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Robinson DJ, Ding L, Howard G, Stanton RJ, Khoury J, Sucharew H, Haverbusch M, Nobel L, Khatri P, Adeoye O, Broderick JP, Ferioli S, Mackey J, Woo D, Rios La Rosa FDL, Flaherty M, Slavin S, Star M, Martini SR, Demel S, Walsh KB, Coleman E, Jasne AS, Mistry EA, Kleindorfer D, Kissela B. Temporal Trends and Racial Disparities in Long-Term Survival After Stroke. Neurology 2024; 103:e209653. [PMID: 39008784 PMCID: PMC11249510 DOI: 10.1212/wnl.0000000000209653] [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: 02/22/2024] [Accepted: 05/20/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Few studies have examined trends and disparities in long-term outcome after stroke in a representative US population. We used a population-based stroke study in the Greater Cincinnati Northern Kentucky region to examine trends and racial disparities in poststroke 5-year mortality. METHODS All patients with acute ischemic strokes (AISs) and intracerebral hemorrhages (ICHs) among residents ≥20 years old were ascertained using ICD codes and physician-adjudicated using a consistent case definition during 5 periods: July 1993-June 1994 and calendar years 1999, 2005, 2010, and 2015. Race was obtained from the medical record; only those identified as White or Black were included. Premorbid functional status was assessed using the modified Rankin Scale, with a score of 0-1 being considered "good." Mortality was assessed with the National Death Index. Trends and racial disparities for each subtype were analyzed with logistic regression. RESULTS We identified 8,428 AIS cases (19.3% Black, 56.3% female, median age 72) and 1,501 ICH cases (23.5% Black, 54.8% female, median age 72). Among patients with AIS, 5-year mortality improved after adjustment for age, race, and sex (53% in 1993/94 to 48.3% in 2015, overall effect of study year p = 0.009). The absolute decline in 5-year mortality in patients with AIS was larger than what would be expected in the general population (5.1% vs 2.8%). Black individuals were at a higher risk of death after AIS (odds ratio [OR] 1.23, 95% CI 1.08-1.39) even after adjustment for age and sex, and this effect was consistent across study years. When premorbid functional status and comorbidities were included in the model, the primary effect of Black race was attenuated but race interacted with sex and premorbid functional status. Among male patients with a good baseline functional status, Black race remained associated with 5-year mortality (OR 1.4, 95% CI 1.1-1.7, p = 0.002). There were no changes in 5-year mortality after ICH over time (64.4% in 1993/94 to 69.2% in 2015, overall effect of study year p = 0.32). DISCUSSION Long-term survival improved after AIS but not after ICH. Black individuals, particularly Black male patients with good premorbid function, have a higher mortality after AIS, and this disparity did not change over time.
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Affiliation(s)
- David J Robinson
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Lili Ding
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - George Howard
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Robert J Stanton
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Jane Khoury
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Heidi Sucharew
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Mary Haverbusch
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Lisa Nobel
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Pooja Khatri
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Opeolu Adeoye
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Joseph P Broderick
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Simona Ferioli
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Jason Mackey
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Daniel Woo
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Felipa De Los Rios La Rosa
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Matthew Flaherty
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Sabreena Slavin
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Michael Star
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Sharyl R Martini
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Stacie Demel
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Kyle B Walsh
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Elisheva Coleman
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Adam S Jasne
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Eva A Mistry
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Dawn Kleindorfer
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Brett Kissela
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
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2
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Tao C, Yuan Y, Xu Y, Zhang S, Wang Z, Wang S, Liang J, Wang Y. Role of cognitive reserve in ischemic stroke prognosis: A systematic review. Front Neurol 2023; 14:1100469. [PMID: 36908598 PMCID: PMC9992812 DOI: 10.3389/fneur.2023.1100469] [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: 11/20/2022] [Accepted: 01/26/2023] [Indexed: 02/24/2023] Open
Abstract
Objective This systematic review was performed to identify the role of cognitive reserve (CR) proxies in the functional outcome and mortality prognostication of patients after acute ischemic stroke. Methods PubMed, Embase, Web of Science, and Cochrane Library were comprehensively searched by two independent reviewers from their inception to 31 August 2022, with no restrictions on language. The reference lists of reviews or included articles were also searched. Cohort studies with a follow-up period of ≥3 months identifying the association between CR indicators and the post-stroke functional outcome and mortality were included. The outcome records for patients with hemorrhage and ischemic stroke not reported separately were excluded. The Quality In Prognosis Studies (QUIPS) tool was used to assess the quality of included studies. Results Our search yielded 28 studies (n = 1,14,212) between 2004 and 2022, of which 14 were prospective cohort studies and 14 were retrospective cohort studies. The follow-up period ranged from 3 months to 36 years, and the mean or median age varied from 39.6 to 77.2 years. Of the 28 studies, 15 studies used the functional outcome as their primary outcome interest, and 11 of the 28 studies included the end-point interest of mortality after ischemic stroke. In addition, two of the 28 studies focused on the interest of functional outcomes and mortality. Among the included studies, CR proxies were measured by education, income, occupation, premorbid intelligence quotient, bilingualism, and socioeconomic status, respectively. The quality of the review studies was affected by low to high risk of bias. Conclusion Based on the current literature, patients with ischemic stroke with higher CR proxies may have a lower risk of adverse outcomes. Further prospective studies involving a combination of CR proxies and residuals of fMRI measurements are warranted to determine the contribution of CR to the adverse outcome of ischemic stroke. Systematic review registration PROSPERO, identifier CRD42022332810, https://www.crd.york.ac.uk/PROSPERO/.
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Affiliation(s)
- Chunhua Tao
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China.,School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Yuan Yuan
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China.,Division of Satoyama Nursing and Telecare, Nagano College of Nursing, Komagane, Japan
| | - Yijun Xu
- Department of the Advanced Biomedical Research, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo, Japan
| | - Song Zhang
- Department of Biomedical Science and Institute of Bioscience and Biotechnology, Kangwon National University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Zheng Wang
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Sican Wang
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Jingyan Liang
- Department of Anatomy, Medical College, Yangzhou University, Yangzhou, China.,Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Yingge Wang
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
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3
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Wu YY, Chen PY, Wu CC, Chen HJ, Liang CL, Lee YC, Lin CW, Hung CM, Lin IF, Wang HK. Long-term mortality rates of young stroke in Taiwan: A decade-long epidemiology population-based study. Eur Stroke J 2022; 7:447-455. [PMID: 36478751 PMCID: PMC9720855 DOI: 10.1177/23969873221115268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/04/2022] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION Stroke remains a leading cause of death worldwide. Stroke in young adults is an important issue, gaining extra attention in recent years. This study aims to investigate the mortality after stroke in young adults in Taiwan. PATIENTS AND METHODS This is a registry- and population-based study in Taiwan of patients aged 20-50 years with first-ever stroke between 1999 and 2012, with follow-up until January 1, 2022. Patients and mortalities were identified through Taiwan National Health Insurance database. RESULTS The study population included 65,097 patients with stroke (mean age, 42.6 ± 6.6 years; 30.5% woman). There were 23,481 (36.1%) intracranial hemorrhage, 37,522 (57.6%) ischemic stroke, and 4094 (6.3%) stroke not otherwise specified. At the end of follow-up, a total of 18,248 deaths (28.0%) occurred during a median follow-up of 9.8 years (interquartile range, 6.4-13.7 years). CONCLUSION Taiwan young adults who were 30-day survivors of first-ever stroke have significantly higher long-term mortality rates when compared to other population-based studies.
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Affiliation(s)
- Yu-ying Wu
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Neurosurgery, E-Da
Hospital, Kaohsiung
| | - Po-Yuan Chen
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Neurosurgery, E-Da
Hospital, Kaohsiung
| | - Cheng-Chun Wu
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
| | - Han-Jung Chen
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Neurosurgery, E-Da
Hospital, Kaohsiung
| | - Cheng-Loong Liang
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Neurosurgery, E-Da
Hospital, Kaohsiung
| | - Yi-Che Lee
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Nephrology, E-Da
Hospital, Kaohsiung
| | - Chi-Wei Lin
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Family Medicine, E-Da
Hospital, Kaohsiung
| | - Chao-Ming Hung
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of General Surgery, E-Da
cancer Hospital, Kaohsiung
| | - I-Fan Lin
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Infectious Disease, E-Da
Hospital, Kaohsiung
| | - Hao-Kuang Wang
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Neurosurgery, E-Da
Hospital, Kaohsiung
- Department of Neurosurgery, E-Da Cancer
Hospital, Kaohsiung
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Maldonado-Cárceles AB, Hernando-Arizaleta L, Palomar-Rodríguez JA, Morales-Ortiz A. Trends in hospitalisation for ischaemic stroke in young adults in the region of Murcia (Spain) between 2006 and 2014. Neurologia 2022; 37:524-531. [PMID: 32001039 DOI: 10.1016/j.nrl.2019.10.005] [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: 03/04/2019] [Revised: 08/13/2019] [Accepted: 10/13/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Recent studies conducted in Europe and the United States suggest upward trends in both incidence and hospitalisation rates for ischaemic stroke in young adults; however, data for Spain are scarce. This study analyses the trend in hospitalisation due to ischaemic stroke in adults aged under 50 years in the region of Murcia between 2006 and 2014. METHOD We performed a retrospective study of patients discharged after hospitalisation due to cerebrovascular disease (CVD); data were obtained from the regional registry of the Minimum Basic Data Set. Standardised rates were calculated, disaggregated by age and CVD subtype. Time trends were analysed using joinpoint regression to obtain the annual calculated standardised rate and the annual percentage of change (APC). RESULTS A total of 27 064 patients with CVD were discharged during the 9-year study period. Ischaemic stroke was the most frequent subtype (61.0%). In patients aged 18 to 49 years, the annual number of admissions due to ischaemic stroke increased by 26%, and rates by 29.2%; however, the joinpoint regression analysis showed no significant changes in the trend (APC=2.74%, P≥.05). By contrast, a downward trend was identified in individuals older than 49 (APC=-1.24%, P<.05). CONCLUSIONS No significant changes were observed in the rate of hospitalisation due to ischaemic stroke among young adults, despite the decline observed in older adults. Identifying the causes of these disparate trends may be beneficial to the development of specific measures targeting younger adults.
