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Huhtakangas JK, Saaresranta T, Huhtakangas M, Haapea M, Huhtakangas J. Thrombolysis treatment protected impairment of functional ability, quality of life and fatigue seven years after stroke. J Stroke Cerebrovasc Dis 2024; 33:107707. [PMID: 38561166 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES We studied quality of life, functional outcome, depression, and fatigue of ischemic stroke patients treated with or without thrombolysis seven years post-stroke. MATERIALS AND METHODS A total of 204 ischemic stroke patients treated with or without thrombolysis during 2013-2015. After seven years the 136 survivors were assessed with telephone interview, which included questions about subjective quality of life (European Quality of Life-5 Dimensions), depression, fatigue with Fatigue Severity Scale, functional ability assessed with Barthel Index and Modified Rankin Scale, living conditions, need of care, and medical aids. RESULTS At admission patients with thrombolysis had higher National Institutes of Health Stroke Scale scores compared with those not treated with thrombolysis. At seven years post-stroke, 99% of alive patients answered the questionnaires. There were no group differences concerning functional outcome, quality of life, depression, fatigue, or insomnia. The Barthel Index was normal in both groups. The quality of life was good in both groups without group differences in any domains. Of all patients, 68% reported no problems in usual activities, and 61% were without pain. Anxiety or depression were experienced by 19% of all stroke patients, while fatigue was present in 32% of cases. CONCLUSIONS Seven years post-stroke the quality of life was good and functional outcome remained in good level in both study groups. One third experienced fatigue, while every fifth experienced depression. The thrombolysis treatment seems to protect from decreased quality of life, fatigue, and decreased mobility, self-care, and usual activities despite more severe stroke.
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Affiliation(s)
| | - Tarja Saaresranta
- Sleep Research Center, University of Turku, Lämmikäisenkatu 3B, Turku FI-20520, Finland; Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
| | - Moona Huhtakangas
- Welfare State Research and Reform, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marianne Haapea
- Research Service Unit, Oulu University Hospital, University of Oulu, MRC Oulu, Finland
| | - Juha Huhtakangas
- Department of Neurology, Neurocenter, Oulu University Hospital, Oulu, Finland; Research Unit of Clinical Medicine, Faculty of Medicine, University of Oulu, Oulu Finland.
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Wang L, Zeng Y, Zhou L, Xu P, Guo X, Xie Y, Cai J, Pan M, Tang J, Gong Q, Su R, Liu Y, Lou Y. Cost-effectiveness of tirofiban for acute ischemic stroke without large or medium-sized vessel occlusion: A Markov modelling analysis from the Chinese and United States perspectives. PLoS One 2024; 19:e0297939. [PMID: 38363737 PMCID: PMC10871502 DOI: 10.1371/journal.pone.0297939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/14/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The RESCUE BT2 trial recently showcased the efficacy of tirofiban in treating acute ischemic stroke (AIS) without large or medium-sized vessel occlusion. To further assess the value of tirofiban from the perspectives of Chinese and US healthcare system, a study was conducted to evaluate its cost-effectiveness. METHODS A hybrid model, integrating a short-term decision tree with a long-term Markov model, was developed to assess cost-effectiveness between tirofiban and aspirin for stroke patients without large or medium-sized vessel occlusion. Efficacy data for tirofiban was sourced from the RESCUE BT2 trial, while cost information was derived from published papers. Outcomes measured included respective cost, effectiveness, and incremental cost-effectiveness ratio (ICER). We conducted a one-way sensitivity analysis to assess the robustness of the results. Additionally, we performed probabilistic sensitivity analysis (PSA) through 10,000 Monte Carlo simulations to evaluate the uncertainties associated with the results. RESULTS The study revealed that tirofiban treatment in AIS patients without large or medium-sized vessel occlusion led to a considerable reduction of 2141 Chinese Yuan (CNY) in total cost, along with a lifetime gain of 0.14 quality-adjusted life years (QALYs). In the US settings, tirofiban also exhibited a lower cost ($197,055 versus $201,984) and higher effectiveness (4.15 QALYs versus 4.06 QALYs) compared to aspirin. One-way sensitivity analysis revealed that post-stroke care costs and stroke utility had the greatest impact on ICER fluctuation in both Chinese and US settings. However, these variations did not exceed the willingness-to-pay threshold. PSA demonstrated tirofiban's superior acceptability over aspirin in over 95% of potential scenarios. CONCLUSION Tirofiban treatment for AIS without large or medium-sized vessel occlusion appeared dominant compared to aspirin in both China and the US.
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Affiliation(s)
- Li Wang
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Yuhong Zeng
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
- Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
| | - Limei Zhou
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Ping Xu
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Xianbin Guo
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Yu Xie
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Junxiu Cai
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Min Pan
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Jie Tang
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Qingtao Gong
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Rong Su
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Yan Liu
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Yake Lou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Wang L, Yu Y, Zhou L, Xu P, Guo X, Xie Y, Cai J, Pan M, Tang J, Gong Q, Su R, Lou Y, Liu Y. Endovascular treatment for basilar artery occlusion: a cost-effectiveness analysis based on a meta-analysis. Front Neurol 2023; 14:1267554. [PMID: 37928158 PMCID: PMC10623329 DOI: 10.3389/fneur.2023.1267554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023] Open
Abstract
Objective This study aimed to investigate the efficacy and economic effect of endovascular treatment (EVT) combined with standard medical treatment (SMT) vs. SMT alone in Chinese patients with basilar artery occlusion (BAO) from the perspective of the Chinese healthcare system. Methods We conducted a cost-effectiveness analysis using the results from a meta-analysis comparing EVT and SMT efficacy in Chinese patients with BAO-induced stroke using direct medical costs from the China National Stroke Registry. The meta-analysis's primary outcome was excellent functional outcome (mRS scores of 0-2), with secondary outcomes being poor functional outcome (mRS scores of 3-5) and death (mRS score of 6). To compare EVT plus SMT's cost-effectiveness with that of SMT alone, we constructed a combined decision tree and Markov model with a lifetime duration and a 3-month cycle length. The primary cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER), representing the incremental cost per incremental quality-adjusted life year (QALY). EVT was considered cost-effective if the ICER was lower than the willingness-to-pay (WTP) threshold of three times the per capita gross domestic product (GDP) in 2021 in China; otherwise, it would not be cost-effective. Results The meta-analysis results indicated that EVT could increase the incidence of excellent functional outcomes, with a risk ratio (RR) of 2.23 (95% confidence interval, CI, 1.18-4.21), p = 0.01. Simultaneously, EVT reduced the risk of poor functional outcome and mortality in the EVT group, with RRs of 0.83 (95% CI, 0.67-1.03), p = 0.09, and 0.71 (95% CI, 0.59-0.85), p = 0.0002, respectively. The study also found that EVT plus SMT resulted in a lifetime effectiveness of 2.15 QALY (3.88 life years) for 32,213 international dollars (Intl.$) per patient with BAO. In contrast, SMT alone achieved an effectiveness of 1.46 QALY (3.03 life years) with a total cost of Intl.$ 13,592 per patient. The ICER was Intl.$ 27,265 per QALY (Intl.$ 22,098 per life-year), which fell below the WTP threshold. Conclusion Compared to SMT, EVT improves the prognosis of BAO-induced stroke. Considering the Chinese healthcare system, adding EVT to SMT proves to be cost-effective for patients with BAO compared to SMT alone.
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Affiliation(s)
- Li Wang
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Ying Yu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Limei Zhou
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Ping Xu
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Xianbin Guo
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Yu Xie
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Junxiu Cai
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Min Pan
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Jie Tang
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Qingtao Gong
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Rong Su
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Yake Lou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Liu
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
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Hu M, Zhang B, Lin Y, Xu M, Zhu C. Trajectories of post-stroke quality of life and long-term prognosis: Results from an eleven-year prospective study. J Psychosom Res 2023; 173:111466. [PMID: 37647831 DOI: 10.1016/j.jpsychores.2023.111466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE The relationship between quality of life (QoL) and long-term prognosis in stroke patients is still unclear. We explored physical and mental QoL trajectories during the first six months after stroke and determined the associations between trajectories and long-term prognosis in patients with first-ever ischemic stroke. METHODS Included were 733 participants from a prospective study. QoL was assessed with the 12-item Short Form Survey (SF-12) at baseline, 3 and 6 months. Patients' prognoses (stroke recurrence and death) were identified from 2010 to 2021. The latent class growth model (LCGM) was used to identify distinct trajectories of physical and mental QoL measured over the first 6 months. We employed the Cox model or Fine-Gray model for prognoses to examine the associations between QoL trajectories and prognosis. RESULTS Five trajectories of physical QoL and five trajectories of mental QoL were identified. For physical QoL of the Poor-Improved, and Moderate-Impaired trajectory versus Moderate-Improved trajectory, the hazard ratio (HR) for death was 2.39 (1.14 to 5.02), and 2.03(0.93 to 4.44); the HR for recurrence was 1.56 (0.83 to 2.94) and 2.33 (1.28 to 4.24). For mental QoL of the Moderate-Impaired trajectory versus the Moderate-Improved trajectory, the HR for death was 2.48 (1.21 to 5.07). The results were robust in the sensitivity analysis. CONCLUSION QoL during the first six months after ischemic stroke can be categorized into distinct groups. Change in QoL was associated with long-term survival. Secondary prevention of recurrent strokes might rely more on improving patients' physical QoL.
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Affiliation(s)
- Meijing Hu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Baiyang Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yidie Lin
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Minghan Xu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Cairong Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China.
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Gil-Salcedo A, Dugravot A, Fayosse A, Landré B, Yerramalla MS, Sabia S, Schnitzler A. Role of age and sex in the association between BMI and functional limitations in stroke patients: Cross-sectional analysis in three European and US cohorts. J Stroke Cerebrovasc Dis 2023; 32:107270. [PMID: 37481939 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND A U- or J-shaped association between BMI and different post-stroke outcomes is suggested. Thus, the aim is to evaluate the association between BMI with ADL, IADL and mobility limitations in the ageing post-stroke population at different ages, as well as the differences in this association by sex. METHODS A total of 5,468 participants with stroke and 21,872 without stroke over 50 years of age were assessed for the number of limitations in basic or instrumental activities of daily living (ADL/IADL) as well as mobility tasks. The association between BMI at the interview (continuous time-dependent variable) and the level of limitations was assessed using a linear mixed model stratified by sex and stroke status. RESULTS The association between BMI and ADL/IADL and mobility limitations were found to be significant in both men and women regardless of stroke status (p<0.001 for all). The association differs between those who have suffered a stroke and those who have not (p<0.001 for all). In ADL/IADL limitations, men with stroke showed a transition from an inverted J-shape to a U-shape association with age. In women, the BMI showed a less pronounced association between BMI and ADL/IADL limitations compared to men but with similar trends. A effect of sex was observed in the association between BMI and mobility, with women with and without stroke showing a linear association that differed from the inverted J-shaped or U-shaped association of men. CONCLUSION Our results suggest that BMI is associated with limitations in ADL, IADL and mobility in stroke patients. In addition, this association differs between men and women and is also influenced by age.
