1
|
Predicting 10-year stroke mortality: development and validation of a nomogram. Acta Neurol Belg 2022; 122:685-693. [PMID: 34406610 PMCID: PMC9170668 DOI: 10.1007/s13760-021-01752-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/12/2021] [Indexed: 11/02/2022]
Abstract
Predicting long-term stroke mortality is a clinically important and unmet need. We aimed to develop and internally validate a 10-year ischaemic stroke mortality prediction score. In this UK cohort study, 10,366 patients with first-ever ischaemic stroke between January 2003 and December 2016 were followed up for a median (interquartile range) of 5.47 (2.96-9.15) years. A Cox proportional-hazards model was used to predict 10-year post-admission mortality. The predictors associated with 10-year mortality included age, sex, Oxfordshire Community Stroke Project classification, estimated glomerular filtration rate (eGFR), pre-stroke modified Rankin Score, admission haemoglobin, sodium, white blood cell count and comorbidities (atrial fibrillation, coronary heart disease, heart failure, cancer, hypertension, chronic obstructive pulmonary disease, liver disease and peripheral vascular disease). The model was internally validated using bootstrap resampling to assess optimism in discrimination and calibration. A nomogram was created to facilitate application of the score at the point of care. Mean age (SD) was 78.5 ± 10.9 years, 52% female. Most strokes were partial anterior circulation syndromes (38%). 10-year mortality predictors were: total anterior circulation stroke (hazard ratio, 95% confidence intervals) (2.87, 2.62-3.14), eGFR < 15 (1.97, 1.55-2.52), 1-year increment in age (1.04, 1.04-1.05), liver disease (1.50, 1.20-1.87), peripheral vascular disease (1.39, 1.23-1.57), cancers (1.37, 1.27-1.47), heart failure (1.24, 1.15-1.34), 1-point increment in pre-stroke mRS (1.20, 1.17-1.22), atrial fibrillation (1.17, 1.10-1.24), coronary heart disease (1.09, 1.02-1.16), chronic obstructive pulmonary disease (1.13, 1.03-1.25) and hypertension (0.77, 0.72-0.82). Upon internal validation, the optimism-adjusted c-statistic was 0.76 and calibration slope was 0.98. Our 10-year mortality model uses routinely collected point-of-care information. It is the first 10-year mortality score in stroke. While the model was internally validated, further external validation is also warranted.
Collapse
|
2
|
Levy SA, Pedowitz E, Stein LK, Dhamoon MS. Healthcare Utilization for Stroke Patients at the End of Life: Nationally Representative Data. J Stroke Cerebrovasc Dis 2021; 30:106008. [PMID: 34330019 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106008] [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: 02/07/2021] [Revised: 05/20/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022] Open
Abstract
Objectives Stroke and post-stroke complications are associated with high morbidity, mortality, and cost. Our objective was to examine healthcare utilization and hospice enrollment for stroke patients at the end of life. Materials and methods The 2014 Nationwide Readmissions Database is a national database of > 14 million admissions. We used validated ICD-9 codes to identify fatal ischemic stroke, summarized demographics and hospitalization characteristics, and examined healthcare use within 30 days before fatal stroke admission. We used de-identified 2014 Medicare hospice data to identify stroke and non-stroke patients admitted to hospice. Results Among IS admissions in 2014 (n = 472,969), 22652 (4.8%) had in-hospital death. 28.2% with fatal IS had two or more hospitalizations in 2014. Among those with fatal IS admission, 13.0% were admitted with cerebrovascular disease within 30 days of fatal IS admission. Half of stroke patients discharged to hospice from the Medicare dataset were hospitalized with cerebrovascular disease within the thirty days prior to hospice enrollment. Within the study year, 6.9% of hospice enrollees had one or more emergency room visits, 31.7% had one or more inpatient encounters, and 5.2% had one or more nursing facility encounters (compared to 21.4%, 70.6%, and 27.2% respectively in the 30-day period prior to enrollment). Conclusions High rates of readmission prior to fatal stroke may indicate opportunity for improvement in acute stroke management, secondary prevention, and palliative care involvement as encouraged by AHA/ASA guidelines. For patients who are expected to survive 6 months or less, hospice may offer goal-concordant services for patients and caregivers who desire comfort-focused care.
Collapse
Affiliation(s)
- Sarah A Levy
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, Annenberg 301B, New York 10029, United States.
| | - Elizabeth Pedowitz
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, United States.
| | - Laura K Stein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, Annenberg 301B, New York 10029, United States.
| | - Mandip S Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, Annenberg 301B, New York 10029, United States.
| |
Collapse
|
3
|
Sodium-Glucose Cotransporter-2 Inhibitors and Protection Against stroke in Patients with type 2 Diabetes and Impaired Renal Function: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2021; 30:105708. [DOI: 10.1016/j.jstrokecerebrovasdis.2021.105708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 01/25/2023] Open
|
4
|
Abstract
BACKGROUND Early Warning Score systems are used to monitor patients at risk of deterioration. How comorbidities impact Early Warning Score's ability to predict short-term mortality in the emergency department is not fully elucidated. The aim of the study was to investigate how comorbidities impact Early Warning Score as predictor of 7-day mortality. METHODS This is an observational cohort study of adult emergency department patients attending one of the five emergency departments in Central Region Denmark from 1 March 2015 to 31 May 2015. Charlson Comorbidity Index was used as a measure of comorbidities. Logistic regression was used to calculate the odds ratio for 7-day mortality. Patients were compared in three groups: Charlson Comorbidity Index: 0, 1-2, 3+. RESULTS A total of 30 060 adult patients attended one of the five emergency departments. Nineteen thousand one hundred twenty-three patients were included. Charlson Comorbidity Index 3+ patients presenting with Early Warning Score 0, 1-2 or 3-4 had significantly higher odds ratio of 7-day mortality compared to Charlson Comorbidity Index 0 patients with equal Early Warning Score. For patients with Early Warning Score 5+, Charlson Comorbidity Index -status had no significant impact on 7-day mortality after adjusting for age. CONCLUSION In patients presenting with lower acuity (Early Warning Score 0-4) Charlson Comorbidity Index has a significant impact on 7-day mortality regardless of Early Warning Score. Including Charlson Comorbidity Index status in Early Warning Score or adjusting for Charlson Comorbidity Index -status could increase the predictive value of Early Warning Score in predicting 7-day mortality.
Collapse
|
5
|
Yoon S, Yoo S, Hur M, Park SK, Lee HC, Jung CW, Bahk JH, Kim JT. The cumulative duration of bispectral index less than 40 concurrent with hypotension is associated with 90-day postoperative mortality: a retrospective study. BMC Anesthesiol 2020; 20:200. [PMID: 32795266 PMCID: PMC7427057 DOI: 10.1186/s12871-020-01122-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between intraoperative low bispectral index (BIS) values and poor clinical outcomes has been controversial. Intraoperative hypotension is associated with postoperative complication. The purpose of this study was to investigate the influence of intraoperative low BIS values and hypotension on postoperative mortality in patients undergoing major abdominal surgery. METHODS This retrospective study analyzed 1862 cases of general anesthesia. We collected the cumulative time of BIS values below 20 and 40 as well as electroencephalographic suppression and documented the incidences in which these states were maintained for at least 5 min. Durations of intraoperative mean arterial pressures (MAP) less than 50 mmHg were also recorded. Multivariable logistic regression was used to evaluate the association between suspected risk factors and postoperative mortality. RESULTS Ninety-day mortality and 180-day mortality were 1.5 and 3.2% respectively. The cumulative time in minutes for BIS values falling below 40 coupled with MAP falling below 50 mmHg was associated with 90-day mortality (odds ratio, 1.26; 95% confidence interval, 1.04-1.53; P = .019). We found no association between BIS related values and 180-day mortality. CONCLUSIONS The cumulative duration of BIS values less than 40 concurrent with MAP less than 50 mmHg was associated with 90-day postoperative mortality, not 180-day postoperative mortality.
Collapse
Affiliation(s)
- Soohyuk Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seokha Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Min Hur
- Department of Anesthesiology and Pain Medicine, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Sun-Kyung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chul-Woo Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jae-Hyon Bahk
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| |
Collapse
|
6
|
Blondon M, Le Gal G, Meyer G, Righini M, Robert-Ebadi H. Age-adjusted D-dimer cutoff for the diagnosis of pulmonary embolism: A cost-effectiveness analysis. J Thromb Haemost 2020; 18:865-875. [PMID: 31925875 DOI: 10.1111/jth.14733] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND In patients with suspected pulmonary embolism (PE) and a non-high pretest probability, the use of an age-adjusted D-dimer cutoff (AADD, <500 ng/mL up to 50 years, then METHODS We created a decision tree to compare the use of the AADD with the standard D-dimer cutoff. The model included short-term venous thromboembolism-related events and long-term complications, their associated morbidity/mortality, and costs. Probabilities were derived from published literature and the ADJUST-PE study, and costs from US estimates. The time horizon was lifetime, with a health care system perspective. RESULTS Using the AADD cutoff, compared with the standard cutoff, was associated with a loss of 0.0001 quality-adjusted life-years (QALY) and an average cost reduction of $33.4. The decremental cost-effectiveness ratio (DCER) was +$282 881/lost QALY (95% confidence interval from +$43 209/lost QALY to a dominant strategy). The probability that the use of the AADD cutoff was either dominant or gained >$200 000/lost QALY was 79.4%. In sensitivity analyses, the DCER became <+$200 000/lost QALY only if, among patients with D-dimer below the AADD cutoff, the mortality of an undiagnosed PE was >6% or the prevalence of PE was >0.6%. CONCLUSIONS The AADD cutoff results in a clinically nonsignificant decrease in QALY but important costs reductions. It is a decrementally cost-effective innovation, with a potential of cost savings of >$80 million per year for the United States health care system.