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Affiliation(s)
- A B Maldonado-Cárceles
- Medicina Preventiva, Complejo Hospitalario Universitario de Cartagena, Murcia, España; Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Murcia, Murcia, España.
| | - L Hernando-Arizaleta
- Servicio de Planificación y Financiación Sanitaria, Consejería de Salud, Murcia, España
| | - J A Palomar-Rodríguez
- Servicio de Planificación y Financiación Sanitaria, Consejería de Salud, Murcia, España
| | - A Morales-Ortiz
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
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5
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Maldonado-Cárceles A, Hernando-Arizaleta L, Palomar-Rodríguez J, Morales-Ortiz A. Trends in hospitalisation for ischaemic stroke in young adults in the region of Murcia (Spain) between 2006 and 2014. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:524-531. [DOI: 10.1016/j.nrleng.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 10/13/2019] [Indexed: 11/16/2022] Open
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6
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Gallucci L, Umarova RM. Association of cognitive reserve with stroke outcome: a protocol for a systematic review. BMJ Open 2022; 12:e059378. [PMID: 35803623 PMCID: PMC9272103 DOI: 10.1136/bmjopen-2021-059378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The concept of cognitive reserve (CR) was introduced to account for individual differences in the clinical manifestation of neurodegenerative diseases. Though several mechanisms and risk factors are shared between neurodegeneration and stroke, the effect of CR on poststroke functional outcome has been poorly addressed. This systematic review aims to synthesise the available research evidence on the association of CR with stroke outcome, in order to implement the understanding of interindividual variability in stroke outcome and to improve its prediction. METHODS AND ANALYSIS Cochrane Library, Embase, PubMed, Web of Science and reference lists of relevant literature will be searched for publications on CR proxies (eg, education, years of education, occupational attainment, premorbid intelligence) and stroke outcome, published between 1 January 1980 and 10 March 2022. Two reviewers will independently perform the study selection, data extraction and quality assessment. Disagreements between reviewers will be resolved by a third independent reviewer. The Quality In Prognosis Studies tool will be used to assess the quality of each included study. The primary outcome will be functional outcome after stroke assessed with modified Rankin Scale, activities of daily living (eg, Barthel Index), National Institute of Health Stroke Scale, dichotomised as favourable versus not favourable as well as reported as continuous or ordinal variables. Qualitative and quantitative findings will be summarised and, if possible, data will be synthesised using appropriate meta-analytical methods. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. ETHICS AND DISSEMINATION No ethical approval is required as it is a protocol for a systematic review and the data used will be extracted from published studies. The findings from this systematic review will be disseminated in a peer-reviewed scientific journal and presented at conferences. The data will be made freely available. PROSPERO REGISTRATION NUMBER CRD42021256175.
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Affiliation(s)
- Laura Gallucci
- Department of Neurology, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Roza M Umarova
- Department of Neurology, Inselspital, University Hospital, University of Bern, Bern, Switzerland
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7
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Doehner W, Scherbakov N, Schellenberg T, Jankowska EA, Scheitz JF, von Haehling S, Joebges M. Iron deficiency is related to low functional outcome in patients at early rehabilitation after acute stroke. J Cachexia Sarcopenia Muscle 2022; 13:1036-1044. [PMID: 35166066 PMCID: PMC8977949 DOI: 10.1002/jcsm.12927] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Iron deficiency (ID) is a common co-morbidity in patients with cardiovascular disease and contributes to impaired functional capacity. The relevance of ID in patients in recovery after acute stroke is not known. We assessed the prevalence of ID and anaemia in relation to functional capacity and to recovery during early rehabilitation after stroke. METHODS This observational study enrolled consecutively 746 patients with ischaemic or haemorrhagic stroke at in-patient early rehabilitation (age 68 ± 13 years, female 47%, ischaemic stroke 87%). Functional capacity was assessed before and after rehabilitation using Barthel index (reha-BI), motricity index (MI), trunk control test (TCT), and functional ambulatory category (FAC). ID was defined as ferritin <100 μg/L or as transferrin saturation (TSAT) < 20% if ferritin was 100- < 300 μg/L or if CrP > 5 mg/L. Anaemia was defined as Hb < 12 g/dL (women) and <13 g/dL (men). RESULTS The prevalence of ID and anaemia before rehabilitation were 45% and 46%, respectively, and remained high at discharge (after 27 ± 17 days) at 40% and 48%, respectively. Patients with ID had lower functional capacity compared with patients without ID (reha-BI 20 [±86] vs. 40 [±80], MI 64 [±66] vs. 77 [±41], TCT 61 [±76] vs. 100 [±39], FAC 1 [±4] vs. 4 [±4]; median [IQR], all P < 0.001). ID was related to inflammation (OR 2.68 [95% CI 1.98-3.63], P < 0.001), female sex (OR 2.13 [95% CI 1.59-2.85], P < 0.001), haemorrhagic stroke (OR 1.70 [95% CI 1.11-2.61], P = 0.015), initial treatment on stroke unit (OR 3.59 [95% CI 1.08-11.89], P < 0.001), and anaemia (OR 2.94 [95% CI 2.18-3.96], P < 0.001), while age, BMI, and renal function were not related to ID. In adjusted analysis, ID was associated with low functional capacity in all functional scores: reha-BI (OR 1.66 [95% CI 1.08-2.54], P = 0.02), motricity index (OR 1.94 [95% CI 1.36-2.76], P < 0.001), trunk control test (OR 2.34 [95% CI] 1.64-3.32, P < 0.001) and functional ambulatory category (OR 1.77 [95% CI 1.2-2.63], P < 0.02). Functional capacity improved during rehabilitation regardless of presence of ID, but functional outcome remained significantly lower in patients with ID at the end of rehabilitation (rehab BI and MI, both P < 0.001). CONCLUSIONS Iron deficiency and anaemia are common and persistent findings in patients after acute stroke. ID and anaemia are independently related to lower functional capacity after acute stroke and to poor functional outcome after rehabilitation. Regular assessment of iron status may identify patients at risk of low functional recovery.
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Affiliation(s)
- Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin, and German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nadja Scherbakov
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tim Schellenberg
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ewa A Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Jan F Scheitz
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Michael Joebges
- Department of Neurology, Brandenburg Klinik, Bernau, Germany
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8
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Norman K, Eriksson M, von Euler M. Sex Differences in Ischemic Stroke Within the Younger Age Group: A Register-Based Study. Front Neurol 2022; 13:793181. [PMID: 35237226 PMCID: PMC8882967 DOI: 10.3389/fneur.2022.793181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Stroke incidence is decreasing in most developing countries. However, worrisome trends of an increase in the younger population have been described. Aim To investigate sex differences and longitudinal changes in ischemic stroke regarding incidence, cardiovascular risk factors, and outcome, in the young. Methods This is an observational study based on the data from the Swedish national stroke registry, Riksstroke. Patients, 18–54 years of age, having ischemic stroke between 2005 and 2018 were included, resulting in a study population of 16,210 patients. Results The incidence was higher in men than in women (30.6 vs. 19.1 per 100,000, P < 0.001). After an initial increase, the incidence stabilized and then decreased, resulting in a similar level in 2018 as in 2005. Atrial fibrillation, diabetes, and usage of anti-hypertensives at stroke onset were more common among men and did not change over time. Smoking was common and slightly more so in women, but with a reduced prevalence in both men and women during the study period. Dependency in Activities of Daily Living (ADL) and case fatality showed no clear trends or sex differences. Conclusions The results show that there are sex differences in ischemic stroke in the younger age group regarding incidence and vascular risk factors, particularly smoking. Temporal trends in stroke incidence are difficult to interpret as fluctuations are substantial, largely due to stroke being quite uncommon in the younger population.
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Affiliation(s)
| | - Marie Eriksson
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - Mia von Euler
- Department of Neurology and Rehabilitation, School of Medicine, Örebro University, Örebro, Sweden
- *Correspondence: Mia von Euler
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9
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Krishnamurthi RV, Feigin VL. Global Burden of Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00014-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Ognev VA, Mishchenko MM, Mishchenko AN, Trehub PO. NATIONAL TRENDS IN MORBIDITY AND MORTALITY FROM CIRCULATORY SYSTEM AND CEREBROVASCULAR DISEASES AND STROKES. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1152-1155. [PMID: 35758494 DOI: 10.36740/wlek202205118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: To determine national trends in morbidity and mortality from diseases of the circulatory system, cerebrovascular diseases and strokes. PATIENTS AND METHODS Materials and methods: Data from official sources of statistical information of Ukraine were used and systematic analysis and generalization of the obtained data was performed and trends in morbidity and mortality from diseases of the circulatory system, cerebrovascular diseases and strokes in Ukraine were calculated. RESULTS Results: Were found tendencies to decrease of national levels of prevalence and primary morbidity in Ukraine for DCS (-16.3 % and -28.0 %), CVD (-22.8 % and 24.1 %) and strokes (-12.2 %) with significant trends (+83.9 %) of increase in primary incidence of strokes in 2010-2017 with fairly high and threatening levels for 2017 (respectively 22199563, 2521601 and 96978 - prevalence and 1725137, 290557 and 96978 - primary incidence). National levels of reduction of deaths from DCS in Ukraine from 440369 (2013) to 389348 (2019) with a trend of -11.6 % and a decrease in mortality due to CVD from 94267 (2013) to 76232 (2019) with a trend -19.1 % were found. CONCLUSION Conclusions: The trends to reduce of national prevalence, primary morbidity and mortality rates in Ukraine for DCS, CVD and stroke are fully consistent with other global trends of reduction of these levels among world countries.