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Affiliation(s)
- Andres Gil-Salcedo
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Benjamin Landré
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Manasa S Yerramalla
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Alexis Schnitzler
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France; Université Versailles Saint Quentin en Yvelines, EA 4047 Handi-Resp, Service de neurologie hôpital A. Mignot, Garches, France.
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Chen JJ, Cheng YC, Lin LH, Chiang CC, Lin KH, Liu TC, Chou YJ, Lee IH, Huang N. Perception of transitional care quality associated with functional outcomes among patients with fractures and stroke in Taiwan. Geriatr Nurs 2023; 53:247-254. [PMID: 37598428 DOI: 10.1016/j.gerinurse.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
This study aimed to examine the relationship between self-perceived quality of transitional care and functional outcome among patients with stroke and fractures. The Care Transition Measure (CTM-15) was used to survey patient's self-perceived transitional care quality before discharge. General estimating equations were used to investigate the influences of transitional care quality on patient's functional outcomes at before, 1 week after, and 1 or 3 months after discharge. Among stroke patients, higher CTM-15 scores were positively associated with greater outcome in Instrumental Activities of Daily Living (IADL) following discharge. Higher scores for "reader-friendly written care plan," "consideration of patient's preferences," and "understanding of health management" had significantly positive effects on functional recovery in IADL among both patient groups following discharge. These findings suggest that heterogeneity in transitional care needs between medical and surgical patients shall not be overlooked. A one-size-fits-all strategy may be insufficient for ensuring patient care continuity following discharge.
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Affiliation(s)
- Jing-Jer Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chun Cheng
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Hwa Lin
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao-Ching Chiang
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kung-Hou Lin
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Ching Liu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-Hui Lee
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Nicole Huang
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Zhai M, Cao S, Yang J, Cao X, Dong Z, Liu W, Fu Y, Guan Q, Wang Y, Liu H. Effect of Intravenous Thrombolytic Dose of Alteplase on Long-Term Prognosis in Patients with Acute Ischemic Stroke. Neurol Ther 2023; 12:1105-1118. [PMID: 37166676 PMCID: PMC10310604 DOI: 10.1007/s40120-023-00488-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION This study aimed to investigate the long-term prognostic effects of different alteplase doses on patients with acute ischemic stroke (AIS). METHODS In this cohort study, we enrolled 501 patients with AIS treated with intravenous thrombolysis with alteplase, with the primary endpoint event of recurrence of ischemic stroke and the secondary endpoint event of death. The effects of different doses of alteplase on recurrence of ischemic stroke and death were analyzed using a Cox proportional risk model. RESULTS Among 501 patients with AIS treated with thrombolysis, 295 patients (58.9%) and 206 patients (41.1%) were treated with low-dose and standard-dose alteplase, respectively. During the study period, 61 patients (12.2%) had a confirmed recurrence of ischemic stroke. Multivariate Cox proportional risk analysis showed that standard-dose alteplase thrombolysis (HR 0.511, 95% CI 0.288-0.905, P = 0.021) was significantly associated with a reduced risk of long-term recurrence of AIS, whereas atrial fibrillation was associated with an increased risk of long-term recurrence of AIS. Thirty-nine (7.8%) patients died during the study period. Multivariate Cox proportional risk analysis showed that age, baseline National Institutes of Health Stroke Scale (NIHSS) score, and symptomatic steno-occlusion were associated with an increased long-term risk of death from AIS. The alteplase dose was not associated with the risk of death from AIS. CONCLUSIONS Standard-dose alteplase treatment reduced the risk of long-term recurrence of AIS after hospital discharge and the alteplase dose was not associated with the long-term risk of death from AIS.
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Affiliation(s)
- Mingfeng Zhai
- Department of Neurology, The Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang People's Hospital, Fuyang, China
| | - Shugang Cao
- Department of Neurology, The Affiliated Hefei Hospital of Anhui Medical University, The Second People's Hospital of Hefei, Hefei, China
| | - Jinwei Yang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Xiaoyan Cao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Public Health Clinical Center, Hefei, China
| | - Zhong Dong
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Public Health Clinical Center, Hefei, China
| | - Wanyin Liu
- Department of Neurology, The Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang People's Hospital, Fuyang, China
| | - Yongzhan Fu
- Department of Neurology, The Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang People's Hospital, Fuyang, China
| | - Qiyue Guan
- Department of Neurology, The Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang People's Hospital, Fuyang, China
| | - Yu Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
- Anhui Public Health Clinical Center, Hefei, China.
| | - Hongbo Liu
- Department of Emergency, The Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, China.
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Gunasekera L, Mitchell P, Dowling RJ, Bush S, Yan B. Functional recovery continues beyond 3 months post-basilar artery thrombectomy: A retrospective cohort study. CNS Neurosci Ther 2023. [PMID: 36942501 DOI: 10.1111/cns.14182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 01/19/2023] [Accepted: 03/05/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Untreated basilar artery occlusion (BAO) carries 70% mortality. Guidelines recommend thrombectomy with or without thrombolysis. AIM We compared Modified Rankin Scores (mRS) at 3 and 12 months post thrombectomy to determine benefit of long-term follow up. METHODS Retrospective, single centre analysis of BAO thrombectomies between 2015 and 2019. Inclusion criteria were symptomatic BAO on CT angiography, absent early ischemic changes, premorbid independence and intervention within 24 h. All received stroke ward care. Results were analysed with simple statistics and binary logistic regression as appropriate. RESULTS Of 82 patients: most were male (61%, 50/82) with median age 68 years (IQR 17 years) and median NIHSS 14 (IQR 15). Median door-to-puncture time was 42 min (IQR 72 min). Total deaths were 34.1% (28/82) at 3 months, and 37.8% (31/82) at 12 months. Of 51 patients alive at 12 months: 41% (21/51) had improved mRS, 16% (8/51) had worse mRS and 43% (22/51) had unchanged mRS, compared to 3 months. Improvements to mRS were: one point in 57.1% (14/21), two points in 28.9% (6/21) and three points in 4.8% (1/21). Nursing home admission was avoided in 11.8% (6/51) who improved from mRS4. Increased age was associated with decreased likelihood of reaching the primary outcome OR 0.87, 95% CI 0.76-0.99 (p value = 0.03). CONCLUSION Over a quarter of patients improved beyond 3 months. Future studies should adopt long-term follow up as primary outcome.
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Affiliation(s)
- Lakshini Gunasekera
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Peter Mitchell
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Richard J Dowling
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Steven Bush
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Bernard Yan
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Parkville, Melbourne, Victoria, Australia
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Privitera CM, Neerukonda SV, Aiyagari V, Yokobori S, Puccio AM, Schneider NJ, Stutzman SE, Olson DM, Hill M, DeWitt J, Atem F, Barnes A, Xie D, Kuramatsu J, Koehn J, Swab S. A differential of the left eye and right eye neurological pupil index is associated with discharge modified Rankin scores in neurologically injured patients. BMC Neurol 2022; 22:273. [PMID: 35869429 PMCID: PMC9306158 DOI: 10.1186/s12883-022-02801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Automated infrared pupillometry (AIP) and the Neurological Pupil index (NPi) provide an objective means of assessing and trending the pupillary light reflex (PLR) across a broad spectrum of neurological diseases. NPi quantifies the PLR and ranges from 0 to 5; in healthy individuals, the NPi of both eyes is expected to be ≥ 3.0 and symmetric. AIP values demonstrate emerging value as a prognostic tool with predictive properties that could allow practitioners to anticipate neurological deterioration and recovery. The presence of an NPi differential (a difference ≥ 0.7 between the left and right eye) is a potential sign of neurological abnormality.
Methods
We explored NPi differential by considering the modified Rankin Score at discharge (DC mRS) among patients admitted to neuroscience intensive care units (NSICU) of 4 U.S. and 1 Japanese hospitals and for two cohorts of brain injuries: stroke (including subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, and aneurysm, 1,200 total patients) and 185 traumatic brain injury (TBI) patients for a total of more than 54,000 pupillary measurements.
Results
Stroke patients with at least 1 occurrence of an NPi differential during their NSICU stay have higher DC mRS scores (3.9) compared to those without an NPi differential (2.7; P < .001). Patients with TBI and at least 1 occurrence of an NPi differential during their NSICU stay have higher discharge modified Rankin Scale scores (4.1) compared to those without an NPi differential (2.9; P < .001). When patients experience both abnormalities, abnormal (NPi < 3.0) and an NPi differential, the latter has an anticipatory relationship with respect to the former (P < .001 for z-score skewness analysis). Finally, our analysis confirmed ≥ 0.7 as the optimal cutoff value for the NPi differential (AUC = 0.71, P < .001).
Conclusion
The NPi differential is an important factor that clinicians should consider when managing critically ill neurological injured patients admitted to the neurocritical care units.
Trial registration
NCT02804438, Date of Registration: June 17, 2016.
