1
|
Ho JSY, Zheng H, Tan BYQ, Ho AFW, Foo D, Foo LL, Lim PZY, Liew BW, Ahmad A, Chan BPL, Chang HM, Kong KH, Young SH, Tang KF, Chua T, Hausenloy DJ, Yeo TC, Tan HC, Yip JWL, Chai P, Venketasubramanian N, Chan MYY, Yeo LLL, Sia CH. Incidence and Outcomes of Cardiocerebral Infarction: A Cohort Study of 2 National Population-Based Registries. Stroke 2024; 55:2221-2230. [PMID: 39082144 DOI: 10.1161/strokeaha.123.044530] [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: 07/15/2023] [Revised: 06/19/2024] [Accepted: 07/09/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Cardiocerebral infarction (CCI), which is concomitant with acute myocardial infarction (AMI) and acute ischemic stroke (AIS), is a rare but severe presentation. However, there are few data on CCI, and the treatment options are uncertain. We investigated the characteristics and outcomes of CCI compared with AMI or AIS alone. METHODS We performed a retrospective cohort study of 120 531 patients with AMI and AIS from the national stroke and AMI registries in Singapore. Patients were categorized into AMI only, AIS only, synchronous CCI (same-day), and metachronous CCI (within 1 week). The primary outcome was all-cause mortality, and the secondary outcome was cardiovascular mortality. The mortality risks were compared using Cox regression. Multivariable models were adjusted for baseline demographics, clinical variables, and treatment for AMI or AIS. RESULTS Of 127 919 patients identified, 120 531 (94.2%) were included; 74 219 (61.6%) patients had AMI only, 44 721 (37.1%) had AIS only, 625 (0.5%) had synchronous CCI, and 966 (0.8%) had metachronous CCI. The mean age was 67.7 (SD, 14.0) years. Synchronous and metachronous CCI had a higher risk of 30-day mortality (synchronous: adjusted HR [aHR], 2.41 [95% CI, 1.77-3.28]; metachronous: aHR, 2.80 [95% CI, 2.11-3.73]) than AMI only and AIS only (synchronous: aHR, 2.90 [95% CI, 1.87-4.51]; metachronous: aHR, 4.36 [95% CI, 3.03-6.27]). The risk of cardiovascular mortality was higher in synchronous and metachronous CCI than AMI (synchronous: aHR, 3.03 [95% CI, 2.15-4.28]; metachronous: aHR, 3.41 [95% CI, 2.50-4.65]) or AIS only (synchronous: aHR, 2.58 [95% CI, 1.52-4.36]; metachronous: aHR, 4.52 [95% CI, 2.95-6.92]). In synchronous CCI, AMI was less likely to be managed with PCI and secondary prevention medications (P<0.001) compared with AMI only. CONCLUSIONS Synchronous CCI occurred in 1 in 200 cases of AIS and AMI. Synchronous and metachronous CCI had higher mortality than AMI or AIS alone.
Collapse
Affiliation(s)
- Jamie Sin-Ying Ho
- Department of Cardiology, National University Heart Centre Singapore (J.S.-Y.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., C.-H.S.)
| | - Huili Zheng
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore (H.Z.)
| | - Benjamin Yong-Qiang Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (B.Y.-Q.T., D.J.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., L.L.-L.Y., C.-H.S.)
- Division of Neurology, Department of Medicine (B.Y.-Q.T., B.P.L.C., L.L.-L.Y.), National University Health System, Singapore
| | - Andrew Fu-Wah Ho
- Department of Emergency Medicine, Singapore General Hospital (A.F.-W.H.)
- Pre-Hospital and Emergency Research Centre (A.F.-W.H.), Duke-National University of Singapore Medical School
| | - David Foo
- Tan Tock Seng Hospital, Singapore (D.F.)
| | - Ling-Li Foo
- Health Promotion Board, National Registry of Diseases Office, Singapore (L.-L.F.)
| | | | - Boon Wah Liew
- Department of Cardiology, Changi General Hospital, Singapore (B.W.L.)
| | - Aftab Ahmad
- Department of Neurology, Ng Teng Fong General Hospital (A.A.), National University Health System, Singapore
| | - Bernard P L Chan
- Division of Neurology, Department of Medicine (B.Y.-Q.T., B.P.L.C., L.L.-L.Y.), National University Health System, Singapore
| | - Hui Meng Chang
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute (H.M.C.)
| | - Keng He Kong
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, Singapore (K.H.K.)
| | - Sherry H Young
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore (S.H.Y.)
| | - Kok Foo Tang
- Tang Neurology and Medical Clinic, Mount Elizabeth Medical Centre, Singapore (K.F.T.)
| | - Terrance Chua
- Department of Cardiology (T.C.), National Heart Centre Singapore
| | - Derek J Hausenloy
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (B.Y.-Q.T., D.J.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., L.L.-L.Y., C.-H.S.)