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Affiliation(s)
| | | | - Alexander N Mishchenko
- EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY "KHARKIV POLYTECHNIC INSTITUTE", KHARKIV, UKRAINE
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11
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Shlobin NA, Baig AA, Waqas M, Patel TR, Dossani RH, Wilson No Degree M, Cappuzzo JM, Siddiqui AH, Tutino VM, Levy EI. Artificial Intelligence for Large Vessel Occlusion Stroke: A Systematic Review. World Neurosurg 2021; 159:207-220.e1. [PMID: 34896351 DOI: 10.1016/j.wneu.2021.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Tatsat R Patel
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo NY USA
| | - Rimal H Dossani
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | | | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Vincent M Tutino
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo NY USA; Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo NY USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
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12
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Liu M, Qian Q, Wang W, Chen L, Wang L, Zhou Y, Xu S, Wu J, Feng T, Zhu Z, Xiang J. Improvement in Language Function in Patients with Aphasia using Computer-Assisted Executive Function Training: A Controlled Clinical Trial. PM R 2021; 14:913-921. [PMID: 34310072 DOI: 10.1002/pmrj.12679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/13/2021] [Accepted: 07/02/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Non-verbal cognitive training has gained popularity for the management of aphasia. The correlation between language function and cognitive control has been explored previously. Cognitive status affects language to a certain degree. In this study, we aimed to determine whether non-verbal computer-assisted executive control training (CAET) to improve cognitive status affects language performance in patients with aphasia (PWA). DESIGN A total of 73 participants were included in the study, and 5 subjects dropped out. A total of 68 individuals were randomly divided into two groups and underwent treatment. The experimental group was treated with traditional speech and language therapy (SLT) combined with CAET. The control group underwent SLT only. RESULTS Differences between pre- and post-treatment language outcomes expect oral naming (group × time, P = 0.236) were significantly greater in the experimental group compared with the control group: Spontaneous speech (group × time, P = 0.026), Auditory Comprehension (group × time, P < 0.001), Speech repetition (group × time, P = 0.001), AQ (group × time, P < 0.001). A similar effect was observed for cognitive function such as TMT-A (group × time, P = 0.006), TMT-B (group × time, P = 0.005) and VFT-V (group × time, P = 0.018). CONCLUSION Our study demonstrates that CAET combined with SLT can yield favorable language outcomes for PWA, especially improvements in auditory comprehension and AQ. CAET combined with SLT generates benefits in both cognitive function and language performance. Therefore, CAET may be applied as an adjuvant aphasia therapy in conjunction with traditional SLT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mengting Liu
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Medical Technology School, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Qiuchen Qian
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Medical Technology School, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wei Wang
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Medical Technology School, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Lu Chen
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Lingmin Wang
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yeqing Zhou
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Siwei Xu
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jie Wu
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Tao Feng
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zude Zhu
- School of Linguistic Sciences and Arts, Jiangsu Normal University, Xuzhou, China
| | - Jie Xiang
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Medical Technology School, Xuzhou Medical University, Xuzhou, Jiangsu, China
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13
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Song YS, Lee SH, Jung JH, Song IH, Park HS, Moon BS, Kim SE, Lee BC. TSPO Expression Modulatory Effect of Acetylcholinesterase Inhibitor in the Ischemic Stroke Rat Model. Cells 2021; 10:cells10061350. [PMID: 34072449 PMCID: PMC8227181 DOI: 10.3390/cells10061350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 12/21/2022] Open
Abstract
We performed in vivo PET imaging with 3-[18F]F-CP118,954 (1) for acetylcholinesterase (AChE) and [18F]fluoromethyl-PBR28-d2 (2) for translocator protein 18-kDa (TSPO) to investigate the inflammatory brain response after stroke. Imaging studies were performed in the middle cerebral artery occlusion (MCAO) Sprague-Dawley rat model for a period of three weeks. The percentage injected dose per tissue weight (%ID/g) of striatum of 1, and cortex of 2 were obtained, respectively. To trace the sequential inflammatory responses, AChE imaging of 1 was done on post-MCAO day 2, after giving cold PK-11195 for 1 day, and TSPO imaging of 2 was carried out on post-MCAO day 11, after giving donepezil for 10 days. AChE activity in the MCAO-lesioned side were significantly higher than that of the contralateral side on day one, and TSPO activity was highest on day 11. TSPO inhibitor, PK-11195 did not affect AChE activity on day two, while AChE inhibitor, donepezil significantly lowered TSPO binding on day 12. Our study demonstrates that AChE level is elevated in the early course of brain ischemia as a trigger for the inflammatory response, and TSPO level is elevated persistently throughout the post-ischemic injury in the brain. Also, the AChE inhibitor may be able to inhibit or delay neurotoxic inflammatory responses and serve as a beneficial treatment option.
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Affiliation(s)
- Yoo Sung Song
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (Y.S.S.); (S.H.L.); (J.H.J.); (I.H.S.); (H.S.P.)
| | - Sang Hee Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (Y.S.S.); (S.H.L.); (J.H.J.); (I.H.S.); (H.S.P.)
- Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 08826, Korea
| | - Jae Ho Jung
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (Y.S.S.); (S.H.L.); (J.H.J.); (I.H.S.); (H.S.P.)
| | - In Ho Song
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (Y.S.S.); (S.H.L.); (J.H.J.); (I.H.S.); (H.S.P.)
| | - Hyun Soo Park
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (Y.S.S.); (S.H.L.); (J.H.J.); (I.H.S.); (H.S.P.)
| | - Byung Seok Moon
- Department of Nuclear Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul 07804, Korea;
| | - Sang Eun Kim
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (Y.S.S.); (S.H.L.); (J.H.J.); (I.H.S.); (H.S.P.)
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 08826, Korea
- Center for Nanomolecular Imaging and Innovative Drug Development, Advanced Institutes of Convergence Technology, Suwon 16229, Korea
- Correspondence: (S.E.K.); (B.C.L.); Tel.: +82-31-787-7671 (S.E.K.); +82-31-787-2956 (B.C.L.)
| | - Byung Chul Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (Y.S.S.); (S.H.L.); (J.H.J.); (I.H.S.); (H.S.P.)
- Center for Nanomolecular Imaging and Innovative Drug Development, Advanced Institutes of Convergence Technology, Suwon 16229, Korea
- Correspondence: (S.E.K.); (B.C.L.); Tel.: +82-31-787-7671 (S.E.K.); +82-31-787-2956 (B.C.L.)
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Trends of Stroke Incidence and 28-Day All-Cause Mortality after a Stroke in Malaysia: A Linkage of National Data Sources. Glob Heart 2021; 16:39. [PMID: 34211825 PMCID: PMC8162294 DOI: 10.5334/gh.791] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Data on nationwide trends for stroke metrics are crucial to understand the extent of the disease burden to a country’s health system. Yet, this information remains scarce in low- and middle-income countries. Objectives: This study investigated trends of stroke incidence and 28-day all-cause mortality after a stroke from 2008 to 2016 in Malaysia, through linkage across national data sources. Methods: Hospital admissions with a principal diagnosis of stroke or transient ischemic attack were included. Cases with first stroke were identified through linkage of hospital admission registers where age and sex-standardized trends of stroke incidence and its subtypes were calculated. By linking hospital registers to the National Death Register, the 28-day all-cause mortality rates after a stroke were estimated. Mann-Kendall’s test was used for trend evaluation. Results: From 243,765 records, the trend of stroke incidence showed an increase of 4.9% in men and a drop of 3.8% among women. Incidences were higher in men, at 99.1 per 100,000 population in 2008 and 103.9 per 100,000 in 2016 than women (80.3 per 100,000 in 2008 and 77.2 per 100,000 in 2016). There was a substantial increase in stroke incidence among those below 65 years old, with the largest increase of 53.3% in men aged between 35–39 years and 50.4% in women of similar age group. The trend for 28-day all-cause mortality showed a decline for men at –13.1% and women, –10.6%. Women had higher mortality from stroke (22.0% in 2008 and 19.7% in 2016) than men (19.4% in 2008 to 17.2% in 2016). Conclusion: This first empirical study on stroke trends in Malaysia revealed a worrying increase in stroke incidence among the younger population. Despite a declining trend, mortality rates remained moderately high especially in women. Comprehensive strategies to strengthen the prevention and management of stroke care are warranted.
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Kõrv L, Vibo R, Mallene S, Kõrv J. High incidence of stroke in young adults in Tartu, Estonia, 2013 to 2017: A prospective population-based study. Eur J Neurol 2021; 28:1984-1991. [PMID: 33686770 DOI: 10.1111/ene.14812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies conducted elsewhere in the world have demonstrated an increase in the incidence of ischemic stroke (IS) in younger ages. We sought to determine stroke incidence and 28-day case-fatality rates in 15- to 54-year-old residents of Tartu, Estonia from 2013 to 2017. METHODS All stroke cases that were the first ever in a lifetime (IS, nontraumatic intracerebral hemorrhage [ICH], and subarachnoid hemorrhage [SAH]) in 15- to 54-year-old residents of Tartu, Estonia were prospectively registered from January 1, 2013 to December 31, 2017. Several additional overlapping data sources were used for case ascertainment including other departments of the Tartu University Hospital and outpatient clinic, Estonian Cause of Death Registry, and the Estonian Electronic Health Record. All cases were thoroughly validated before inclusion. RESULTS We identified 110 cases (43.6% female) of first-ever stroke (IS 72.7%, ICH 12.7%, SAH 14.6%), out of which 85.5% were included prospectively. The mean age at onset was 44.3 ± 8.5 (SD) years. The mean age at onset was higher for men than for women (p = 0.046). The incidence of stroke standardized to the 1976 European standard population (EUR) was 46.1/100,000 (95% confidence interval [CI]: 37.4-54.8). IS incidence was 33.4/100,000 EUR (95% CI: 26-40.7). The total stroke incidence was higher in 45- to 54-year-old men than in women in the same age group (rate ratio, 2.24; 95% CI: 1.35-3.71). There were no more significant differences between sexes or age groups. The 28-day case-fatality rate was 10.9% for all strokes. CONCLUSIONS Our study shows higher crude incidence and case fatality of stroke in the young compared to studies from other high-income countries.
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Affiliation(s)
- Liisa Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Riina Vibo
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Sandra Mallene
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
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16
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Joundi RA, Smith EE, Yu AYX, Rashid M, Fang J, Kapral MK. Temporal Trends in Case Fatality, Discharge Destination, and Admission to Long-term Care After Acute Stroke. Neurology 2021; 96:e2037-e2047. [PMID: 33970881 DOI: 10.1212/wnl.0000000000011791] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/13/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine contemporary trends in case fatality, discharge destination, and admission to long-term care after acute ischemic stroke and intracerebral hemorrhage (ICH) using a large, population-based cohort. METHODS We used linked administrative data to identify all emergency department visits and hospital admissions for first-ever ischemic stroke or ICH in Ontario, Canada, from 2003 to 2017. We calculated crude and age-/sex-standardized risk of death at 30 days and 1 year from stroke onset. We stratified crude trends by stroke type, age, and sex and used the Kendall τ-b correlation coefficient to evaluate the significance of trends. We determined trends in discharge home and to rehabilitation and admission to long-term care at 1 year. We used Cox proportional hazard and logistic regression models to assess whether trends in outcomes persisted after adjustment for baseline factors, estimated stroke severity, and use of life-sustaining care. RESULTS There were 163,574 people with acute ischemic stroke or ICH across the study period. Between 2003 and 2017, age-/sex-standardized 30-day stroke case fatality decreased from 20.5% to 13.2% (7.3% absolute and 36% relative reduction) while that at 1 year decreased from 32.2% to 22.8% (9.3% absolute and 29% relative reduction). Findings were consistent across age, sex, and stroke type, and after adjustment for comorbid conditions, stroke severity, and use of life-sustaining care. There was a reduction in long-term care admission after ischemic stroke and an increase in discharge home or to rehabilitation for both stroke types. CONCLUSION We observed substantial reductions in acute stroke case fatality from 2003 to 2017 with a concurrent increase in discharge to home or rehabilitation and a decrease in long-term care admissions, suggesting continuous improvements in stroke systems of care.