Collapse
Affiliation(s)
- Marc Blondon
- Division of Angiology and Haemostasis, Faculty of Medicine and Geneva University Hospitals, Geneva, Switzerland
| | - Gregoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Guy Meyer
- Department of Respiratory Disease, Hôpital Européen Georges Pompidou, APHP, Paris, France
- Université Paris Descartes, Paris, France
| | - Marc Righini
- Division of Angiology and Haemostasis, Faculty of Medicine and Geneva University Hospitals, Geneva, Switzerland
| | - Helia Robert-Ebadi
- Division of Angiology and Haemostasis, Faculty of Medicine and Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
7
|
Contribution of adapted physical activity on body composition and fitness related to the health of vascular hemiplegic patients. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.533214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
8
|
Steigleder T, Kollmar R, Ostgathe C. Palliative Care for Stroke Patients and Their Families: Barriers for Implementation. Front Neurol 2019; 10:164. [PMID: 30894836 PMCID: PMC6414790 DOI: 10.3389/fneur.2019.00164] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/07/2019] [Indexed: 11/17/2022] Open
Abstract
Stroke is a leading cause of death, disability and is a symptom burden worldwide. It impacts patients and their families in various ways, including physical, emotional, social, and spiritual aspects. As stroke is potentially lethal and causes severe symptom burden, a palliative care (PC) approach is indicated in accordance with the definition of PC published by the WHO in 2002. Stroke patients can benefit from a structured approach to palliative care needs (PCN) and the amelioration of symptom burden. Stroke outcome is uncertain and outlook may change rapidly. Regarding these challenges, core competencies of PC include the critical appraisal of various treatment options, and openly and respectfully discussing therapeutic goals with patients, families, and caregivers. Nevertheless, PC in stroke has to date mainly been restricted to short care periods for dying patients after life-limiting complications. There is currently no integrated concept for PC in stroke care addressing the appropriate moment to initiate PC for stroke patients, and the question of how to screen for symptoms remains unanswered. Therefore, PC for stroke patients is often perceived as a stopgap in cases of unfavorable prognosis and very short survival times. In contrast, PC can provide much more for stroke patients and support a holistic approach, improve quality of life and ensure treatment according to the patient's wishes and values. In this short review we identify key aspects of PC in stroke care and current barriers to implementation. Additionally, we provide insights into our approach to PC in stroke care.
Collapse
Affiliation(s)
- Tobias Steigleder
- Department of Palliative Care, University Hospital Erlangen-Nuremberg, Erlangen, Germany
- Department of Neurology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Rainer Kollmar
- Department of Neurology and Neurointensive Care, Darmstadt Academic Hospital, Darmstadt, Germany
| | - Christoph Ostgathe
- Department of Palliative Care, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| |
Collapse
|
9
|
Kaduka L, Korir A, Oduor CO, Kwasa J, Mbui J, Wabwire S, Gakunga R, Okerosi N, Opanga Y, Kisiang'ani I, Chepkurui MR, Muniu E, Remick SC. Stroke distribution patterns and characteristics in Kenya's leading public health tertiary institutions: Kenyatta National Hospital and Moi Teaching and Referral Hospital. Cardiovasc J Afr 2019; 29:68-72. [PMID: 29745965 PMCID: PMC6008906 DOI: 10.5830/cvja-2017-046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/07/2017] [Indexed: 12/02/2022] Open
Abstract
Background Cardiovascular diseases are the second leading cause of morbidity and mortality in Kenya. However, there is limited clinico-epidemiological data on stroke to inform decision making. This study sought to establish stroke distribution patterns and characteristics in patients seeking care at Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH), with the ultimate aim of establishing the first national stroke registry in Kenya. Methods This was a prospective multicentre cohort study among stroke patients. The study used a modified World Health Organisation STEP-wise approach to stroke surveillance tool in collecting data on incidence, major risk factors and mortality rate. The Cochran’s Mantel–Haenszel chisquared test of conditional independence was used with p-value set at 0.05. Results A total of 691 patients with confirmed stroke were recruited [KNH 406 (males: 40.9%; females: 59.1%); MTRH 285 (males: 44.6%; females: 55.4%)] and followed over a 12-month period. Overall, ischaemic stroke accounted for 55.6% of the stroke cases, with women being the most affected (57.5%). Mortality rate at day 10 was 18.0% at KNH and 15.5% at MTRH, and higher in the haemorrhagic cases (20.3%). The most common vascular risk factors were hypertension at 77.3% (males: 75.7%; females: 78.5%), smoking at 16.1% (males: 26.6%; females: 8.3%) and diabetes at 14.9% (males: 15.7%; females: 14.4%). Ischaemic stroke was conditionally independent of gender after adjusting for age. Conclusions To our knowledge this is the first pilot demonstration establishing a stroke registry in sub-Saharan Africa and clearly establishes feasibility for this approach. It also has utility to both inform and potentially guide public policy and public health measures on stroke in Kenya. Important and unexpected observations included the preponderance of women affected by cerebrovascular disease and that cigarette smoking was the second most common risk factor. The latter, over time, will further impact on the clinico-epidemiological profile of cerebrovascular disease in Kenya.
Collapse
Affiliation(s)
- Lydia Kaduka
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya.
| | - Anne Korir
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Chrispine Owuor Oduor
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Judith Kwasa
- Department of Clinical Medicine and Therapeutics, Kenyatta National Hospital, Nairobi, Kenya
| | - Jane Mbui
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | | | - Yvonne Opanga
- School of Public Health, Moi University, Eldoret, Kenya
| | - Isaac Kisiang'ani
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Mercy Rotich Chepkurui
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Erastus Muniu
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Scot C Remick
- Maine Medical Center Research Institute, Portland, ME, USA
| |
Collapse
|
10
|
Mukundan G, Seidenwurm DJ. Economic and Societal Aspects of Stroke Management. Neuroimaging Clin N Am 2018; 28:683-689. [DOI: 10.1016/j.nic.2018.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
11
|
Shamshirgaran SM, Barzkar H, Savadi-Oskouei D, Yazdchi Marandi M, Safaiyan A, Sarbazi E, Novbakht H, Gaffari S. Predictors of short-term mortality after acute stroke in East Azerbaijan province, 2014. J Cardiovasc Thorac Res 2018; 10:36-40. [PMID: 29707176 PMCID: PMC5913691 DOI: 10.15171/jcvtr.2018.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 03/05/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction: Stroke is one of the important causes of death and disability in Iran. This study aimed to examine the factors influencing the short-term mortality of stroke in Northwest of Iran. Methods: Study population were all patients with confirming the diagnosis of the first-ever stroke who were hospitalized in two referral teaching hospitals from October 2013 to March 2015. They were followed up to 30 days after onset of stroke. A neurology year three resident was responsible for extracting the clinical data and assessment of stroke severity on admission using National Institute of Health Stroke Scale (NIHSS), and information about risk factors and socio-demographic factors were collected using face to face interview. Data were analysed using Cox proportional regression by STATA software version 14. Results: A total of 1036 consecutive patients with first-ever stroke were included in this study. Of them, 228 patients (22%) died within 30 days after stroke accordance. Advanced age was significantly associated with a hazard for early mortality (HR=1.05 95% CI 1.09-1.04), the inverse was true for education level; mortality decreased as the education level increased; it was 25.7 percent among illiterate and 14.3 among patients with higher education. The NIHSS score on admission for 30-days mortality and hemorrhagic stroke were associated with HR=1.11 (95% CI 1.09-1.13) and HR= 1.65 (95% CI 1.15-2.36) respectively. Conclusion: Advanced age, stroke subtype and high NIHSS score are the independent predictors of early mortality in this study. This provides important implications for the clinicians to target the high-risk patients for the specific therapies and management strategies.
Collapse
Affiliation(s)
- Seyed Morteza Shamshirgaran
- Epidemiology and Statistics Departement, Faculty of Health Sciences, Tabriz University of Medical Siences, Tabriz, Iran.,Injury Epidemiology Prevention Research Centre, Tabriz University of Medical Siences, Tabriz, Iran
| | - Hamid Barzkar
- Injury Epidemiology Prevention Research Centre, Tabriz University of Medical Siences, Tabriz, Iran
| | - Darioush Savadi-Oskouei
- Neurosciences Research Centre, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Yazdchi Marandi
- Neurosciences Research Centre, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolrasoul Safaiyan
- Epidemiology and Statistics Departement, Faculty of Health Sciences, Tabriz University of Medical Siences, Tabriz, Iran
| | - Ehsan Sarbazi
- Epidemiology and Statistics Departement, Faculty of Health Sciences, Tabriz University of Medical Siences, Tabriz, Iran
| | - Hossein Novbakht
- Epidemiology and Statistics Departement, Faculty of Health Sciences, Tabriz University of Medical Siences, Tabriz, Iran
| | - Saber Gaffari
- School of Nursing of Miandoab, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
12
|
Wan‐Arfah N, Hafiz HM, Naing NN, Muzaimi M, Shetty HG. Short-term and long-term survival probabilities among first-ever ischaemic and haemorrhagic stroke patients at a hospital in the suburban east coast of Peninsular Malaysia. Health Sci Rep 2018; 1:e27. [PMID: 30623059 PMCID: PMC6266517 DOI: 10.1002/hsr2.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/29/2017] [Accepted: 01/08/2018] [Indexed: 11/15/2022] Open
Abstract
AIM This study aimed to determine the 28-day, 1-year, and 5-year survival probabilities in first-ever stroke patients in a relatively understudied setting: a suburban hospital that serves a predominantly rural population in the east coast of Peninsular Malaysia. METHODS AND RESULTS A retrospective record review was conducted among 432 first-ever stroke patients admitted to the Hospital Universiti Sains Malaysia, Kelantan, Malaysia. Data from between January 1, 2005 and December 31, 2011, were extracted from the medical records. The Kaplan-Meier product limit estimator was applied to determine the 28-day, 1-year, and 5-year survival probabilities. Log-rank test was used to test the equality of survival time between different groups. A total of 101 patients died during the study period. The 28-day, 1-year, and 5-year survival probabilities were 78.0% (95% confidence interval [CI]: 73.5-81.9), 74.2% (95% CI: 69.4-78.4), and 70.9% (95% CI: 65.1-75.9), respectively. There were significant differences in the survival time based on the types of stroke, Glasgow Coma Scale, hyperlipidaemia, atrial fibrillation, fasting blood glucose, and diastolic blood pressure. CONCLUSION This study, though retrospective, highlights several clinical parameters that influenced the survival probabilities among first-ever stroke patients managed in a suburban setting in Malaysia, and compared them to those reported in more urban regions. Our data emphasise the need for wider establishment of specialized stroke units and teams, as well as for prospective multi-centre studies on first-ever stroke patients to better inform the development of stroke care provision in Malaysia.
