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Attention to acute cerebrovascular disease in Guipúzcoa: description of the results of a reference hospital in a centralized care model. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:355-361. [PMID: 35672122 DOI: 10.1016/j.nrleng.2019.03.022] [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: 10/12/2018] [Accepted: 03/03/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In the last 15 years, considerable improvements have been made in acute stroke care in Guipuzkoa, including the implementation of a centralised care model at Hospital Universitario Donostia (HUD), improved coordination between professionals, early detection campaigns, new treatments, a stroke unit, and specific rehabilitation. The aim of this work is to describe the results of a reference hospital (HUD) in a centralised care model. MATERIAL AND METHODS We performed a retrospective observational study of a sample of patients discharged between August and December 2015 from the HUD with a diagnosis of acute stroke (ICD-9-CM codes 430-436, except 433.10). We review patients' baseline characteristics, acute-phase care, and functional outcomes and mortality at discharge and at one year. RESULTS AND DISCUSSION We identified 536 patients, with a mean age of 73.6 years and a high comorbidity rate. Ischaemic stroke accounted for 64.8% of patients, followed by haemorrhagic stroke (20%) and transient ischaemic attack (14.8%). A total of 53% of patients were attended in < 6 hours, with code stroke being activated in 37.1%; 52.2% of patients were admitted to the stroke unit. Intravenous therapy was administered to 8.3% of patients with ischaemic stroke, and 9.5% underwent mechanical thrombectomy. Surgery was performed in 12.1% patients with haemorrhagic stroke. Rehabilitation was started at hospital in 56% of patients, and 39.6% continued with this treatment at discharge. Mortality was 13.8% at discharge and 25.9% at one year (ischaemic stroke, 25.3%; haemorrhagic stroke, 47.5%); these figures are lower than those previously reported in Guipuzkoa. At one year, 62.5% of patients had a Barthel Index score of 95-100, and 50% a modified Rankin Scale score of 0-2. CONCLUSIONS After the strategic changes implemented in acute stroke care in Guipuzkoa, including the centralisation of the acute stroke care model, mortality rates at discharge and at one year are lower in 2015 than the previously reported rates, with similar rates of independence. These results are consistent with those published by other Spanish and European centres.
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Fernández-Eulate G, Arocena P, Muñoz-Lopetegi A, Rodriguez-Antigüedad J, Campo-Caballero D, Equiza J, Andrés N, de Arce A, Gonzalez F, Diez N, Basterrechea J, Suquia E, de la Riva P, Martinez-Zabaleta M. Attention to acute cerebrovascular disease in Guipúzcoa: Description of the results of a reference hospital in a centralized care model. Neurologia 2022; 37:355-361. [PMID: 31053483 DOI: 10.1016/j.nrl.2019.03.009] [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: 10/12/2018] [Revised: 02/22/2019] [Accepted: 03/03/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In the last 15 years, considerable improvements have been made in acute stroke care in Guipuzkoa, including the implementation of a centralised care model at Hospital Universitario Donostia (HUD), improved coordination between professionals, early detection campaigns, new treatments, a stroke unit, and specific rehabilitation. The aim of this work is to describe the results of a reference hospital (HUD) in a centralised care model. MATERIAL AND METHODS We performed a retrospective observational study of a sample of patients discharged between August and December 2015 from the HUD with a diagnosis of acute stroke (ICD-9-CM codes 430-436, except 433.10). We review patients' baseline characteristics, acute-phase care, and functional outcomes and mortality at discharge and at one year. RESULTS AND DISCUSSION We identified 536 patients, with a mean age of 73.6 years and a high comorbidity rate. Ischaemic stroke accounted for 64.8% of patients, followed by haemorrhagic stroke (20%) and transient ischaemic attack (14.8%). A total of 53% of patients were attended in <6 hours, with code stroke being activated in 37.1%; 52.2% of patients were admitted to the stroke unit. Intravenous therapy was administered to 8.3% of patients with ischaemic stroke, and 9.5% underwent mechanical thrombectomy. Surgery was performed in 12.1% patients with haemorrhagic stroke. Rehabilitation was started at hospital in 56% of patients, and 39.6% continued with this treatment at discharge. Mortality was 13.8% at discharge and 25.9% at one year (ischaemic stroke, 25.3%; haemorrhagic stroke, 47.5%); these figures are lower than those previously reported in Guipuzkoa. At one year, 62.5% of patients had a Barthel Index score of 95-100, and 50% a modified Rankin Scale score of 0-2. CONCLUSIONS After the strategic changes implemented in acute stroke care in Guipuzkoa, including the centralisation of the acute stroke care model, mortality rates at discharge and at one year are lower in 2015 than the previously reported rates, with similar rates of independence. These results are consistent with those published by other Spanish and European centres.