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Affiliation(s)
- Raed A Joundi
- From the Department of Clinical Neurosciences (R.A.J., E.E.S.), Cumming School of Medicine, University of Calgary; ICES (R.A.J., A.Y.X.Y., M.R., J.F., M.K.K.), Toronto; and the Department of Medicine, Divisions of Neurology (A.Y.X.Y.) and General Internal Medicine (M.K.K.), and Institute of Health Policy, Management, and Evaluation (M.K.K.), University of Toronto, Canada
| | - Eric E Smith
- From the Department of Clinical Neurosciences (R.A.J., E.E.S.), Cumming School of Medicine, University of Calgary; ICES (R.A.J., A.Y.X.Y., M.R., J.F., M.K.K.), Toronto; and the Department of Medicine, Divisions of Neurology (A.Y.X.Y.) and General Internal Medicine (M.K.K.), and Institute of Health Policy, Management, and Evaluation (M.K.K.), University of Toronto, Canada
| | - Amy Y X Yu
- From the Department of Clinical Neurosciences (R.A.J., E.E.S.), Cumming School of Medicine, University of Calgary; ICES (R.A.J., A.Y.X.Y., M.R., J.F., M.K.K.), Toronto; and the Department of Medicine, Divisions of Neurology (A.Y.X.Y.) and General Internal Medicine (M.K.K.), and Institute of Health Policy, Management, and Evaluation (M.K.K.), University of Toronto, Canada
| | - Mohammed Rashid
- From the Department of Clinical Neurosciences (R.A.J., E.E.S.), Cumming School of Medicine, University of Calgary; ICES (R.A.J., A.Y.X.Y., M.R., J.F., M.K.K.), Toronto; and the Department of Medicine, Divisions of Neurology (A.Y.X.Y.) and General Internal Medicine (M.K.K.), and Institute of Health Policy, Management, and Evaluation (M.K.K.), University of Toronto, Canada
| | - Jiming Fang
- From the Department of Clinical Neurosciences (R.A.J., E.E.S.), Cumming School of Medicine, University of Calgary; ICES (R.A.J., A.Y.X.Y., M.R., J.F., M.K.K.), Toronto; and the Department of Medicine, Divisions of Neurology (A.Y.X.Y.) and General Internal Medicine (M.K.K.), and Institute of Health Policy, Management, and Evaluation (M.K.K.), University of Toronto, Canada
| | - Moira K Kapral
- From the Department of Clinical Neurosciences (R.A.J., E.E.S.), Cumming School of Medicine, University of Calgary; ICES (R.A.J., A.Y.X.Y., M.R., J.F., M.K.K.), Toronto; and the Department of Medicine, Divisions of Neurology (A.Y.X.Y.) and General Internal Medicine (M.K.K.), and Institute of Health Policy, Management, and Evaluation (M.K.K.), University of Toronto, Canada.
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17
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Trends in ischemic stroke outcomes in a rural population in the United States. J Neurol Sci 2021; 422:117339. [PMID: 33592506 DOI: 10.1016/j.jns.2021.117339] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/18/2021] [Accepted: 02/05/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018. METHODS This was a retrospective cohort study based on electronic health records (EHR) data. A comprehensive stroke database called "Geisinger NeuroScience Ischemic Stroke (GNSIS)" was built for this study. Clinical data were extracted from multiple sources, including EHR and quality data. RESULTS The cohort included in the study comprised of 8561 consecutive ischemic stroke patients (mean age: 70.1 ± 13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The one-year recurrence and all-cause mortality rates were 6.3% and 16.1%, respectively. Although the one-year stroke recurrence increased during the study period, the one-year stroke mortality rate decreased significantly. Age > 65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Cause-specific hazard model, diabetes, chronic kidney disease and age < 65 years were found to be associated with one-year ischemic stroke recurrence. CONCLUSION Although all-cause mortality after stroke has decreased, stroke recurrence has significantly increased in stroke patients from rural population between 2004 and 2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes, chronic kidney disease and age less than 65 years were predictors of ischemic stroke recurrence.
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Wu HH, Chang TY, Liu CH, Lin JR, Liou CW, Lee JD, Peng TI, Lee M, Lee TH. Impact of chronic kidney disease severity on causes of death after first-ever stroke: A population-based study using nationwide data linkage. PLoS One 2020; 15:e0241891. [PMID: 33211729 PMCID: PMC7676709 DOI: 10.1371/journal.pone.0241891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Stroke is prevalent in patients with chronic kidney disease (CKD) and is associated with high mortality, but the causes of death after stroke among different CKD stages are not well known. AIMS We aimed to investigate whether the severity of CKD would impact on the causes of death after first-ever stroke. METHODS This retrospective multicenter cohort study included stoke patients with CKD between 2007 and 2012. The cause of death and date of death were ascertained by linking the National Death Registry Database of Taiwan. Clinical outcomes, 1-month, and 1-year mortality rates, and major causes of death were compared according to five CKD stages (G1 to G5) in the ischemic and hemorrhagic stroke separately. RESULTS Of these patients, 9,878 were first-ever ischemic stroke (IS) patients, and 1,387 were first-ever hemorrhagic stroke (HS) patients. Patients with CKD G5 had the highest one-year mortality rate with hazard ratio 5.28 [95%CI, 3.94-7.08] in IS and 3.03 [95%CI, 2.03-4.54] in HS when compared to G1 patients. Leading causes of one-year death after IS were stroke, cancer, and pneumonia in early (G1-3) CKD patients, while diabetes mellitus, CKD, and stroke itself contributed to the major mortality in CKD G5 patients. An inverse association between eGFR decrement and the proportion of deaths caused by stroke itself was observed in CKD G2-5 patients after IS. Stroke was the leading cause of one-year death among all CKD patients after HS. CONCLUSIONS Asides from high mortality, late-stage CKD patients had different causes of death from early CKD patients after stroke. This study highlights the need to imply different treatment strategies in late-stage CKD post-stroke patients to improve their prognosis.
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Affiliation(s)
- Hsin-Hsu Wu
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
| | - Ting-Yu Chang
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Neurology, Stroke Section, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chi-Hung Liu
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Neurology, Stroke Section, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Wei Liou
- Department of Neurology, Stroke Section, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Tsung-I Peng
- Department of Neurology, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Meng Lee
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Tsong-Hai Lee
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Neurology, Stroke Section, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
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Twenty-Year Time Trends in Long-Term Case-Fatality and Recurrence Rates After Ischemic Stroke Stratified by Etiology. Stroke 2020; 51:2778-2785. [DOI: 10.1161/strokeaha.120.029972] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background and Purpose:
Data on long-term survival and recurrence after stroke are lacking. We investigated time trends in ischemic stroke case-fatality and recurrence rates over 20-years stratified by etiological subtype according to the Trial of ORG 10172 in Acute Stroke Treatment classification within a population-based stroke register in Germany.
Methods:
Data was collected within the Erlangen Stroke Project, a prospective, population-based stroke register covering a source population of 105 164 inhabitants (2010). Case fatality and recurrence rates for 3 months, 1 year, and 5 years were estimated with Kaplan-Meier estimates. Sex-specific time trends for case-fatality and recurrence rates were estimated with Cox regression. We adjusted for age, sex, and year of event and stratified for etiological subtypes. A sensitivity analysis with competing risk analysis for time trends in recurrence were performed.
Results:
Between 1996 and 2015, 3346 patients with first ischemic stroke were included; age-standardized incidence per 100 000 was 75.8 in women and 131.6 in men (2015). Overall, 5-year survival probabilities were 50.4% (95% CI, 47.9–53.1) in women and 59.2% (95% CI, 56.4–62.0) in men; 5-year survival was highest in patients with first stroke due to small-artery occlusion (women, 71.8% [95% CI, 67.1–76.9]; men, 75.9% [95% CI, 71.3–80.9]) and lowest in cardioembolic stroke (women, 35.7% [95% CI, 31.0–41.1]; men, 47.8% [95% CI, 42.2–54.3]). Five-year recurrence rates were 20.1% (95% CI, 17.5–22.6) in women and 20.1% (95% CI, 17.5–22.7) in men; 5-year recurrence rate was lowest in women in stroke due to small artery occlusion 16.0% (95% CI, 11.7–20.1) and in men in large-artery atherosclerosis 16.6% (95% CI, 8.7–23.9); highest risk of recurrence was observed in undefined strokes (women, 22.3% [95% CI, 17.8–26.6]; men, 21.4% [95% CI, 16.7–25.9]). Cox regression revealed improvements in case-fatality rates over time with differences in stroke causes. No time trends in recurrence rates were observed.
Conclusions:
Long-term survival and recurrence varied substantially by first stroke cause. Survival probabilities improved over the past 2 decades; no major trends in stroke recurrence rates were observed.
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Yun SM, Lee SY, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Lee YS, Joo MC, Lee SY, Han J, Ahn J, Oh GJ, Lee YH, Chang WH, Kim YH. Factors Associated with Changes in Functional Independence after Six Months of Ischemic Stroke. BRAIN & NEUROREHABILITATION 2020; 13:e19. [PMID: 36741795 PMCID: PMC9879371 DOI: 10.12786/bn.2020.13.e19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/09/2020] [Accepted: 06/20/2020] [Indexed: 11/08/2022] Open
Abstract
The aim of this study is to investigate the changes in functional independence and their associated factors during the first 6 months to 1 year after stroke onset. This study is the interim results of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 1,011 participants were included and classified into 3 subgroups according to changes in the Korean version of Modified Barthel Index (K-MBI) scores that occurred between 6 months to 1 year after stroke onset: the improved group (IG), with scores that increased 5 points or more; the stationary group (SG), with the K-MBI score changes ranging from -4 to +4 points; and the declined group (DG), with the K-MBI scores that decreased 5 points or more. Ordinal logistic regression analyses were used to assess the factors influencing changes in the K-MBI score. Among 1,011 patient, 436 patients (43.1%), 398 patients (39.4%) and 117 patients (17.5%) were classified into the IG, SG, and DG, respectively. Obesity and Geriatric Depression Scale score were significant influencing factors for changes in the K-MBI scores. Obesity showed a positive influence on the K-MBI score, while depression showed a negative influence.