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Chan DYC, Li LF, Lui WM, Poon CCM, Tsang ACO, Leung GKK. Predictive value of Bispectral Index (BIS) in emergency neurosurgical patients: Loss of BIS reactivity to propofol predicts poor functional outcomes. Clin Neurol Neurosurg 2022; 221:107382. [DOI: 10.1016/j.clineuro.2022.107382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022]
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11
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Shin S, Lee Y, Chang WH, Sohn MK, Lee J, Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Kim YH. Multifaceted Assessment of Functional Outcomes in Survivors of First-time Stroke. JAMA Netw Open 2022; 5:e2233094. [PMID: 36149652 PMCID: PMC9508656 DOI: 10.1001/jamanetworkopen.2022.33094] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPORTANCE Because stroke causes diverse functional deficits, understanding the long-term recovery pattern of each functional domain may inform prognosis and therapeutic strategies. OBJECTIVE To observe long-term changes in functional status and residual disability in survivors of first-time stroke. DESIGN, SETTING, AND PARTICIPANTS This cohort study was an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. Between August 2012 and May 2015, 7858 of 10 636 screened patients with first-time strokes from 9 district hospitals in Korea provided informed consent to participate. Data were analyzed from September 2021 through February 2022. EXPOSURE First-time stroke. MAIN OUTCOMES AND MEASURES Study data include multifaceted face-to-face functional assessments obtained at 8 to 9 points until 60 months after stroke onset. The Korean Mini-Mental State Examination (K-MMSE), Fugl-Meyer Assessment, Functional Ambulatory Category, American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale, and Short Korean version of the Frenchay Aphasia Screening Test were performed from 7 days to 60 months after stroke. The Korean Modified Barthel Index was measured from 3 months to 60 months after stroke. RESULTS A total of 4443 patients (2649 men [59.62%]; mean [SD] age 62.13 [12.43] years) who underwent repeated functional assessments for 60 months after stroke (3508 patients with ischemic and 935 patients with hemorrhagic stroke) were included. Overall, functions plateaued between 12 and 18 months after stroke and declined after 30 months; for example, mean (SD) K-MMSE improved from 7 days (22.89 [7.89]) to 12 months (26.03 [5.48]) (P < .001), plateaued until 36 months (26.03 [5.84]), and decreased to 48 months (26.02 [5.82]) (P < .001). Interaction associations were found between time after stroke and age, stroke severity, and stroke type in functional assessment outcomes. For example, mean (SE) FMA for ages 65 years or younger vs older than 65 years was 81.64 (0.63) vs 80.69 (0.68) at 7 days and 91.28 (0.47) vs 88.46 (0.58) at 6 months (P for interaction < .001), and for IS vs HS, it was 84.46 (0.47) vs 69.02 (1.24) at 7 days and 91.20 (0.38) vs 85.51 (0.98) at 6 months (P for interaction < .001). Mean (SE) FMA was 94.39 (0.21) at 7 days and 97.57 (0.14) at 6 months for mild stroke, 44.69 (1.18) at 7 days and 70.43 (1.21) at 6 months for moderate stroke, and 13.22 (0.99) at 7 days and 48.07 (2.62) at 6 months for severe stroke (P for interaction < .001). Factors associated with activities of daily living independence at 60 months included older age (β per 1-year increase = -0.35; standard error [SE], 0.03; P < .001), male sex (β = 2.12; SE, 0.73; P = .004), and hemorrhagic stroke type (β vs ischemic stroke = 2.35; SE, 0.81; P = .004). CONCLUSIONS AND RELEVANCE This study found that long-term recovery patterns in multifaceted functional domains differed from one another and varied by patient age, stroke severity, and stroke type. Understanding the diversity of long-term functional recovery patterns and factors associated with these outcomes in survivors of stroke may help clinicians develop strategies for effective stroke care and rehabilitation.
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Affiliation(s)
- Seyoung Shin
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yaesuel Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University, School of Medicine, Iksan, Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju City, Republic of Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Science and Technology, Department of Medical Devices Management and Research, Department of Digital Healthcare, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
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12
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García-Rudolph A, Saurí J, Cegarra B, Madai VI, Frey D, Kelleher JD, Cisek K, Opisso E, Tormos JM, Bernabeu M. Long-term trajectories of motor functional independence after ischemic stroke in young adults: Identification and characterization using inpatient baseline assessments. NeuroRehabilitation 2022; 50:453-465. [DOI: 10.3233/nre-210293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Stroke is a major worldwide cause of serious long-term disability. Most previous studies addressing functional independence included only inpatients with limited follow-up. OBJECTIVE: To identify novel classes of patients having similar temporal patterns in motor functional independence and relate them to baseline clinical features. METHODS: Retrospective observational cohort study, data were obtained for n = 428 adult patients with ischemic stroke admitted to rehabilitation (March 2005–March 2020), including baseline clinical features and follow-ups of motor Functional Independence Measure (mFIM) categorized as poor, fair or good. Growth mixture models (GMMs) were fitted to identify classes of patients with similar mFIM trajectories. RESULTS: GMM identified three classes of trajectories (1,664 mFIM assessments): C1 (11.2 %), 97.9% having poor admission mFIM, at 4.93 years 61.1% still poor, with the largest percentage of hypertension, neglect, dysphagia, diabetes and dyslipidemia of all three classes. C2 (23.1%), 99% had poor admission mFIM, 25% poor discharge mFIM, the largest percentage of aphasia and greatest mFIM gain, at 4.93 years only 6.2% still poor. C3 (65.7%) the youngest, lowest NIHSS, 37.7% poor admission mFIM, 73% good discharge mFIM, only 4.6% poor discharge mFIM, 90% good at 4.93 years. CONCLUSIONS: GMM identified novel motor functional classes characterized by baseline features.
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Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònomade Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Joan Saurí
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònomade Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Blanca Cegarra
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònomade Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Vince Istvan Madai
- CLAIM Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health (BIH), Charité – Universitätsmedizin Berlin, Berlin, Germany
- School of Computing and Digital Technology, Faculty of Computing, Engineering and the Built Environment, Birmingham City University, Birmingham, United Kingdom
| | - Dietmar Frey
- CLAIM Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John D. Kelleher
- Information, Communication and Entertainment Research Institute, Technological University Dublin (TU Dublin), Dublin, Ireland
| | - Katryna Cisek
- Information, Communication and Entertainment Research Institute, Technological University Dublin (TU Dublin), Dublin, Ireland
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònomade Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep María Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònomade Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Montserrat Bernabeu
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònomade Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
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13
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Yamauchi K, Kumagae K, Goto K, Harayama E, Tanaka S, Hagiwara R, Uchida Y, Kuroyama S, Koyanagi Y, Arakawa S. Ambulation status at an acute care hospital predicts pneumonia and mortality in stroke patients: A retrospective cohort study. Geriatr Gerontol Int 2022; 22:554-559. [PMID: 35706408 DOI: 10.1111/ggi.14411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/26/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
AIM Higher post-stroke functional performance is associated with lower mortality in patients with stroke. This study aimed to investigate the relationship between ambulation ability in the acute phase of stroke, and pneumonia and mortality 1 year after stroke onset. METHODS This retrospective cohort study included consecutive stroke patients between April 2008 and December 2018. Patients were divided into six groups according to their Functional Ambulation Category score at discharge (0 [unable to walk] to 5 [able to walk independently]). We observed pneumonia cases and all-cause mortality over 1 year, and investigated the association between Functional Ambulation Category score and pneumonia or mortality. Survival analysis was carried out using Kaplan-Meier curves, log-rank tests and Cox regression models. RESULTS We analyzed 1727 consecutive patients (median age 77 years; 54% men). During the observation period, 144 patients (8.3%) experienced pneumonia and 157 (9.1%) died. Increasing ambulatory impairment showed stepwise relationships with the risk of pneumonia and mortality. Compared with patients with a Functional Ambulation Category score of 5, those with scores of 4 and 3 showed no significant association with pneumonia risk; a score ≤2 was significantly different. There was a stepwise relationship between increased gait disturbance and risk of death compared with the Functional Ambulation Category 5 group. CONCLUSIONS Ambulation ability at discharge from an acute hospital is an important predictor of pneumonia incidence and survival in stroke patients at 1 year; these associations were observed even after controlling for clinical parameters, such as stroke severity and comorbidity. Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Kota Yamauchi
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Kenichi Kumagae
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Kei Goto
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Eisei Harayama
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Shota Tanaka
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Risa Hagiwara
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Yoshiko Uchida
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Sota Kuroyama
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Yasuhiro Koyanagi
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Shuji Arakawa
- Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan
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14
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Gil-Salcedo A, Dugravot A, Fayosse A, Landré B, Jacob L, Bloomberg M, Sabia S, Schnitzler A. Pre-stroke Disability and Long-Term Functional Limitations in Stroke Survivors: Findings From More of 12 Years of Follow-Up Across Three International Surveys of Aging. Front Neurol 2022; 13:888119. [PMID: 35775052 PMCID: PMC9237334 DOI: 10.3389/fneur.2022.888119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Almost 50% of the post-stroke disabled population already have a premorbid disability before stroke. These patients may be offered a different care pathway in the acute and subacute phase than those without pre-morbid disability. Therefore, the aim of this study was to assess the association of the severity of premorbid disability with change of limitations in basic and instrumental activities of daily living (ADL/IADL) 1 year after stroke and over the following decade. Methods Among 3,432 participants from HRS, SHARE and ELSA cohorts with a first stroke, ADL/IADL limitations were measured at 1-2 years prior to stroke, at 1 year post-stroke, and during the chronic phase. Modified Ranking Scale (P-mRS) was used to categorize the participants by level of premorbid disability (1-2 years pre-stroke). Change in ADL/IADL limitations by P-mRS level (0-1, 2-3, and 4-5) was assessed using a piecewise linear mixed model with a breakpoint set at 1 year post-stroke, stratified by median age groups. Results Increase in ADL limitations at 1 year post-stroke was less pronounced in P-mRS ≥2 (p < 0.005). After years of relative stability, limitations of ADL increased for all P-mRS levels (p = 0.003). In those aged ≥75 years at stroke event, the increase was similar irrespective of P-mRS (p = 0.090). There were no significant differences in IADL trajectories between P-mRS levels (p ≥ 0.127). Conclusion These results suggest similar trajectories of functional limitations between P-mRS levels up to 9 years post-stroke, highlighting the possible benefit of including patients with pre-morbid disability to certain treatments during the acute phase.
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Affiliation(s)
- Andres Gil-Salcedo
- Université Paris-Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Aline Dugravot
- Université Paris-Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Aurore Fayosse
- Université Paris-Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Benjamin Landré
- Université Paris-Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France.,Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain
| | - Mikaela Bloomberg
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Séverine Sabia
- Université Paris-Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Alexis Schnitzler
- Université Paris-Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.,Université Versailles Saint Quentin en Yvelines, EA 4047 Handi-Resp, Service de neurologie hôpital A. Mignot, Garches, France
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15
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Gil-Salcedo A, Dugravot A, Fayosse A, Jacob L, Bloomberg M, Sabia S, Schnitzler A. Long-Term Evolution of Functional Limitations in Stroke Survivors Compared With Stroke-Free Controls: Findings From 15 Years of Follow-Up Across 3 International Surveys of Aging. Stroke 2022; 53:228-237. [PMID: 34470497 DOI: 10.1161/strokeaha.121.034534] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE In the chronic phase 2 to 5 years poststroke, limitations in activities of daily living (ADL) and instrumental ADL (IADL) initially plateau before steady increasing. However, the impact of age and differences in initial levels of disability on the evolution of these limitations remains unclear. As such, this study aims to evaluate differences in long-term evolution of ADL/IADL limitations between stroke survivors and stroke-free population, and how limitations differ by initial level of disability for stroke survivors. METHODS Thirty-three thousand six hundred sixty participants (5610 first-ever stroke cases with no recurrence during follow-up and 28 050 stroke-free controls) aged ≥50 from the Health and Retirement Study, Survey of Health, Ageing and Retirement in Europe, and English Longitudinal Study of Ageing were assessed for number of ADL/IADL limitations during the poststroke chronic phase (for cases) and over follow-up years 1996 to 2018 (for controls). Three thousand seven hundred eighteen stroke cases were additionally categorized by disability level using the modified Rankin Scale score of 1 to 2 years poststroke. Evolution of ADL/IADL limitations was assessed in stroke cases and controls and by modified Rankin Scale score (0-1, 2-3, 4-5) using linear mixed models. Models were stratified by age group (50-74 and ≥75 years) and adjusted for baseline characteristics, health behaviors, BMI, and comorbidities. RESULTS Findings showed relative stability of ADL/IADL limitations during 3 to 6 years poststroke followed by an increase for both populations, which was faster for younger stroke cases, suggesting a differential age-effect (P<0.001). Disability level at 1 to 2 years poststroke influenced the evolution of limitations over time, especially for severe disability (modified Rankin Scale score, 4-5) associated with a reduction in limitations at 5 to 6 years poststroke. CONCLUSIONS Our findings showed that during the poststroke chronic phase functional limitations first plateau and then increase and the evolution differs by disability severity. These results highlight the importance of adaptive long-term health and social care measures for stroke survivors.