Collapse
Affiliation(s)
- Nadiah Wan‐Arfah
- Institute for Community (Health) Development (i‐CODE)Universiti Sultan Zainal AbidinTerengganuMalaysia
| | - Hanafi Muhammad Hafiz
- Department of Neurosciences, School of Medical SciencesUniversiti Sains MalaysiaKubang KerianKelantanMalaysia
| | - Nyi Nyi Naing
- Institute for Community (Health) Development (i‐CODE)Universiti Sultan Zainal AbidinTerengganuMalaysia
| | - Mustapha Muzaimi
- Department of Neurosciences, School of Medical SciencesUniversiti Sains MalaysiaKubang KerianKelantanMalaysia
| | | |
Collapse
|
13
|
Rakic M, Dittrich T, Elger BS, Shaw D. Enhancing patients' autonomy by involving them in research ethics committees. Int J Qual Health Care 2017; 29:896-900. [PMID: 29077835 DOI: 10.1093/intqhc/mzx128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/22/2017] [Indexed: 01/15/2023] Open
Abstract
Objective Although clinical trial participants are the most affected by research ethics committee's decisions, they are not formally represented on Swiss committees. We aimed to find out what patients think about the idea of being members of such committees. Design Latent thematic analysis was used to analyse the interviews. Setting Patients were recruited in a Swiss university hospital. Participants The study involved 26 patients suffering from diabetes or gout. Interventions We conducted semi-structured interviews. Main Outcome Measures We explored what patients think of being established members of research ethics committees. Results We identified three different attitudes among our participants regarding participation in research ethics committees: (i) positive attitude regarding the idea of being members of such committees, (ii) ambivalent attitude and (iii) negative attitude. Patients belonging to the first group (i) often mentioned that they wanted their health condition to be more visible. Patients from the second group (ii) mentioned positive as well as negative aspects. Patients from the third group (iii) said that patients in general did not have enough background knowledge to be able to gain an overview of a whole clinical trial. Conclusions Our study adds important knowledge about the idea of patients becoming research ethics committee members by exploring their perceptions of being members. Stable patients tended to be interested in the idea of participation and some specific recommendations could be derived (patients could have an advisory instead of a decision-making role on committees). However, further studies with more patients and further quantitative research are needed.
Collapse
Affiliation(s)
- Milenko Rakic
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Tolga Dittrich
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - David Shaw
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| |
Collapse
|
14
|
Hägg-Holmberg S, Thorn LM, Forsblom CM, Gordin D, Elonen N, Harjutsalo V, Liebkind R, Putaala J, Tatlisumak T, Groop PH. Prognosis and Its Predictors After Incident Stroke in Patients With Type 1 Diabetes. Diabetes Care 2017; 40:1394-1400. [PMID: 28811283 DOI: 10.2337/dc17-0681] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/09/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although patients with type 1 diabetes have a poor prognosis after a stroke, predictors of survival after an incident stroke in these patients are poorly studied. RESEARCH DESIGN AND METHODS In this observational study, a total of 144 patients of 4,083 with type 1 diabetes from the Finnish Diabetic Nephropathy (FinnDiane) Study suffered an incident stroke in 1997-2010, and were followed for a mean 3.4 ± 3.1 years after the stroke. Information was recorded on hard cardiovascular events and death as a result of cardiovascular or diabetes-related cause, collectively referred to as vascular composite end point. Information was collected from medical records, death certificates, and the National Care Register of Health Care. Predictors at the time of the incident stroke were studied for the end points. RESULTS During follow-up, 104 (72%) patients suffered a vascular composite end point. Of these, 33 (32%) had a recurrent stroke, 33 (32%) a hard cardiovascular event, and 76 (53%) died of cardiovascular or diabetes-related causes, with an overall 1-year survival of 76% and 5-year survival of 58%. The predictors of a vascular composite end point were hemorrhagic stroke subtype (hazard ratio 2.03 [95% CI 1.29-3.19]), as well as chronic kidney disease stage 2 (2.48 [1.17-5.24]), stage 3 (3.04 [1.54-6.04]), stage 4 (3.95 [1.72-9.04]), and stage 5 (6.71 [3.14-14.34]). All-cause mortality increased with deteriorating kidney function. CONCLUSIONS Patients with type 1 diabetes with an incident stroke have a poor cardiovascular prognosis and a high risk of all-cause mortality. In particular, hemorrhagic stroke subtype and progression of diabetic kidney disease conveys worse outcome.
Collapse
Affiliation(s)
- Stefanie Hägg-Holmberg
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Carol M Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Nina Elonen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Ron Liebkind
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland .,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | | |
Collapse
|
15
|
Huang CC, Ho CH, Chen YC, Lin HJ, Hsu CC, Wang JJ, Su SB, Guo HR. Demographic and clinical characteristics of carbon monoxide poisoning: nationwide data between 1999 and 2012 in Taiwan. Scand J Trauma Resusc Emerg Med 2017; 25:70. [PMID: 28705214 PMCID: PMC5512843 DOI: 10.1186/s13049-017-0416-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 07/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Carbon monoxide poisoning (COP) is not uncommon, but nationwide epidemiological data are limited. We conducted a study in Taiwan to fill the data gaps. METHODS We used a nationwide poisoning database to study all COP patients in Taiwan diagnosed between 1999 and 2012. We conducted descriptive analyses and compared the differences between the two sexes. In addition, we assessed the trends in suicide and mortality rates from 1999 to 2012. RESULTS We identified 25,912 COP patients with an almost equal female and male distribution (50.6% vs. 49.4%). The mean age was 36.0 years, and most of the patients were between 20 and 50 years old. The highest incidence rate in the year occurred during winter. While female patients were more likely to have mental disorders (35.9% vs. 28.1%, p < 0.001), male patients were more likely to be resulted from suicide attempts (22.9% vs. 17.7%, p < 0.001). In both sexes, the suicidal rate increased from 1999, reached the peak in 2007, and then decreased gradually. Hyperbaric oxygen therapy was performed in 24.2% of the patients. Neurological sequelae developed in 9.1% of the patients, and chronic respiratory failure and requirement of long-term care were observed in 5.0% and 0.1% of the patients. The 1-month and 3-month mortality rates were 1.6% and 5.0%. The 3-month mortality rate did not show significant change between 1999 and 2012. DISCUSSION This study showed a whole picture of COP in Taiwan, which could add to the important knowledge of this disastrous problem in public health. CONCLUSION Some important findings, including higher percentages of mental disorders in female patients and suicide attempt in male patients, seasonal changes, and trends in mortality and morbidity (suicide) rates, may help developing strategies for prevention and treatment of COP.
Collapse
Affiliation(s)
- Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 1 Daxue Road, East District, Tainan City, 701, Taiwan.,Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Shih-Bin Su
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Department of Medical Research, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 1 Daxue Road, East District, Tainan City, 701, Taiwan. .,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
| |
Collapse
|
16
|
Effects of Transferring to the Rehabilitation Ward on Long-Term Mortality Rate of First-Time Stroke Survivors: A Population-Based Study. Arch Phys Med Rehabil 2017; 98:2399-2407. [PMID: 28433415 DOI: 10.1016/j.apmr.2017.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 03/08/2017] [Accepted: 03/22/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the long-term health outcomes of acute stroke survivors transferred to the rehabilitation ward. DESIGN Long-term mortality rates of first-time stroke survivors during hospitalization were compared among the following sets of patients: patients transferred to the rehabilitation ward, patients receiving rehabilitation without being transferred to the rehabilitation ward, and patients receiving no rehabilitation. SETTING Retrospective cohort study. PARTICIPANTS Patients (N = 11,419) with stroke from 2005 to 2008 were initially assessed for eligibility. After propensity score matching, 390 first-time stroke survivors were included. INTERVENTIONS None. MAIN OUTCOME MEASURE Cox proportional hazards regression model was used to assess differences in 5-year poststroke mortality rates. RESULTS Based on adjusted hazard ratios (HRs), the patients receiving rehabilitation without being transferred to the rehabilitation ward (adjusted HR, 2.20; 95% confidence interval [CI], 1.36-3.57) and patients receiving no rehabilitation (adjusted HR, 4.00; 95% CI, 2.55-6.27) had significantly higher mortality risk than the patients transferred to the rehabilitation ward. Mortality rate of the stroke survivors was affected by age ≥65 years (compared with age <45y; adjusted HR, 3.62), being a man (adjusted HR, 1.49), having ischemic stroke (adjusted HR, 1.55), stroke severity (Stroke Severity Index [SSI] score≥20, compared with SSI score<10; adjusted HR, 2.68), and comorbidity (Charlson-Deyo Comorbidity Index [CCI] score≥3, compared with CCI score=0; adjusted HR, 4.23). CONCLUSIONS First-time stroke survivors transferred to the rehabilitation ward had a 5-year mortality rate 2.2 times lower than those who received rehabilitation without transfer to the rehabilitation ward and 4 times lower than those who received no rehabilitation.
Collapse
|
17
|
Ducci RDP, Lange MC, Zétola VDHF, Rundek T. Factors Related to Cardioembolism as Major Predictors of Poor Survival after First-Ever Middle Cerebral Artery Stroke Treated with Thrombolysis. Cerebrovasc Dis 2017; 43:178-185. [DOI: 10.1159/000455723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/30/2016] [Indexed: 12/27/2022] Open
Abstract
<b><i>Background and Purpose:</i></b> Prognostic factors related to mortality rates after stroke have been reported; however, most studies included different treatments and did not focus solely on ischemic stroke. The study aimed to report the short- and long-term survival and predictors of death in patients with first-ever ischemic stroke in the middle cerebral artery (MCA) territory, submitted to intravenous thrombolysis (IVT). <b><i>Methods:</i></b> A prospective observational cohort study of patients with first-ever ischemic stroke in the MCA territory treated with IVT from March 2010 to February 2015 was conducted, and patients were followed up until May 2015. The Kaplan-Meier method was used to estimate the cumulative case fatality rates. The potential prognostic factors were identified using Cox proportional hazards regression analysis. <b><i>Results:</i></b> A total of 169 patients, 51% women of mean age of 64.1 ± 12.9 years were followed up for a median time of 23.6 (8.1-36.2) months. At the end of the study, 53 (31.4%) patients had died. The estimated cumulative case fatality rate was 41.8% for 5 years. Chronic heart failure (hazards ratio [HR] 2.89, 95% CI 1.43-5.84, <i>p</i> = 0.003), atrial fibrillation (HR 3.88, 95% CI 1.30-11.57, <i>p</i> = 0.015), and symptomatic intracerebral hemorrhage (SICH; HR 7.83, 95% CI 3.43-17.92, <i>p</i> < 0.001) were significant unfavorable independent outcome predictors. The most frequent cause of death was infection (46%). <b><i>Conclusions:</i></b> Stroke in the MCA territory has a high mortality rate, even in patients treated with IVT. SICH, atrial fibrillation, and chronic heart failure are modifiable factors related to cardioembolism that need to be aggressively targeted for improved outcomes after stroke.
