1
|
Abdel-Fattah AR, Pana TA, Smith TO, Pasdar Z, Aslam M, Mamas MA, Myint PK. Gender differences in mortality of hospitalised stroke patients. Systematic review and meta-analysis. Clin Neurol Neurosurg 2022; 220:107359. [PMID: 35835023 DOI: 10.1016/j.clineuro.2022.107359] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/22/2022] [Accepted: 07/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Gender differences in mortality after stroke remains unclear in the current literature. We therefore aimed to systematically review the gender differences in mortality up to five years after ischaemic (IS) or haemorrhagic stroke (HS) to address this evidence gap. METHODS The literature was systematically searched using Ovid EMBASE, Ovid Medline, and Web of Science databases, from inception-November 2021. The quality of evidence was appraised using the CASP Cohort-study checklist. Unadjusted and adjusted odds and hazard ratios were meta-analysed, separately for IS and HS and a subgroup analysis of age-stratified mortality data was conducted. RESULTS Forty-one studies were included (n = 8,128,700; mean-age 68.5 yrs; 47.1% female). 37 studies were included in meta-analysis (n = 8, 8008, 110). Compared to men, women who had an IS had lower mortality risk in-hospital (0.94; 95%CI 0.91-0.97), at one-month (0.87; 95%CI 0.77-0.98), 12-months (0.94; 95%CI 0.91-0.98) and five-years (0.93 95%CI 0.90-0.96). The subgroup analysis showed that this gender difference in mortality was present in women ≥ 70 years up to one-month post-IS (in-hospital: 0.94; 95%CI 0.91-0.97; one-month: 0.87; 95% CI 0.77-0.98), however, in women < 70 years this difference was no longer present. Nevertheless, analysis of crude data showed women were at higher risk of mortality in-hospital, at 12-months and five-years (in-hospital: 1.05; 95%CI 1.03-1.07, 12-months: 1.10; 95%CI 1.06-1.14, five-years: 1.06; 95%CI 1.02-1.10). After HS, women had higher mortality risk in-hospital (1.03; 95%CI 1.01-1.04) however, no gender differences were found post-discharge. CONCLUSION The gender differences in post-stroke mortality differ by stroke type, age group and follow-up. Crude stroke mortality in women is higher than in men and this appears to be driven by pre-existing comorbidities. In adjusted models, women have a lower mortality risk following IS, independent of duration of follow-up. After HS, women had higher mortality in hospital however, no gender differences after hospital discharge were found.
Collapse
Affiliation(s)
- Abdel-Rahman Abdel-Fattah
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK.
| | - Tiberiu A Pana
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Zahra Pasdar
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Maha Aslam
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Phyo K Myint
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
2
|
|
3
|
Towfighi A, Benson RT, Tagge R, Moy CS, Wright CB, Ovbiagele B. Inaugural Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving Symposium. Stroke 2020; 51:3382-3391. [PMID: 33104474 DOI: 10.1161/strokeaha.120.030423] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Race/ethnic minorities face significant inequities in stroke incidence, prevalence, care, and outcomes. The Health Equity and Actionable Disparities in Stroke: Understanding and Problem-solving symposium, a collaborative initiative of the American Heart Association and National Institute of Neurological Disorders and Stroke, was the first-ever annual multidisciplinary scientific forum focused on race/ethnic inequities in cerebrovascular disease, with the overarching goal of reducing inequities in stroke and accelerating the translation of research findings to improve outcomes for race/ethnic minorities. The symposium featured esteemed invited plenary speakers, lecturing on determinants of race/ethnic inequities in stroke and interventions aimed at redressing the inequities. The Edgar J. Kenton III Award recognized Ralph Sacco, MD, MS, for his lifetime contributions to investigation, management, mentorship, and community service in the field of stroke inequities. Early career investigators were provided with travel awards to attend the symposium; presented their research at moderated poster and Think Tank sessions; received career development advice at the Building Momentum session; and networked with experienced stroke inequities researchers. Future conferences-The Health Equity and Actionable Disparities in Stroke: Understanding and Problem-solving 2021 to 2024-will broaden the focus to include 5 major persistent inequities (race/ethnic, sex, geographic, socioeconomic, and global). Each year will focus on a different theme (community and stakeholder engagement; clinical trials; implementation science; and policy and dissemination). By fostering a community of stroke inequities researchers, we hope to highlight promising work, illuminate research gaps, facilitate networking, inform policy makers, recognize achievement, inspire greater interest among junior investigators to pursue careers in this field, and provide networking opportunities for underrepresented minority scientists.