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Affiliation(s)
- Andres Gil-Salcedo
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France (A.G.-S., A.D., A.F., L.J., S.S., A.S.)
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France (A.G.-S., A.D., A.F., L.J., S.S., A.S.)
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France (A.G.-S., A.D., A.F., L.J., S.S., A.S.)
| | - Louis Jacob
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France (A.G.-S., A.D., A.F., L.J., S.S., A.S.)
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Spain (L.J.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain (L.J.)
| | - Mikaela Bloomberg
- Department of Epidemiology and Public Health, University College London, United Kingdom (M.B., S.S.)
| | - Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France (A.G.-S., A.D., A.F., L.J., S.S., A.S.)
- Department of Epidemiology and Public Health, University College London, United Kingdom (M.B., S.S.)
| | - Alexis Schnitzler
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France (A.G.-S., A.D., A.F., L.J., S.S., A.S.)
- Université Versailles Saint Quentin en Yvelines, EA 4047 Handi-Resp, Garches, France (A.S.)
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16
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Bhatt NR, Backster A, Ido MS, Nogueira RG, Bayakly R, Wright DW, Frankel MR. Impact of Intravenous Alteplase Door-to-Needle Times on 2-Year Mortality in Patients With Acute Ischemic Stroke. Front Neurol 2021; 12:747185. [PMID: 34721274 PMCID: PMC8548610 DOI: 10.3389/fneur.2021.747185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: We sought to determine whether administration of Intravenous Thrombolysis (IVT) to patients with Acute Ischemic Stroke (AIS) within 60 min from hospital arrival is associated with lower 2-year mortality. Methods: This retrospective study was conducted among patients receiving IVT in hospitals participating in the Georgia Coverdell Acute Stroke Registry (GCASR) from January 1, 2008 through June 30, 2018. Two-year mortality data was obtained by linking the 2008–2018 Georgia Discharge Data System data and the 2008–2020 Georgia death records. We analyzed the study population in two groups based on the time from hospital arrival to initiation of IVT expressed as Door to Needle time (DTN) in a dichotomized (DTN ≤ 60 vs. > 60 min) fashion. Results: The median age of patients was 68 years, 49.4% were females, and the median NIHSS was 9. DTN ≤60 min was associated with lower 30-day [odds ratio (OR), 0.62; 95% CI, 0.52–0.73; P < 0.0001], 1-year (OR, 0.71; 95% CI, 0.61–0.83; P < 0.0001) and 2-year (OR, 0.76; 95% CI, 0.65–0.88; P = 0.001) mortality as well as lower rates of sICH at 36 h (OR, 0.57; 95% CI, 0.43–0.75; P = 0.0001), higher rates of ambulation at discharge (OR, 1.38; 95% CI, 1.25–1.53; P < 0.0001) and discharge to home (OR, 1.36; 95% CI, 1.23–1.52; P < 0.0001). Conclusion: Faster DTN in patients with AIS was associated with lower 2-year mortality across all age, gender and race subgroups. These findings reinforce the need for intensifying quality improvement measures to reduce DTN in AIS patients.
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Affiliation(s)
- Nirav R Bhatt
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Anika Backster
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Moges S Ido
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, United States.,Georgia Department of Public Health, Division of Health Protection, Epidemiology Program, Atlanta, GA, United States
| | - Raul G Nogueira
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Rana Bayakly
- Georgia Department of Public Health, Division of Health Protection, Epidemiology Program, Atlanta, GA, United States
| | - David W Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael R Frankel
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
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17
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Effect of Sociodemographic Factors, Concomitant Disease States, and Measures Performed in the Emergency Department on Patient Disability in Ischemic Stroke: Retrospective Study from Lebanon. Stroke Res Treat 2021; 2021:5551558. [PMID: 34136116 PMCID: PMC8175140 DOI: 10.1155/2021/5551558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/30/2021] [Accepted: 05/10/2021] [Indexed: 12/05/2022] Open
Abstract
Background Stroke is a leading cause of death and disability in developed countries. The major factor affecting long-term survival other than age is the disability severity caused by stroke. The modified Rankin Scale (mRS) is a global functional endpoint measurement used in acute stroke to evaluate the degree of disability or dependence in daily life activities. The objective of this study was to assess the effects of sociodemographic factors, concomitant disease states, and some measures performed in the emergency department (ED) on patients' disability. Methods We conducted a retrospective study on ischemic stroke patients admitted to Intensive Care Unit of three Lebanese university hospitals between June and December 2016. Patients were excluded if they had been discharged from ED without hospital admission or if mRS was not performed. The mRS was further subdivided into two categories considered as “good prognosis” (0-2 or 0-3) and “poor prognosis” (>2 or > 3). Results 204 patients were included in the study with mean age of 65.4 ± 11.9 years, hypertension was the most previous concomitant past medical disease (77.1%), and 27.1% of these patients had previous history of stroke. No significant differences were found in both mRS categories for all sociodemographic factors, and past medical history except that arrhythmia was significantly more common in the higher mRS categories > 2 and > 3. Based on multivariable analysis, there was a trend for previous intake of calcium channel blocker to be associated with lower mRS at admission (beta -0.586). However, intracranial arterial stenosis, ED blood glucose > 180 mg/dL, and performing brain imaging above 20 minutes after patient presentation to ED were significantly associated with higher mRS scores at discharge with an ORa and (confidence interval) of 2.986 (0.814, 10.962), 3.301 (1.072, 1.261), and 1.138 (1.071, 9.080), respectively. Conclusion mRS is affected by previous disease states, prescribed medications, and acute measures performed in ED. It is also influenced by intracranial arterial stenosis etiology, which is associated with worse outcome.
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18
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Shavelle RM, Brooks JC, Strauss DJ, Turner-Stokes L. Life Expectancy after Stroke Based On Age, Sex, and Rankin Grade of Disability: A Synthesis. J Stroke Cerebrovasc Dis 2019; 28:104450. [PMID: 31676160 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104450] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of death and disability in the developed world. The major factor affecting long term survival (other than age) is known to be the severity of disability. Yet to our knowledge there are no studies reporting life expectancies stratified by both age and severity. Remaining life expectancy is a key measure of health. METHODS We identified 11 long-term follow-up studies of stroke patients that reported the multivariate effects of age, sex, the modified Rankin Scale (mRS) grade of disability, and other factors. From these we computed the composite effects of these factors on survival, then used these to calculate age-, sex-, and mRS-specific mortality rates. Finally we used the rates to construct life tables, and hence obtain life expectancies. RESULTS Life expectancy varies by age, sex, and mRS. The life expectancies of males age 70, for example, were 13, 13, 11, 8, 6, and 5 years for Rankin Grades 0-5, respectively, representing reductions of 1, 1, 3, 6, 8, and 9 years from the corresponding general population figure. CONCLUSIONS These figures demonstrate the importance of rehabilitation following stroke, and can be used in discussion of public policy and benchmarking of future results.
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Affiliation(s)
| | | | | | - Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Northwick Park Hospital, Harrow, Middlesex, UK
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Rejnö Å, Nasic S, Bjälkefur K, Bertholds E, Jood K. Changes in functional outcome over five years after stroke. Brain Behav 2019; 9:e01300. [PMID: 31066194 PMCID: PMC6576172 DOI: 10.1002/brb3.1300] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Data on the long-term time course of poststroke functional outcome is limited. We investigated changes in functional outcome over 5 years after stroke in a hospital based cohort. MATERIALS AND METHODS Consecutive patients who were independent in activities of daily living (ADL) and admitted to a Stroke Unit at Skaraborg Hospital, Sweden for a first acute stroke from 2007 to 2009 (n = 1,421) were followed-up after 3 months and thereafter annually over 5 years using a postal questionnaire. Clinical variables at acute stroke and 3 months post stroke were obtained from the Swedish Stroke Register. ADL dependency was defined as dependence in dressing, toileting or indoor mobility. RESULTS The proportions of survivors who reported ADL dependency remained stable throughout follow-up (19%-22%). However, among survivors who were ADL independent at 3 months, about 3% deteriorated to dependency each year. Deterioration was predicted by age (HR 1.11; 95% CI 1.08-1.13), diabetes (HR 1.65; 95% CI 1.12-2.44), NIHSS score (HR 1.07; 95% CI 1.04-1.10), and self-perceived unmet care needs one year post stroke (HR 2.01; 95% CI 1.44-2.81). Transitions from ADL dependency to independence occurred mainly during the first year post stroke. Improvement was negatively predicted by living alone before stroke (HR 0.41 95% CI 0.19-0.91), NIHSS score (HR 0.90; 95% CI 0.86-0.95) and ischemic stroke (vs. hemorrhagic stroke), HR 0.39; 95% CI 0.17-0.89. CONCLUSION Transitions between ADL independence and dependency occur up to 5 years after stroke. Some of the factors predicting these transitions are potentially modifiable.