- Cardiovascular and Metabolic Disorders Program (D.J.H.), Duke-National University of Singapore Medical School
- National Heart Research Institute Singapore (D.J.H.), National Heart Centre Singapore
- The Hatter Cardiovascular Institute, University College London, United Kingdom (D.J.H.)
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore (J.S.-Y.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., C.-H.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (B.Y.-Q.T., D.J.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., L.L.-L.Y., C.-H.S.)
| | - Huay-Cheem Tan
- Department of Cardiology, National University Heart Centre Singapore (J.S.-Y.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., C.-H.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (B.Y.-Q.T., D.J.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., L.L.-L.Y., C.-H.S.)
| | - James W L Yip
- Department of Cardiology, National University Heart Centre Singapore (J.S.-Y.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., C.-H.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (B.Y.-Q.T., D.J.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., L.L.-L.Y., C.-H.S.)
| | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore (J.S.-Y.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., C.-H.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (B.Y.-Q.T., D.J.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., L.L.-L.Y., C.-H.S.)
| | | | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre Singapore (J.S.-Y.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., C.-H.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (B.Y.-Q.T., D.J.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., L.L.-L.Y., C.-H.S.)
| | - Leonard Leong-Litt Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (B.Y.-Q.T., D.J.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., L.L.-L.Y., C.-H.S.)
- Division of Neurology, Department of Medicine (B.Y.-Q.T., B.P.L.C., L.L.-L.Y.), National University Health System, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore (J.S.-Y.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., C.-H.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (B.Y.-Q.T., D.J.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., L.L.-L.Y., C.-H.S.)
| |
Collapse
|
2
|
Bhutta ZA, Akhtar N, Pathan SA, Castren M, Harris T, Ganesan GS, Kamran S, Thomas SH, Cameron PA, Azad AM, Puolakka T. Epidemiological profile of stroke in Qatar: Insights from a seven-year observational study. J Clin Neurosci 2024; 123:30-35. [PMID: 38520927 DOI: 10.1016/j.jocn.2024.03.014] [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: 09/24/2023] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES Stroke prevalence is progressively increasing in developing countries due to increased vascular risk factors. This study aims to describe the epidemiology, prevalent risk factors, and outcomes of stroke in a multi-ethnic society of Qatar. MATERIALS AND METHODS We conducted a retrospective analysis of all patients with suspected stroke admitted to stroke services between January 2014 and September 2020. RESULTS A total of 11,892 patients were admitted during this period with suspected stroke. Of these, the diagnosis was ischemic stroke (48.8 %), transient ischemic attack (10.3 %), intracerebral hemorrhage (10.9 %), cerebral venous sinus thrombosis (1.3 %), and stroke mimics (28.6 %). The median age was 52 (43-62), with a male-female ratio of 3:1. The study population was predominantly Asian (56.8 %) and Arab (36 %). The majority of the patients were hypertensive (66.8 %), diabetic (47.9 %), and dyslipidemic (45.9 %). A history of prior stroke was observed in 11.7 %, while 0.9 % had prior transient ischemic attack. Among ischemic strokes, 31.7 % arrived within 4.5 h, 12.5 % received thrombolysis, and 4.6 % underwent thrombectomy. Median Door-to-Needle time was 51 (33-72) minutes. The average length of stay was 5.2 ± 9.0 days, with 71.5 % discharged home, 13.8 % transferred to rehabilitation, 9.3 % to other specialties, 3 % to long-term care, and 2.4 % suffered in-hospital mortality. CONCLUSION Stroke in Qatar is characterized by a younger, expatriate-dominant cohort, with notable prevalence of ischemic and hemorrhagic stroke and a distinct risk factor profile. Further analysis of epidemiological differences among different population groups can inform targeted policies for prevention and management to reduce the burden of disease.