Collapse
|
18
|
Almekhlafi MA. Trends in one-year mortality for stroke in a tertiary academic center in Saudi Arabia: a 5-year retrospective analysis. Ann Saudi Med 2016; 36:197-202. [PMID: 27236391 PMCID: PMC6074538 DOI: 10.5144/0256-4947.2016.197] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Numerous studies have reported a decline in stroke-related mortality in developed countries. OBJECTIVE To assess trends in one-year mortality following a stroke diagnosis in Saudi Arabia. DESIGN Retrospective longitudinal cohort study. SETTING Single tertiary care center from 2010 through 2014. PATIENTS All patients admitted with a primary admitting diagnosis of stroke. METHODS Demographic data (age, gender, nationality), risk factor profile, stroke subtypes, in-hospital complications and mortality data as well as cause of death were collected for all patients. A multivariable logistic regression model was used to assess factors associated with one-year mortality following a stroke admission. MAIN OUTCOME MEASURE(S) One-year mortality. RESULTS In 548 patients with a mean age of 62.9 years (SD 16.9), the most frequent vascular risk factors were hypertension (90.6%), diabetes (65.5%), and hyperlipidemia (27.2%). Hemorrhagic stroke was diagnosed in 9.9%. The overall mortality risk was 26.9%. Non-Saudis had a significantly higher one-year mortality risk compared with Saudis (25% vs. 16.8%, respectively; P=.025). The most frequently reported causes of mortality were neurological and related to the underlying stroke (32%), sepsis (30%), and cardiac or other organ dysfunction-related (each 9%) in addition to other etiologies (collectively 9.5%) such as pulmonary embolism or an underlying malignancy. Significant predictors in the multivariate model were age (P < .0001), non-Saudi nationality (OR 1.8, CI 95 1.1 to 2.9; P=.019), and hospital length of stay (OR 1.01, CI 95 1 to 1.004; P=.001). CONCLUSION We observed no decline in stroke mortality in our center over the 5-year span. The establishment of stroke systems of care, use of thrombolytic agents, and opening of a stroke unit should play an important role in a decline in stroke mortality. LIMITATIONS Retrospective single center study. Mortality data were available only for patients who died in our hospital.
Collapse
Affiliation(s)
- Mohammed A Almekhlafi
- Dr. Mohammed Almekhlafi, Department of Internal Medicine,, Division of Neurology,, King Abdulaziz University,, PO Box 80215, Jeddah, 21589, Saudi Arabia, , ORCID ID: orcid.org/0000-0001-9550-8197
| |
Collapse
|
19
|
N'goran YNK, Traore F, Tano M, Kramoh KE, Kakou JBA, Konin C, Kakou MG. [Epidemiological aspects of stroke at emergencies services of Abidjan Heart Institute]. Pan Afr Med J 2015; 21:160. [PMID: 26327997 PMCID: PMC4546777 DOI: 10.11604/pamj.2015.21.160.6852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 06/17/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction L'objectif de notre étude était de décrire les caractéristiques sociodémographiques et les Facteurs de Risque cardio-Vasculaires (FRV) des patients admis pour accidents vasculaires cérébraux (AVC) dans un service autre que celui de la neurologie. Méthodes Étude transversale rétrospective sur une période de 2 ans (janv. 2010 et déc. 2011), réalisée aux urgences de l'institut de cardiologie d'Abidjan. Résultats Il s'agissait de 176 adultes avec un âge moyen de 60 ans, une prédominance féminine. Les facteurs de risque majeurs retrouvés étaient l'hypertension artérielle dans 86,4% des cas, le diabète dans 11,4% des cas, le tabagisme dans 2,2% des cas. Les motifs de consultation étaient la perte de connaissance dans 36,4% des cas, l'hémiplégie dans 31,8% des cas, les céphalées dans 17,4% des cas, les vertiges dans 10,9% et les palpitations dans 2,2% des cas. La tension artérielle systolique moyenne était à 174 mmHg, la tension artérielle diastolique moyenne était à 105 mmHg et la pression pulsée moyenne était à 70 mmHg. Les AVC étaient associés à une arythmie complète par fibrillation auriculaire dans 11,4% des cas. Les AVC ischémiques représentaient 84,1%. L’évolution aux urgences a été marquée par un décès dans 17% (30) des cas. Conclusion Les AVC constituent un problème majeur de santé publique. Malgré sa prédominance féminine, ils (AVC) touchaient 44% des hommes dans notre étude lorsqu'on sait qu'en Afrique l'activité sociale repose sur les hommes. Ils restent une pathologie grave par la forte létalité.
Collapse
Affiliation(s)
| | - Fatou Traore
- Service des Urgences, Institut de Cardiologie d'Abidjan, Abidjan, Côte d'Ivoire
| | - Micesse Tano
- Service des Urgences, Institut de Cardiologie d'Abidjan, Abidjan, Côte d'Ivoire
| | | | | | - Christophe Konin
- Service des Urgences, Institut de Cardiologie d'Abidjan, Abidjan, Côte d'Ivoire
| | | |
Collapse
|
20
|
Kamal AK, Shaikh QN, Pasha O, Azam I, Islam M, Memon AA, Rehman H, Affan M, Nazir S, Aziz S, Jan M, Andani A, Muqeet A, Ahmed B, Khoja S. Improving medication adherence in stroke patients through Short Text Messages (SMS4Stroke)-study protocol for a randomized, controlled trial. BMC Neurol 2015; 15:157. [PMID: 26311325 PMCID: PMC4551769 DOI: 10.1186/s12883-015-0413-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 08/20/2015] [Indexed: 11/10/2022] Open
Abstract
Background Stroke is a major cause of morbidity and mortality, especially in low and middle income countries. Medical management is the mainstay of therapy to prevent recurrence of stroke. Current estimates are that only 1 in 6 patients have perfect adherence to medication schedules. Using SMS (Short Messaging Service) as reminders to take medicines have been used previously for diseases such as diabetes and HIV with moderate success. We aim to explore the effectiveness and acceptability of SMS in increasing adherence to medications in patients with stroke. Methods This will be a randomized, controlled, assessor blinded single center superiority trial. Adult participants with access to a cell phone and a history of stroke longer than 1 month on multiple risk modifying medications will be selected from Neurology and Stroke Clinic. They will be randomized into two parallel groups in a 1:1 ratio via block technique with one group receiving the standard of care as per institutional guidelines while the parallel group receiving SMS reminders for each dose of medicine in addition to the standard of care. In addition intervention group will receive messages for lifestyle changes, medication information, risk factors and motivation for medication adherence. These will bemodeled on Social Cognitive Theory and Health Belief Model and will be categorized by Michies Taxonomy of Behavioral Change Communication. Patient compliance to medicines will be measured at baseline and then after 2 months in each group by using the Morisky Medication Adherence Scale. The change in compliance to medication regimen after the intervention and the difference between the two groups will be used to determine the effectiveness of SMS reminders as a tool to increase medication compliance. The acceptability of the SMS will be determined by a tool designed for this study whose attributes are based Rogers Diffusion of innovation theory. A sample size of 86 participants in each arm will be sufficient to detect a difference of 1 point on the MMAS with a power of 90 % and significance level of 5 % between the two groups; using an attrition rate of 15 %, 200 participants in all will be randomized. Discussion The SMS for Stroke Study will provide evidence for feasibility and effectiveness of SMS in improving post stroke medication adherence in an LMIC setting. Trial registration https://clinicaltrials.gov/ct2/show/NCT01986023 11 /11/2013 Electronic supplementary material The online version of this article (doi:10.1186/s12883-015-0413-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ayeesha Kamran Kamal
- Neurology, Stroke Service, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Quratulain Nauman Shaikh
- The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Omrana Pasha
- Director Masters in Epidemiology and Biostatistics Program, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | - Muhammad Islam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | - Adeel Ali Memon
- SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Hasan Rehman
- Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Muhammad Affan
- SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Sumaira Nazir
- SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Salman Aziz
- SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Muhammad Jan
- Stroke Service, Section of Neurology, Department of Medicine The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Anita Andani
- Stroke Service, Section of Neurology, Department of Medicine The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Abdul Muqeet
- eHealth Innovation, Global, Aga Khan Development Network, Karachi, Pakistan.
| | - Bilal Ahmed
- Epidemiology and Biostatistics, Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Shariq Khoja
- Evidence, Capacity & Policy mHealth Alliance, United Nations Foundation Geneva Associate Professor COMSATS Institute of Information Technology, Islamabad Visiting faculty-University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
21
|
Li S, Bruen BK, Lantz PM, Mendez D. Impact of Health Insurance Expansions on Nonelderly Adults With Hypertension. Prev Chronic Dis 2015; 12:E105. [PMID: 26133648 PMCID: PMC4512839 DOI: 10.5888/pcd12.150111] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Hypertension is a risk factor for cardiovascular disease (CVD), the leading cause of death in the United States. The treatment and control of hypertension is inadequate, especially among patients without health insurance coverage. The Affordable Care Act offered an opportunity to improve hypertension management by increasing the number of people covered by insurance. This study predicts the long-term effects of improved hypertension treatment rates due to insurance expansions on the prevalence and mortality rates of CVD of nonelderly Americans with hypertension. METHODS We developed a state-transition model to simulate the lifetime health events of the population aged 25 to 64 years. We modeled the effects of insurance coverage expansions on the basis of published findings on the relationship between insurance coverage, use of antihypertensive medications, and CVD-related events and deaths. RESULTS The model projected that currently anticipated health insurance expansions would lead to a 5.1% increase in treatment rate among hypertensive patients. Such an increase in treatment rate is estimated to lead to 111,000 fewer new coronary heart disease events, 63,000 fewer stroke events, and 95,000 fewer CVD-related deaths by 2050. The estimated benefits were slightly greater for men than for women and were greater among nonwhite populations. CONCLUSION Federal and state efforts to expand insurance coverage among nonelderly adults could yield significant health benefits in terms of CVD prevalence and mortality rates and narrow the racial/ethnic disparities in health outcomes for patients with hypertension.
