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Hurskainen M, Tynkkynen J, Eskola M, Hernesniemi J. Incidence of stroke and mortality due to stroke after acute coronary syndrome. J Stroke Cerebrovasc Dis 2022; 31:106842. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/05/2022] [Accepted: 10/03/2022] [Indexed: 11/21/2022] Open
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Cho KH, Nam CM, Lee SG, Kim TH, Lee SH, Park EC. Measuring of quality of care in patients with stroke and acute myocardial infarction: An application of algebra effectiveness model. Medicine (Baltimore) 2019; 98:e15353. [PMID: 31096434 PMCID: PMC6531128 DOI: 10.1097/md.0000000000015353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Ischemic stroke, hemorrhagic stroke, and acute myocardial infarction (AMI) are diseases with golden hour. This study aimed to identify and compare factors that affect in-hospital mortality in patients with stroke and AMI who admitted via the emergency department.This study used the Korean National Health Insurance claims data from 2002 to 2013. The study sample included 7693 patients who had an ischemic stroke, 2828 patients who had a hemorrhagic stroke, and 4916 patients with AMI who were admitted via the emergency departments of a superior general hospital and general hospital, did not transfer to another hospital or come from another hospital, and were aged ≥20 years. This study was analyzed by using Cox's proportional hazards frailty model.Five hundred (6.5%) of 7693 patients with ischemic stroke, 569 (20.1%) of 2828 patients with hemorrhagic stroke, and 399 (8.1%) of 4916 patients with AMI were dead. The clinical factors were associated with in-hospital mortality such as age, CCI, hypertension, and diabetes of patient characteristics. In treatment characteristics, performing PCI and weekday admission was associated with in-hospital mortality (aHR, 0.43; 95% CI, 0.27-0.67; aHR, 1.42; 95% CI, 1.14-1.77, respectively). In hospital characteristics, the volume, the proportion of transferred patient to other hospital and ratio of beds per one nurse was associated with in-hospital mortality.Clinical factors of patient characteristics, intervention such as performing PCI and reducing ICP of treatment characteristics, and the volume, transferred rate, and the number of nurse of hospital characteristics were associated with in-hospital mortality.
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Affiliation(s)
- Kyoung Hee Cho
- Department of Public Health, Graduate School
- Institute of Health Services Research, College of Medicine
- Health Insurance Policy Research Insititue, National Health Insurance Service, Wonju
| | - Chung Mo Nam
- Institute of Health Services Research, College of Medicine
- Department of Biostatistics, College of Medicine
| | - Sang Gyu Lee
- Institute of Health Services Research, College of Medicine
- Graduate School of Public Health, Yonsei University, Seoul
| | - Tae Hyun Kim
- Institute of Health Services Research, College of Medicine
- Graduate School of Public Health, Yonsei University, Seoul
| | - Seon-Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon
| | - Eun-Cheol Park
- Institute of Health Services Research, College of Medicine
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea
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Eriksson SE. Secondary prophylactic treatment and long-term prognosis after TIA and different subtypes of stroke. A 25-year follow-up hospital-based observational study. Brain Behav 2017; 7:e00603. [PMID: 28127521 PMCID: PMC5256186 DOI: 10.1002/brb3.603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/29/2016] [Accepted: 10/10/2016] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To assess long-term prognosis after transient ischemic attack (TIA)/subtypes of stroke relative to secondary prophylactic treatment(s) given. MATERIALS AND METHODS Retro/prospective follow-up of patients hospitalized in the Stroke Unit or in the Department of Neurology, Linköping, in 1986 and followed up to Feb. 2011. RESULTS A total of 288 men were followed up for 2254 years (mean 7.8 years) and 261 women for 1984 years (mean 7.6 years). In men, the distribution to anticoagulants (AC) (warfarin treatment) was 18%, antiplatelet therapy (APT) usually ASA 75 mg/day 54%, untreated 27%, unknown 2%. In women, the distribution to AC was 15%, APT 60%, untreated 23%, unknown 2%, respectively. Mortality rates at 1 year, 10 years, and 25 years for men were 21%, 67%, and 93%, respectively, versus the rates in women of 24%, 71%, and 