Collapse
Affiliation(s)
- Amytis Towfighi
- Department of Neurology, University of Southern California, Los Angeles (A.T.).,Los Angeles County-Department of Health Services, Los Angeles, CA (A.T.)
| | - Richard T Benson
- Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Raelle Tagge
- Northern California Institute for Research and Education, San Francisco, CA (R.T.)
| | - Claudia S Moy
- Division of Clinical Research (C.S.M., C.B.W.), National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Clinton B Wright
- Division of Clinical Research (C.S.M., C.B.W.), National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, CA (B.O.)
| |
Collapse
|
4
|
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4752] [Impact Index Per Article: 1188.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
5
|
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5242] [Impact Index Per Article: 1048.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
6
|
Singh GM, Becquart N, Cruz M, Acevedo A, Mozaffarian D, Naumova EN. Spatiotemporal and Demographic Trends and Disparities in Cardiovascular Disease Among Older Adults in the United States Based on 181 Million Hospitalization Records. J Am Heart Assoc 2019; 8:e012727. [PMID: 31658854 PMCID: PMC6898811 DOI: 10.1161/jaha.119.012727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The US population is aging, with concurrent increases in cardiovascular disease (CVD) burdens; however, spatiotemporal and demographic trends in CVD incidence in the US elderly have not been investigated in detail. This study aims to characterize trends from 1991 to 2014 in CVD hospitalizations among US Medicare beneficiaries, aged 65+ years, by single year of age/sex/race/state using records from the US Centers for Medicare & Medicaid, covering 98% of older Americans. Methods and Results We abstracted 181 202 758 US Centers for Medicare & Medicaid hospitalization records indicating CVD in any of 10 diagnosis codes; tabulated total cases of CVD by sex, age, race, state, and calendar year (1991–2014); and normalized hospitalization counts to standardize over data batches. Stratum‐specific hospitalization rates were calculated using US Centers for Medicare & Medicaid records and US Census population counts; a cubic polynomial function was fit to year‐specific distributions of rates by single year of age. Nationwide, CVD‐related hospitalization rates increased from 1991 to 2014. Differences between hospitalization rates at age 65 and 66 years, representing magnitude of healthcare deferral until Medicare onset, increased by 7.49 per 100 people 1991 to 2006 overall, and were largest among blacks and Native Americans. Rates of CVD hospitalizations were consistently highest in the Midwest/Deep South. Evidence of misclassification of race/ethnicity in US Centers for Medicare & Medicaid hospitalization records in the 1990s was noted. Conclusions Trends in CVD‐related hospitalization rates among older Americans highlight the essential need for targeted policies to reduce CVD burdens, to improve reporting of race/ethnicity in large administrative databases, and to enhance access to affordable healthcare.
Collapse
Affiliation(s)
| | - Ninon Becquart
- Tufts Friedman School of Nutrition Science & Policy Boston MA
| | - Melissa Cruz
- Tufts Friedman School of Nutrition Science & Policy Boston MA
| | - Andrea Acevedo
- Department of Community Health Tufts University Medford MA
| | | | - Elena N Naumova
- Tufts Friedman School of Nutrition Science & Policy Boston MA
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW Although the clinical approach to the young adult stroke patient is similar to that of an older adult, several important differences exist. The purpose of this article is to concisely review the epidemiology, pathophysiology, risk factors, clinical manifestations, diagnostic methods and current treatment options for the young adult ischemic stroke patient. RECENT FINDINGS Evidence clearly indicates that the incidence ischemic stroke in young adults is on the rise. A variety of factors are implicated, including an increased burden of classic and emerging vascular risk factors, and improved stroke detection, among other causes. Improved awareness, prevention and successful treatment of the young adult stroke patient is of great importance, particularly given the major long-term socioeconomic impact strokes have on the patient, their family and society at large. SUMMARY In this review, we focus on the latest epidemiologic, diagnostic and treatment paradigms to improve physician awareness and optimize outcomes in young adult ischemic stroke patients. An overview of the clinical presentations of various stroke syndromes is described, emphasizing key causes physicians should consider, as well as providing recommendations regarding evaluation and treatment. Important causes including dissection and inflammatory and noninflammatory vasculopathies are emphasized. The diagnoses of cerebral venous thromboses, cardioembolic stroke and paradoxical emboli are also discussed. The effects of established and emerging risk factors on large and small vessel disease, as well as genetic contributions, are also highlighted.