Collapse
Affiliation(s)
- Suhui Li
- Milken Institute School of Public Health, Department of Health Policy and Management, The George Washington University, 950 New Hampshire Ave, NW, Washington, DC 20052.
| | - Brian K Bruen
- Department of Health Policy and Management, The George Washington University, Washington, DC
| | - Paula M Lantz
- Department of Health Policy and Management, The George Washington University, Washington, DC
| | - David Mendez
- Department of Health Management and Policy, The University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
22
|
Johnston SS, Sheehan JJ, Shah M, Cappell K, Princic N, Smith D, Kalsekar I. Cardiovascular event costs in patients with Type 2 diabetes mellitus. J Med Econ 2015; 18:1032-40. [PMID: 26189723 DOI: 10.3111/13696998.2015.1074078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To quantify the cost of acute major adverse cardiac events (MACE; myocardial infarction [MI] and stroke) stratified by cardiovascular disease (CVD) risk factors in commercially, Medicare Supplemental-, and Medicaid-insured patients with type 2 diabetes mellitus (T2DM). METHODS US administrative claims data were used to identify patients with T2DM aged ≥18 and continuously enrolled with insurance benefits from July 1, 2009-June 30, 2010 (baseline). Patients were classified into three baseline CVD risk groups (highest, medium, and lowest) and followed from July 1, 2010 until 1 year or censoring (follow-up) to measure per-patient per-month (PPPM) all-cause healthcare costs. Multivariable regression compared costs between patients with/without MACE during follow-up. Patients with MACE were further followed for up to 1 year after initial event to quantify longitudinal event costs. RESULTS Sample comprised 1,415,598 T2DM patients. Over average follow-up ranging from 301-343 days across CVD risk groups, 10,399 patients experienced MACE. Expected multivariable-adjusted mean PPPM costs of MACE per 100 covered patients within each CVD risk group varied by payer and generally increased with CVD risk (range = $1555 in lowest-risk commercially insured patients to $18,727 in highest-risk Medicaid-insured patients). Longitudinal costs of MACE were lowest among Medicare Supplemental-insured patients with stroke ($22,657 initial event, $2488 PPPM up-to 1-year follow-up care) and highest among Medicaid-insured patients with MI ($41,505 initial event, $4799 PPPM up to 1-year follow-up care). CONCLUSIONS These results illustrate the potential clinical and economic importance of considering patients' CVD risk and medications' cardiovascular safety profile when treating T2DM patients.
Collapse
Affiliation(s)
| | | | - Manan Shah
- c c Bristol-Myers Squibb , Plainsboro , NJ , USA
| | | | | | - David Smith
- d d Truven Health Analytics , Ann Arbor , MI , USA
| | | |
Collapse
|
23
|
Easton JF, Stephens CR, Angelova M. Risk factors and prediction of very short term versus short/intermediate term post-stroke mortality: A data mining approach. Comput Biol Med 2014; 54:199-210. [DOI: 10.1016/j.compbiomed.2014.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 08/17/2014] [Accepted: 09/05/2014] [Indexed: 10/24/2022]
|
24
|
Anuncibay-Soto B, Pérez-Rodríguez D, Llorente IL, Regueiro-Purriños M, Gonzalo-Orden JM, Fernández-López A. Age-dependent modifications in vascular adhesion molecules and apoptosis after 48-h reperfusion in a rat global cerebral ischemia model. AGE (DORDRECHT, NETHERLANDS) 2014; 36:9703. [PMID: 25182537 PMCID: PMC4453934 DOI: 10.1007/s11357-014-9703-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/04/2014] [Indexed: 06/03/2023]
Abstract
Stroke is one of the leading causes of death and permanent disability in the elderly. However, most of the experimental studies on stroke are based on young animals, and we hypothesised that age can substantially affect the stroke response. The two-vessel occlusion model of global ischemia by occluding the common carotid arteries for 15 min at 40 mmHg of blood pressure was carried out in 3- and 18-month-old male Sprague-Dawley rats. The adhesion molecules E- and P-selectin, cell adhesion molecules (CAMs), both intercellular (ICAM-1) and vascular (VCAM-1), as well as glial fibrillary acidic protein (GFAP), and cleaved caspase-3 were measured at 48 h after ischemia in the cerebral cortex and hippocampus using Western blot, qPCR and immunofluorescence techniques. Diametric expression of GFAP and a different morphological pattern of caspase-3 labelling, although no changes in the cell number, were observed in the neurons of young and old animals. Expression of E-selectin and CAMs was also modified in an age- and ischemia/reperfusion-dependent manner. The hippocampus and cerebral cortex had similar response patterns for most of the markers studied. Our data suggest that old and young animals present different time-courses of neuroinflammation and apoptosis after ischemic damage. On the other hand, these results suggest that neuroinflammation is dependent on age rather than on the different vulnerability described for the hippocampus and cerebral cortex. These differences should be taken into account in searching for therapeutic targets.
Collapse
Affiliation(s)
- Berta Anuncibay-Soto
- />Área de Biología Celular, Instituto de Biomedicina, Universidad de León, Leon, Spain
| | - Diego Pérez-Rodríguez
- />Área de Biología Celular, Instituto de Biomedicina, Universidad de León, Leon, Spain
| | - Irene L Llorente
- />Área de Biología Celular, Instituto de Biomedicina, Universidad de León, Leon, Spain
| | - Marta Regueiro-Purriños
- />Área de Medicina, Cirugía y Anatomía Veterinaria, Instituto de Biomedicina, Universidad de León, Leon, Spain
| | - José Manuel Gonzalo-Orden
- />Área de Medicina, Cirugía y Anatomía Veterinaria, Instituto de Biomedicina, Universidad de León, Leon, Spain
| | | |
Collapse
|
25
|
Jackson JW, Schneeweiss S, VanderWeele TJ, Blacker D. Quantifying the role of adverse events in the mortality difference between first and second-generation antipsychotics in older adults: systematic review and meta-synthesis. PLoS One 2014; 9:e105376. [PMID: 25140533 PMCID: PMC4139353 DOI: 10.1371/journal.pone.0105376] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/23/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Observational studies have reported higher mortality among older adults treated with first-generation antipsychotics (FGAs) versus second-generation antipsychotics (SGAs). A few studies examined risk for medical events, including stroke, ventricular arrhythmia, venous thromboembolism, myocardial infarction, pneumonia, and hip fracture. OBJECTIVES 1) Review robust epidemiologic evidence comparing mortality and medical event risk between FGAs and SGAs in older adults; 2) Quantify how much these medical events explain the observed mortality difference between FGAs and SGAs. DATA SOURCES Pubmed and Science Citation Index. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS Studies of antipsychotic users that: 1) evaluated mortality or medical events specified above; 2) restricted to populations with a mean age of 65 years or older 3) compared FGAs to SGAs, or both to a non-user group; (4) employed a "new user" design; (5) adjusted for confounders assessed prior to antipsychotic initiation; (6) and did not require survival after antipsychotic initiation. A separate search was performed for mortality estimates associated with the specified medical events. STUDY APPRAISAL AND SYNTHESIS METHODS For each medical event, we used a non-parametric model to estimate lower and upper bounds for the proportion of the mortality difference-comparing FGAs to SGAs-mediated by their difference in risk for the medical event. RESULTS We provide a brief, updated summary of the included studies and the biological plausibility of these mechanisms. Of the 1122 unique citations retrieved, we reviewed 20 observational cohort studies that reported 28 associations. We identified hip fracture, stroke, myocardial infarction, and ventricular arrhythmias as potential intermediaries on the causal pathway from antipsychotic type to death. However, these events did not appear to explain the entire mortality difference. CONCLUSIONS The current literature suggests that hip fracture, stroke, myocardial infarction, and ventricular arrhythmias partially explain the mortality difference between SGAs and FGAs.
Collapse
Affiliation(s)
- John W. Jackson
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Tyler J. VanderWeele
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Deborah Blacker
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Gerontology Research Unit, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
26
|
Hatakeyama T, Okauchi M, Hua Y, Keep RF, Xi G. Deferoxamine reduces neuronal death and hematoma lysis after intracerebral hemorrhage in aged rats. Transl Stroke Res 2014; 4:546-53. [PMID: 24187595 DOI: 10.1007/s12975-013-0270-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Intracerebral hemorrhage (ICH) is primarily a disease of the elderly. Deferoxamine (DFX), an iron chelator, reduces long-term neurological deficits and brain atrophy after ICH in aged rats. In the present study, we investigated whether DFX can reduce acute ICH-induced neuronal death and whether it affects the endogenous response to ICH (ferritin upregulation and hematoma resolution) in aged rats. Male Fischer 344 rats (18 months old) had an intracaudate injection of 100 μL autologous whole blood into the right basal ganglia and were treated with DFX (100 mg/kg) or vehicle 2 hours post-ICH and then every 12 hours up to 7 days. Rats were euthanized 1, 3, or 7 days later for neuronal death, ferritin and hematoma size measurements. Plasma ferritin levels and behavioral outcome following ICH were also examined. DFX treatment significantly reduced ICH-induced neuronal death and neurological deficits. DFX also suppressed ferritin upregulation in the ipsilateral basal ganglia after ICH and hematoma lysis (hematoma volume at day 7: 13.2±4.9 vs. 3.8±1.2 mm3 in vehicle-treated group, p<0.01). However, effects of DFX on plasma ferritin levels after ICH did not reach significance. In conclusion, DFX reduces neuronal death and neurological deficits after ICH in aged rats. It also affects the endogenous response to ICH.