90%, respectively. Survival curves showed markedly increased risk of death compared to the normal population. AC treatment was more favorable for men regarding the annual risk of stroke, compared with APT (9.4% vs. 9.8%), as well as the risks of MI, (5.6% vs. 6.7%), and death (8.1% vs. 10.3%), compared to women for stroke (11.6% vs. 8.8%) and MI (5.3% vs. 3.7%) but not for death (8.3% vs. 8.4%). The risk of fatal bleeding was 0.86% annually on AC compared to 0.17% on APT. According to Cox regression analysis included patients with TIA/ischemic stroke, first-line treatment had beneficial effects on survival: AC OR 0.67 (0.5-0.9), APT 0.67 (0.52-0.88) versus untreated. CONCLUSIONS Patients with a history of TIA/stroke had a higher mortality rate versus controls, providing support for both primary and secondary prophylaxis regarding vascular risk factors for death. This study also provided support for secondary prophylactic treatment with either AC or ASA (75 mg once daily) to reduce the vascular risk of death unless there are contraindications.
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Affiliation(s)
- Sven-Erik Eriksson
- Division of Neurology Department of Medicine Falun Hospital Falun Sweden
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Hassan M. Gulf CARE: Heart failure in the Middle East. Glob Cardiol Sci Pract 2015; 2015:34. [PMID: 26566528 PMCID: PMC4625206 DOI: 10.5339/gcsp.2015.34] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 06/30/2015] [Indexed: 12/20/2022] Open
Affiliation(s)
- Mohamed Hassan
- Division of Cardiology, Aswan Heart Centre, Aswan, Egypt
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Zubaid M, Ahmed Albinali H, Almahmeed W. The Gulf Heart Association: a professional association supporting research and collaboration in the Middle East. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv044] [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]
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Khafaji HAR, Sulaiman K, Singh R, AlHabib KF, Asaad N, Alsheikh-Ali A, Al-Jarallah M, Bulbanat B, AlMahmeed W, Ridha M, Bazargani N, Amin H, Al-Motarreb A, AlFaleh H, Elasfar A, Panduranga P, Al Suwaidi J. Clinical characteristics, precipitating factors, management and outcome of patients with prior stroke hospitalised with heart failure: an observational report from the Middle East. BMJ Open 2015; 5:e007148. [PMID: 25908674 PMCID: PMC4410120 DOI: 10.1136/bmjopen-2014-007148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/20/2015] [Accepted: 03/01/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The purpose of this study is to report the prevalence, clinical characteristics, precipitating factors, management and outcome of patients with prior stroke hospitalised with acute heart failure (HF). DESIGN Retrospective analysis of prospectively collected data. SETTING Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multicentre study of consecutive patients hospitalised with acute HF in 2012 in seven Middle Eastern countries and analysed according to the presence or absence of prior stroke; demographics, management and outcomes were compared. PARTICIPANTS A total of 5005 patients with HF. OUTCOME MEASURES In-hospital and 1-year outcome. RESULTS The prevalence of prior stroke in patients with HF was 8.1%. Patients with stroke with HF were more likely to be admitted under the care of internists rather than cardiologists. When compared with patients without stroke, patients with stroke were more likely to be older and to have diabetes mellitus, hypertension, atrial fibrillation, hyperlipidaemia, chronic kidney disease, ischaemic heart disease, peripheral arterial disease and left ventricular dysfunction (p=0.001 for all). Patients with stroke were less likely to be smokers (0.003). There were no significant differences in terms of precipitating risk factors for HF hospitalisation between the two groups. Patients with stroke with HF had a longer hospital stay (mean±SD days; 11±14 vs 9±13, p=0.03), higher risk of recurrent strokes and 1-year mortality rates (32.7% vs 23.2%, p=0.001). Multivariate logistic regression analysis showed that stroke is an independent predictor of in-hospital and 1-year mortality. CONCLUSIONS This observational study reports high prevalence of prior stroke in patients hospitalised with HF. Internists rather than cardiologists were the predominant caregivers in this high-risk group. Patients with stroke had higher risk of in-hospital recurrent strokes and long-term mortality rates. TRIAL REGISTRATION NUMBER NCT01467973.
