Non-compliance with medical recommendations results in delayed hospitalization and poorer prognosis in patients with cerebral ischemic stroke in Poland: Non-compliance effects on post-ischemic stroke prognosis

OBJECTIVES

This study aimed to reveal and analyze the causes of delays in reaching the hospital of patients with cerebral ischemic stroke and to assess their clinical picture.

MATERIAL AND METHODS

The study group included 161 patients with stroke, who reported to the hospital beyond the thrombolytic treatment therapeutic window. The control group consisted of 85 patients recruited consecutively with stroke who received thrombolytic treatment per eligibility criteria. Laboratory and medical imaging tests essential for neurological condition assessment were conducted in the study group. Control group research was based on retrospective analysis of medical records.

RESULTS

The rate of deaths during hospitalization was lower in the control group (4.7%) compared to the study group (14.9%). In the study group, more patients (16.8%) admitted to non-compliance with medical recommendations than in the control group (5.9%). There were no statistically significant differences in nicotinism and alcohol dependence syndrome frequency between both groups.

CONCLUSIONS

Based on each group inclusion criteria, a lower mortality rate in the control group indicates a crucial role of the therapeutic window in cerebral stroke treatment. Analysis of reasons for delay points out that efficient prophylaxis is the education of patients with stroke risk factors and their families.

Comparative Evaluation of Stroke Awareness of Individuals Whose First-Degree Relatives had a Stroke and that of Individuals Whose First-Degree Relatives Did Not

OBJECTIVE

To assess the stroke awareness levels of individuals whose first-degree relatives had a stroke and to compare the results with those of individuals whose first-degree relatives did not have a stroke.

MATERIALS AND METHODS

This cross-sectional study was conducted between March and May 2019, with first-degree relatives of patients who had a stroke (group 1) and a comparable set of individuals whose first-degree relatives did not have a stroke (group 2). Participants were asked to complete a questionnaire asking about signs and symptoms, risk factors, treatment options, information sources, responses after the development of stroke, and early treatment of stroke.

RESULTS

In response to the questions about the signs and symptoms of stroke, group 1 mentioned dizziness and comprehension disorder as a symptom of stroke more frequently than the other group. Stress was the second most frequently mentioned risk factor (by 81% of group 1 and 80.5% in group 2). When the participants were asked about the sources of information about stroke, family circle and friends were the most frequently mentioned sources for both groups.

CONCLUSION

The present study can serve as a guide in planning training to improve stroke awareness in the future, especially by including individuals whose first-degree relatives had a stroke.

Public knowledge of people visiting Imam Reza hospital regarding stroke symptoms and risk factors

Background

Early recognition of stroke symptoms results in a lower time period after stroke onset to treatment with a better outcome. This depends on the awareness of patients, family members, and the general public.

Objective

The aim of this study was to evaluate public awareness about stroke risk factors, warning symptoms, and treatments.

Methods

This cross-sectional study was conducted as a hospital-based survey on 2712 people who visited clinics or emergency department of Imam Reza hospital for any reason, from March 2015 to February 2016. All subjects were interviewed face-to-face by four trained physicians and a structured, pre-tested questionnaire was filled.

Results

The mean age of participants was 41.0 ± 12.1 years old. Considering Cincinnati prehospital stroke scale (CPSS) as the main diagnostic system, the percentage of participants that mentioned face asymmetry, speech disturbances, and arm paralysis as a symptom of stroke was 7, 1.5, and 7.9%, respectively. Meanwhile, 71.2% of participants could not mention any of the stroke symptoms. Among participants, 20.2% did not know any of stroke risk factors although 35.1, 27.8, and 17.3% could name one, two and three or more risk factors, respectively. Among participants, only 1.1% were aware of thrombolytic therapy (t-PA) as a first-line drug for stroke treatment.

Conclusion

In this study, public knowledge regarding stroke symptoms, risk factors, and therapy approaches was low. Taken together, public education is necessary to reduce the time for recognition of stroke symptoms and subsequently prompt and proper proceeding seems to be necessary for the community.

Needs and rights awareness of stroke survivors and caregivers in urban and rural China: a cross-sectional, multiple-centre questionnaire survey

OBJECTIVES

Stroke survivors require assistance and support in their daily lives. This survey aims to investigate the needs and rights awareness in Chinese stroke survivors and caregivers in rural and urban settings.

SETTING

This survey was adapted from the one created by the World Stroke Organization. The questionnaire included demands for psychological support, treatment and care, social support and information. From January 2015 to January 2016, the survey was pilot tested with urban and rural-dwelling stroke survivors and caregivers from 12 hospitals. Stroke survivors were invited to participate if they were over 18 years old and had experienced a stroke. Exclusion criteria were patients who had disorders of consciousness, significant cognitive impairment, aphasia, communication difficulties or psychiatric disorders. Only caregivers who were family members of the patients were chosen. Paid caregivers were excluded.