Collapse
Affiliation(s)
- Zain A Bhutta
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Naveed Akhtar
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Sameer A Pathan
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; Blizard Institute of Barts & The London School of Medicine, Queen Mary University of London, UK; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Maaret Castren
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Tim Harris
- Blizard Institute of Barts & The London School of Medicine, Queen Mary University of London, UK.
| | - Gowrii S Ganesan
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Saadat Kamran
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Stephen H Thomas
- Blizard Institute of Barts & The London School of Medicine, Queen Mary University of London, UK; Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA.
| | - Peter A Cameron
- The Alfred Hospital, Emergency and Trauma Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Aftab M Azad
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Tuukka Puolakka
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| |
Collapse
|
3
|
Korompoki E, Ntaios G, Tountopoulou A, Mavraganis G, Tsampalas E, Kalliontzakis I, Vassilopoulou S, Manios E, Savopoulos C, Milionis H, Protogerou A, Kakaletsis N, Galanis P, Kaitelidou D, Siskou O, Vemmos K. Quality Indicators and Clinical Outcomes of Acute Stroke: Results from a Prospective Multicenter Registry in Greece (SUN4P). J Clin Med 2024; 13:917. [PMID: 38337611 PMCID: PMC10856279 DOI: 10.3390/jcm13030917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/21/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
AIM The Stroke Units Necessity for Patients (SUN4P) project aims to provide essential data on stroke healthcare in Greece. Herein, we present results on established quality indicators and outcomes after first-ever stroke occurrences. METHODS This prospective multicenter study included consecutive patients admitted to nine hospitals across Greece in 2019-2021. Descriptive statistics were used to present patients' characteristics, key performance measures and stroke outcomes. RESULTS Among 892 patients, 755 had ischemic stroke (IS) (mean age 75.6 ± 13.6, 48.7% males) and 137 had hemorrhagic stroke (HS) (mean age 75.8 ± 13.2, 57.7% males). Of those, 15.4% of IS and 8% of HS patients were treated in the acute stroke unit (ASU) and 20.7% and 33.8% were admitted to the intensive care unit (ICU) or high-dependency unit (HDU), respectively. A total of 35 (4.6%) out of 125 eligible patients received intravenous alteplase with a door-to needle time of 60 min (21-90). The time to first scan for IS patients was 60 min (31-105) with 53.2% undergoing a CT scan within 60 min post presentation. Furthermore, 94.4% were discharged on antiplatelets, 69.8% on lipid-lowering therapy and 61.6% on antihypertensives. Oral anticoagulants (OAC) were initiated in 73.2% of the 153 IS patients with atrial fibrillation (AF). Among the 687 IS patients who survived, 85.4% were discharged home, 12% were transferred to rehabilitation centers, 1.2% to nursing homes and 1.3% to another hospital. CONCLUSIONS The SUN4P Registry is the first study to provide data from a prospectively collected cohort of consecutive patients from nine representative national hospitals. It represents an important step in the evaluation and improvement of the quality of acute stroke care in Greece.
Collapse
Affiliation(s)
- Eleni Korompoki
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece; (G.M.); (E.M.)
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larissa, Greece;
| | - Argyro Tountopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.T.); (S.V.)
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece; (G.M.); (E.M.)
| | | | | | - Sofia Vassilopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.T.); (S.V.)
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece; (G.M.); (E.M.)
| | - Christos Savopoulos
- First Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece;
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, 45500 Ioannina, Greece;
| | - Athanasios Protogerou
- Clinic-Laboratory of Pathophysiology, First Department of Propeadeutic Internal Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Nikolaos Kakaletsis
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokrateion General Hospital of Thessaloniki, 54643 Thessaloniki, Greece;
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.G.); (D.K.); (O.S.)
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.G.); (D.K.); (O.S.)
| | - Olga Siskou
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.G.); (D.K.); (O.S.)