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Affiliation(s)
- G Fernández-Eulate
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España.
| | - P Arocena
- Facultad de Medicina, UPV, San Sebastián, Guipúzcoa, España
| | - A Muñoz-Lopetegi
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - J Rodriguez-Antigüedad
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - D Campo-Caballero
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - J Equiza
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - N Andrés
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - A de Arce
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - F Gonzalez
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - N Diez
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - J Basterrechea
- Servicio de Calidad, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - E Suquia
- Servicio de Calidad, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - P de la Riva
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - M Martinez-Zabaleta
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España; Facultad de Medicina, UPV, San Sebastián, Guipúzcoa, España
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Ramírez-Moreno JM, Felix-Redondo FJ, Fernández-Bergés D, Lozano-Mera L. Trends in stroke hospitalisation rates in Extremadura between 2002 and 2014: Changing the notion of stroke as a disease of the elderly. Neurologia 2018; 33:561-569. [PMID: 27776958 DOI: 10.1016/j.nrl.2016.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 09/08/2016] [Accepted: 09/10/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The incidence of stroke in Spain has been evaluated in several studies, whose results are highly variable and not comparable. No studies of stroke have analysed epidemiological changes in younger patients. METHOD We conducted a retrospective observational study using the Spanish health system's Minimum Data Set and included all patients older than 19 hospitalised due to stroke (ICD-9-CM codes 434.01, 434.11, 434.91, 430, 431, 432.9, 436, and 435) between 2002 and 2013. The analysis was performed using joinpoint regression. RESULTS A total of 39,321 patients were identified (47.25% were women); 3.73% were aged 20-44, 6.29% were 45-54, 11.49% were 55-64, 23.89% were 65-74, and 54.60% were > 74 years. The hospitalisation rate due to ischaemic stroke has increased significantly in men aged 45-54 (+6.7%; 95% CI, 3.3-10.2) and in women aged 20-44 and 45-54 (+6.1%; 95% CI, 0.8-11.7 and +5.7%; 95% CI, 3.0-8.4, respectively). We also observed a significant increase in the rate of hospitalisation due to ischaemic stroke in men aged over 74 (+4.2%; 95% CI, 1.3-7.2). The rate of hospitalisations due to transient ischaemic attack has also increased significantly whereas the rate of hospitalisations due to brain haemorrhage has stabilised over time. CONCLUSIONS Our results provide indirect evidence that the epidemiological profile of stroke is changing based on the increase in hospitalisation rates in young adults.
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Affiliation(s)
- J M Ramírez-Moreno
- Sección de Neurología, Hospital Universitario Infanta Cristina, Badajoz, España; Departamento de Ciencias Biomédicas, Facultad de Medicina, Universidad de Extremadura, Badajoz, España.