PARTICIPANTS

One thousand, one hundred and sixty-seven stroke survivors and 1119 caregivers were enrolled.

PRIMARY OUTCOME MEASURES

The needs of stroke survivors and caregivers in rural and urban areas were compared. The correlations between needs of rural and urban stroke survivors and caregivers and potential effect factors were analysed, respectively.

RESULTS

Among the cohort, 93.5% reported the need for psychological support, 88.6% for treatment and care, 84.8% for information and 62.7% for social support. The total needs and each aspect of needs of stroke survivors in urban settings were greater than of those in rural settings (p<0.01). In rural areas, total needs and each aspect of needs were positively correlated with education level (p<0.01).

CONCLUSIONS

Needs and rights awareness of stroke survivors should also be recognised in both urban and rural China. According to the different needs of patients and their caregivers, regional and individualised services were needed by stroke survivors and their caregivers.

Extended Risk Factors for Stroke Prevention

Stroke causes disability and high mortality, while it can be prevented by increasing public awareness of risk factors. The common known risk factors are hypertension, atrial fibrillation, heart failure, smoking, alcohol consumption, low physical activity, overweight and hypercholesterolemia. However, the deep understanding of risk factors is limited. Moreover, more risk factor emerges in recent years. To further increase the awareness of risk factors for stroke prevention, this review indicates the reasonable application of antihypertensive agents according to the age-dependent changes of hypertension, and some new risk factors including chronic kidney disease, obstructive sleep apnea, migraine with aura, working environment, genetic factors and air pollution. Therefore, internal risk factors (e.g. heredity, hypertension, hyperglycemia) and external risk factors (e.g. working environment, air pollution) are both important for stroke prevention. All of these are reviewed to provide more information for the pre-hospital prevention and management, and the future clinical studies.

Acute stroke patients' knowledge of stroke at discharge in China: a cross-sectional study

OBJECTIVES

A good mastery of stroke-related knowledge can be of great benefit in developing healthy behaviours. This study surveyed the knowledge about stroke and influencing factors among patients with acute ischaemic stroke (AIS) at discharge in a Chinese province.

METHODS

A cross-section study was conducted from November 1, 2014 to January 31, 2015. A total of 1531 AIS patients in Hubei Province completed a questionnaire at discharge. Multivariate linear regression was used to identify the influencing factors of their knowledge of stroke.

RESULTS

About 31.2% of the respondents did not know that stroke is caused by blockage or rupture of cerebral blood vessels and 20.3% did not realise they need immediate medical attention after onset. Approximately 50% did not know that sudden blurred vision, dizziness, headache and unconsciousness are the warning signs of stroke. Over 40% were not aware of the risk factors of the condition, such as hypertension, hyperlipidaemia, diabetes mellitus, smoking and obesity. Over 20% had no idea that they need long-term medication and strict control of blood pressure, blood lipids and blood sugar. Their knowledge levels were correlated with regions of residence (P < 0.0001), socioeconomic status (P < 0.05), physical condition (P < 0.01), previous stroke (P < 0.0001) and family members and friends having had a stroke (P < 0.01).

CONCLUSIONS

Most AIS patients in Hubei Province, China, had little knowledge of stroke at discharge. Further efforts should be devoted to strengthening the in-hospital education of stroke patients, especially those with a low income and those from rural areas.

Intrinsic factors influencing help-seeking behaviour in an acute stroke situation

The proportion of stroke patients eligible for intravenous or intra-arterial treatment is still limited because many patients do not seek medical help immediately after stroke onset. The aim of our study was to explore which intrinsic factors and considerations influence help-seeking behaviour of relatively healthy participants, confronted with stroke situations. Semi-structured interviews were conducted with 25 non-stroke participants aged 50 years or older. We presented 5 clinical stroke situations as if experienced by the participants themselves. Recognition and interpretation of symptoms were evaluated and various factors influencing help-seeking behaviour were explored in-depth. We used the thematic synthesis method for data analysis. Five themes influencing help-seeking behaviour in a stroke situation were identified: influence of knowledge, views about seriousness, ideas about illness and health, attitudes towards others and beliefs about the emergency medical system. A correct recognition of stroke symptoms or a correct interpretation of the stroke situations did not automatically result in seeking medical help. Interestingly, similar factors could lead to different types of actions between participants. Many intrinsic, as well as social and environmental factors are of influence on help-seeking behaviour in an acute stroke situation. All these factors seem to play a complex role in help-seeking behaviour with considerable inter-individual variations. Accomplishing more patients eligible for acute stroke treatment, future research should focus on better understanding of all factors at various levels grounded in a theory of help-seeking behaviour.

Subjective and objective knowledge and decisional role preferences in cerebrovascular patients compared to controls

BACKGROUND

Risk knowledge and active role preferences are important for patient involvement in treatment decision-making and adherence. Although knowledge about stroke warning signs and risk factors has received considerable attention, objective knowledge on secondary prevention and further self-esteem subjective knowledge have rarely been studied. The aim of our study was to investigate knowledge and treatment decisional role preferences in cerebrovascular patients compared to controls.