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Affiliation(s)
- Åsa Rejnö
- Department of Medicine, Skaraborg Hospital Skövde, Skövde, Sweden.,Department of Health Sciences, University West, Trollhättan, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital Skövde, Skövde, Sweden
| | - Kerstin Bjälkefur
- Department of Health and Social Care, Municipality of Lidköping, Sweden
| | - Eric Bertholds
- Department of Medicine, Skaraborg Hospital Skövde, Skövde, Sweden
| | - Katarina Jood
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Kaboré N, Marnat G, Rouanet F, Barreau X, Verpillot E, Menegon P, Maachi I, Berge J, Sibon I, Bénard A. Cost-effectiveness analysis of mechanical thrombectomy plus tissue-type plasminogen activator compared with tissue-type plasminogen activator alone for acute ischemic stroke in France. Rev Neurol (Paris) 2019; 175:252-260. [PMID: 30642680 DOI: 10.1016/j.neurol.2018.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/29/2018] [Accepted: 06/14/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Recent studies demonstrated the benefit of mechanical thrombectomy (MT) plus intravenous tissue-type plasminogen activator (IV-tPA) (MT-IV-tPA) in acute ischemic stroke. This study aimed to estimate the cost-utility of MT-IV-tPA compared with IV-tPA alone from the perspective of the French National Health Insurance. METHODS We developed a decision tree for the first 3 months after stroke onset and a Markov model until 10 years post-stroke. The health states of the Markov model were according to the modified Rankin Scale (mRS): independent (mRS=0-2), dependent (mRS=3-5), dead (mRS=6). Recurrent stroke was the fourth health stage of our model. We conducted systematic literature reviews and meta-analyses to estimate the cost and utility of each health state, and the transition probabilities between health states. A microcosting study was conducted to estimate the cost of MT. We estimated the incremental cost-effectiveness ratio of MT-IV-tPA and conducted a probabilistic analysis in order to estimate the probability that MT-IV-tPA is cost-effective compared to IV-tPA, the expected value of perfect information (EVPI), and the expected value of partial perfect information (EVPPI), given the uncertainty surrounding the value of our model's parameters. RESULTS The total mean (standard deviation (SD) cost of MT was €6708.9 (2357.0). The incremental cost-effectiveness ratio (ICER) of the strategy using IV-tPA combined to MT costs was €14,715 per QALY gained as compared to a strategy using IV-tPA alone. The probabilistic analysis showed that the probability of MT-IV-TPA being cost-effective was 85.4% at threshold willingness-to-pay of €30,000 per QALY gained, reaching 98% at €50,000 per QALY gained. CONCLUSION Although there is no universally accepted willingness-to-pay threshold in France, our analysis suggest that MT combined to IV-tPA can be considered a cost-effective treatment compared with IV-tPA alone.
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Affiliation(s)
- N Kaboré
- Pôle de santé publique, service d'information médicale, USMR & CIC-EC 14-01, CHU de Bordeaux, 33000 Bordeaux, France; Inserm, Bordeaux Population Health Research Center, team EMOS, UMR 1219, université Bordeaux, 33000 Bordeaux, France
| | - G Marnat
- Pôle imagerie médicale, service de radiologie et de neuro-imagerie diagnostique et thérapeutique, CHU de Bordeaux, 33000 Bordeaux, France
| | - F Rouanet
- Pôle neurosciences cliniques, unité neurovasculaire, CHU de Bordeaux, 33000 Bordeaux, France
| | - X Barreau
- Pôle imagerie médicale, service de radiologie et de neuro-imagerie diagnostique et thérapeutique, CHU de Bordeaux, 33000 Bordeaux, France
| | - E Verpillot
- Inserm, Bordeaux Population Health Research Center, team EMOS, UMR 1219, université Bordeaux, 33000 Bordeaux, France
| | - P Menegon
- Pôle imagerie médicale, service de radiologie et de neuro-imagerie diagnostique et thérapeutique, CHU de Bordeaux, 33000 Bordeaux, France
| | - I Maachi
- Pôle produits de santé, pharmacie clinique dispositifs médicaux, CHU de Bordeaux, 33000 Bordeaux, France
| | - J Berge
- Pôle imagerie médicale, service de radiologie et de neuro-imagerie diagnostique et thérapeutique, CHU de Bordeaux, 33000 Bordeaux, France
| | - I Sibon
- Pôle neurosciences cliniques, unité neurovasculaire, CHU de Bordeaux, 33000 Bordeaux, France; INCIA, CNRS UMR 5287, université de Bordeaux, 33000 Bordeaux, France
| | - A Bénard
- Pôle de santé publique, service d'information médicale, USMR & CIC-EC 14-01, CHU de Bordeaux, 33000 Bordeaux, France; Inserm, Bordeaux Population Health Research Center, team EMOS, UMR 1219, université Bordeaux, 33000 Bordeaux, France.
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Kim MS, Joo MC, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Kim SY, Oh GJ, Lee YS, Han EY, Han J, Ahn J, Chang WH, Kim YH. Impact of Functional Status on Noncardioembolic Ischemic Stroke Recurrence Within 1 Year: The Korean Stroke Cohort for Functioning and Rehabilitation Study. J Clin Neurol 2019; 15:54-61. [PMID: 30618217 PMCID: PMC6325355 DOI: 10.3988/jcn.2019.15.1.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose Few studies have investigated the relationship between the specific functional factors potentially associated with functional level and stroke recurrence. We conducted a study of patients with noncardioembolic ischemic stroke (NCIS) to determine the functional factors affecting recurrence within the first year. Methods In total, 568 first-ever NCIS patients (age=65.1±17.4 years, mean±SD) were analyzed in a multicenter, prospective cohort study registered from August 2012. Demographic characteristics, past medical history, comorbidities, laboratory data, stroke features in neuroimaging, acute treatments, and medications at discharge were assessed. Functional factors reflecting gross functional impairment, ambulatory function, motor function, activities of daily living, cognition, language ability, swallowing function, mood, and quality of life were comprehensively evaluated in face-to-face assessments using standardized tools at the time of discharge. Results The cumulative incidence of stroke recurrence in NCIS was 6.0% (n=34) at 1 year. The period from admission to discharge was 34.4±7.0 days. The independent predictors of stroke recurrence within 1 year in multivariate Cox proportional-hazards regression analyses were 1) age [per-year hazard ratio (HR)=1.04, 95% confidence interval (CI)=0.97–1.06, p=0.048], 2) Charlson Comorbidity Index higher than 2 (HR=1.72, 95% CI=1.26–2.22, p=0.016), 3) modified Rankin Scale score of 3 or more at discharge (HR=1.56, 95% CI=1.22–1.94, p=0.032), and 4) Functional Ambulation Category of 3 or less at discharge (HR=2.56, 95% CI=1.84–3.31, p=0.008). Conclusions In addition to patient age, moderate-to-severe functional impairment requiring the help of others (especially for ambulation) at the time of discharge and the severity of comorbidity were independent predictors of stroke recurrence within 1 year of the first NCIS.
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Affiliation(s)
- Min Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Korea.
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sam Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soo Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Gyung Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Yang Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Hee Kim
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Arora N, Makino K, Tilden D, Lobotesis K, Mitchell P, Gillespie J. Cost-effectiveness of mechanical thrombectomy for acute ischemic stroke: an Australian payer perspective. J Med Econ 2018; 21:799-809. [PMID: 29741126 DOI: 10.1080/13696998.2018.1474746] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIMS The goal of this study was to assess the cost-effectiveness of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) from an Australian payer perspective. METHODS This study used a Markov model that employed a life-time time horizon, modeling patients from symptom onset of stroke until end of life. Clinical efficacy and safety data were taken from an individual patient level data (IPD) meta-analysis of clinical studies. The treatment effect of MT compared to usual care was measured by changes in modified Rankin Score (mRS). Post-treatment mRS scores were used to determine short- and long-term stroke care costs. Treatment costs were modeled, with health state utility values determined by literature review. All analyses were conducted using Microsoft Excel. RESULTS In comparison to usual care, MT is associated with higher costs ($10,666 per patient) and additional quality-adjusted life years (QALYs) (0.8281 per patient), resulting in an incremental cost per QALY of $12,880. Sensitivity analyses demonstrated the reliability of the base case results across a range of assumptions. The higher cost associated with MT is, to an extent, offset by the cost savings resulting from lower stroke care costs due to improved patient outcomes. The life-time cost savings in terms of stroke care costs are estimated to be more than $8,000 per patient for patients who had received MT in combination with usual care. LIMITATIONS Stroke care costs based on patient disability/functional level were not available and were derived. As a consequence, long-term care costs for patients with poorer outcomes may be under-estimated. Patient outcomes at 90 days were extrapolated to a lifetime horizon, but this approach was supported by long-term evidence on stroke survival. CONCLUSIONS Mechanical thrombectomy is a cost-effective treatment option for AIS, with clinical benefits translating to short- and long-term cost benefits. This analysis supports rapid update of stroke care pathways to incorporate this therapy as a treatment option.
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Affiliation(s)
- Nimita Arora
- a THEMA Consulting Pty Ltd , Pyrmont , New South Wales , Australia
| | - Koji Makino
- a THEMA Consulting Pty Ltd , Pyrmont , New South Wales , Australia
| | - Dominic Tilden
- a THEMA Consulting Pty Ltd , Pyrmont , New South Wales , Australia
| | - Kyriakos Lobotesis
- b Imperial College Healthcare NHS Trust , Charing Cross Hospital , London , UK
| | - Peter Mitchell
- c University of Melbourne , Melbourne , Victoria , Australia
| | - John Gillespie
- d Medtronic Australasia Pty Ltd , Macquarie Park , New South Wales , Australia
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Allen L, John-Baptiste A, Meyer M, Richardson M, Speechley M, Ure D, Markle-Reid M, Teasell R. Assessing the impact of a home-based stroke rehabilitation programme: a cost-effectiveness study. Disabil Rehabil 2018; 41:2060-2065. [PMID: 29631453 DOI: 10.1080/09638288.2018.1459879] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Stroke is often a severe and debilitating event that requires ongoing rehabilitation. The Community Stroke Rehabilitation Teams (CSRTs) offer home-based stroke rehabilitation to individuals for whom further therapy is unavailable or inaccessible. The objective of this study was to evaluate the cost-effectiveness of the CSRT programme compared with a "Usual Care" cohort. Methods: We collected data on CSRT clients from January 2012 to February 2013. Comparator data were derived from a study of stroke survivors with limited access to specialised stroke rehabilitation. Literature-derived values were used to inform a long-term projection. Using Markov modelling, we projected the model for 35 years in six-month cycles. One-way, two-way, and probabilistic sensitivity analyses were performed. Results were discounted at 3% per year. Results: Results demonstrated that the CSRT programme has a net monetary benefit (NMB) of $43,655 over Usual Care, and is both less costly and more effective (incremental cost = -$17,255; incremental effect = 1.65 Quality Adjusted Life Years [QALYs]). Results of the probabilistic sensitivity analysis revealed that incremental cost-effectiveness of the CSRT programme is superior in 100% of iterations when compared to Usual Care. Conclusions: The study shows that CSRT model of care is cost-effective, and should be considered when evaluating potential stroke rehabilitation delivery methods. Implications for Rehabilitation Ongoing rehabilitation following stroke is imperative for optimal recovery. Home-based specialised stroke rehabilitation may be an option for individuals for whom ongoing rehabilitation is unavailable or inaccessible. The results of this study demonstrated that home-based rehabilitation is a cost-effective means of providing ongoing rehabilitation to individuals who have experienced a stroke.