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Affiliation(s)
- Sang Moon Yun
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Yeol Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 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 Yangsan Hospital, Yangsan, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University, School of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - So Young Lee
- 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
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Young Hoon Lee
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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21
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Kim TJ, Lee JS, Yoon JS, Oh MS, Kim JW, Jung KH, Yu KH, Lee BC, Ko SB, Yoon BW. Impact of the Dedicated Neurointensivists on the Outcome in Patients with Ischemic Stroke Based on the Linked Big Data for Stroke in Korea. J Korean Med Sci 2020; 35:e135. [PMID: 32476299 PMCID: PMC7261699 DOI: 10.3346/jkms.2020.35.e135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/22/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Neurocritical care by dedicated neurointensivists may improve outcomes of critically ill patients with severe brain injury. In this study, we aimed to validate whether neurointensive care could improve the outcome in patients with critically ill acute ischemic stroke using the linked big dataset on stroke in Korea. METHODS We included 1,405 acute ischemic stroke patients with mechanical ventilator support in the intensive care unit after an index stroke. Patients were retrieved from linking the Clinical Research Center for Stroke Registry and the Health Insurance Review and Assessment Service data from the period between January 2007 and December 2014. The outcomes were mortality at discharge and at 3 months after an index stroke. The main outcomes were compared between the centers with and without dedicated neurointensivists. RESULTS Among the included patients, 303 (21.6%) were admitted to the centers with dedicated neurointensivists. The patients treated by dedicated neurointensivists had significantly lower in-hospital mortality (18.3% vs. 26.8%, P = 0.002) as well as lower mortality at 3-month (38.0% vs. 49.1%, P < 0.001) than those who were treated without neurointensivists. After adjusting for confounders, a treatment without neurointensivists was independently associated with higher in-hospital mortality (odds ratio [OR], 1.59; 95% confidence intervals [CIs], 1.13-2.25; P = 0.008) and 3-month mortality (OR, 1.48; 95% CIs, 1.12-1.95; P = 0.005). CONCLUSION Treatment by dedicated neurointensivists is associated with lower in-hospital and 3-month mortality using the linked big datasets for stroke in Korea. This finding stresses the importance of neurointensivists in treating patients with severe ischemic stroke.
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Affiliation(s)
- Tae Jung Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji Sung Lee
- Department of Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sun Yoon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ji Woo Kim
- Health Insurance Review and Assessment Service, Wonju, Korea
| | - Keun Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Kyung Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Byung Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sang Bae Ko
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Byung Woo Yoon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.
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22
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Zhao W, Wu J, Liu J, Wu Y, Ni J, Gu H, Tu J, Wang J, An Z, Ning X. Trends in the incidence of recurrent stroke at 5 years after the first-ever stroke in rural China: a population-based stroke surveillance from 1992 to 2017. Aging (Albany NY) 2020; 11:1686-1694. [PMID: 30888967 PMCID: PMC6461163 DOI: 10.18632/aging.101862] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/06/2019] [Indexed: 01/01/2023]
Abstract
Recent data on the incidence and trends for recurrent strokes in China are scarce. We assessed the temporal trends in recurrent stroke incidence using in rural China. The age-standardized incidences of recurrent stroke, within 5 years of the incident stroke event, were estimated for 3 time periods: 1992–1998, 1999–2005, and 2006–2012. Among the 768 documented incident stroke cases, 26.3% of the patients experienced recurrent stroke within 5 years. The overall age-adjusted recurrent stroke incidence was 43.93 per 100,000 person-years (1992–2012). During the 2006–2012 period, the recurrent stroke incidence per 100,000 person-years was 107.79 in men, and 557.76 in individuals ≥65 years old. There were significant upward tendencies observed in this population across sex, age, or type of stroke (except for among individuals ≥65 years old with incident intracerebral hemorrhages). Compared with the recurrent stroke incidence observed in the 1992–1998 period, that observed during the 2006–2012 period was more than 3-fold higher; the greatest increase (6.8-fold) was observed in women. These findings suggest an urgent need to improve risk factor management and implement appropriate medical resources to contain this upward trend in recurrent stroke incidence and reduce the overall stroke burden in China.
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Affiliation(s)
- Wenjuan Zhao
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300350, China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin 300350, China
| | - Jialing Wu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300350, China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin 300350, China
| | - Jie Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Yanan Wu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Jingxian Ni
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Hongfei Gu
- Department of Neurology, Tianjin Haibin People's Hospital, Tianjin 300280, China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Zhongping An
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300350, China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin 300350, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
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23
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Lernfelt G, Mandalenakis Z, Hornestam B, Lernfelt B, Rosengren A, Sundh V, Hansson PO. Atrial fibrillation in the elderly general population: a 30-year follow-up from 70 to 100 years of age. SCAND CARDIOVASC J 2020; 54:232-238. [PMID: 32079431 DOI: 10.1080/14017431.2020.1729399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives. There is limited knowledge of atrial fibrillation (AF) incidence among the very old. Data from longitudinal cohort studies may give us a better insight. The aim of the study was to investigate the incidence rate and prevalence of AF, as well as the impact of AF on mortality, in the general population, from 70 to 100 years of age. Design. This was a population-based prospective cohort study where three representative samples of 70-year-old men and women (n = 2,629) from the Gerontological and Geriatric Populations Studies in Gothenburg (H-70) were included between 1971 and 1982. The participants were examined at age 70 years and were re-examined repeatedly until 100 years of age. AF was diagnosed according to a 12-lead electrocardiogram (ECG) recording at baseline and follow-up examinations, from the Swedish National Patient Register (NPR), or from the Cause of Death Register. Results. The cumulative incidence of AF from 70 to 100 years of age was 65.6% for men and 52.8% for women. Mortality was significantly higher in participants with AF compared with those without, rate ratio (RR) 1.92 (95% CI 1.73-2.14). In a subgroup analysis comprising only participants with AF diagnosed by ECG at screening, the RR for death was 1.29 (95% C.I: 1.03-1.63). Conclusions. Among persons surviving to age 70, the cumulative incidence of AF was over 50% during follow-up. Mortality rate was twice as high in participants with AF compared to participants without AF. Among participants with AF first recorded at a screening examination, the increased risk was only 29%.
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Affiliation(s)
- Gustaf Lernfelt
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Hornestam
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bodil Lernfelt
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Valter Sundh
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Per-Olof Hansson
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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24
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Lu H, Guo Z, Liu J, Zhang H, Zhao W, Wu Y, Ni J, Liu W, Tu J, Wang J, Ning X, Zhang J. Trends in stroke incidence among elderly low-income residents of rural China: a population-based study from 1992 to 2016. Aging (Albany NY) 2019; 10:3438-3449. [PMID: 30487317 PMCID: PMC6286840 DOI: 10.18632/aging.101657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/15/2018] [Indexed: 11/25/2022]
Abstract
In China, >70% of stroke deaths occur in people aged ≥65 years. However, trends in the stroke incidence among elderly people are unclear. We aimed to determine trends in the stroke incidence among elderly people in rural China. This was a population-based surveillance study conducted in Tianjin, China. Stroke events and all deaths were registered annually. Trends and annual proportion of change in incidence of first-ever stroke were evaluated from 1992 to 2016. The age-standardized incidence of first-ever stroke increased annually by 3.7% overall in elderly people (2.7% for men; 5.0% for women; all P<0.05). However, from 2008 to 2016, there was no significant change in the trends of stroke incidence among elderly people, across gender and subtypes. The proportion of elderly patients with first-ever stroke decreased by 1.1% annually. In contrast to young patients, annual changes in the incidence of stroke tended to be slight in elderly patients (3.7% vs. 9.5%) with greater increase in female patients than those in male patients (2.7% vs. 10.3% for men; 5.0% vs. 8.9% for women). Thus, the control of risk factors for stroke among elderly people is crucial, especially among older women, to reduce the burden of stroke in China.
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Affiliation(s)
- Hongyan Lu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Zaiyu Guo
- Department of Neurology, Tianjin TEDA Hospital, Tianjin, 300457, China
| | - Jie Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, China
| | - Heliang Zhang
- Department of Neurology, Tianjin TEDA Hospital, Tianjin, 300457, China
| | - Wei Zhao
- Department of Neurology, Tianjin TEDA Hospital, Tianjin, 300457, China
| | - Yanan Wu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, China
| | - Jingxian Ni
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, China
| | - Wei Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, China
| | - Jianning Zhang
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.,Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
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25
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Nawaz B, Eide GE, Fromm A, Øygarden H, Sand KM, Thomassen L, Næss H, Waje-Andreassen U. Young ischaemic stroke incidence and demographic characteristics - The Norwegian stroke in the young study - A three-generation research program. Eur Stroke J 2019; 4:347-354. [PMID: 31903433 PMCID: PMC6921944 DOI: 10.1177/2396987319863601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/22/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Norwegian Stroke in the Young Study (NOR-SYS) is a three-generation research program of young ischaemic stroke. In this study, we assessed ischaemic stroke incidence, education and work status among young stroke patients. Furthermore, we evaluated the participation of family members for future validated information on hereditary cardiovascular events. PATIENTS AND METHODS Patients aged 15-60 years with radiologically verified acute ischaemic stroke, admitted to Haukeland University Hospital in Bergen, Norway from 2010 to 2015, were included. Patients' partners, common offspring ≥ 18 years and biological parents of patients and partners were invited to participate. Ischaemic stroke incidence was analysed with respect to year, age and sex using multiple logistic regression. RESULTS A total of 385 patients, 260 partners (80.0%) and 414 offspring (74.6%) were clinically examined. The mean annual ischaemic stroke incidence rate was 30.2 per 100,000. Incidence was higher in men, and the difference was accentuated with increasing age (p = 0.008). There was no sex difference in educational status (p = 0.104) in contrast to work status (p < 0.001) for patients. In all, 84.1% of men worked, and of these, 80.3% are fulltime. In all, 74.4% of women worked, and of these, 52.9% are fulltime. Parents participated by returning a questionnaire. For patients, 91 fathers (55.2%) and 142 mothers (57.3%) participated. For partners, 48 fathers (38.4%) and 68 mothers (40.2%) participated. CONCLUSION The mean annual incidence rate of young stroke was 30.2 per 100,000, and the incidence rate was higher in men. Work status was high among both sexes. Active participation rates were high for patients, partners and offspring.