Collapse
|
8
|
Ross KH, Patzer RE, Goldberg D, Osborne NH, Lynch RJ. Rural-Urban Differences in In-Hospital Mortality Among Admissions for End-Stage Liver Disease in the United States. Liver Transpl 2019; 25:1321-1332. [PMID: 31206223 DOI: 10.1002/lt.25587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/10/2019] [Indexed: 02/07/2023]
Abstract
Access to quality hospital care is a persistent problem for rural patients. Little is known about disparities between rural and urban populations regarding in-hospital outcomes for end-stage liver disease (ESLD) patients. We aimed to determine whether rural ESLD patients experienced higher in-hospital mortality than urban patients and whether disparities were attributable to the rurality of the patient or the center. This was a retrospective study of patient admissions in the National Inpatient Sample, a population-based sample of hospitals in the United States. Admissions were included if they were from adult patients who had an ESLD-related admission defined by codes from the International Classification of Diseases, Ninth Revision, between January 2012 and December 2014. The primary exposures of interest were patient-level rurality and hospital-level rurality. The main outcome was in-hospital mortality. We stratified our analysis by disease severity score. After accounting for patient- and hospital-level covariates, ESLD admissions to rural hospitals in every category of disease severity had significantly higher odds of in-hospital mortality than patient admissions to urban hospitals. Those with moderate or major risk of dying had more than twice the odds of in-hospital mortality (odds ratio [OR] for moderate risk, 2.41; 95% confidence interval [CI], 1.62-3.59; OR for major risk, 2.49; 95% CI, 1.97-3.14). There was no association between patient-level rurality and mortality in the adjusted models. In conclusion, ESLD patients admitted to rural hospitals had increased odds of in-hospital mortality compared with those admitted to urban hospitals, and the differences were not attributable to patient-level rurality. Our results suggest that interventions to improve outcomes in this population should focus on the level of the health system.
Collapse
Affiliation(s)
- Katherine H Ross
- Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Emory University, Atlanta, GA
| | - Rachel E Patzer
- Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Emory University, Atlanta, GA.,Division of Transplantation, Department of Surgery, Emory University School of Medicine, Emory University, Atlanta, GA
| | - David Goldberg
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nicolas H Osborne
- Division of Vascular Surgery, Department of Surgery, School of Medicine, University of Michigan, Ann Arbor, MI
| | - Raymond J Lynch
- Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Emory University, Atlanta, GA.,Division of Transplantation, Department of Surgery, Emory University School of Medicine, Emory University, Atlanta, GA
| |
Collapse
|
9
|
Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4467] [Impact Index Per Article: 744.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
10
|
Otite FO, Liaw N, Khandelwal P, Malik AM, Romano JG, Rundek T, Sacco RL, Chaturvedi S. Increasing prevalence of vascular risk factors in patients with stroke: A call to action. Neurology 2017; 89:1985-1994. [PMID: 29021359 PMCID: PMC5679417 DOI: 10.1212/wnl.0000000000004617] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 08/09/2017] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To evaluate trends in prevalence of cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking, and drug abuse) and cardiovascular diseases (carotid stenosis, chronic renal failure [CRF], and coronary artery disease [CAD]) in acute ischemic stroke (AIS) in the United States. METHODS We used the 2004-2014 National Inpatient Sample to compute weighted prevalence of each risk factor in hospitalized patients with AIS and used joinpoint regression to evaluate change in prevalence over time. RESULTS Across the 2004-2014 period, 92.5% of patients with AIS had ≥1 risk factor. Overall age- and sex-adjusted prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse were 79%, 34%, 47%, 15%, and 2%, respectively, while those of carotid stenosis, CRF, and CAD were 13%, 12%, and 27%, respectively. Risk factor prevalence varied by age (hypertension: 44% in 18-39 years vs 82% in 60-79 years), race (diabetes: Hispanic 49% vs white 30%), and sex (drug abuse: men 3% vs women 1.4%). Using joinpoint regression, prevalence of hypertension increased annually by 1.4%, diabetes by 2%, dyslipidemia by 7%, smoking by 5%, and drug abuse by 7%. Prevalence of CRF, carotid stenosis, and CAD increased annually by 13%, 6%, and 1%, respectively. Proportion of patients with multiple risk factors also increased over time. CONCLUSIONS Despite numerous guidelines and prevention initiatives, prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse in AIS increased across the 2004-2014 period. Proportion of patients with carotid stenosis, CRF, and multiple risk factors also increased. Enhanced risk factor modification strategies and implementation of evidence-based recommendations are needed for optimal stroke prevention.