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Affiliation(s)
- Laura Allen
- a Department of Aging, Rehabilitation, and Geriatric Care , Lawson Health Research Institute , London , Canada.,b Department of Epidemiology and Biostatistics , Western University , London , Canada
| | - Ava John-Baptiste
- b Department of Epidemiology and Biostatistics , Western University , London , Canada
| | - Matthew Meyer
- a Department of Aging, Rehabilitation, and Geriatric Care , Lawson Health Research Institute , London , Canada
| | - Marina Richardson
- a Department of Aging, Rehabilitation, and Geriatric Care , Lawson Health Research Institute , London , Canada
| | - Mark Speechley
- b Department of Epidemiology and Biostatistics , Western University , London , Canada
| | - David Ure
- c St. Joseph's Health Care, Parkwood Institute , London , Canada
| | | | - Robert Teasell
- a Department of Aging, Rehabilitation, and Geriatric Care , Lawson Health Research Institute , London , Canada.,c St. Joseph's Health Care, Parkwood Institute , London , Canada.,e Schulich School of Medicine and Dentistry , University of Western Ontario, Physical Medicine and Rehabilitation , London , Canada
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Muruet W, Rudd A, Wolfe CDA, Douiri A. Long-Term Survival After Intravenous Thrombolysis for Ischemic Stroke: A Propensity Score-Matched Cohort With up to 10-Year Follow-Up. Stroke 2018; 49:607-613. [PMID: 29440582 PMCID: PMC5839705 DOI: 10.1161/strokeaha.117.019889] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/03/2018] [Accepted: 01/08/2018] [Indexed: 12/17/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Intravenous thrombolysis with alteplase is one of the few approved treatments for acute ischemic stroke; nevertheless, little is known about its long-term effects on survival and recovery because clinical trials follow-up times are limited. Methods— Patients registered between January 2005 and December 2015, to the population-based South London Stroke Register of first-ever strokes. Propensity score was used to match thrombolyzed and control cases to a 1:2 ratio by demographical and clinical covariates. The primary outcome was survival up to 10 years using Kaplan–Meier estimates, Cox proportional hazards, and restricted mean survival time. Secondary outcomes included stroke recurrence and functional status (Barthel Index and Frenchay Activities Index scores) at 5 years. Results— From 2052 ischemic strokes, 246 treated patients were matched to 492 controls. Median follow-up time 5.45 years (interquartile range, 4.56). Survival was higher in the treatment group (median, 5.72 years) compared with control group (4.98 years, stratified log-rank test <0.001). The number needed to treat to prevent 1 death at 5 years was 12 and 20 at 10 years. After Cox regression analysis, thrombolysis reduced risk of mortality by 37% (hazard ratio, 0.63; 95% confidence interval [CI], 0.48–0.82) at 10 years; however, after introducing a multiplicative interaction term into the model, mortality risk reduction was 42% (hazard ratio, 0.58; 95% CI, 0.40–0.82) at 10 years for those arriving within 3 hours to the hospital. On average, in a 10-year period, treated patients lived 1 year longer than controls. At 5 years, thrombolysis was associated with independence (Barthel Index≥90; odds ratio, 3.76; 95% CI, 1.22–13.34) and increased odds of a higher Frenchay Activities Index (proportional odds ratio, 2.37; 95% CI, 1.16–4.91). There was no difference in stroke recurrence. Conclusions— Thrombolysis with intravenous alteplase is associated with improved long-term survival and functional status after ischemic stroke.
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Affiliation(s)
- Walter Muruet
- From the School of Population Health & Environmental Sciences, King's College London, United Kingdom (W.M., A.R., C.D.A.W., A.D.); NIHR Comprehensive Biomedical Research Center, Guy's and St Thomas' NHS Foundation Trust, and King's College London, United Kingdom (A.R., C.D.A.W., A.D.); and National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, United Kingdom (C.D.A.W.).
| | - Anthony Rudd
- From the School of Population Health & Environmental Sciences, King's College London, United Kingdom (W.M., A.R., C.D.A.W., A.D.); NIHR Comprehensive Biomedical Research Center, Guy's and St Thomas' NHS Foundation Trust, and King's College London, United Kingdom (A.R., C.D.A.W., A.D.); and National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, United Kingdom (C.D.A.W.)
| | - Charles D A Wolfe
- From the School of Population Health & Environmental Sciences, King's College London, United Kingdom (W.M., A.R., C.D.A.W., A.D.); NIHR Comprehensive Biomedical Research Center, Guy's and St Thomas' NHS Foundation Trust, and King's College London, United Kingdom (A.R., C.D.A.W., A.D.); and National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, United Kingdom (C.D.A.W.)
| | - Abdel Douiri
- From the School of Population Health & Environmental Sciences, King's College London, United Kingdom (W.M., A.R., C.D.A.W., A.D.); NIHR Comprehensive Biomedical Research Center, Guy's and St Thomas' NHS Foundation Trust, and King's College London, United Kingdom (A.R., C.D.A.W., A.D.); and National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, United Kingdom (C.D.A.W.)
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Song TJ, Chang Y, Chun MY, Lee CY, Kim AR, Kim Y, Kim YJ. High Dietary Glycemic Load is Associated with Poor Functional Outcome in Patients with Acute Cerebral Infarction. J Clin Neurol 2018; 14:165-173. [PMID: 29629525 PMCID: PMC5897198 DOI: 10.3988/jcn.2018.14.2.165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/25/2017] [Accepted: 10/27/2017] [Indexed: 12/11/2022] Open
Abstract
Background and Purpose Elevated postprandial blood glucose is a critical risk factor for stroke. The dietary glycemic load (GL) and glycemic index (GI) are frequently used as markers of the postprandial blood glucose response to estimate the overall glycemic effect of diets. We hypothesized that high dietary GL, GI, or total carbohydrate intake is associated with a poor functional outcome in patients with acute ischemic stroke. Methods We prospectively included 263 first-ever ischemic stroke patients who completed a semiquantitative food-frequency questionnaire. The dietary GL, GI, and total carbohydrate intake were investigated by examining the average frequency of intake during the previous year based on reference amounts for various food items. Poor functional outcome was defined as a score on the modified Rankin Scale (mRS) of ≥3 at 3 months after stroke. Results The patients were aged 65.4±11.7 years (mean±standard deviation), and 58.2% of them were male. A multivariate analysis adjusted for age, sex, marital status, prestroke mRS score, diabetes mellitus, hyperlipidemia, body mass index, triglycerides, low-density lipoprotein, hemoglobin A1c, stroke classification, and National Institutes of Health Stroke Scale score, early neurological deterioration, and high-grade white-matter hyperintensities revealed that the dietary GL and total carbohydrate intake were associated with a poor functional outcome, with odds ratios for the top quartile relative to the bottom quartile of 28.93 (95% confidence interval=2.82–296.04) and 36.84 (95% confidence interval=2.99–453.42), respectively (p for trend=0.002 and 0.002, respectively). In contrast, high dietary GI was not associated with a poor functional outcome (p for trend=0.481). Conclusions Increased dietary GL and carbohydrate intake were associated with a poor short-term functional outcome after an acute ischemic stroke.
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Affiliation(s)
- Tae Jin Song
- Stroke Center, Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yoonkyung Chang
- Stroke Center, Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Min Young Chun
- Stroke Center, Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chan Young Lee
- Stroke Center, Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - A Ram Kim
- Department of Clinical Nutrition, The Graduate School of Converging Clinical & Public Health, Seoul, Korea
| | - Yuri Kim
- Department of Clinical Nutrition, The Graduate School of Converging Clinical & Public Health, Seoul, Korea.,Department of Nutritional Science and Food Management, Ewha Womans University, Seoul, Korea
| | - Yong Jae Kim
- Stroke Center, Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea.
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Chwojnicki K, Kozera G, Sobolewski P, Fryze W, Nyka WM. Intravenous thrombolysis and three-year ischemic stroke mortality. Acta Neurol Scand 2017; 135:540-545. [PMID: 27334369 DOI: 10.1111/ane.12625] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Intravenous thrombolysis (IVT) in ischemic stroke (IS) does not reduce three-month mortality; however, longer-term survival after IVT has not been clearly established. Thus, we aimed to compare three-year mortality after IS in IVT-treated vs non-treated patients and to indicate predictors of long-term mortality after IVT. METHODS We have evaluated data of 366 subjects with IS (196 treated with IVT and 170 non-treated with IVT, whose age, sex, and calendar time of IS occurrence matched the control group) collected via the Pomeranian Stroke Register. We estimated the three-year survival and its determinants in both groups. RESULTS In univariate analysis, IVT was not associated with three-year mortality (OR 0.68; 95% CI 0.44-1.05). Independent predictors for unfavorable long-term outcome in a Cox regression model were older age, parenchymal hemorrhage type 2 (ph2), and modified Rankin scale >2 points at discharge from the hospital. IVT was strongly associated with a lower risk of death in the period 0-36 months from IS (HR 0.44, 95% CI 0.28-0.69, P<.001). CONCLUSIONS Treatment of IS with intravenous recombinant tissue plasminogen activator was associated with increased survival during the three-year follow-up.
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Affiliation(s)
- K. Chwojnicki
- Department of Neurology; Medical University of Gdańsk; Gdańsk Poland
| | - G. Kozera
- Department of Neurology; Medical University of Gdańsk; Gdańsk Poland
- Department of Neurology; Nicolaus Copernicus University Collegium Medicum in Bydgoszcz; Poland
| | - P. Sobolewski
- Department of Neurology and Stroke Unit; Hospital of Sandomierz; Sandomierz Poland
| | - W. Fryze
- Nicolaus Copernicus Pomeranian Traumatology Centre; Gdańsk Poland
| | - W. M. Nyka
- Department of Neurology; Medical University of Gdańsk; Gdańsk Poland
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Steen Carlsson K, Andsberg G, Petersson J, Norrving B. Long-term cost-effectiveness of thrombectomy for acute ischaemic stroke in real life: An analysis based on data from the Swedish Stroke Register (Riksstroke). Int J Stroke 2017; 12:802-814. [DOI: 10.1177/1747493017701154] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Randomised controlled trials have demonstrated substantial clinical benefit for thrombectomy in patients with acute ischaemic stroke and proximal anterior circulation arterial occlusion. Aim We investigated the long-term cost-effectiveness of thrombectomy after thrombolysis versus thrombolysis alone using real-world outcome data on need for health care, home help and nursing home care. Methods We used real-life resource use and survival data from the Swedish Stroke Register and pooled outcomes from five randomised controlled trials published in 2015 in a newly constructed Markov cost-effectiveness model with a societal perspective. Data were stratified by age (18–64; 65–74; 75–84 years) and modified Rankin scale at three months for patients with an index ischaemic stroke in 2014 fulfilling inclusion criteria NIHSS ≥ 8 before treatment and treated with thrombolysis ( n = 710). Univariate sensitivity analyses explored robustness of results. A life-time perspective and 3% discount rate were applied. Results Thrombectomy increases the health care cost per patient (+GBP 9000) mainly because of intervention costs, but the reduced burden on the social services (home help services −GBP 13,000; nursing home care −GBP 26,000) implies overall cost savings. The average patient gain was 1.0 quality-adjusted life year (QALY) with higher gains for younger age groups. Thrombectomy was a dominant strategy in the base case and all sensitivity analyses where social services were considered. Conclusion Thrombectomy has a small effect on hospital costs except for the direct intervention cost. However, thrombectomy is highly likely to lead to substantial cost savings in the social service sector, up to four times the increase in health-care costs.