METHODS

We performed a survey on subjective and objective stroke risk knowledge and autonomy preferences in cerebrovascular patients from our stroke outpatient clinic (n=262) and from pedestrians on the street taken as controls during a "World Stroke Day" (n=274). The questionnaire includes measures for knowledge and decisional role preferences from previously published questionnaires and newly developed measures, for example, subjective knowledge, revealed on a visual analog scale.

RESULTS

The overall stroke knowledge was low to moderate, with no differences between patients and controls. Knowledge about secondary prevention was particularly low. Only 10%-15% of participants correctly estimated the stroke absolute risk reduction potential of aspirin. The medical data interpretation competence was moderate in both groups. Age and basic mathematical and statistical understanding (numeracy) were the only independent predictors of objective stroke knowledge, whereas previous stroke had no impact on stroke knowledge. However, patients were thought to be better informed than controls. Approximately 60% of both patients and controls claimed to prefer a shared decision-making approach in treatment decisions.

CONCLUSION

The level of stroke risk knowledge in patients with cerebrovascular diseases was as low as in randomly selected pedestrians, although patients felt better informed. Both groups preferred involvement in treatment decision-making. We conclude that educational concepts for increasing awareness of knowledge gaps as well as for stroke risk and for prevention strategies are needed.

Knowledge, perceptions and thoughts of stroke among Arab-Muslim Israelis

BACKGROUND

Age-adjusted stroke mortality rates in Israel are higher among Arabs compared with Jews; therefore, knowledge of stroke signs and prevention strategies is especially important in the Arab population. Data on stroke knowledge among Arabs in Israel are lacking.

AIM

We aimed to examine knowledge, perceptions and thoughts of stroke among Arab-Muslim Israelis.

METHODS

A complementary mixed method design was used. Ninety-nine Arab Muslims living in Israel, older than 40 years, with no history of stroke, were personally interviewed. Knowledge of stroke was assessed using quantitative analysis by a semi-structured interview. Information on perceptions and thoughts evoked by stroke was analyzed using qualitative analysis by the constant comparative method. Rates of reported knowledge-related variables were presented.

RESULTS

Mean (SD) age of participants was 50.1 (8.0) years, 52.5% were women. Most of the participants (84.8%) knew the causes of stroke but only 29.3% mentioned sudden weakness or paralysis in one side of the body as a warning sign and other warning signs were even less known. The main known risk factor was hypertension (43.3%). Although knowledge of stroke prevention was poor, 89% were interested in learning about stroke and its prevention. The qualitative findings showed that stroke evokes negative thoughts of mental and physical burden and is associated with death, disability, dependence and depression.

CONCLUSION

Levels of stroke knowledge among Arab-Muslim Israelis are low to moderate. Healthcare professionals should assist high risk populations in controlling and treating risk factors in order to reduce mortality and disability following a stroke.

Functional recovery at 3 months in stroke patients not receiving thrombolytic therapy: the comparison between patients arriving earlier and later than 4.5 hours

BACKGROUND

We aim to study the recovery of functional abilities of stroke patients who did not receive recombinant tissue plasminogen activator (rtPA) after treatment for 3 months comparing patients who arrived at a hospital within 4.5 hours and those who arrived after 4.5 hours of symptom onset. Also, we investigated the predictors of the functional recovery and the quality of life (QOL) at 3 months after stroke.

MATERIAL AND METHOD

Data were collected by interviewing the stroke patients and caregivers twice on Day 1 and at 3 months after the stroke onset. We collected the demographic data, Modified Rankin Scale (mRS), Barthel Index, National Institutes of Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS), and World Health Organization Quality of Life-Bref-Thai (WHOQOL-Bref-Thai).

RESULTS

Eighty-eight and 85 patients arrived at a hospital within 4.5 and after 4.5 hours respectively. At 3 months after treatment, the recovery of stroke patients as assessed by mRS, Barthel Index, and the QOL in both groups did not differ significantly (P > .05). Approximately 80% in both groups had good QOL. Both groups of patients had a similar low stroke awareness and knowledge in terms of risk factors (P = .825) and care of stroke patients (P = .562). Four variables that significantly predicted the improvement of the mRS score at 3 months after treatment were age 60 years and younger, premorbid self-care ability, the NIHSS score of 14 or less and Day 1 mRS score.

CONCLUSION

Stroke patients arriving at the hospital within and after 4.5 hours of the onset who did not receive the rtPA did not have significant differences in the functional outcomes and quality of life at 3 months. However, the eligibility for rtPA is not known before arriving at the hospital so that the necessity of seeking medical treatment as quickly as possible is still warranted. Increasing effective public awareness regarding stroke risk factors and care should be implemented.