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Affiliation(s)
- Beenish Nawaz
- Department of Clinical Medicine, University of Bergen, Bergen,
Norway
| | - Geir E Eide
- Centre for Clinical Research, Haukeland University Hospital,
Bergen, Norway
- Department of Global Public Health and Primary Care, University
of Bergen, Bergen, Norway
| | - Annette Fromm
- Department of Neurology, Haukeland University Hospital, Bergen,
Norway
| | - Halvor Øygarden
- Department of Neurology, Sørlandet Hospital, Kristiansand,
Norway
| | - Kristin M Sand
- Department of Medicine, Sørlandet Hospital, Flekkefjord,
Norway
| | - Lars Thomassen
- Department of Clinical Medicine, University of Bergen, Bergen,
Norway
- Department of Neurology, Haukeland University Hospital, Bergen,
Norway
| | - Halvor Næss
- Department of Neurology, Haukeland University Hospital, Bergen,
Norway
- SESAM, Centre for Age-related Medicine, Stavanger University
Hospital, Stavanger, Norway
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26
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Lam KH, Blom E, Kwa VIH. Predictors of quality of life 1 year after minor stroke or TIA: a prospective single-centre cohort study. BMJ Open 2019; 9:e029697. [PMID: 31678939 PMCID: PMC6830651 DOI: 10.1136/bmjopen-2019-029697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/05/2019] [Accepted: 10/03/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In patients after a transient ischaemic attack (TIA) or minor stroke, dysfunction is often underestimated by clinical measures due to invisible symptoms, including cognitive and emotional problems. Many of these patients need stroke care programme, but others do not. In this study, we aim to identify potential predictors of quality of life (QoL) in patients with TIA or minor stroke 1 year poststroke to be able to select which of these patients will need aftercare. DESIGN Prospective observational cohort study. SETTING Single-centre hospital in the Netherlands. PARTICIPANTS 120 patients, diagnosed with TIA or minor stroke and discharged without rehabilitation treatment, completed the study. PRIMARY AND SECONDARY OUTCOME MEASURES QoL (RAND-36), anxiety and depressive symptoms (Hospital Anxiety and Depression scale), the degree of disability or functional dependence after stroke (modified Rankin Scale (mRS)) and symptoms of anxiety and depression specific to stroke (SSADQ) were assessed at baseline (2-6 weeks poststroke) and compared with follow-up at 1 year poststroke. RESULTS Depression (B=-1.35, p<0.001) and anxiety (B=-0.57, p=0.041) at baseline predicted a worse mental component of QoL after 1 year. Depression (B=-1.100, p<0.001) at baseline, but also age (B=-0.261, p=0.002) and female sex (B=4.101, p=0.034) predicted a worse physical component of QoL after 1 year. CONCLUSION With the identification of these predictors, we might be able to select more efficiently and timely the patients with TIA or minor stroke who need stroke aftercare.
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Affiliation(s)
- Ka-Hoo Lam
- Department of Neurology, OLVG, Amsterdam, Noord-Holland, Netherlands
| | - Emma Blom
- Department of Neurology, OLVG, Amsterdam, Noord-Holland, Netherlands
| | - Vincent I H Kwa
- Department of Neurology, OLVG, Amsterdam, Noord-Holland, Netherlands
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27
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Ekker MS, Verhoeven JI, Vaartjes I, Jolink WMT, Klijn CJM, de Leeuw FE. Association of Stroke Among Adults Aged 18 to 49 Years With Long-term Mortality. JAMA 2019; 321:2113-2123. [PMID: 31121602 PMCID: PMC6547225 DOI: 10.1001/jama.2019.6560] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Stroke remains the second leading cause of death worldwide. Approximately 10% to 15% of all strokes occur in young adults. Information on prognosis and mortality specifically in young adults is limited. OBJECTIVE To determine short- and long-term mortality risk after stroke in young adults, according to age, sex, and stroke subtype; time trends in mortality; and causes of death. DESIGN, SETTING, AND PARTICIPANTS Registry- and population-based study in the Netherlands of 15 527 patients aged 18 to 49 years with first stroke between 1998 and 2010, and follow-up until January 1, 2017. Patients and outcomes were identified through linkage of the national Hospital Discharge Registry, national Cause of Death Registry, and the Dutch Population Register. EXPOSURES First stroke occurring at age 18 to 49 years, documented using International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes for ischemic stroke, intracerebral hemorrhage, and stroke not otherwise specified. MAIN OUTCOMES AND MEASURES Primary outcome was all-cause cumulative mortality in 30-day survivors at end of follow-up, stratified by age, sex, and stroke subtype, and compared with all-cause cumulative mortality in the general population. RESULTS The study population included 15 527 patients with stroke (median age, 44 years [interquartile range, 38-47 years]; 53.3% women). At end of follow-up, a total of 3540 cumulative deaths had occurred, including 1776 deaths within 30 days after stroke and 1764 deaths (23.2%) during a median duration of follow-up of 9.3 years (interquartile range, 5.9-13.1 years). The 15-year mortality in 30-day survivors was 17.0% (95% CI, 16.2%-17.9%). The standardized mortality rate compared with the general population was 5.1 (95% CI, 4.7-5.4) for ischemic stroke (observed mortality rate 12.0/1000 person-years [95% CI, 11.2-12.9/1000 person-years]; expected rate, 2.4/1000 person-years; excess rate, 9.6/1000 person-years) and the standardized mortality rate for intracerebral hemorrhage was 8.4 (95% CI, 7.4-9.3; observed rate, 18.7/1000 person-years [95% CI, 16.7-21.0/1000 person-years]; expected rate, 2.2/1000 person-years; excess rate, 16.4/1000 person-years). CONCLUSIONS AND RELEVANCE Among young adults aged 18 to 49 years in the Netherlands who were 30-day survivors of first stroke, mortality risk compared with the general population remained elevated up to 15 years later.
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Affiliation(s)
- Merel Sanne Ekker
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Jamie Inge Verhoeven
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wilhelmus Martinus Tim Jolink
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Catharina Johanna Maria Klijn
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Nijmegen, the Netherlands
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank-Erik de Leeuw
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Nijmegen, the Netherlands
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Ekker MS, Verhoeven JI, Vaartjes I, van Nieuwenhuizen KM, Klijn CJM, de Leeuw FE. Stroke incidence in young adults according to age, subtype, sex, and time trends. Neurology 2019; 92:e2444-e2454. [PMID: 31019103 DOI: 10.1212/wnl.0000000000007533] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/22/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate incidence of stroke and its subtypes in young adults, according to sex and age, and to study trends over time. METHODS We established a nationwide cohort through linkage of national registries (hospital discharge, cause of death, and population register) with patients aged 18-50 years and those ≥50 years with first-ever ischemic stroke, intracerebral hemorrhage, or unspecified stroke, using ICD-9/ICD-10 codes between 1998 and 2010 in the Netherlands. Outcomes were yearly incidence of stroke stratified by age, sex, and stroke subtype, its changes over time, and comparison of incidence in patients 18-50 years to patients ≥50 years. RESULTS We identified 15,257 patients (53% women; mean age 41.8 years). Incidence increased exponentially with age (R 2 = 0.99) and was higher for women than men, most prominently in the youngest patients (18-44 years). The relative proportion of ischemic stroke increased with age (18-24 years: 38.3%; 44-49 years: 56.5%), whereas the relative proportion of intracerebral hemorrhage decreased (18-24 years: 34.0%; 44-49 years: 18.3%). Incidence of any stroke in young adults increased (1998: 14.0/100,000 person-years: 2010: 17.2; +23%; p < 0.001), driven by an increase in those aged over 35 years and ischemic stroke incidence (46%), whereas incidence decreased in those ≥50 years (329.1%-292.2%; -11%; p = 0.009). CONCLUSIONS Incidence of any stroke in the young increases with age in patients over 35, is higher in women than men aged 18-44 years, and has increased by 23% in one decade, through an increase in ischemic stroke. Incidence of intracerebral hemorrhage is comparable for women and men and remained stable over time.
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Affiliation(s)
- Merel S Ekker
- From the Department of Neurology (M.S.E., J.I.V., C.J.M.K., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; and Julius Center for Health Sciences and Primary Care (I.V.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (K.M.v.N., C.J.M.K.), University Medical Center Utrecht, the Netherlands
| | - Jamie I Verhoeven
- From the Department of Neurology (M.S.E., J.I.V., C.J.M.K., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; and Julius Center for Health Sciences and Primary Care (I.V.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (K.M.v.N., C.J.M.K.), University Medical Center Utrecht, the Netherlands
| | - Ilonca Vaartjes
- From the Department of Neurology (M.S.E., J.I.V., C.J.M.K., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; and Julius Center for Health Sciences and Primary Care (I.V.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (K.M.v.N., C.J.M.K.), University Medical Center Utrecht, the Netherlands
| | - Koen M van Nieuwenhuizen
- From the Department of Neurology (M.S.E., J.I.V., C.J.M.K., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; and Julius Center for Health Sciences and Primary Care (I.V.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (K.M.v.N., C.J.M.K.), University Medical Center Utrecht, the Netherlands
| | - Catharina J M Klijn
- From the Department of Neurology (M.S.E., J.I.V., C.J.M.K., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; and Julius Center for Health Sciences and Primary Care (I.V.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (K.M.v.N., C.J.M.K.), University Medical Center Utrecht, the Netherlands
| | - Frank-Erik de Leeuw
- From the Department of Neurology (M.S.E., J.I.V., C.J.M.K., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; and Julius Center for Health Sciences and Primary Care (I.V.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (K.M.v.N., C.J.M.K.), University Medical Center Utrecht, the Netherlands.
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Malperfusion in acute type A aortic dissection: An update from the Nordic Consortium for Acute Type A Aortic Dissection. J Thorac Cardiovasc Surg 2019; 157:1324-1333.e6. [DOI: 10.1016/j.jtcvs.2018.10.134] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 09/21/2018] [Accepted: 10/16/2018] [Indexed: 11/22/2022]
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van Baal P, Perry‐Duxbury M, Bakx P, Versteegh M, van Doorslaer E, Brouwer W. A cost-effectiveness threshold based on the marginal returns of cardiovascular hospital spending. HEALTH ECONOMICS 2019; 28:87-100. [PMID: 30273967 PMCID: PMC6585934 DOI: 10.1002/hec.3831] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/19/2018] [Accepted: 07/02/2018] [Indexed: 05/17/2023]
Abstract
Traditionally, threshold levels of cost-effectiveness have been derived from willingness-to-pay studies, indicating the consumption value of health (v-thresholds). However, it has been argued that v-thresholds need to be supplemented by so-called k-thresholds, which are based on the marginal returns to health care. The objective of this research is to estimate a k-threshold based on the marginal returns to cardiovascular disease (CVD) hospital care in the Netherlands. To estimate a k-threshold for hospital care on CVD, we proceed in two steps: First, we estimate the impact of hospital spending on mortality using a Bayesian regression modelling framework, using data on CVD mortality and CVD hospital spending by age and gender for the period 1994-2010. Second, we use life tables in combination with quality of life data to convert these estimates into a k-threshold expressed in euros per quality-adjusted life year gained. Our base case estimate resulted in an estimate of 41,000 per quality-adjusted life year gained. In our sensitivity analyses, we illustrated how the incorporation of prior evidence into the estimation pushes estimates downwards. We conclude that our base case estimate of the k-threshold may serve as a benchmark value for decision making in the Netherlands as well as for future research regarding k-thresholds.