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Affiliation(s)
| | - Gunnar Andsberg
- Department of Neurology and Rehabilitation Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Jesper Petersson
- Department of Neurology and Rehabilitation Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Bo Norrving
- Department of Clinical Sciences and Neurology, Skane University Hospital, Lund University, Lund, Sweden
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Rangaraju S, Haussen D, Nogueira RG, Nahab F, Frankel M. Comparison of 3-Month Stroke Disability and Quality of Life across Modified Rankin Scale Categories. INTERVENTIONAL NEUROLOGY 2016; 6:36-41. [PMID: 28611832 DOI: 10.1159/000452634] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Modified Rankin Scale (mRS) score 0-2 has been used to define "good outcome" while stroke patients with mRS 3 are grouped with mRS 4-6 as having "poor outcome." Long-term data comparing quality of life (QoL), particularly across the mRS 2, 3, and 4 subgroups, are sparse. METHODS Participants in the Interventional Management of Stroke 3 (IMS3) trial with documented 3-month mRS, functional disability (Barthel index [BI]), and self-reported EQ5D-3L QoL questionnaires at 3 months after stroke were included. EQ5D-3L summary indices were calculated using published utility weights for the US population. BI and EQ5D-3L indices were compared across mRS categories using multiple pairwise comparisons with appropriate alpha error corrections. RESULTS Four hundred twenty-three patients were included (mean age 64 ± 13 years, median baseline NIHSS 16 [IQR 12-19], mean BI 84.1 ± 25.3, and mean EQ5D-3L index 0.73 ± 0.24). While significant differences in BI were observed across mRS categories, QoL in the mRS 2 and 3 categories was similar. Based on BI and EQ5D-3L index, mRS 3 status was more similar to mRS 2 than to mRS 4 status, and large heterogeneity in the mRS 3 group was observed. CONCLUSIONS Ischemic stroke patients who achieve mRS 2 and 3 functional outcomes seem to have similar health-related QoL scores. mRS 0-3, rather than 0-2, should be considered a good outcome category in moderate to severe ischemic stroke.
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Affiliation(s)
| | - Diogo Haussen
- Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - Raul G Nogueira
- Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - Fadi Nahab
- Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - Michael Frankel
- Emory University and Grady Memorial Hospital, Atlanta, GA, USA
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Berge E, Cohen G, Wardlaw JM, Sandercock PAG, Whiteley WN. Mortality after thrombolysis - Authors' reply. Lancet Neurol 2016; 15:1305. [PMID: 27839642 DOI: 10.1016/s1474-4422(16)30280-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Eivind Berge
- Department of Internal Medicine, Oslo University Hospital, NO-0407 Oslo, Norway.
| | - Geoffrey Cohen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - William N Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Kalladka D, Sinden J, Pollock K, Haig C, McLean J, Smith W, McConnachie A, Santosh C, Bath PM, Dunn L, Muir KW. Human neural stem cells in patients with chronic ischaemic stroke (PISCES): a phase 1, first-in-man study. Lancet 2016; 388:787-96. [PMID: 27497862 DOI: 10.1016/s0140-6736(16)30513-x] [Citation(s) in RCA: 279] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND CTX0E03 is an immortalised human neural stem-cell line from which a drug product (CTX-DP) was developed for allogeneic therapy. Dose-dependent improvement in sensorimotor function in rats implanted with CTX-DP 4 weeks after middle cerebral artery occlusion stroke prompted investigation of the safety and tolerability of this treatment in stroke patients. METHODS We did an open-label, single-site, dose-escalation study. Men aged 60 years or older with stable disability (National Institutes of Health Stroke Scale [NIHSS] score ≥6 and modified Rankin Scale score 2-4) 6-60 months after ischaemic stroke were implanted with single doses of 2 million, 5 million, 10 million, or 20 million cells by stereotactic ipsilateral putamen injection. Clinical and brain imaging data were collected over 2 years. The primary endpoint was safety (adverse events and neurological change). This trial is registered with ClinicalTrials.gov, number NCT01151124. FINDINGS 13 men were recruited between September, 2010, and January, 2013, of whom 11 (mean age 69 years, range 60-82) received CTX-DP. Median NIHSS score before implantation was 7 (IQR 6-8) and the mean time from stroke was 29 (SD 14) months. Three men had subcortical infarcts only and seven had right-hemisphere infarcts. No immunological or cell-related adverse events were seen. Other adverse events were related to the procedure or comorbidities. Hyperintensity around the injection tracts on T2-weighted fluid-attenuation inversion recovery MRI was seen in five patients. At 2 years, improvement in NIHSS score ranged from 0 to 5 (median 2) points. INTERPRETATION Single intracerebral doses of CTX-DP up to 20 million cells induced no adverse events and were associated with improved neurological function. Our observations support further investigation of CTX-DP in stroke patients. FUNDING ReNeuron Limited.
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Affiliation(s)
- Dheeraj Kalladka
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - John Sinden
- ReNeuron Ltd, Surrey Research Park, Guildford, Surrey, UK
| | | | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - John McLean
- Department of Neuroradiology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Wilma Smith
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Celestine Santosh
- Department of Neuroradiology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Laurence Dunn
- Neurosurgery, Institute of Neurological Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK.
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Keheya S, Tekatas A, Aynacı Ö, Utku U, Solmaz V. A comparison of risk factors and prognosis between intra and extracranial acute atherosclerotic stroke in the Turkish population: a prospective study. Neurol Res 2016; 38:864-70. [PMID: 27477568 DOI: 10.1080/01616412.2016.1215032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to compare the differences in risk factors and prognosis between acute stroke caused by definitive intracranial atherosclerosis (ICAS) or extracranial atherosclerosis (ECAS) in the Turkısh population. METHODS This study was prospectively designed in a single centre and conducted with patients who were hospitalised due to acute ischaemic stroke. Inclusion criteria were the diagnosis of atherosclerotic ischaemic stroke, defined as more than 50% stenosis or occlusion in the arterial structure supplying the ischaemic area, having excluded other possible causes. RESULTS Information on 58 ICAS and 57 ECAS stroke patients was collected in a 13-month period. The ECAS patients had male gender predominance (p = 0.003). Ageing, stroke history and hyperlipidaemia were related with stroke severity in ECAS, and gender was associated with severity in ICAS. Hypertension and being female were related with poor prognosis in ICAS (p = 0.081 vs. 0.087). Congestive heart failure (p = 0.002) was associated with poor prognosis and alcohol with a favourable outcome (p = 0.087) in ECAS. Stroke severity was related with poor prognosis in both groups (p < 0.001). CONCLUSIONS The prevalence of risk factors differs between ICAS and ECAS, and their influence differs for stroke severity and prognosis.
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Affiliation(s)
- Sezgin Keheya
- a Department of Neurology , Agri State Hospital , Agri , Turkey
| | - Aslan Tekatas
- b Department of Neurology, Faculty of Medicine , Trakya University , Edirne , Turkey
| | - Özer Aynacı
- c Department of Neurology , Sivas State Hospital , Sivas , Turkey
| | - Ufuk Utku
- b Department of Neurology, Faculty of Medicine , Trakya University , Edirne , Turkey
| | - Volkan Solmaz
- b Department of Neurology, Faculty of Medicine , Trakya University , Edirne , Turkey
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Berge E, Cohen G, Roaldsen MB, Lundström E, Isaksson E, Rudberg AS, Slot KB, Forbes J, Smith J, Drever J, Wardlaw JM, Lindley RI, Sandercock PAG, Whiteley WN. Effects of alteplase on survival after ischaemic stroke (IST-3): 3 year follow-up of a randomised, controlled, open-label trial. Lancet Neurol 2016; 15:1028-34. [PMID: 27450474 DOI: 10.1016/s1474-4422(16)30139-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 04/18/2016] [Accepted: 06/13/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The effect of alteplase on patient survival after ischaemic stroke is the subject of debate. We report the effect of intravenous alteplase on long-term survival after ischaemic stroke of participants in the Third International Stroke Trial (IST-3). METHODS In IST-3, done at 156 hospitals in 12 countries (Australia, Europe, and the UK), participants (aged >18 years) were randomly assigned with a telephone voice-activated or web-based system in a 1:1 ratio to treatment with intravenous 0·9 mg/kg alteplase plus standard care or standard care alone within 6 h of ischaemic stroke. We followed up participants in the UK and Scandinavia (Sweden and Norway) for survival up to 3 years after randomisation using data from national registries and compared survival in the two groups with proportional hazards survival analysis, adjusting for key prognostic variables. IST-3 is registered with the ISRCTN registry, number ISRCTN25765518. FINDINGS Between May 5, 2000, and July 27, 2011, 3035 participants were enrolled in IST-3. Of these, 1948 (64%) of 3035 participants were scheduled for analysis of 3 year survival, and 1946 (>99%) of these were included in the analysis (967 [50%] in the alteplase plus standard care group and 979 [50%] in the standard care alone group). By 3 years after randomisation, 453 (47%) of 967 participants in the alteplase plus standard care group and 494 (50%) of 979 in the standard care alone group had died (risk difference 3·6% [95% CI -0·8 to 8·1]). Participants allocated to alteplase had a significantly higher hazard of death during the first 7 days (99 [10%] of 967 died in the alteplase plus standard care group vs 65 [7%] of 979 in the standard care alone group; hazard ratio 1·52 [95% CI 1·11-2·08]; p=0·004) and a significantly lower hazard of death between 8 days and 3 years (354 [41%] of 868 vs 429 [47%] of 914; 0·78 [0·68-0·90]; p=0·007). INTERPRETATION Alteplase treatment within 6 h after ischaemic stroke was associated with a small, non-significant reduction in risk of death at 3 years, but among individuals who survived the acute phase, treatment was associated with a significant increase in long-term survival. These results are reassuring for clinicians who have expressed concerns about the effect of alteplase on survival. FUNDING Heart and Stroke Scotland, UK Medical Research Council, Health Foundation UK, Stroke Association UK, Research Council of Norway, AFA Insurance, Swedish Heart Lung Fund, Foundation of Marianne and Marcus Wallenberg, Polish Ministry of Science and Education, Australian Heart Foundation, Australian National Health and Medical Research Council, Swiss National Research Foundation, Swiss Heart Foundation, Assessorato alla Sanita (Regione dell'Umbria), and Danube University.