- Department of Tourism Studies, University of Piraeus, 18534 Piraeus, Greece
| | | | | |
Collapse
|
4
|
Jia W, Jiang Y, Ma R, Huang X, Gu H, Meng X, Li H, Zhao X, Wang Y, Wang Y, Li Z, Wang C. 10-year Temporal Trends of Intravenous Thrombolysis in Acute Ischemic Stroke: Analysis of the China National Stroke Registry I-Ⅲ. J Stroke Cerebrovasc Dis 2024; 33:107431. [PMID: 37951082 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107431] [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: 08/07/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 11/13/2023] Open
Abstract
OBJECTIVES To investigate the 10-year trend in healthcare quality of intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator in acute ischemic stroke (AIS) in China. MATERIALS AND METHODS We analyzed 42,188 AIS within 7 days of onset from the China National Stroke Registry (CNSR) Ⅰ-Ⅲ. Primary outcomes were temporal changes in the proportion of patients arriving at the hospital within 3.5 hours (and 2 hours) of onset and receiving IVT within 4.5 hours (and 3 hours), stratified by region and hospital tier. Secondary outcomes included temporal changes in door-to-needle time (DNT), DNT ≤60 min and favorable outcome defined as a 90-day modified Rankin Scale (mRS) of 0-1. RESULTS Among patients arriving at the hospital within 3.5 hours of onset, 13.5%, 7.1% and 33.4% patients received IVT within 4.5 hours in CNSR Ⅰ, Ⅱ and Ⅲ, respectively, including a higher proportion from eastern China (37.0%) and tertiary hospitals (36.5%). The median DNT was shorter in CNSR Ⅲ (60.0 min) than those in Ⅱ (95.0 min) and I (94.0 min). The proportion of patients with DNT ≤60 min was greater in Ⅲ (53.4%) than those in Ⅱ (26.7%) and Ⅰ (13.4%). The proportion of favorable outcomes was higher in CNSR Ⅲ (72.8%) than those in Ⅱ (49.6%) and Ⅰ (49.4%). Similar trends were observed for patients arriving at the hospital within 2 hours and receiving IVT within 3 hours of onset. CONCLUSIONS The healthcare quality of IVT has improved remarkably in the past decade, notably in eastern China and tertiary hospitals.
Collapse
Affiliation(s)
- Weili Jia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Ruihua Ma
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Xinying Huang
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders; Advanced Innovation Center for Human Brain Protection, Capital Medical University; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders; Advanced Innovation Center for Human Brain Protection, Capital Medical University; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences; Chinese Institute for Brain Research, Beijing, China.
| | - Chunjuan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
| |
Collapse
|
5
|
Moraes MDA, Jesus PAD, Muniz LS, Baccin CA, Barreto ABM, Sales RS, Pires CGDS, Teles CADS, Mussi FC. Arrival time at a referral hospital and functional disability of people with stroke: a cohort study. SAO PAULO MED J 2023; 141:e2022510. [PMID: 37194766 DOI: 10.1590/1516-3180.2022.0510.r1.27022023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/27/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Stroke is a major cause of death and functional disability worldwide. Knowledge of the associated factors is essential for defining education, management, and healthcare strategies. OBJECTIVE To analyze the association between arrival time at a neurology referral hospital (ATRH) and functional disability in patients with ischemic stroke 90 days after the event. DESIGN AND SETTING Prospective cohort study conducted at a public institution of higher education in Brazil. METHODS This study included 241 people aged ≥ 18 years who presented ischemic stroke. The exclusion criteria were death, inability to communicate without companions who could answer the research questions, and > 10 days since ictus. Disability was assessed using the Rankin score (mR). Variables for which associations showed a P value ≤ 0.20 in bivariate analysis were tested as modifiers between ATRH and disability. Significant interaction terms were used for multivariate analysis. Multivariate logistic regression analysis was performed with all variables, arriving at the complete model and adjusted beta measures. The confounding variables were included in the robust logistic regression model, and Akaike's Information Criterion was adopted to choose the final model. The Poisson model assumes a statistical significance of 5% and risk correction. RESULTS Most participants (56.0%) arrived at the hospital within 4.5 hours of symptom onset, and 51.7% presented with mRs of 3 to 5 after 90 days of ictus. In the multivariate model, ATRH ≥ 4.5 hours and females were associated with more significant disability. CONCLUSIONS Arrival at the referral hospital 4.5 hours after the onset of symptoms or wake-up stroke was an independent predictor of a high degree of functional disability.