Collapse
Affiliation(s)
- Tetsuhiro Hatakeyama
- Department of Neurosurgery, University of Michigan, USA ; Department of Neurological Surgery, Kagawa University, Japan
| | | | | | | | | |
Collapse
|
27
|
Cost-Effectiveness Analysis of Extended Duration Anticoagulation with Rivaroxaban to Prevent Recurrent Venous Thromboembolism. Thromb Res 2014; 133:743-9. [DOI: 10.1016/j.thromres.2014.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 01/29/2014] [Accepted: 02/04/2014] [Indexed: 11/18/2022]
|
28
|
Khan NA, Quan H, Hill MD, Pilote L, McAlister FA, Palepu A, Shah BR, Zhou L, Zhen H, Kapral MK. Risk factors, quality of care and prognosis in South Asian, East Asian and White patients with stroke. BMC Neurol 2013; 13:74. [PMID: 23829874 PMCID: PMC3726470 DOI: 10.1186/1471-2377-13-74] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 06/28/2013] [Indexed: 11/10/2022] Open
Abstract
Background Stroke has emerged as a significant and escalating health problem for Asian populations. We compared risk factors, quality of care and risk of death or recurrent stroke in South Asian, East Asian and White patients with acute ischemic and hemorrhagic stroke. Methods Retrospective analysis was performed on consecutive patients with ischemic stroke or intracerebral hemorrhage admitted to 12 stroke centers in Ontario, Canada (July 2003-March 2008) and included in the Registry of the Canadian Stroke Network database. The database was linked to population-based administrative databases to determine one-year risk of death or recurrent stroke. Results The study included 253 South Asian, 513 East Asian and 8231 White patients. East Asian patients were more likely to present with intracerebral hemorrhage (30%) compared to South Asian (17%) or White patients (15%) (p<0.001). Time from stroke to hospital arrival was similarly poor with delays >2 hours for more than two thirds of patients in all ethnic groups. Processes of stroke care, including thrombolysis, diagnostic imaging, antithrombotic medications, and rehabilitation services were similar among ethnic groups. Risk of death or recurrent stroke at one year after ischemic stroke was similar for patients who were White (27.6%), East Asian (24.7%, aHR 0.97, 95% CI 0.78-1.21 vs. White), or South Asian (21.9%, aHR 0.91, 95% CI 0.67-1.24 vs. White). Although risk of death or recurrent stroke at one year after intracerebral hemorrhage was higher in East Asian (35.5%) and White patients (47.9%) compared to South Asian patients (30.2%) (p=0.002), these differences disappeared after adjustment for age, sex, stroke severity and comorbid conditions (aHR 0.89 [0.67-1.19] for East Asian vs White and 0.99 [0.54-1.81] for South Asian vs. White). Conclusion After stratification by stroke type, stroke care and outcomes are similar across ethnic groups in Ontario. Enhanced health promotion is needed to reduce delays to hospital for all ethnic groups.
Collapse
Affiliation(s)
- Nadia A Khan
- Department of Medicine, University of British Columbia, 620 B, 1081 Burrard Street, St, Paul's Hospita, Vancouver, BC V6Z 1Y6, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Sarikaya H. Safety and Efficacy of Thrombolysis with Intravenous Alteplase in Older Stroke Patients. Drugs Aging 2013; 30:227-34. [DOI: 10.1007/s40266-013-0052-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
30
|
Lee J, Morishima T, Kunisawa S, Sasaki N, Otsubo T, Ikai H, Imanaka Y. Derivation and Validation of In-Hospital Mortality Prediction Models in Ischaemic Stroke Patients Using Administrative Data. Cerebrovasc Dis 2013; 35:73-80. [DOI: 10.1159/000346090] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 11/22/2012] [Indexed: 11/19/2022] Open
|
31
|
Abstract
The objectives of the present study were to investigate survival time, possible predictors of survival and clinical outcome in dogs with ischaemic stroke. A retrospective study of dogs with a previous diagnosis of ischaemic stroke diagnosed by magnetic resonance imaging (MRI) was performed. The association between survival and the hypothesised risk factors was examined using univariable exact logistic regression. Survival was examined using Kaplan-Meier and Cox regression. Twenty-two dogs were identified. Five dogs (23%) died within the first 30days of the stroke event. Median survival in 30-day survivors was 505days. Four dogs (18%) were still alive by the end of the study. Right-sided lesions posed a significantly increased risk of mortality with a median survival time in dogs with right-sided lesions of 24days vs. 602days in dogs with left sided lesions (P=0.006). Clinical outcome was considered excellent in seven of 17 (41%) 30-day survivors. Another seven 30-day survivors experienced new acute neurological signs within 6-17months of the initial stroke event; in two of those cases a new ischaemic stroke was confirmed by MRI. In conclusion, dogs with ischaemic stroke have a fair to good prognosis in terms of survival and clinical outcome. However, owners should be informed of the risk of acute death within 30days and of the possibility of new neurological events in survivors. Mortality was increased in dogs with right-sided lesions in this study.
Collapse
|
32
|
LIMA HELBERTN, CABRAL NORBERTOL, FRANKLIN JARROD, MORO CARLAHELOISAC, PECOITS-FILHO ROBERTO, GONÇALVES ANDERSONR. Age dependent impact of estimated glomerular filtration rate on long-term survival after ischaemic stroke. Nephrology (Carlton) 2012; 17:725-32. [DOI: 10.1111/j.1440-1797.2012.01643.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
33
|
|
34
|
Lively S, Schlichter LC. Age-related comparisons of evolution of the inflammatory response after intracerebral hemorrhage in rats. Transl Stroke Res 2012; 3:132-46. [PMID: 22707991 PMCID: PMC3372776 DOI: 10.1007/s12975-012-0151-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 02/28/2012] [Accepted: 03/01/2012] [Indexed: 12/14/2022]
Abstract
In the hours to days after intracerebral hemorrhage (ICH), there is an inflammatory response within the brain characterized by the infiltration of peripheral neutrophils and macrophages and the activation of brain-resident microglia and astrocytes. Despite the strong correlation of aging and ICH incidence, and increasing information about cellular responses, little is known about the temporal- and age-related molecular responses of the brain after ICH. Here, we monitored a panel of 27 genes at 6 h and 1, 3, and 7 days after ICH was induced by injecting collagenase into the striatum of young adult and aged rats. Several molecules (CR3, TLR2, TLR4, IL-1β, TNFα, iNOS, IL-6) were selected to reflect the classical activation of innate immune cells (macrophages, microglia) and the potential to exacerbate inflammation and damage brain cells. Most of the others are associated with the resolution of innate inflammation, alternative pathways of macrophage/microglial activation, and the repair phase after acute injury (TGFβ, IL-1ra, IL-1r2, IL-4, IL-13, IL-4Rα, IL-13Rα1, IL-13Rα2, MRC1, ARG1, CD163, CCL22). In young animals, the up-regulation of 26 in 27 genes (not IL-4) was detected within the first week. Differences in timing or levels between young and aged animals were detected for 18 of 27 genes examined (TLR2, GFAP, IL-1β, IL-1ra, IL-1r2, iNOS, IL-6, TGFβ, MMP9, MMP12, IL-13, IL-4Rα, IL-13Rα1, IL-13Rα2, MRC1, ARG1, CD163, CCL22), with a generally less pronounced or delayed inflammatory response in the aged animals. Importantly, within this complex response to experimental ICH, the induction of pro-inflammatory, potentially harmful mediators often coincided with resolving and beneficial molecules.
Collapse
|
35
|
Bardia A, Arieas ET, Zhang Z, Defilippis A, Tarpinian K, Jeter S, Nguyen A, Henry NL, Flockhart DA, Hayes DF, Hayden J, Storniolo AM, Armstrong DK, Davidson NE, Fetting J, Ouyang P, Wolff AC, Blumenthal RS, Ashen MD, Stearns V. Comparison of breast cancer recurrence risk and cardiovascular disease incidence risk among postmenopausal women with breast cancer. Breast Cancer Res Treat 2011; 131:907-14. [PMID: 22042368 DOI: 10.1007/s10549-011-1843-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 10/15/2011] [Indexed: 12/21/2022]
Abstract
The majority of breast cancers are diagnosed in postmenopausal women. Competing comorbidities, particularly cardiovascular disease (CVD), should be considered when individualizing adjuvant therapies for these women. We compared the 10-year predicted breast cancer recurrence risk with CVD risk among postmenopausal women with hormone receptor-positive (HR+), non-metastatic breast cancer. CVD risk factor data were prospectively collected from postmenopausal women with stage I-III, HR+ breast cancer initiating adjuvant aromatase inhibitor therapy. We compared predicted 10-year CVD risk, including the composite index heart age, computed from modified Framingham risk score, with predicted 10-year risk of breast cancer recurrence using Adjuvant! Online. We created multivariable logistic regression models to estimate the odds ratios (OR) and 95% confidence intervals (CI) for greater CVD risk than breast cancer recurrence risk. Among 415 women, mean age and heart age were 60 and 67 years, respectively. Overall, 43% of women had a predicted 10-year CVD risk equivalent to breast cancer recurrence risk and 37% had CVD risk higher than breast cancer recurrence risk. Predicted CVD risk was higher than breast cancer recurrence risk for stage I disease (OR: 6.1, 95% CI: 3.4-11.2) or heart age >65 (OR: 12.4, 95% CI: 7.0-22.6). The majority of postmenopausal women with HR+ early breast cancer had a predicted 10-year CVD risk that was equivalent to or higher than breast cancer recurrence risk. Physicians should weigh competing risks and offer early screening and cardiac prevention strategies for women at a greater risk for CVD.
Collapse
Affiliation(s)
- Aditya Bardia
- Breast Cancer Program, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Bunting-Blaustein Cancer Research Building 1, Room 144, 1650 Orleans Street, Baltimore, MD 21231, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Giralt-Steinhauer E, Cuadrado-Godia E, Ois Á, Jiménez-Conde J, Rodríguez-Campello A, Planellas L, Jimena-García S, Rubio MÁ, Roquer-González J. CHA2DS2-VASc score and prognosis in ischemic strokes with atrial fibrillation. J Neurol 2011; 259:745-51. [DOI: 10.1007/s00415-011-6259-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 09/12/2011] [Accepted: 09/14/2011] [Indexed: 12/28/2022]
|
37
|
Kim CG, Park HA. [Development and evaluation of a web-based education program to prevent secondary stroke]. J Korean Acad Nurs 2011; 41:47-60. [PMID: 21515999 DOI: 10.4040/jkan.2011.41.1.47] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was conducted to develop and evaluate a web-based education program for secondary stroke prevention. METHODS A web-based secondary stroke prevention education program was developed using the system's life cycle methods and evaluated by comparing the effects of education among three groups, a web group, a booklet group and a control group. RESULTS Knowledge level of both patients and family, as well as some health behavior compliance in the web-based and booklet education groups were significantly higher than those of the control group. Family support in the web-based and booklet education groups was significantly higher than that of the control group after 12 weeks. The urine cotinine level in the web-based education group was significantly lower than that of the control group after 12 weeks. Medication adherence, blood pressure and perceived health status were not statistically different among the three groups at any time. CONCLUSION Web-based and booklet education programs were equally effective regarding the level of knowledge of patients and their families, family support, health behavior compliance, and urine cotinine level. These results demonstrate the potential use of a web-based education program for secondary stroke prevention.