Collapse
Affiliation(s)
- Fadar Oliver Otite
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL.
| | - Nicholas Liaw
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Priyank Khandelwal
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Amer M Malik
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Jose G Romano
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Tatjana Rundek
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Ralph L Sacco
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Seemant Chaturvedi
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| |
Collapse
|
11
|
Lecoffre C, de Peretti C, Gabet A, Grimaud O, Woimant F, Giroud M, Béjot Y, Olié V. National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014. Stroke 2017; 48:2939-2945. [DOI: 10.1161/strokeaha.117.017640] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/12/2017] [Accepted: 08/11/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Camille Lecoffre
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
| | - Christine de Peretti
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
| | - Amélie Gabet
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
| | - Olivier Grimaud
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
| | - France Woimant
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
| | - Maurice Giroud
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
| | - Yannick Béjot
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
| | - Valérie Olié
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
| |
Collapse
|
12
|
Abstract
OPINION STATEMENT Optimal diagnosis and management of stroke in young adults benefit from a multidisciplinary team, including a vascular neurology specialist. In addition to the "standard" vascular risk factors including smoking, hypertension, diabetes, and hyperlipidemia, one needs to consider alternative etiologies including substance abuse, carotid/vertebral artery dissections, and rare genetic conditions among others. Once a young patient is determined to have had a stroke, the next question a clinician should ask is why did this patient have a stroke? A "heart to head" diagnostic approach is recommended. A thorough history is performed, including a detailed family history with specific annotations on each family member. A thorough physical examination is necessary including a careful evaluation of the patient's general appearance, noting any joint laxity, and/or abnormalities of the skin, eyes, and heart. Findings across multiple organ systems in the patient and/or their family may indicate a genetic etiology. After an initial head CT rules out hemorrhagic stroke, additional testing should include a brain MRI, neck and cerebral vascular imaging (e.g., CTA for head and neck), transthoracic echocardiogram with a bubble study, telemetry monitoring, basic risk factor blood work (e.g., lipid panel, hemoglobin A1c, TSH, ESR, CRP, RPR, HIV, and toxicology screen), and, when appropriate, sickle screen and pregnancy test. There should be a low threshold to obtain blood cultures or a lumbar puncture. The acute treatment of ischemic stroke in young adult patients does not differ from treatment of older adults, using intravenous alteplase within 4.5 h, assuming no contraindications. In suspected proximal large artery occlusive disease, interventional clot extraction procedures should be employed in patients deemed eligible. Long-term secondary prevention strategies aimed to reduce recurrent stroke risk by targeting and modifying vascular risk factors should be instituted. The mainstay of preventative therapy is aspirin for most etiologies; however, for atrial fibrillation, anticoagulation is recommended. Statin therapy is another pharmacologic intervention recommended in most stroke patients. Other measures employed are blood pressure reduction, smoking cessation, optimal glucose control in diabetic patients, the initiation of a healthy diet and regular exercise, and lastly, substance abuse counseling in appropriate patients.
Collapse
Affiliation(s)
- Christopher A Stack
- Department of Neurology, University of Maryland Medical Center, 16 South Eutaw Street Suite 300, Baltimore, MD, 21201, USA
| | - John W Cole
- Department of Neurology, Baltimore VA Medical Center, University of Maryland School of Medicine, 12th Floor, Bressler Building, Room 12-006, 655 West Baltimore Street, Baltimore, MD, 21201-1559, USA.