| | - F J Felix-Redondo
- Centro de Salud Villanueva Norte, Villanueva de la Serena, Badajoz, España; Unidad de Investigación Área sanitaria de Don Benito-Villanueva, Grupo GRIMEX, Badajoz, España
| | - D Fernández-Bergés
- Unidad de Investigación Área sanitaria de Don Benito-Villanueva, Grupo GRIMEX, Badajoz, España
| | - L Lozano-Mera
- Subdirección de Sistemas de Información, Servicio Extremeño de Salud, Mérida, Badajoz, España
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Trends in stroke hospitalisation rates in Extremadura between 2002 and 2014: Changing the notion of stroke as a disease of the elderly. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mortalidad y fibrilación auricular en el estudio FIACA: evidencia de un efecto diferencial según el diagnóstico al ingreso hospitalario. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Maestre-Moreno J, Fernández-Pérez M, Triguero-Cueva L, Gutiérrez-Zúñiga R, Herrera-García J, Espigares-Molero A, Mínguez-Castellanos A. Stroke-related mortality in a tertiary care hospital in Andalusia: Analysis and reflections. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2016.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Maestre-Moreno J, Fernández-Pérez M, Triguero-Cueva L, Gutiérrez-Zúñiga R, Herrera-García J, Espigares-Molero A, Mínguez-Castellanos A. Mortalidad asociada al ictus en un hospital andaluz de tercer nivel. Análisis y reflexiones. Neurologia 2017; 32:559-567. [DOI: 10.1016/j.nrl.2016.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 02/29/2016] [Accepted: 03/05/2016] [Indexed: 11/28/2022] Open
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Clavel-Ruipérez FG, Consuegra-Sánchez L, Félix Redondo FJ, Lozano Mera L, Mellado-Delgado P, Martínez-Díaz JJ, López Mínguez JR, Fernández-Bergés D. Mortality and Atrial Fibrillation in the FIACA Study: Evidence of a Differential Effect According to Admission Diagnosis. ACTA ACUST UNITED AC 2017; 71:155-161. [PMID: 28528882 DOI: 10.1016/j.rec.2017.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/09/2017] [Indexed: 01/30/2023]
Abstract
INTRODUCTION AND OBJECTIVES Atrial fibrillation (AF) is an independent risk factor for mortality in several diseases. However, data published in acute decompensated heart failure (DHF) are contradictory. Our objective was to investigate the impact of AF on mortality in patients admitted to hospital for DHF compared with those admitted for other reasons. METHODS This retrospective cohort study included all patients admitted to hospital within a 10-year period due to DHF, acute myocardial infarction (AMI), or ischemic stroke (IS), with a median follow-up of 6.2 years. RESULTS We included 6613 patients (74 ± 11 years; 54.6% male); 2177 with AMI, 2208 with DHF, and 2228 with IS. Crude postdischarge mortality was higher in patients with AF hospitalized for AMI (incident rate ratio, 2.48; P < .001) and IS (incident rate ratio, 1.84; P < .001) than in those without AF. No differences were found in patients with DHF (incident rate ratio, 0.90; P = .12). In adjusted models, AF was not an independent predictor of in-hospital mortality by clinical diagnosis. However, AF emerged as an independent predictor of postdischarge mortality in patients with AMI (HR, 1.494; P = .001) and IS (HR, 1.426; P < .001), but not in patients admitted for DHF (HR, 0.964; P = .603). CONCLUSIONS AF was as an independent risk factor for postdischarge mortality in patients admitted to hospital for AMI and IS but not in those admitted for DHF.
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Affiliation(s)
| | | | - Francisco Javier Félix Redondo
- Unidad de Investigación, Programa de Investigación en Enfermedades Cardiovasculares PERICLES, Servicio Extremeño de Salud, Área de Salud Don Benito-Villanueva, Villanueva de la Serena, Badajoz, Spain
| | - Luis Lozano Mera
- Unidad de Investigación, Programa de Investigación en Enfermedades Cardiovasculares PERICLES, Servicio Extremeño de Salud, Área de Salud Don Benito-Villanueva, Villanueva de la Serena, Badajoz, Spain; Centro de Salud Urbano I, Servicio Extremeño de Salud, Mérida, Badajoz, Spain
| | - Pedro Mellado-Delgado
- Unidad de Investigación, Programa de Investigación en Enfermedades Cardiovasculares PERICLES, Servicio Extremeño de Salud, Área de Salud Don Benito-Villanueva, Villanueva de la Serena, Badajoz, Spain
| | - Juan José Martínez-Díaz
- Servicio de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - José Ramón López Mínguez
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - Daniel Fernández-Bergés
- Unidad de Investigación, Programa de Investigación en Enfermedades Cardiovasculares PERICLES, Servicio Extremeño de Salud, Área de Salud Don Benito-Villanueva, Villanueva de la Serena, Badajoz, Spain.