Collapse
Affiliation(s)
- Chul-Gyu Kim
- Department of Nursing, Cheongju University, Cheongju, Korea
| | | |
Collapse
|
38
|
Xu J, Wang W, Shi H, Chen S, Liu Z, Li W, Zhang J, Li Y, Chen N. Chronic kidney disease is prevalent in Chinese patients admitted with verified cerebrovascular lesions and predicts short-term prognosis. Nephrol Dial Transplant 2011; 26:2590-4. [DOI: 10.1093/ndt/gfq748] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
39
|
Chen RL, Balami JS, Esiri MM, Chen LK, Buchan AM. Ischemic stroke in the elderly: an overview of evidence. Nat Rev Neurol 2010; 6:256-65. [PMID: 20368741 DOI: 10.1038/nrneurol.2010.36] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Stroke mostly occurs in elderly people and patient outcomes after stroke are highly influenced by age. A better understanding of the causes of stroke in the elderly might have important practical implications not only for clinical management, but also for preventive strategies and future health-care policies. In this Review, we explore the evidence from both human and animal studies relating to the effect of old age-in terms of susceptibility, patient outcomes and response to treatment-on ischemic stroke. Several aging-related changes in the brain have been identified that are associated with an increase in vulnerability to ischemic stroke in the elderly. Furthermore, risk factor profiles for stroke and mechanisms of ischemic injury differ between young and elderly patients. Elderly patients with ischemic stroke often receive less-effective treatment and have poorer outcomes than younger individuals who develop this condition. Neuroprotective agents for ischemic stroke have been sought for decades but none has proved effective in humans. One contributing factor for this translational failure is that most preclinical studies have used young animals. Future research on ischemic stroke should consider age as a factor that influences stroke prevention and treatment, and should focus on the management of acute stroke in the elderly to reduce the incidence and improve outcomes in this vulnerable group.
Collapse
Affiliation(s)
- Ruo-Li Chen
- Nuffield Department of Medicine, University of Oxford, Headington, Oxford, UK
| | | | | | | | | |
Collapse
|
40
|
Chang KC, Lee HC, Tseng MC, Huang YC. Three-year survival after first-ever ischemic stroke is predicted by initial stroke severity: A hospital-based study. Clin Neurol Neurosurg 2010; 112:296-301. [PMID: 20106589 DOI: 10.1016/j.clineuro.2009.12.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 12/02/2009] [Accepted: 12/23/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to report 3-year survival and causes of death of first-ever ischemic stroke stratified by initial stroke severity. STUDY DESIGN AND SETTING From September 1998 to October 1999, 360 acute first-ever ischemic stroke patients consecutively admitted were followed up prospectively. Patients' vital status and causes of death were identified from the National Death Registry, till December 31, 2002. Potential prognostic factors available at admission were evaluated using Cox proportional hazards regression analysis with bootstrap validation. RESULTS Three hundred and sixty patients, 58% males with age 64.9 years on average, were followed up for 43.4 months with no lost follow-up. Ninety-two (25.6%) patients died, 25 in the first month. The cumulative case-fatality rates were 12.2%, 15.8%, 20.5% and 25.6% for years 1-4. The proportion of vascular deaths was 84% during the first 30 days and 71% for the subsequent 5 months. The hazard ratio (95% CI) was 1.08 (1.05-1.11) for age (1-year increment), 335.90 (20.72-5446.23) for NIHSS 16-38, 2.48 (1.39-4.42) for NIHSS 7-15, and 0.95 (0.91-0.99) for an interaction term of age and NIHSS 16-38. CONCLUSION This study confirmed that the initial stroke severity and age were early prognostic factors for 3-year survival after first-ever ischemic stroke, and further demonstrated that the influence of age on survival time was slightly lower in patients with severe stroke.
Collapse
Affiliation(s)
- Ku-Chou Chang
- Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | | | | | | |
Collapse
|
41
|
Rosen VM, Taylor DCA, Parekh H, Pandya A, Thompson D, Kuznik A, Waters DD, Drummond M, Weinstein MC. Cost effectiveness of intensive lipid-lowering treatment for patients with congestive heart failure and coronary heart disease in the US. PHARMACOECONOMICS 2010; 28:47-60. [PMID: 20014876 DOI: 10.2165/11531440-000000000-00000] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND A recent study found fewer hospitalizations for congestive heart failure (CHF) patients receiving high-dose versus low-dose statin therapy. OBJECTIVE To examine the cost effectiveness of high-dose versus low-dose statin therapy in CHF patients. METHODS Two scenarios (literature-based [base-case scenario] vs trial-based post-event mortality [alternative scenario]) assessed the cost effectiveness of atorvastatin 80 mg/day (A80) versus atorvastatin 10 mg/day (A10) in patients with both CHF and coronary heart disease (CHD) [CHF/CHD], using a lifetime Markov model. The model predicts treatment-specific probabilities of major and minor cardiovascular events and death, based on clinical trial data. The quality of life and costs were literature based. Measures included costs per life-year saved (LYS) and QALY gained. Health consequences and costs were discounted at 3.0% annually. Analyses were conducted from the payer perspective and valued in $US, year 2006-7 values. RESULTS Literature-based mortality estimates (base case) increased life-years and QALYs for A80 compared with A10 (incremental cost-effectiveness ratios [ICERs]: $US9600 per LYS; $US13 600 per QALY). At a willingness to pay of $US100 000 per QALY, A80 was cost effective in 80% of simulations. A10 dominated A80 when using trial-based mortality estimates (alternative scenario). At a willingness to pay of $US100 000 per QALY, A80 was cost effective in 48% of simulations. CONCLUSIONS Intensive A80 treatment may be cost effective versus A10 in cardiovascular prevention in CHF/CHD patients in the US, due to projected gains in life expectancy and health-related quality of life. However, the results are highly sensitive to assumptions about the mortality rate in the model. When using the mortality rate observed in the trial, A10 dominates A80.
Collapse
|
42
|
Feigin VL, Lawes CMM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 2009; 8:355-69. [PMID: 19233729 DOI: 10.1016/s1474-4422(09)70025-0] [Citation(s) in RCA: 1806] [Impact Index Per Article: 120.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This systematic review of population-based studies of the incidence and early (21 days to 1 month) case fatality of stroke is based on studies published from 1970 to 2008. Stroke incidence (incident strokes only) and case fatality from 21 days to 1 month post-stroke were analysed by four decades of study, two country income groups (high-income countries and low to middle income countries, in accordance with the World Bank's country classification) and, when possible, by stroke pathological type: ischaemic stroke, primary intracerebral haemorrhage, and subarachnoid haemorrhage. This Review shows a divergent, statistically significant trend in stroke incidence rates over the past four decades, with a 42% decrease in stroke incidence in high-income countries and a greater than 100% increase in stroke incidence in low to middle income countries. In 2000-08, the overall stroke incidence rates in low to middle income countries have, for the first time, exceeded the level of stroke incidence seen in high-income countries, by 20%. The time to decide whether or not stroke is an issue that should be on the governmental agenda in low to middle income countries has now passed. Now is the time for action.
Collapse
Affiliation(s)
- Valery L Feigin
- National Research Centre for Stroke, Applied Neurosciences and Neurorehabilitation, School of Rehabilitation and Occupation Studies, AUT University, North Shore Campus, AA254, Northcote 0627, Auckland 1142, New Zealand.
| | | | | | | | | |
Collapse
|
43
|
Dziedzic T, Slowik A, Pera J, Szczudlik A. Association between hyperglycemia, heart failure and mortality in stroke patients. Eur J Neurol 2009; 16:251-6. [DOI: 10.1111/j.1468-1331.2008.02400.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
44
|
Wasserman JK, Yang H, Schlichter LC. Glial responses, neuron death and lesion resolution after intracerebral hemorrhage in young vs. aged rats. Eur J Neurosci 2009; 28:1316-28. [PMID: 18973558 DOI: 10.1111/j.1460-9568.2008.06442.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Intracerebral hemorrhage (ICH) usually affects older humans but almost no experimental studies have assessed aged animals. We address how aging alters inflammation, neuron death and lesion resolution after a hemorrhage in the rat striatum. In the normal aged brain, microglia displayed a 'dystrophic' phenotype, with shorter cellular processes and large gaps between adjacent cells, and there was more astrocyte reactivity. The ICH injury was monitored as hematoma volume and number of dying neurons at 1 and 3 days, and the volume of the residual lesion, ventricles and lost tissue at 28 days. Inflammation at 1 and 3 days was assessed from densities of microglia with resting vs. activated morphologies, or expressing the lysosomal marker ED1. Despite an initial delay in neuron death in aged animals, by 28 days, there was no difference in neuron density or volume of tissue lost. However, lesion resolution was impaired in aged animals and there was less compensatory ventricular expansion. At 1 day after ICH, there were fewer activated microglia/macrophages in the aged brain, but by 3 days there were more of these cells at the edge of the hematoma and in the surrounding parenchyma. In both age groups a glial limitans had developed by 3 days, but astrocyte reactivity and the spread of activated microglia/macrophages into the surrounding parenchyma was greater in the aged. These findings have important implications for efforts to reduce secondary injury after ICH and to develop anti-inflammatory therapies to treat ICH in aged humans.