| |
Collapse
|
13
|
Jin P, Matos Diaz I, Stein L, Thaler A, Tuhrim S, Dhamoon MS. Intermediate risk of cardiac events and recurrent stroke after stroke admission in young adults. Int J Stroke 2017; 13:576-584. [DOI: 10.1177/1747493017733929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background In older adults with stroke, there is an increased risk of cardiovascular events in the intermediate period, up to one year after stroke. The risk of cardiovascular events in this period in young adults after stroke has not been studied. We hypothesized that in the intermediate risk period, young adults with ischemic stroke have an increased risk of recurrent stroke and a smaller increase of cardiac events. Methods Using the National Readmissions Database during the year 2013, we identified ischemic stroke admissions among those aged 18–45 years using International Classification of Disease, Ninth Revision, Clinical Modification codes to identify index vascular events and risk factors. Primary outcomes were readmission for cardiac events and stroke. Multivariable Cox proportional hazard models and Kaplan–Meier analysis were used to estimate risk of primary outcomes. Results We identified 12,392 young adults with index stroke. The readmission rate due to recurrent stroke was higher than for cardiac events (2913.3.1 vs. 1132.4 per 100,000 index hospitalizations at 90 days). There was a higher cumulative risk of both cardiac events and recurrent stroke in the presence of baseline diabetes and hypercholesterolemia. Conclusion In a large, nationally representative database, the intermediate risk of recurrent stroke after index stroke in young adults was higher than the risk of cardiac events. The presence of vascular risk factors augmented this risk but did not entirely account for it. The aggressive control of hypercholesterolemia and diabetes may play an important role in secondary prevention in young adults with stroke.
Collapse
Affiliation(s)
- Peter Jin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ivan Matos Diaz
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Laura Stein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alison Thaler
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Stanley Tuhrim
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mandip S Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|
14
|
Kanwal F, Tansel A, Kramer JR, Feng H, Asch SM, El-Serag HB. Trends in 30-Day and 1-Year Mortality Among Patients Hospitalized With Cirrhosis From 2004 to 2013. Am J Gastroenterol 2017; 112:1287-1297. [PMID: 28607480 DOI: 10.1038/ajg.2017.175] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/12/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Recent data suggest decreasing in-patient mortality in patients hospitalized with cirrhosis. We sought to determine if improvements in short-term outcomes for patients with cirrhosis are associated with changes in longer-term outcomes. METHODS We examined temporal trends in 30 days and 1-year postdischarge mortality among patients hospitalized with cirrhosis at any of the 126 Veterans Administration hospitals from 2004 and 2013. We adjusted for a range of demographic, liver disease severity, and comorbidity-related factors to account for differences in patient cohorts over time. RESULTS We identified 109,358 unique patients who were hospitalized with cirrhosis between 2004 and 2013. In-hospital mortality decreased from 11.4 to 7.6%, whereas 1-year mortality decreased from 34.5 to 33.2%. Over a third of out-of-hospital deaths occurred within the first 30 days after discharge; 30-day mortality increased from 9.3 to 10.1%. After adjusting for patient factors, the odds of in-hospital mortality in 2013 were 30% lower (adjusted odds ratio (OR)=0.70, 95% confidence interval (CI), 0.64-0.78), 1-year mortality were 13% lower (adjusted OR=0.87, 95% CI=0.82-0.93), whereas the 30-day mortality were 10% higher than 2004 (adjusted OR=1.10, 95% CI=0.99-1.21), although the latter did not reach statistical significance. CONCLUSIONS In patients admitted with cirrhosis, reduction in in-hospital mortality was associated with less marked reduction in 1-year mortality, and an unchanged, if not higher, 30-day mortality following discharge. Our data suggest that some of the burden of mortality in cirrhosis has shifted from in-hospital to the immediate postdischarge period.