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Affiliation(s)
- Hadi A R Khafaji
- Department of Cardiology, Saint Michael's Hospital, Toronto University, Canada
| | | | - Rajvir Singh
- Biostatistics Section, Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Nidal Asaad
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Bassam Bulbanat
- Department of Cardiology, Sabah Al-Ahmed Cardiac Center, Kuwait
| | - Wael AlMahmeed
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mustafa Ridha
- Department of Cardiology, Adan Hospital, Kuwait, Kuwait
| | | | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain
| | - Ahmed Al-Motarreb
- Department of Cardiology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Hussam AlFaleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Abdelfatah Elasfar
- Department of Cardiology, Prince Salman Heart Center, King Fahad Medical City, Saudi Arabia
- Department or Cardiology, Tanta University, Tanta, Egypt
| | | | - Jassim Al Suwaidi
- Biostatistics Section, Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
- Qatar Cardiovascular Research Center and Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Ulvenstam A, Kajermo U, Modica A, Jernberg T, Söderström L, Mooe T. Incidence, trends, and predictors of ischemic stroke 1 year after an acute myocardial infarction. Stroke 2014; 45:3263-8. [PMID: 25236874 DOI: 10.1161/strokeaha.114.005770] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Ischemic stroke after acute myocardial infarction is an important complication. It is unknown whether the risk has changed because the treatment of acute myocardial infarction has improved during the past decade. There is also conflicting data about predictors of stroke risk. METHODS To obtain the 1-year incidence of stroke after acute myocardial infarction, the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions database for the years 1998 to 2008 was merged with the Swedish National Patient Register (NPR). The time trend was studied by dividing the entire time period into 5 separate periods. Independent predictors were identified using a multivariable Cox proportional hazards regression model. RESULTS Between 1998 and 2008, 7185 of 173 233 patients with acute myocardial infarction had an ischemic stroke within 1 year (4.1%). There was a 20% relative risk reduction during the study period (1998-2000 versus 2007-2008) relative risk 0.80 (95% confidence interval, 0.75-0.86; P<0.001. Independent predictors of stroke were age, female sex, ST-segment-elevation myocardial infarction, previous stroke, previous diabetes mellitus, heart failure at admission, angiotensin-converting enzyme inhibitor treatment and atrial fibrillation. Reperfusion treatment with fibrinolysis and percutaneous coronary intervention and treatment with aspirin, P2Y12-inhibitors, and statins predicted a reduced risk of stroke. CONCLUSIONS The risk of ischemic stroke within a year after myocardial infarction is substantial but has clearly been reduced during the studied time period. The major predictive factors found to correlate well with previous investigations. Reperfusion treatment, thrombocyte aggregation inhibition, and lipid lowering are the main contributors to the observed risk reduction.