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Affiliation(s)
- Pieter van Baal
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Meg Perry‐Duxbury
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Pieter Bakx
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Matthijs Versteegh
- Institute for Medical Technology AssessmentErasmus University RotterdamRotterdamThe Netherlands
| | - Eddy van Doorslaer
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
- Department of Applied EconomicsErasmus School of EconomicsRotterdamThe Netherlands
| | - Werner Brouwer
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
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Lakomkin N, Dhamoon M, Carroll K, Singh IP, Tuhrim S, Lee J, Fifi JT, Mocco J. Prevalence of large vessel occlusion in patients presenting with acute ischemic stroke: a 10-year systematic review of the literature. J Neurointerv Surg 2018; 11:241-245. [PMID: 30415226 DOI: 10.1136/neurintsurg-2018-014239] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/12/2018] [Accepted: 10/19/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Accurate assessment of the prevalence of large vessel occlusion (LVO) in patients presenting with acute ischemic stroke (AIS) is critical for optimal resource allocation in neurovascular intervention. OBJECTIVE To perform a systematic review of the literature in order to identify the proportion of patients with AIS presenting with LVO on image analysis. METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in order to identify studies reporting LVO rates for patients presenting with AIS. Studies that included patients younger than 18 years, were non-clinical, or did not report LVO rates in the context of a consecutive AIS series were excluded. Characteristics regarding presentation, diagnosis, and LVO classification were recorded for each paper. RESULTS Sixteen studies, spanning a total of 11 763 patients assessed for stroke, were included in the qualitative synthesis. The majority (10/16) of articles reported LVO rates exceeding 30% in patients presenting with AIS. There was substantial variability in the LVO definitions used, with nine unique classification schemes among the 16 studies. The mean prevalence of LVO was 31.1% across all studies, and 29.3% when weighted by the number of patients included in each study. CONCLUSIONS Despite the wide variability in LVO classification, the majority of studies in the last 10 years report a high prevalence of LVO in patients presenting with AIS. These rates of LVO may have implications for the volume of patients with AIS who may benefit from endovascular therapy.
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Affiliation(s)
- Nikita Lakomkin
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mandip Dhamoon
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kirsten Carroll
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Inder Paul Singh
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Stanley Tuhrim
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Joyce Lee
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
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Ramírez-Moreno JM, Felix-Redondo FJ, Fernández-Bergés D, Lozano-Mera L. Trends in stroke hospitalisation rates in Extremadura between 2002 and 2014: Changing the notion of stroke as a disease of the elderly. Neurologia 2018; 33:561-569. [PMID: 27776958 DOI: 10.1016/j.nrl.2016.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 09/08/2016] [Accepted: 09/10/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The incidence of stroke in Spain has been evaluated in several studies, whose results are highly variable and not comparable. No studies of stroke have analysed epidemiological changes in younger patients. METHOD We conducted a retrospective observational study using the Spanish health system's Minimum Data Set and included all patients older than 19 hospitalised due to stroke (ICD-9-CM codes 434.01, 434.11, 434.91, 430, 431, 432.9, 436, and 435) between 2002 and 2013. The analysis was performed using joinpoint regression. RESULTS A total of 39,321 patients were identified (47.25% were women); 3.73% were aged 20-44, 6.29% were 45-54, 11.49% were 55-64, 23.89% were 65-74, and 54.60% were > 74 years. The hospitalisation rate due to ischaemic stroke has increased significantly in men aged 45-54 (+6.7%; 95% CI, 3.3-10.2) and in women aged 20-44 and 45-54 (+6.1%; 95% CI, 0.8-11.7 and +5.7%; 95% CI, 3.0-8.4, respectively). We also observed a significant increase in the rate of hospitalisation due to ischaemic stroke in men aged over 74 (+4.2%; 95% CI, 1.3-7.2). The rate of hospitalisations due to transient ischaemic attack has also increased significantly whereas the rate of hospitalisations due to brain haemorrhage has stabilised over time. CONCLUSIONS Our results provide indirect evidence that the epidemiological profile of stroke is changing based on the increase in hospitalisation rates in young adults.
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Affiliation(s)
- J M Ramírez-Moreno
- Sección de Neurología, Hospital Universitario Infanta Cristina, Badajoz, España; Departamento de Ciencias Biomédicas, Facultad de Medicina, Universidad de Extremadura, Badajoz, España.
| | - F J Felix-Redondo
- Centro de Salud Villanueva Norte, Villanueva de la Serena, Badajoz, España; Unidad de Investigación Área sanitaria de Don Benito-Villanueva, Grupo GRIMEX, Badajoz, España
| | - D Fernández-Bergés
- Unidad de Investigación Área sanitaria de Don Benito-Villanueva, Grupo GRIMEX, Badajoz, España
| | - L Lozano-Mera
- Subdirección de Sistemas de Información, Servicio Extremeño de Salud, Mérida, Badajoz, España
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Rücker V, Wiedmann S, O’Flaherty M, Busch MA, Heuschmann PU. Decline in Regional Trends in Mortality of Stroke Subtypes in Germany From 1998 to 2015. Stroke 2018; 49:2577-2583. [DOI: 10.1161/strokeaha.118.023193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Viktoria Rücker
- From the Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany (V.R., S.W., P.U.H.)
| | - Silke Wiedmann
- From the Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany (V.R., S.W., P.U.H.)
| | - Martin O’Flaherty
- Department of Public Health and Policy, Institute of Psychology, Health, and Society, University of Liverpool, United Kingdom (M.O.)
| | - Markus A. Busch
- Department of Epidemiology, Robert Koch Institute, Berlin, Germany (M.A.B.)
| | - Peter U. Heuschmann
- From the Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany (V.R., S.W., P.U.H.)
- Comprehensive Heart Failure, University of Würzburg, Germany (P.U.H.)
- Center for Clinical Studies, University Hospital Würzburg, Germany (P.U.H.)
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Trends in stroke hospitalisation rates in Extremadura between 2002 and 2014: Changing the notion of stroke as a disease of the elderly. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Stroke incidence in the young: evidence from a Norwegian register study. J Neurol 2018; 266:68-84. [PMID: 30377817 PMCID: PMC6342904 DOI: 10.1007/s00415-018-9102-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/19/2018] [Accepted: 10/21/2018] [Indexed: 02/03/2023]
Abstract
Introduction While there is a general agreement that stroke incidence among the elderly is declining in the developed world, there is a concern that it may be increasing among the young. The present study investigates this issue for the Norwegian population for the years 2010–2015. Cerebrovascular accidents (CVAs) for patients younger than 55 years were identified through the Norwegian Patient Registry and the Norwegian Cause-of-death Registry. Methods Negative binomial regression modelling was used to estimate temporal trends in the CVA incidence rates for the young, aged 15–54, with 10-year sub-intervals, and for children below the age of 18. The main outcomes were CVA incidence per 100,000 person-years at risk (PY), 30-day stroke mortality per 100,000 PY, and 30-day case-fatality rates. Results The analysis showed a negative and non-significant temporal trend in the CVA incidence (\documentclass[12pt]{minimal}
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\begin{document}$$p = 0.052$$\end{document}p=0.052) as well as for 30-day mortality (\documentclass[12pt]{minimal}
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\begin{document}$$p = 0.074$$\end{document}p=0.074) for the age group 15–54. Overall, the inclusion of an interaction for age in the bracket 45–54 suggested that any temporal decline is restricted to this age bracket. The analyses of the 10-year age brackets 15–24, 25–34, and 34–45, provided evidence neither for an increase, nor for a decrease, in incidence. Among the children, the estimated temporal coefficients were positive, but non-significant, consistent with a stationary trend. Conclusion Weak statistical evidence was found for a decline in CVA incidence and for overall stroke 30-day case fatality for 15–54 year olds, but the decline was significant only for the 45–54 age band. All results considered, the study suggests a stationary or decreasing temporal trend in CVA incidence and stroke fatality for children (0–18) and young (15–54) in Norway. Even larger data sets are needed to estimate these temporal trends accurately.
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Time trends in stroke incidence and in prevalence of risk factors in Southern Germany, 1989 to 2008/09. Sci Rep 2018; 8:11981. [PMID: 30097633 PMCID: PMC6086828 DOI: 10.1038/s41598-018-30350-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/24/2018] [Indexed: 11/08/2022] Open
Abstract
In prior studies, stroke incidence has mainly shown either declining time trends or stable rates in high-income countries. Changes could partially be linked to trends in classic cardiovascular disease (CVD) risk factors. In the present study, we analyzed the incidence of stroke in parallel with the prevalence of CVD risk factors over time in a German population. Data from three independent population-based MONICA/KORA Augsburg surveys conducted in 1989/90 (S2), 1994/95 (S3), and 1999/2001 (S4) were used to calculate age-standardized incidence rates (IR) of first-ever stroke over eight years from each baseline survey. Furthermore, the age-standardized prevalence rates of CVD risk factors were analyzed for these surveys. Changes in IR or prevalence were considered significantly different if their 95% confidence intervals (CI) did not overlap. The age-standardized IR of stroke showed no significant time trend (S2: IR = 203.4 per 100,000 person-years; CI 176.4-233.4, S3: IR = 225.6; 197.1-257.0, S4: IR = 209.9; CI 182.4-240.3). In agreement, the prevalence of the CVD risk factors was quite stable over time, showing divergent, but mostly non-significant changes. However, due to the aging Western societies and the longer survival time of stroke patients, the total number of stroke patients in the population will increase even with a stable IR.