Collapse
Affiliation(s)
- Fasiha Kanwal
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Aylin Tansel
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Jennifer R Kramer
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Hua Feng
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Steven M Asch
- Center for Innovation to Implementation (Ci2i), Palo Alto Veterans Affairs Medical Center, Palo Alto, California, USA.,Division of General Medical Disciplines, Stanford University, Palo Alto, California, USA
| | - Hashem B El-Serag
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
15
|
Cruz C, Campuzano-Rincón JC, Calleja-Castillo JM, Hernández-Álvarez A, Parra MDS, Moreno-Macias H, Hernández-Girón C. Temporal Trends in Mortality from Ischemic and Hemorrhagic Stroke in Mexico, 1980-2012. J Stroke Cerebrovasc Dis 2017; 26:725-732. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/22/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022] Open
|
16
|
Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6039] [Impact Index Per Article: 862.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
17
|
Otite FO, Khandelwal P, Chaturvedi S, Romano JG, Sacco RL, Malik AM. Increasing atrial fibrillation prevalence in acute ischemic stroke and TIA. Neurology 2016; 87:2034-2042. [PMID: 27733570 DOI: 10.1212/wnl.0000000000003321] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/27/2016] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To evaluate trends in atrial fibrillation (AF) prevalence in acute ischemic stroke (AIS) and TIA in the United States. METHODS We used the Nationwide Inpatient Sample to retrospectively compute weighted prevalence of AF in AIS (n = 4,355,140) and TIA (n = 1,816,459) patients admitted to US hospitals from 2004 to 2013. Multivariate-adjusted models were used to evaluate the association of AF with clinical factors, mortality, length of stay, and cost. RESULTS From 2004 to 2013, AF prevalence increased by 22% in AIS (20%-24%) and by 38% in TIA (12%-17%). AF prevalence varied by age (AIS: 6% in 50-59 vs 37% in ≥80 years; TIA: 4% in 50-59 vs 24% in ≥80 years), sex (AIS: male 19% vs female 25%; TIA: male 15% vs female 14%), race (AIS: white 26% vs black 12%), and region (AIS: Northeast 25% vs South 20%). Advancing age, female sex, white race, high income, and large hospital size were associated with increased odds of AF in AIS. AF in AIS was a risk factor for in-hospital death (odds ratio 1.93, 95% confidence interval 1.89-1.98) but mortality in AIS with AF decreased from 11.6% to 8.3% (p < 0.001). Compared to no AF, AF was associated with increased cost of $2,310 and length of stay 1.1 days in AIS. CONCLUSIONS AF prevalence in AIS and TIA has continued to increase. Disparity in AF prevalence in AIS and TIA exists by patient and hospital factors. AF is associated with increased mortality in AIS. Innovative AIS preventive strategies are needed in patients with AF, especially in the elderly.
Collapse
Affiliation(s)
- Fadar Oliver Otite
- From the Department of Neurology (F.O.O., S.C., J.G.R., R.L.S., A.M.M.), University of Miami Miller School of Medicine, FL; and Department of Endovascular Neurosurgery (P.K.), Brigham and Women's Hospital, Boston, MA.
| | - Priyank Khandelwal
- From the Department of Neurology (F.O.O., S.C., J.G.R., R.L.S., A.M.M.), University of Miami Miller School of Medicine, FL; and Department of Endovascular Neurosurgery (P.K.), Brigham and Women's Hospital, Boston, MA
| | - Seemant Chaturvedi
- From the Department of Neurology (F.O.O., S.C., J.G.R., R.L.S., A.M.M.), University of Miami Miller School of Medicine, FL; and Department of Endovascular Neurosurgery (P.K.), Brigham and Women's Hospital, Boston, MA
| | - Jose G Romano
- From the Department of Neurology (F.O.O., S.C., J.G.R., R.L.S., A.M.M.), University of Miami Miller School of Medicine, FL; and Department of Endovascular Neurosurgery (P.K.), Brigham and Women's Hospital, Boston, MA
| | - Ralph L Sacco
- From the Department of Neurology (F.O.O., S.C., J.G.R., R.L.S., A.M.M.), University of Miami Miller School of Medicine, FL; and Department of Endovascular Neurosurgery (P.K.), Brigham and Women's Hospital, Boston, MA
| | - Amer M Malik
- From the Department of Neurology (F.O.O., S.C., J.G.R., R.L.S., A.M.M.), University of Miami Miller School of Medicine, FL; and Department of Endovascular Neurosurgery (P.K.), Brigham and Women's Hospital, Boston, MA
| |
Collapse
|
18
|
Ramirez L, Kim-Tenser MA, Sanossian N, Cen S, Wen G, He S, Mack WJ, Towfighi A. Trends in Transient Ischemic Attack Hospitalizations in the United States. J Am Heart Assoc 2016; 5:JAHA.116.004026. [PMID: 27664805 PMCID: PMC5079046 DOI: 10.1161/jaha.116.004026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transient ischemic attack (TIA) is a major predictor of subsequent stroke. No study has assessed nation‐wide trends in hospitalization for TIA in the United States. Methods and Results Temporal trends in hospitalization for TIA (International Classification of Diseases, Ninth Revision code 435.0–435.9) from 2000 to 2010 were assessed among adults aged ≥25 years using the Nationwide Inpatient Sample. Age‐, sex‐, and race/ethnic‐specific TIA hospitalization rates were calculated using the weighted number of hospitalizations as the numerator and the US population as the denominator. Age‐adjusted rates were standardized to the 2000 US Census population. From 2000 to 2010, age‐adjusted TIA hospitalization rates decreased from 118 to 83 per 100 000 (overall rate reduction, −29.7%). Age‐specific TIA hospitalization rates increased for individuals aged 24 to 44 years (10–11 per 100 000), but decreased for individuals aged 45 to 64 (74 to 65 per 100 000), 65 to 84 (398 to 245 per 100 000), and ≥85 years (900 to 619 per 100 000). Blacks had the highest age‐adjusted yearly hospitalization rates, followed by Hispanics and whites (124, 82, and 67 per 100 000 in 2010). Rates slightly increased for blacks, but decreased for Hispanics and whites. Compared to women, age‐adjusted TIA hospitalization rates were lower and declined more steeply in men (132 to 89 per 100 000 versus 134 to 97 per 100 000). Conclusions Although overall TIA hospitalizations have decreased in the United States, the reduction has been more pronounced among older individuals, men, whites, and Hispanics. These findings highlight the need to target risk‐factor control among women, blacks, and individuals aged <45 years.