Collapse
Affiliation(s)
- Mariana de Almeida Moraes
- MSc, PhD. Nurse and Adjunct Professor, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Pedro Antônio de Jesus
- MD, MSc, PhD. Adjunct Professor, Institute of Health Science, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Ludimila Santos Muniz
- MSc. Nurse, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Camila Antunes Baccin
- MSc, PhD. Nurse, Laboratório de Produção, Inovação e Pesquisa em Tecnologias e Informática em Saúde e Enfermagem (LAPETEC/GIATE), Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil
| | | | - Rilary Silva Sales
- Graduate Student, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | | | | | - Fernanda Carneiro Mussi
- MSc, PhD. Nurse and Full Professor, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| |
Collapse
|
6
|
Wang R, Wang Z, Yang D, Wang J, Gou C, Zhang Y, Xian L, Wang Q. Early Hospital Arrival After Acute Ischemic Stroke Is Associated With Family Members' Knowledge About Stroke. Front Neurol 2021; 12:652321. [PMID: 34122301 PMCID: PMC8187751 DOI: 10.3389/fneur.2021.652321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose: Prehospital delay is the major factor limiting intravenous thrombolysis and mechanical thrombectomy in acute ischemic stroke (AIS). This study aimed to: (1) identify factors related to prehospital delay and (2) determine the impact of recognition and behavior of family members on patient delay. Methods: A cross-sectional, multicenter study was conducted at six teaching hospitals in China between December 1, 2018 and November 30, 2019. Patients who experienced AIS within 7 days of onset were interviewed. Results: Of 1,782 consecutive patients (male, 57.97%; mean age, 66.3 ± 9.65 years) who had an AIS, 267 (14.98%) patients arrived within 4.5 h and 722 (40.52%) patients arrived within 6 h of stroke onset. Among patients who arrived within 4.5 h, 103 (38.6%) received thrombolysis. Age over 65 years (OR, 2.009; 95% CI, 1.014-3.982), prior stroke (OR, 3.478; 95% CI, 1.311-9.229), blurred vision (OR, 3.95; 95% CI, 1.71-9.123), and patients deciding to seek medical help (OR, 3.097; 95% CI, 1.417-6.769) were independently associated with late arrival. In contrast, sudden onset of symptoms (OR, 0.075; 95% CI, 0.028-0.196), the National Institutes of Health Stroke Scale 7-15 (OR, 0.093; 95% CI, 0.035-0.251), consciousness disturbance (OR, 0.258; 95% CI, 0.091-0.734), weakness (OR, 0.265; 95% CI, 0.09-0.784), arrival by ambulance (OR, 0.102; 95% CI, 0.049-0.211), decision time <30 min (OR, 0.008; 95% CI, 0.003-0.018), and family member understanding stroke requires early treatment (OR, 0.224; 95% CI, 0.109-0.462) were independently associated with early arrival. Conclusions: The prehospital delay in China lags behind Western countries. Recognition and behavior of stroke patients' family members may play a key role in early arrival.
Collapse
Affiliation(s)
- Rongyu Wang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhiqiang Wang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongdong Yang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jian Wang
- Department of Neurology, Yaan People's Hospital, Yaan, China
| | - Chongji Gou
- Department of Neurology, Pengzhou People's Hospital, Pengzhou, China
| | - Yaodan Zhang
- Department of Neurology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Liulin Xian
- Department of Neurology, Nanbu Traditional Chinese Medicine, Nanbu, China
| | - Qingsong Wang
- Department of Neurology, The General Hospital of Western Theater Command, Chengdu, China
| |
Collapse
|
7
|
Grefkes C, Fink GR. Recovery from stroke: current concepts and future perspectives. Neurol Res Pract 2020; 2:17. [PMID: 33324923 PMCID: PMC7650109 DOI: 10.1186/s42466-020-00060-6] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/22/2020] [Indexed: 12/31/2022] Open
Abstract
Stroke is a leading cause of acquired, permanent disability worldwide. Although the treatment of acute stroke has been improved considerably, the majority of patients to date are left disabled with a considerable impact on functional independence and quality of life. As the absolute number of stroke survivors is likely to further increase due to the demographic changes in our aging societies, new strategies are needed in order to improve neurorehabilitation. The most critical driver of functional recovery post-stroke is neural reorganization. For developing novel, neurobiologically informed strategies to promote recovery of function, an improved understanding of the mechanisms enabling plasticity and recovery is mandatory. This review provides a comprehensive survey of recent developments in the field of stroke recovery using neuroimaging and non-invasive brain stimulation. We discuss current concepts of how the brain reorganizes its functional architecture to overcome stroke-induced deficits, and also present evidence for maladaptive effects interfering with recovery. We demonstrate that the combination of neuroimaging and neurostimulation techniques allows a better understanding of how brain plasticity can be modulated to promote the reorganization of neural networks. Finally, neurotechnology-based treatment strategies allowing patient-tailored interventions to achieve enhanced treatment responses are discussed. The review also highlights important limitations of current models, and finally closes with possible solutions and future directions.
Collapse
Affiliation(s)
- Christian Grefkes
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52425 Jülich, Germany
- Medical Faculty, University of Cologne & Department of Neurology, University Hospital Cologne, 50924 Cologne, Germany
| | - Gereon R. Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52425 Jülich, Germany
- Medical Faculty, University of Cologne & Department of Neurology, University Hospital Cologne, 50924 Cologne, Germany
| |
Collapse
|