Collapse
Affiliation(s)
- Jason K Wasserman
- Toronto Western Research Institute, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada
| | | | | |
Collapse
|
45
|
Johnstone J, Eurich DT, Majumdar SR, Jin Y, Marrie TJ. Long-term morbidity and mortality after hospitalization with community-acquired pneumonia: a population-based cohort study. Medicine (Baltimore) 2008; 87:329-334. [PMID: 19011504 DOI: 10.1097/md.0b013e318190f444] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Little is known about the long-term sequelae of community-acquired pneumonia (CAP). Therefore, we describe the long-term morbidity and mortality of patients after pneumonia requiring hospitalization. We specifically hypothesized that the Pneumonia Severity Index (PSI), designed to predict 30-day pneumonia-related mortality, would also be associated with longer-term all-cause mortality. Between 2000 and 2002, 3415 adults with CAP admitted to 6 hospitals in Edmonton, Alberta, Canada, were prospectively enrolled in a population-based cohort. At the time of hospital admission, demographic, clinical, and laboratory data were collected and the PSI was calculated for each patient. Postdischarge outcomes through to 2006 were ascertained using multiple linked administrative databases. Outcomes included all-cause mortality, hospital admissions, and re-hospitalization for pneumonia over a maximum of 5.4 years of follow-up. Follow-up data were available for 3284 (96%) patients; 66%were > or =65 years of age, 53% were male, and according to the PSI fully 63% were predicted to have greater than 18% 30-day pneumonia-related mortality (that is, PSI class IV-V). Median follow-up was 3.8 years. The 30-day, 1-year, and end of study mortality rates were 12%, 28%, and 53%, respectively. Overall, 82(19%) patients aged <45 years died compared with 1456 (67%) patients aged > or =65 years (hazard ratio [HR], 5.07; 95% confidence interval [CI], 4.06-6.34). Male patients were more likely to die than female patients during follow-up (971 [56%] vs. 767 [49%], respectively; HR, 1.20; 95% CI, 1.13-1.37). Initial PSI classification predicted not only 30-day mortality, but also long-term postdischarge mortality, with 92 (15%) of PSI class I-II patients dying compared with 616 (82%) PSI class V patients (HR, 11.80; 95% CI, 4.70-14.70). Of 2950 patients who survived the initial CAP hospitalization, 72% were hospitalized again (median, 2 admissions over follow-up) and 16% were re-hospitalized with pneumonia. In conclusion, long-term morbidity and mortality are high following hospitalization for pneumonia and are strongly correlated with initial PSI class. This suggests that patients with pneumonia, especially those with PSI class IV and V at admission, might need better attention paid to preventive strategies and much closer follow-up due to their elevated risk of subsequent adverse events and increased health resource utilization.
Collapse
Affiliation(s)
- Jennie Johnstone
- From Department of Medicine (JJ, SRM, TJM), Faculty of Medicine and Dentistry, and Department of Public Health Science (DTE, SRM), School of Public Health, University of Alberta; and Alberta Health and Wellness (YJ), Edmonton, Alberta, Canada
| | | | | | | | | |
Collapse
|
46
|
Nadathur SG. Recorded Categories of Non-Principal Diagnoses in Victorian Public Hospital Transient Ischaemic Attack and Stroke Admissions. HEALTH INF MANAG J 2008; 37:33-44. [DOI: 10.1177/183335830803700305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Information about the number and types of non-principal diagnoses (NPDs) would make an important contribution to prediction of outcome and hence patient management. The study reported here is based on analysis of three fiscal years of the Victorian public hospital transient ischaemic attack (TIA) and stroke admissions. The incidence of NPDs and co-occurrence of NPD-associated prefix categories (that identify the onset or relevance of each condition to the episode) are described in each of the broad stroke subtypes. The distributions of length of stay and in-hospital deaths in the cohorts without and with NPDs and in the various prefix categories are determined. The study also compares the age and gender distribution in the various subpopulations of interest. The importance of collecting complete and accurate data on nature of NPDs and its potential in describing the complexity of presentation are discussed.
Collapse
Affiliation(s)
- Shyamala G Nadathur
- Shyamala G Nadathur BSc, CertIT(BusAppl), GradDip(ClinImmunol), GradDip(InfoSystm), MSc, MHealthMgt, AFACHSE, MPHA, MHISA, Project Manager, Southern Health, Doctoral Candidate (Health Informatics), Monash Institute of Health Services Research, Monash Medical Centre, Locked Bag 29, Clayton VIC 3168, AUSTRALIA
| |
Collapse
|
47
|
|
48
|
Eriksson M, Norrving B, Terént A, Stegmayr B. Functional outcome 3 months after stroke predicts long-term survival. Cerebrovasc Dis 2008; 25:423-9. [PMID: 18349536 DOI: 10.1159/000121343] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 11/02/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND When reporting stroke survival and prognostic factors with a possible effect on outcome, the starting point for the observation of a clinical cohort usually is the onset of stroke or the acute admission of a patient. Thus, acute and early mortality inflict prognosis on long-term outcome. In order to give a more robust analysis of long-term survival after the acute period we chose to start our observation with 3-month survivors. METHODS We used data from Riks-Stroke, the Swedish quality register for stroke care, together with survival information from the Swedish population register to explore the influence of disability level 3 months after stroke on long-term survival. The main analysis included 15,959 stroke patients, registered during 2001-2002, who had been independent in primary activities of daily living before stroke, had suffered an ischaemic or a haemorrhagic stroke and reported no previous stroke. RESULTS Impaired functional outcome after stroke was an independent predictor of poor survival. Patients with modified Rankin scale (mRS) grades 3, 4 and 5 had hazard ratios of 1.7, 2.5 and 3.8, respectively, as compared with patients with lower mRS grades. In addition to high mRS, male sex, high age, diabetes, smoking, hypertension therapy at stroke onset, atrial fibrillation and depressed mood were also recognized as significant predictors of poor survival using a multiple Cox regression model. CONCLUSION The influence of disability on survival is stronger than that of several other well-known prognostic factors. This finding indicates that any intervention in the acute phase that may improve functional status at 3 months will also have favourable secondary effects on survival in the long term.
Collapse
Affiliation(s)
- Marie Eriksson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | | | | | | |
Collapse
|
49
|
Roquer J, Ois A, Rodríguez Campello A, Gomis M, Munteis E, Jiménez Conde J, Martínez-Rodríguez JE. Clustering of vascular risk factors and in-hospital death after acute ischemic stroke. J Neurol 2007; 254:1636-41. [PMID: 18004645 DOI: 10.1007/s00415-007-0559-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Revised: 12/19/2006] [Accepted: 01/21/2007] [Indexed: 01/08/2023]
Abstract
OBJECTIVE to evaluate the influence of clustering of vascular risk factors (VRF) on in-hospital mortality in patients with acute ischemic stroke (AIS) developing a risk score for mortality prediction. METHODS clinical data from 1527 patients admitted to hospital with a first-ever AIS were prospectively evaluated from 1997 to 2005 assessing the presence of six VRF: diabetes, hypertension, hyperlipidemia, ischemic heart disease, atrial fibrillation and peripheral arterial disease. A composite vascular risk score (VRS) was created using five risk factors. Hyperlipidemia was excluded from the score due to its protective impact on mortality. Two modified VRS models were created and assessed for their accuracy as predictors for in-hospital mortality based on the odds ratio for each VRF obtained in the univariate analysis. RESULTS 197 patients (12.9 %) died during the acute hospitalization period. Stroke severity increased with each additional VRF (p = 0.002). Cox proportional hazards model adjusted for confounders showed an association between the composite VRS and in-hospital mortality (p = 0.045). According to the clustering of VRS, the risk for in-hospital death increased from 1.951 (95 % CI 1.041-3.665) for patients having one VRS to 2.343 (95% CI 1.081-5.076) for those having a VRS > or = 4. ROC curves showed that the modified VRS model based on a given value of one for each accumulated VRF, including the absence of hyperlipidemia, had the highest predictive capability for in-hospital mortality (p < 0.0001). CONCLUSIONS the presence of multiple VRF in patients with acute ischemic stroke increases the stroke severity and the risk of in-hospital death.
Collapse
Affiliation(s)
- J Roquer
- Universitat Autonoma de Barcelona, Departament de Medicina, Passeig Marítim 25-29, 08003, Barcelona, Spain.
| | | | | | | | | | | | | |
Collapse
|
50
|
Covic A, Schiller A, Mardare NG, Petrica L, Petrica M, Mihaescu A, Posta N. The impact of acute kidney injury on short-term survival in an Eastern European population with stroke. Nephrol Dial Transplant 2007; 23:2228-34. [PMID: 17989102 DOI: 10.1093/ndt/gfm591] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Stroke is one of the leading causes of death and of serious disability with significant impact on patients' long-term survival. The short-term evolution following stroke can associate acute kidney injury (AKI) as a possible complication, frequently overlooked and underestimated in clinical trials. We aimed to describe in an East European cohort (i) the incidence of AKI and its risk factors; (ii) the 30-day mortality and its risk factors and (iii) the relationship between mortality, pre-existent renal function and subsequent AKI. METHODS A total of 1090 consecutive cases hospitalized-during a 12-month period-with a CT-confirmed diagnosis of stroke, from a distinct administrative region were included. Demographic details, comorbidities, laboratory and outcome data were retrieved from the electronic hospital database. All patients included in the study were followed for 30 days or until death. RESULTS The mean age of this population was 66.1 +/- 11.5 years, 49.3% were males, mean glomerular filtration rate (GFR) 68.9 +/- 22.6 ml/min/1.73 m(2). The 30-day mortality rate was 17.2%. One hundred and fifty-eight patients presented with haemorrhagic stroke and 932 patients had ischaemic stroke. Stroke mortality was-14% for ischaemic stroke and almost twice as high for haemorrhagic stroke-36.3%. One hundred fifty-eight (14.5%) patients were classified as developing AKI. The AKI patients were older, had a higher baseline serum creatinine, lower GFR, higher serum glucose, higher prevalence of chronic heart failure and ischaemic heart disease, were more likely to have suffered a haemorrhagic stroke, and had a significantly higher 30-day mortality rate (43.1 vs 12.8%) (P < 0.05 for all). Independent predictors for AKI development in the logistic regression analysis were age, GFR, presence of comorbidities (ischaemic heart disease and chronic heart failure) and type of stroke (Cox and Snell R(2) 0.244; Nagelkerke R(2) 0.431; P < 0.05). In our study, we demonstrated that the occurrence of AKI is not a rare finding in stroke patients. This is the first study to report the incidence of AKI in a distinct geographic population base, in patients with stroke. Baseline renal function emerged as both a significant independent marker for short-term survival after an acute stroke (even after adjustment for baseline comorbidities) and as a risk factor for subsequent AKI.
Collapse
Affiliation(s)
- Adrian Covic
- Dialysis and Transplantation Center, Dr C.I. Parhon University Hospital, Iai, Romania.
| | | | | | | | | | | | | |
Collapse
|