Collapse
Affiliation(s)
- Lucas Ramirez
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurology, University of Southern California, Los Angeles, CA
| | - May A Kim-Tenser
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurosurgery, University of Southern California, Los Angeles, CA Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California, Los Angeles, CA
| | - Nerses Sanossian
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurosurgery, University of Southern California, Los Angeles, CA Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California, Los Angeles, CA Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | - Steven Cen
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurology, University of Southern California, Los Angeles, CA Department of Neurosurgery, University of Southern California, Los Angeles, CA Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California, Los Angeles, CA
| | - Ge Wen
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Shuhan He
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - William J Mack
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurosurgery, University of Southern California, Los Angeles, CA Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California, Los Angeles, CA
| | - Amytis Towfighi
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurology, University of Southern California, Los Angeles, CA Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
| |
Collapse
|
19
|
Ramirez L, Kim-Tenser MA, Sanossian N, Cen S, Wen G, He S, Mack WJ, Towfighi A. Trends in Acute Ischemic Stroke Hospitalizations in the United States. J Am Heart Assoc 2016; 5:JAHA.116.003233. [PMID: 27169548 PMCID: PMC4889194 DOI: 10.1161/jaha.116.003233] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Population‐based studies have revealed declining acute ischemic stroke (AIS) hospitalization rates in the United States, but no study has assessed recent temporal trends in race/ethnic‐, age‐, and sex‐specific AIS hospitalization rates. Methods and Results Temporal trends in hospitalization for AIS from 2000 to 2010 were assessed among adults ≥25 years using the Nationwide Inpatient Sample. Age‐, sex‐, and race/ethnic‐specific and age‐adjusted stroke hospitalization rates were calculated using the weighted number of hospitalizations and US census data. From 2000 to 2010, age‐adjusted stroke hospitalization rates decreased from 250 to 204 per 100 000 (overall rate reduction 18.4%). Age‐specific AIS hospitalization rates decreased for individuals aged 65 to 84 years (846 to 605 per 100 000) and ≥85 years (2077 to 1618 per 100 000), but increased for individuals aged 25 to 44 years (16 to 23 per 100 000) and 45 to 64 years (149 to 156 per 100 000). Blacks had the highest age‐adjusted yearly hospitalization rates, followed by Hispanics and whites (358, 170, and 155 per 100 000 in 2010). Age‐adjusted AIS hospitalization rates increased for blacks but decreased for Hispanics and whites. Age‐adjusted AIS hospitalization rates were lower in women and declined more steeply compared to men (272 to 212 per 100 000 in women versus 298 to 245 per 100 000 in men). Conclusions Although overall stroke hospitalizations declined in the United States, the reduction was more pronounced among older individuals, women, Hispanics, and whites. Renewed efforts at targeting risk factor control among vulnerable individuals may be warranted.