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Alvarez-Sabín J, Quintana M, Masjuan J, Oliva-Moreno J, Mar J, Gonzalez-Rojas N, Becerra V, Torres C, Yebenes M. Economic impact of patients admitted to stroke units in Spain. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:449-458. [PMID: 27084749 DOI: 10.1007/s10198-016-0799-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/31/2016] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Stroke is a major social and health problem. However, since the recent incorporation of new advances in its management, little is known about the cost of stroke. The aim of this study is to find out the real cost of stroke in Spain. METHODS This is an epidemiological, observational, prospective, multicenter study of patients diagnosed with stroke and admitted to a stroke unit. Patients were recruited from 16 hospitals throughout Spain and followed up for 1 year. Sociodemographic, clinical, and economic data were collected. Costs (€ 2012) were estimated from the social perspective and were divided into direct healthcare (inpatient, outpatient, and medication), direct non-healthcare (mainly formal and informal care) and labor productivity losses. RESULTS A total of 321 patients were included. Mean age was 72.1 years and 176 patients (54.8 %) were male. Total average cost per patient/year was €27,711. Direct healthcare costs amounted to €8491 per patient/year (68.8 % due to inpatient costs) and non-healthcare costs to an average of €18,643 per patient/year (89.5 % due to informal care). Productivity loss costs per patient/year were €276. Total costs of hemorrhagic strokes were slightly higher than ischemic (€28,895 vs. €27,569 per patient/year, p = 0.550) without significant differences. The main variables associated with higher costs were the presence of hypertension (€30,332 vs. €23,234 per patient/year, p < 0.05) and the severity of stroke (p < 0.05), both independently associated after a multivariate analysis. CONCLUSIONS The cost of patients admitted to stroke units in Spain is €27,711 per patient/year. More than two-thirds are social costs, mainly informal care. Stroke remains a major burden on health systems and society, so additional efforts are needed for its prevention.
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Affiliation(s)
- Jose Alvarez-Sabín
- Servei de Neurologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Manuel Quintana
- Servei de Neurologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jaime Masjuan
- Stroke Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - Juan Oliva-Moreno
- Department of Economic Analysis, Universidad de Castilla La Mancha and REDISSEC, Toledo, Spain
| | - Javier Mar
- Clinical Management Service, Hospital Alto Deba, Mondragon, Spain
| | - Nuria Gonzalez-Rojas
- Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain
| | - Virginia Becerra
- Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain
| | | | - María Yebenes
- Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain
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López-Espuela F, González-Gil T, Jiménez-Gracia MA, Bravo-Fernández S, Amarilla-Donoso J. Impacto en la calidad de vida en cuidadores de supervivientes de un ictus. ENFERMERIA CLINICA 2015; 25:49-56. [DOI: 10.1016/j.enfcli.2014.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/10/2014] [Accepted: 12/11/2014] [Indexed: 10/24/2022]
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Gnonlonfoun DD, Adjien C, Ossou-Nguiet PM, Avlessi I, Goudjinou G, Houannou O, Acakpo J, Houinato D, Avode GD. Stroke: Medium and long-term mortality and associated factors in French-speaking West Africa, case of Benin. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/wjns.2014.41008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Martí-Fàbregas J. Ictus isquémico: nihilismo, evidencia y equidad. Rev Clin Esp 2013. [DOI: 10.1016/j.rce.2013.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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