
- Sant Pau i Santa Tecla Hospital; Tarragona Spain
| | - M. Jariod
- Joan XXIII Hospital; Tarragona Spain
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Sánchez-Larsen Á, García-García J, Ayo-Martín O, Hernández-Fernández F, Díaz-Maroto I, Fernández-Díaz E, Monteagudo M, Segura T. Has the aetiology of ischaemic stroke changed in the past decades? Analysis and comparison of data from current and historical stroke databases. Neurologia 2016; 33:S0213-4853(16)30168-2. [PMID: 27645775 DOI: 10.1016/j.nrl.2016.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/04/2016] [Accepted: 07/12/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES We aimed to determine whether the aetiology of ischaemic stroke has changed in recent years and, if so, to ascertain the possible reasons for these changes. PATIENTS AND METHODS We analysed the epidemiological history and vascular risk factors of all patients diagnosed with ischaemic stroke at Complejo Hospitalario Universitario de Albacete (CHUA) from 2009 to 2014. Ischaemic stroke subtypes were established using the TOAST criteria. Our results were compared to data from the classic Stroke Data Bank (SDB); in addition, both series were compared to those of other hospital databases covering the period between the two. RESULTS We analysed 1664 patients (58% were men) with a mean age of 74 years. Stroke aetiology in both series (CHUA, SDB) was as follows: atherosclerosis (12%, 9%), small-vessel occlusion (13%, 25%), cardioembolism (32%, 19%), stroke of other determined aetiology (3%, 4%), and stroke of undetermined aetiology (40%, 44%). Sixty-three percent of the patients from the CHUA and 42% of the patients from the SDB were older than 70 years. Cardioembolic strokes were more prevalent in patients older than 70 years in both series. Untreated hypertension was more frequent in the SDB (SDB = 31% vs CHUA = 10%). The analysis of other databases shows that the prevalence of cardioembolic stroke is increasing worldwide. CONCLUSIONS Our data show that the prevalence of lacunar strokes is decreasing worldwide whereas cardioembolic strokes are increasingly more frequent in both our hospital and other series compared to the SDB. These differences may be explained by population ageing and the improvements in management of hypertension and detection of cardioembolic arrhythmias in stroke units.
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Affiliation(s)
- Á Sánchez-Larsen
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España.
| | - J García-García
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
| | - O Ayo-Martín
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
| | | | - I Díaz-Maroto
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
| | - E Fernández-Díaz
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
| | - M Monteagudo
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
| | - T Segura
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
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Abstract
The burden of stroke is increasing due to aging population and unhealthy lifestyle habits. The considerable rise in atrial fibrillation (AF) is due to greater diffusion of risk factors and screening programs. The link between AF and ischemic stroke is strong. The subtype most commonly associated with AF is cardioembolic stroke, which is particularly severe and shows the highest rates of mortality and permanent disability. A trend toward a higher prevalence of cardioembolic stroke in high-income countries is probably due to the greater diffusion of AF and the control of atherosclerotic of risk factors.
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Affiliation(s)
- Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy.
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy
| | - Cindy Tiseo
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy
| | - Diana Degan
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy
| | - Antonio Carolei
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy
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Nacu A, Fromm A, Sand KM, Waje‐Andreassen U, Thomassen L, Naess H. Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian Stroke Cooperation Study. Acta Neurol Scand 2016; 133:202-7. [PMID: 26032994 PMCID: PMC4744685 DOI: 10.1111/ane.12446] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Age dependency of acute ischaemic stroke aetiology and vascular risk factors have not been adequately evaluated in stroke patients in Norway. Aims of this study were to evaluate how stroke subtypes and vascular risk factors vary with age in a western Norway stroke population. MATERIALS AND METHODS Patients aged 15-100 years consecutively admitted to our neurovascular centre with acute ischaemic stroke between 2006 and 2012 were included. The study population was categorized as young (15-49 years), middle-aged (50-74 years) or elderly (≥ 75 years). Stroke aetiology was defined by TOAST criteria. Risk factors and history of cardiovascular disease were recorded. RESULTS In total, 2484 patients with acute cerebral infarction were included: 1418 were males (57.3%). Mean age was 70.8 years (SD ± 14.9), 228 patients were young, 1126 middle-aged, and 1130 were elderly. The proportion of large-artery atherosclerosis and of small-vessel occlusion was highest among middle-aged patients. The proportion of cardioembolism was high at all ages, especially among the elderly. The proportion of stroke of other determined cause was highest among young patients. Some risk factors (diabetes mellitus, active smoking, angina pectoris, prior stroke and peripheral artery disease) decreased among the elderly. The proportions of several potential causes increased with age. CONCLUSION The proportion of stroke subtypes and vascular risk factors are age dependent. Age 50-74 years constitutes the period in life where cardiovascular risk factors become manifest and stroke subtypes change.
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Affiliation(s)
- A. Nacu
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - A. Fromm
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - K. M. Sand
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - U. Waje‐Andreassen
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
| | - L. Thomassen
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - H. Naess
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
- Centre for Age‐Related Medicine Stavanger University Hospital Stavanger Norway
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Desveaux L. The future of chronic disease management: melting pot or mosaic? Physiother Can 2015; 67:101-4. [PMID: 25931659 DOI: 10.3138/ptc.67.2.gee] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Laura Desveaux
- Rehabilitation Sciences Institute, University of Toronto
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Desveaux L. L'avenir de la gestion des maladies chroniques : melting pot ou mosaïque? Physiother Can 2015. [DOI: 10.3138/ptc.67.2.gef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Laura Desveaux
- Département des études supérieures des sciences de la réadaptation, Université de Toronto
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15
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Altun I, Akin F, Biteker M. The Role of Epicardial Fat Thickness and Neutrophil-to-Lymphocyte Ratio Are Needed to Be Studied in Real-World Stroke Patients. J Stroke Cerebrovasc Dis 2015; 24:1100. [PMID: 25813062 DOI: 10.1016/j.jstrokecerebrovasdis.2014.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 10/24/2014] [Indexed: 10/23/2022] Open
Affiliation(s)
- Ibrahim Altun
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - Fatih Akin
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Murat Biteker
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
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Cardioembolic sources in stroke patients in South of Brazil. THROMBOSIS 2014; 2014:753780. [PMID: 25349734 PMCID: PMC4198824 DOI: 10.1155/2014/753780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/24/2014] [Accepted: 09/24/2014] [Indexed: 11/17/2022]
Abstract
Background. Stroke is a leading cause of mortality and disability in Brazil and around the world. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke. Methods. We analyzed data of 256 patients with cardioembolic ischemic stroke (according to TOAST classification) who were admitted into the Hospital São Lucas-PUCRS from October 2011 to January 2014. The cardioembolic subtype was divided into six subgroups: arrhythmias, valvular heart disease, coronary artery disease, cardiomyopathy, septal abnormalities, and intracardiac injuries. The prevalence of the most important cardiovascular risk factors and medications in use for prevention of systemic embolism by the time of hospital admission was analyzed in each patient. Results. Among 256 patients aged 60.2 +/− 6.9 years, 132 males, arrhythmias were the most common cause of cardioembolism corresponding to 50.7%, followed by valvular heart disease (17.5%) and coronary artery disease (16%). Hypertension (61.7%) and dyslipidemia (43.7%) were the most common risk factors. Less than 50% of patients with arrhythmias were using oral anticoagulants. Conclusions. Identifying the prevalence of cardioembolic stroke sources subgroups has become an increasingly important role since the introduction of new oral anticoagulants. In this study, arrhythmias (especially atrial fibrillation) were the main cause of cardioembolism.
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