Collapse
Affiliation(s)
- Lucas Ramirez
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurology, University of Southern California, Los Angeles, CA
| | - May A Kim-Tenser
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurology, University of Southern California, Los Angeles, CA Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California, Los Angeles, CA
| | - Nerses Sanossian
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurology, University of Southern California, Los Angeles, CA Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California, Los Angeles, CA Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | - Steven Cen
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurology, University of Southern California, Los Angeles, CA Department of Neurosurgery, University of Southern California, Los Angeles, CA Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California, Los Angeles, CA
| | - Ge Wen
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Shuhan He
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - William J Mack
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurosurgery, University of Southern California, Los Angeles, CA Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California, Los Angeles, CA
| | - Amytis Towfighi
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurology, University of Southern California, Los Angeles, CA Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
| |
Collapse
|
20
|
|
21
|
Harvey RE, Coffman KE, Miller VM. Women-specific factors to consider in risk, diagnosis and treatment of cardiovascular disease. ACTA ACUST UNITED AC 2015; 11:239-257. [PMID: 25776297 DOI: 10.2217/whe.14.64] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In the era of individualized medicine, gaps in knowledge remain about sex-specific risk factors, diagnostic and treatment options that might reduce mortality from cardiovascular disease (CVD) and improve outcomes for both women and men. In this review, contributions of biological mechanisms involving the sex chromosomes and the sex hormones on the cardiovascular system will be discussed in relationship to the female-specific risk factors for CVD: hypertensive disorders of pregnancy, menopause and use of hormonal therapies for contraception and menopausal symptoms. Additionally, sex-specific factors to consider in the differential diagnosis and treatment of four prevalent CVDs (hypertension, stroke, coronary artery disease and congestive heart failure) will be reviewed with emphasis on areas where additional research is needed.
Collapse
Affiliation(s)
- Ronée E Harvey
- Department of Physiology & Biomedical, Engineering, Medical Sciences 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Kirsten E Coffman
- Department of Physiology & Biomedical, Engineering, Medical Sciences 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Virginia M Miller
- Department of Physiology & Biomedical, Engineering, Medical Sciences 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.,Department of Surgery, Medical Sciences, 4-20, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| |
Collapse
|
22
|
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3724] [Impact Index Per Article: 413.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
23
|
United States trends in thrombolysis for older adults with acute ischemic stroke. Clin Neurol Neurosurg 2015; 139:16-23. [PMID: 26363362 DOI: 10.1016/j.clineuro.2015.08.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/05/2015] [Accepted: 08/25/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Thrombolysis for ischemic stroke has been increasing in the United States. We sought to investigate recent trends in thrombolysis use in older adults. METHODS A retrospective, observational analysis of hospitalization data from the Nationwide Inpatient Sample (NIS) in 2005-2010 was performed. Older adults (≥65 years) admitted with a primary diagnosis of acute ischemic stroke were included. Trends in the population-based rates of thrombolysis and outcomes from the NIS were evaluated using the Cochran-Armitage test. RESULTS Thrombolysis in older adult stroke patients increased from 1.7% to 5.4% (2005-2010; trend P<0.001). Large increases were observed among urban patients, urban hospitals, and high volume facilities. Individuals ≥85 years were less likely to receive thrombolysis than younger ages throughout the study period, although there was an increase from an odds ratio of 0.50 (95% CI: 0.44-0.57) to 0.75 (95% CI: 0.69-0.81) from 2005-2006 to 2009-2010 when compared to 65-74 year olds. For those receiving thrombolysis, no change was observed in intracerebral hemorrhage over time. In-hospital mortality rates did not change significantly over the study period for age subgroups and length of stay declined from 2005 to 2010 for the thrombolysis group (7.6 vs 7.0 days; trend P<0.001). CONCLUSIONS Rates of thrombolysis in older adults progressively increased, especially in the oldest old. Increases were largely driven by urban and high volume hospitals.
Collapse
|
24
|
Weil TP. Patient falls in hospitals: An increasing problem. Geriatr Nurs 2015; 36:342-7. [DOI: 10.1016/j.gerinurse.2015.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/08/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
|
25
|
Affiliation(s)
- Fasiha Kanwal
- Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas.
| |
Collapse
|
26
|
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2014; 131:e29-322. [PMID: 25520374 DOI: 10.1161/cir.0000000000000152] [Citation(s) in RCA: 4448] [Impact Index Per Article: 444.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
27
|
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014; 129:e28-e292. [PMID: 24352519 PMCID: PMC5408159 DOI: 10.1161/01.cir.0000441139.02102.80] [Citation(s) in RCA: 3518] [Impact Index Per Article: 351.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|