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Affiliation(s)
- Anders Ulvenstam
- From the Östersund Hospital, Frösön, Sweden (A.U., A.M.); Skaraborg Hospital Skövde, Sweden (U.K.); Department of Medicine, Karolinska Institutet, Solna, Sweden (T.J.); Unit of Research, Education and Development, Östersund Hospital, Frösön, Sweden (L.S.); and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (A.U., A.M., U.K., T.M.).
| | - Ulf Kajermo
- From the Östersund Hospital, Frösön, Sweden (A.U., A.M.); Skaraborg Hospital Skövde, Sweden (U.K.); Department of Medicine, Karolinska Institutet, Solna, Sweden (T.J.); Unit of Research, Education and Development, Östersund Hospital, Frösön, Sweden (L.S.); and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (A.U., A.M., U.K., T.M.)
| | - Angelo Modica
- From the Östersund Hospital, Frösön, Sweden (A.U., A.M.); Skaraborg Hospital Skövde, Sweden (U.K.); Department of Medicine, Karolinska Institutet, Solna, Sweden (T.J.); Unit of Research, Education and Development, Östersund Hospital, Frösön, Sweden (L.S.); and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (A.U., A.M., U.K., T.M.)
| | - Tomas Jernberg
- From the Östersund Hospital, Frösön, Sweden (A.U., A.M.); Skaraborg Hospital Skövde, Sweden (U.K.); Department of Medicine, Karolinska Institutet, Solna, Sweden (T.J.); Unit of Research, Education and Development, Östersund Hospital, Frösön, Sweden (L.S.); and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (A.U., A.M., U.K., T.M.)
| | - Lars Söderström
- From the Östersund Hospital, Frösön, Sweden (A.U., A.M.); Skaraborg Hospital Skövde, Sweden (U.K.); Department of Medicine, Karolinska Institutet, Solna, Sweden (T.J.); Unit of Research, Education and Development, Östersund Hospital, Frösön, Sweden (L.S.); and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (A.U., A.M., U.K., T.M.)
| | - Thomas Mooe
- From the Östersund Hospital, Frösön, Sweden (A.U., A.M.); Skaraborg Hospital Skövde, Sweden (U.K.); Department of Medicine, Karolinska Institutet, Solna, Sweden (T.J.); Unit of Research, Education and Development, Östersund Hospital, Frösön, Sweden (L.S.); and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (A.U., A.M., U.K., T.M.)
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Jakobsson S, Graipe A, Huber D, Björklund F, Mooe T. The risk of ischemic stroke after an acute myocardial infarction in patients with decreased renal function. Cerebrovasc Dis 2014; 37:460-9. [PMID: 25073588 DOI: 10.1159/000363616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 05/15/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Data on the incidence, trends over time and predictors of ischemic stroke after an acute myocardial infarction (AMI) are sparse for patients with chronic kidney disease (CKD). METHODS Data for unselected AMI patients were obtained from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA) between 2003 and 2010. Patients with and without CKD were compared. Multiple logistic regression was performed to identify predictors of ischemic stroke during the hospitalization for AMI, Kaplan-Meier analysis was used to analyze the 1-year postdischarge ischemic stroke trends over time and Cox regression analysis was used to identify predictors. RESULTS Of 118,434 AMI patients, 40,679 had CKD. The CKD patients had more extensive previous cardiovascular disease and received less reperfusion and secondary preventive therapies than the patients without CKD. An inhospital ischemic stroke occurred in 2.3 and 1.2% of CKD and non-CKD patients, respectively. The incidence of ischemic stroke during hospitalization for AMI was stable during the study period. The occurrence of ischemic stroke after hospital discharge decreased between 2003-2004 and 2009-2010 from 4.1 to 2.5% in CKD patients and from 2.0 to 1.3% in non-CKD patients, respectively. Percutaneous coronary intervention (PCI) and statins were independently associated with a reduced risk of stroke after discharge from hospital. CONCLUSIONS Ischemic stroke is a more common complication after an AMI in CKD patients than in non-CKD patients, but the risk has decreased in recent years. The increased use of PCI and statins may have contributed to this reduction.