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Affiliation(s)
- Eivind Berge
- Department of Internal Medicine, Oslo University Hospital, Oslo, Norway.
| | - Geoffrey Cohen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Melinda B Roaldsen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Erik Lundström
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Eva Isaksson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Ann-Sofie Rudberg
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | | | - John Forbes
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Joel Smith
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jonathan Drever
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Richard I Lindley
- George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Discipline of Medicine, University of Sydney, Sydney, NSW, Australia
| | | | - William N Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Aoki J, Kimura K, Sakamoto Y. Early administration of tissue-plasminogen activator improves the long-term clinical outcome at 5years after onset. J Neurol Sci 2016; 362:33-9. [DOI: 10.1016/j.jns.2016.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 10/22/2022]
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Machado C, Pinho J, Alves JN, Santos AF, Ferreira MDC, Abreu MJ, Oliveira L, Mota J, Fontes JR, Ferreira C. Five-Year Outcome in Stroke Patients Submitted to Thrombolysis. Stroke 2015; 46:2312-4. [DOI: 10.1161/strokeaha.115.009842] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 06/03/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Little is known on long-term follow-up after thrombolysis in ischemic stroke patients because the majority of studies evaluated outcome at 3 to 12 months. We aimed to assess 5-year outcome after intravenous thrombolysis (IVT).
Methods—
Cohort study based on the prospective registry of all consecutive ischemic stroke patients submitted to IVT in our Stroke Unit. Five-year outcome, including living settings, functional outcome, stroke recurrence, and mortality, was ascertained by telephonic interviews and additional review of clinical records. Multivariate analyses were performed to identify predictors of outcome and mortality. Excellent outcome was defined as modified Rankin scale 0 to 1.
Results—
Five-year outcome was available for 155/164 patients submitted to IVT. At 5 years, 32.9% of patients had an excellent outcome (95% confidence interval (CI) =25.5–43.3) and mortality was 43.9% (95%CI=36.1–51.7). Increasing age (odds ratio =0.93, 95% CI =0.90–0.97) and increasing National Institute of Health Stroke Scale (NIHSS) 24 h after thrombolysis (odds ratio =0.81, 95% CI =0.74–0.90) were independently associated with a lower likelihood of an excellent 5-year outcome. Age (hazards ratio =1.07, 95% CI =1.03–1.11) and excellent functional outcome 3 months after thrombolysis (hazards ratio =0.28, 95%CI=0.12–0.66) were independently associated with mortality during follow-up.
Conclusions—
One third of ischemic stroke patients have excellent 5-year outcome after IVT. Younger age, lower NIHSS 24 h after IVT, and excellent 3-month functional outcome are independent predictors of excellent 5-year outcome.
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Affiliation(s)
- Célia Machado
- From the Neurology Department (C.M., J.P., J.N.A., A.F.S., J.R.F., C.F.) and Psychiatry Department (M.C.F.), Hospital de Braga, Braga, Portugal; Health Unit Department, USF Duovida, Guimarães, Portugal (M.J.A.); Internal Medicine Department, Centro Hospitalar Médio Ave, Unidade de Famalicão, Famalicão, Portugal (L.O.); and Internal Medicine Department, Hospital Santa Maria Maior, Barcelos, Portugal (J.M.)
| | - João Pinho
- From the Neurology Department (C.M., J.P., J.N.A., A.F.S., J.R.F., C.F.) and Psychiatry Department (M.C.F.), Hospital de Braga, Braga, Portugal; Health Unit Department, USF Duovida, Guimarães, Portugal (M.J.A.); Internal Medicine Department, Centro Hospitalar Médio Ave, Unidade de Famalicão, Famalicão, Portugal (L.O.); and Internal Medicine Department, Hospital Santa Maria Maior, Barcelos, Portugal (J.M.)
| | - José Nuno Alves
- From the Neurology Department (C.M., J.P., J.N.A., A.F.S., J.R.F., C.F.) and Psychiatry Department (M.C.F.), Hospital de Braga, Braga, Portugal; Health Unit Department, USF Duovida, Guimarães, Portugal (M.J.A.); Internal Medicine Department, Centro Hospitalar Médio Ave, Unidade de Famalicão, Famalicão, Portugal (L.O.); and Internal Medicine Department, Hospital Santa Maria Maior, Barcelos, Portugal (J.M.)
| | - Ana Filipa Santos
- From the Neurology Department (C.M., J.P., J.N.A., A.F.S., J.R.F., C.F.) and Psychiatry Department (M.C.F.), Hospital de Braga, Braga, Portugal; Health Unit Department, USF Duovida, Guimarães, Portugal (M.J.A.); Internal Medicine Department, Centro Hospitalar Médio Ave, Unidade de Famalicão, Famalicão, Portugal (L.O.); and Internal Medicine Department, Hospital Santa Maria Maior, Barcelos, Portugal (J.M.)
| | - Maria do Céu Ferreira
- From the Neurology Department (C.M., J.P., J.N.A., A.F.S., J.R.F., C.F.) and Psychiatry Department (M.C.F.), Hospital de Braga, Braga, Portugal; Health Unit Department, USF Duovida, Guimarães, Portugal (M.J.A.); Internal Medicine Department, Centro Hospitalar Médio Ave, Unidade de Famalicão, Famalicão, Portugal (L.O.); and Internal Medicine Department, Hospital Santa Maria Maior, Barcelos, Portugal (J.M.)
| | - Maria João Abreu
- From the Neurology Department (C.M., J.P., J.N.A., A.F.S., J.R.F., C.F.) and Psychiatry Department (M.C.F.), Hospital de Braga, Braga, Portugal; Health Unit Department, USF Duovida, Guimarães, Portugal (M.J.A.); Internal Medicine Department, Centro Hospitalar Médio Ave, Unidade de Famalicão, Famalicão, Portugal (L.O.); and Internal Medicine Department, Hospital Santa Maria Maior, Barcelos, Portugal (J.M.)
| | - Liliana Oliveira
- From the Neurology Department (C.M., J.P., J.N.A., A.F.S., J.R.F., C.F.) and Psychiatry Department (M.C.F.), Hospital de Braga, Braga, Portugal; Health Unit Department, USF Duovida, Guimarães, Portugal (M.J.A.); Internal Medicine Department, Centro Hospitalar Médio Ave, Unidade de Famalicão, Famalicão, Portugal (L.O.); and Internal Medicine Department, Hospital Santa Maria Maior, Barcelos, Portugal (J.M.)
| | - João Mota
- From the Neurology Department (C.M., J.P., J.N.A., A.F.S., J.R.F., C.F.) and Psychiatry Department (M.C.F.), Hospital de Braga, Braga, Portugal; Health Unit Department, USF Duovida, Guimarães, Portugal (M.J.A.); Internal Medicine Department, Centro Hospitalar Médio Ave, Unidade de Famalicão, Famalicão, Portugal (L.O.); and Internal Medicine Department, Hospital Santa Maria Maior, Barcelos, Portugal (J.M.)
| | - João Ramalho Fontes
- From the Neurology Department (C.M., J.P., J.N.A., A.F.S., J.R.F., C.F.) and Psychiatry Department (M.C.F.), Hospital de Braga, Braga, Portugal; Health Unit Department, USF Duovida, Guimarães, Portugal (M.J.A.); Internal Medicine Department, Centro Hospitalar Médio Ave, Unidade de Famalicão, Famalicão, Portugal (L.O.); and Internal Medicine Department, Hospital Santa Maria Maior, Barcelos, Portugal (J.M.)
| | - Carla Ferreira
- From the Neurology Department (C.M., J.P., J.N.A., A.F.S., J.R.F., C.F.) and Psychiatry Department (M.C.F.), Hospital de Braga, Braga, Portugal; Health Unit Department, USF Duovida, Guimarães, Portugal (M.J.A.); Internal Medicine Department, Centro Hospitalar Médio Ave, Unidade de Famalicão, Famalicão, Portugal (L.O.); and Internal Medicine Department, Hospital Santa Maria Maior, Barcelos, Portugal (J.M.)
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Yousuf S, Atif F, Sayeed I, Tang H, Wang J, Stein DG. Long-term behavioral deficits and recovery after transient ischemia in middle-aged rats: Effects of behavioral testing. Restor Neurol Neurosci 2015; 33:251-61. [DOI: 10.3233/rnn-140450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wetmore JB, Phadnis MA, Ellerbeck EF, Shireman TI, Rigler SK, Mahnken JD. Relationship between stroke and mortality in dialysis patients. Clin J Am Soc Nephrol 2014; 10:80-9. [PMID: 25318759 DOI: 10.2215/cjn.02900314] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND OBJECTIVES Stroke is common in patients undergoing long-term dialysis, but the implications for mortality after stroke in these patients are not fully understood. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A large cohort of dually-eligible (Medicare and Medicaid) patients initiating dialysis from 2000 to 2005 and surviving the first 90 days was constructed. Medicare claims were used to ascertain ischemic and hemorrhagic strokes occurring after 90-day survival. A semi-Markov model with additive hazard extension was generated to estimate the association between stroke and mortality, to calculate years of life lost after a stroke, and to determine whether race was associated with differential survival after stroke. RESULTS The cohort consisted of 69,371 individuals representing >112,000 person-years of follow-up. Mean age±SD was 60.8±15.5 years. There were 21.1 (99% confidence interval [99% CI], 20.0 to 22.3) ischemic strokes and 4.7 (99% CI, 4.2 to 5.3) hemorrhagic strokes after cohort entry per 1000 patient-years. At 30 days, mortality was 17.9% for ischemic stroke and 53.4% for hemorrhagic stroke. The adjusted hazard ratio (AHR) depended on time since entry into the cohort; for patients who experienced a stroke at 1 year after cohort entry, for example, the AHR of hemorrhagic stroke for mortality was 25.4 (99% CI, 22.4 to 28.4) at 1 week, 9.9 (99% CI, 8.4 to 11.6) at 3 months, 5.9 (99% CI, 5.0 to 7.0) at 6 months, and 1.8 (99% CI, 1.5 to 2.1) at 24 months. The corresponding AHRs for ischemic stroke were 11.7 (99% CI, 10.2 to 13.1) at 1 week, 6.6 (99% CI, 6.4 to 6.7) at 3 months, and 4.7 (99% CI, 4.5 to 4.9) at 6 months, remaining significantly >1.0 even at 48 months. Median months of life lost were 40.7 for hemorrhagic stroke and 34.6 for ischemic stroke. For both stroke types, mortality did not differ by race. CONCLUSIONS Dialysis recipients have high mortality after a stroke with corresponding decrements in remaining years of life. Poststroke mortality does not differ by race.
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Affiliation(s)
- James B Wetmore
- Department of Medicine, Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota; and
| | | | | | | | - Sally K Rigler
- Department of Medicine, University of Kansas School of Medicine, Kansas City, Kansas
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