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Affiliation(s)
- Stina Jakobsson
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden
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Jakobsson S, Bergström L, Björklund F, Jernberg T, Söderström L, Mooe T. Risk of ischemic stroke after an acute myocardial infarction in patients with diabetes mellitus. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2014; 7:95-101. [PMID: 24399329 DOI: 10.1161/circoutcomes.113.000311] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Incidence, any trend over time, and predictors of ischemic stroke after an acute myocardial infarction (AMI) in diabetic patients are unknown. METHODS AND RESULTS Data for 173,233 unselected patients with an AMI, including 33,503 patients with diabetes mellitus, were taken from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA) during 1998 to 2008. Ischemic stroke events were recorded during 1 year of follow-up. Patients with diabetes mellitus more often had a history of cardiovascular disease, received less reperfusion therapy, and were treated with acetylsalicylic acid, P2Y12 inhibitors, and statins to a lesser extent compared with patients without diabetes mellitus. However, the use of evidence-based therapies increased markedly in both groups during the study period. The incidence of ischemic stroke during the first year after AMI decreased from 7.1% to 4.7% in patients with diabetes mellitus and from 4.2% to 3.7% in patients without diabetes mellitus. Risk reduction was significantly larger in the diabetic subgroup. Reperfusion therapy, acetylsalicylic acid, P2Y12 inhibitors, and statins were independently associated with the reduced stroke risk. CONCLUSIONS Ischemic stroke is a fairly common complication after an AMI in patients with diabetes mellitus, but the risk of stroke has decreased during recent years. The increased use of evidence-based therapies contributes importantly to this risk reduction, but there is still room for improvement.
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Affiliation(s)
- Stina Jakobsson
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
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Sex-Related Analysis of Short- and Long-term Clinical Outcomes and Bleeding Among Patients Treated With Primary Percutaneous Coronary Intervention: An Evaluation of the RISK-PCI Data. Can J Cardiol 2013; 29:1097-103. [DOI: 10.1016/j.cjca.2012.11.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 11/02/2012] [Accepted: 11/15/2012] [Indexed: 11/22/2022] Open
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Al Suwaidi J, Al Habib K, Asaad N, Singh R, Hersi A, Al Falaeh H, Al Saif S, Al-Motarreb A, Almahmeed W, Sulaiman K, Amin H, Al-Lawati J, Al-Sagheer NQ, Alsheikh-Ali AA, Salam AM. Immediate and one-year outcome of patients presenting with acute coronary syndrome complicated by stroke: findings from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2). BMC Cardiovasc Disord 2012; 12:64. [PMID: 22894647 PMCID: PMC3480946 DOI: 10.1186/1471-2261-12-64] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 08/09/2012] [Indexed: 11/18/2022] Open
Abstract
Background Stroke is a potential complication of acute coronary syndrome (ACS). The aim of this study was to identify the prevalence, risk factors predisposing to stroke, in-hospital and 1-year mortality among patients presenting with ACS in the Middle East. Methods For a period of 9 months in 2008 to 2009, 7,930 consecutive ACS patients were enrolled from 65 hospitals in 6 Middle East countries. Results The prevalence of in-hospital stroke following ACS was 0.70%. Most cases were ST segment elevation MI-related (STEMI) and ischemic stroke in nature. Patients with in-hospital stroke were 5 years older than patients without stroke and were more likely to have hypertension (66% vs. 47.6%, P = 0.001). There were no differences between the two groups in regards to gender, other cardiovascular risk factors, or prior cardiovascular disease. Patients with stroke were more likely to present with atypical symptoms, advanced Killip class and less likely to be treated with evidence-based therapies. Independent predictors of stroke were hypertension, advanced killip class, ACS type –STEMI and cardiogenic shock. Stroke was associated with increased risk of in-hospital (39.3% vs. 4.3%) and one-year mortality (52% vs. 12.3%). Conclusion There is low incidence of in-hospital stroke in Middle-Eastern patients presenting with ACS but with very high in-hospital and one-year mortality rates. Stroke patients were less likely to be appropriately treated with evidence-based therapy. Future work should be focused on reducing the risk and improving the outcome of this devastating complication.
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Affiliation(s)
- Jassim Al Suwaidi
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar.
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