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Guéniat J, Brenière C, Graber M, Garnier L, Mohr S, Giroud M, Delpont B, Blanc-Labarre C, Durier J, Giroud M, Béjot Y. Increasing Burden of Stroke: The Dijon Stroke Registry (1987–2012). Neuroepidemiology 2018; 50:47-56. [DOI: 10.1159/000486397] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/17/2017] [Indexed: 11/19/2022] Open
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Lecoffre C, de Peretti C, Gabet A, Grimaud O, Woimant F, Giroud M, Béjot Y, Olié V. National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014. Stroke 2017; 48:2939-2945. [DOI: 10.1161/strokeaha.117.017640] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/12/2017] [Accepted: 08/11/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Camille Lecoffre
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
| | - Christine de Peretti
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
| | - Amélie Gabet
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
| | - Olivier Grimaud
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
| | - France Woimant
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
| | - Maurice Giroud
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
| | - Yannick Béjot
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
| | - Valérie Olié
- From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184,
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Saxena S, Hillis AE. An update on medications and noninvasive brain stimulation to augment language rehabilitation in post-stroke aphasia. Expert Rev Neurother 2017; 17:1091-1107. [PMID: 28847186 DOI: 10.1080/14737175.2017.1373020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Aphasia is among the most debilitating outcomes of stroke. Aphasia is a language disorder occurring in 10-30% of stroke survivors. Speech and Language Therapy (SLT) is the gold standard, mainstay treatment for aphasia, but gains from SLT may be incomplete. Pharmaceutical and noninvasive brain stimulation (NIBS) techniques may augment the effectiveness of SLT. Areas covered: Herein reviewed are studies of the safety and efficacy of these adjunctive interventions for aphasia, including randomized placebo-controlled and open-label trials, as well as case series from Pubmed, using search terms 'pharmacological,' 'tDCS' or 'TMS' combined with 'aphasia' and 'stroke.' Expert commentary: Relatively small studies have included participants with a range of aphasia types and severities, using inconsistent interventions and outcome measures. Results to-date have provided promising, but weak to moderate evidence that medications and/or NIBS can augment the effects of SLT for improving language outcomes. We end with recommendations for future approaches to studying these interventions, with multicenter, double-blind, randomized controlled trials.
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Affiliation(s)
- Sadhvi Saxena
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Argye E Hillis
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Luker J, Murray C, Lynch E, Bernhardsson S, Shannon M, Bernhardt J. Carers' Experiences, Needs, and Preferences During Inpatient Stroke Rehabilitation: A Systematic Review of Qualitative Studies. Arch Phys Med Rehabil 2017; 98:1852-1862.e13. [DOI: 10.1016/j.apmr.2017.02.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/30/2017] [Accepted: 02/25/2017] [Indexed: 10/19/2022]
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Widimsky P, Doehner W, Diener HC, Van Gelder IC, Halliday A, Mazighi M. The role of cardiologists in stroke prevention and treatment: position paper of the European Society of Cardiology Council on Stroke. Eur Heart J 2017; 39:1567-1573. [DOI: 10.1093/eurheartj/ehx478] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/01/2017] [Indexed: 02/03/2023] Open
Affiliation(s)
- Petr Widimsky
- Third Faculty of Medicine, Cardiocenter, Charles University, University Hospital Kralovske Vinohrady, Srobárova 50, 100 00 Prague, Czech Republic
| | - Wolfram Doehner
- Center for Stroke Research Berlin and Department of Cardiology, Campus Virchow, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Charite Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Hans Christoph Diener
- Department of Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Isabelle C Van Gelder
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alison Halliday
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Mikael Mazighi
- Stroke Unit Lariboisière Hospital, Interventional Neuroradiology Fondation Rothschild, Denis Diderot University, 2 rue Ambroise Paré, Paris 75010, France
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Huangfu X, Zhu Z, Zhong C, Bu X, Zhou Y, Tian Y, Batu B, Xu T, Wang A, Li H, Zhang M, Zhang Y. Smoking, Hypertension, and Their Combined Effect on Ischemic Stroke Incidence: A Prospective Study among Inner Mongolians in China. J Stroke Cerebrovasc Dis 2017; 26:2749-2754. [PMID: 28797615 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/22/2017] [Accepted: 06/28/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We intended to investigate the combined effect of smoking and hypertension on ischemic stroke incidence based on a 10-year prospective study among Inner Mongolians in China. METHODS A prospective cohort study from June 2003 to July 2012 was conducted among 2589 participants aged 20 years and older from Inner Mongolia, China. We categorized the participants into 4 subgroups according to the status of smoking and hypertension. The cumulative incidence rates of ischemic stroke among the 4 subgroups were estimated using Kaplan-Meier curves and compared by log-rank test. Cox proportional hazard model was used to compute hazard ratios of ischemic stroke across the 4 subgroups after adjusting for important confounding factors. RESULTS The cumulative incidence rates of ischemic stroke were .85%, 2.05%, 3.19%, and 8.14% among non-hypertension/non-smokers, non-hypertension/smokers, hypertension/non-smokers, and hypertension/smokers, respectively. The multivariable-adjusted hazard ratios [95% confidence intervals] of ischemic stroke for hypertension and smoking were 1.84 [1.05-3.23] and 1.89 [1.11-3.22], respectively. The hazard ratios [95% confidence intervals] of ischemic stroke for non-hypertension/smokers, hypertension/non-smokers, and hypertension/smokers were 1.37 [.56-3.33], 1.34 [.54-3.29], and 2.93 [1.26-6.83], respectively, compared with the non-hypertension/non-smokers. Significant interaction was detected between smoking and hypertension on the risk of ischemic stroke. CONCLUSIONS Our study indicated that participants with coexistence of smoking and hypertension were at the highest risk for ischemic stroke. There was a significant interaction between smoking and hypertension on the risk of ischemic stroke.
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Affiliation(s)
- Xinfeng Huangfu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Zhengbao Zhu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Xiaoqing Bu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Yipeng Zhou
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Yunfan Tian
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Buren Batu
- Department of Epidemiology, Tongliao Center for Disease Prevention and Control, Tongliao, China
| | - Tian Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Aili Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Hongmei Li
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Mingzhi Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China.
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Wu J, Lin B, Liu W, Huang J, Shang G, Lin Y, Wang L, Chen L, Tao J. Roles of electro-acupuncture in glucose metabolism as assessed by 18F-FDG/PET imaging and AMPKα phosphorylation in rats with ischemic stroke. Int J Mol Med 2017; 40:875-882. [PMID: 28713979 DOI: 10.3892/ijmm.2017.3057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 06/27/2017] [Indexed: 11/06/2022] Open
Abstract
Targeted energy metabolism balance contributes to neural survival during ischemic stroke. Herein, we tested the hypothesis that electro‑acupuncture (EA) can enhance cerebral glucose metabolism assessed by 18F‑fluorodeoxyglucose/positron emission tomography (18F‑FDG/PET) imaging to prevent propagation of tissue damage and improve neurological outcome in rats subjected to ischemia and reperfusion injury. Rats underwent middle cerebral artery occlusion (MCAO) and received EA treatment at the LI11 and ST36 acupoints or non‑acupoint treatment once a day for 7 days. After EA treatment, a significant reduction in the infarct volume was determined by T2‑weighted imaging, accompanied by the functional recovery in CatWalk and Rota-rod performance. Moreover, EA promoted higher glucose metabolism in the caudate putamen (CPu), motor cortex (MCTX), somatosensory cortex (SCTX) regions as assessed by animal 18F‑FDG/PET imaging, suggesting that three‑brain regional neural activity was enhanced by EA. In addition, the AMP‑activated protein kinase α (AMPKα) in the CPu, MCTX and SCTX regions was phosphorylated at threonine 172 (Thr172) after ischemic injury; however, phosphorylation of AMPK was further increased by EA. These results indicate that EA could promote AMPKα phosphorylation of the CPu, MCTX and SCTX regions to enhance neural activity and motor functional recovery after ischemic stroke.
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Affiliation(s)
- Jingsong Wu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
| | - Bingbing Lin
- Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian 350001, P.R. China
| | - Weilin Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
| | - Jia Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
| | - Guanhao Shang
- Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian 350001, P.R. China
| | - Yunjiao Lin
- Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian 350001, P.R. China
| | - Lulu Wang
- Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian 350001, P.R. China
| | - Lidian Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
| | - Jing Tao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
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Abstract
OBJECTIVE The prevalence of stroke is expected to increase partly because of prolonged life expectancy in the general population. The objective of this study was to investigate trends in the prevalence of patients hospitalized with ischemic stroke (IS) in Sweden from 1995-2010. METHODS The Swedish inpatient and cause-specific death registries were used to estimate the absolute numbers and prevalence of patients who were hospitalized with and survived an IS from 1995-2010. RESULTS The overall number of IS increased from 129,418 in 1995 to 148,778 in 2010. In 1995, the prevalence of IS was 189 patients per 10,000 population. An increase in overall prevalence was observed until 2000, and then it remained stable, followed by a decline with an annual percentage change of (APC) -0.8% (95% CI -1.0 to 0.6) and with a final prevalence of 199 patients per 10,000 population in 2010. The prevalence of IS in people aged <45 years increased from 6.4 in 1995 to 7.6 patients per 10,000 population in 2010, with an APC of 2.1% (95% CI 0.9 to 3.4) from 1995-1998 and 0.7% (95% CI 0.6-0.9) from 1998-2010. Among those aged 45-54 years, the prevalence rose through the mid to late 1990s, followed by a slight decrease (APC: -0.7%, 95% CI-1.1 to -0.4) until 2006 and then remained stable with a prevalence of 43.8 patients per 10,000 population in 2010. Among ≥85 years, there was a minor decrease (APC: -0.3%, 95% CI -0.5 to -0.1) in overall prevalence after 2002 from 1481 to 1453 patients per 10,000 population in 2010. CONCLUSION The overall prevalence of IS increased until 2000, but then remained stable followed by a slight decline. However, the prevalence of IS in the young increased through the study period. The absolute number of IS survivors has markedly increased, mainly because of demographic changes.
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Eriksson SE. Secondary prophylactic treatment and long-term prognosis after TIA and different subtypes of stroke. A 25-year follow-up hospital-based observational study. Brain Behav 2017; 7:e00603. [PMID: 28127521 PMCID: PMC5256186 DOI: 10.1002/brb3.603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/29/2016] [Accepted: 10/10/2016] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To assess long-term prognosis after transient ischemic attack (TIA)/subtypes of stroke relative to secondary prophylactic treatment(s) given. MATERIALS AND METHODS Retro/prospective follow-up of patients hospitalized in the Stroke Unit or in the Department of Neurology, Linköping, in 1986 and followed up to Feb. 2011. RESULTS A total of 288 men were followed up for 2254 years (mean 7.8 years) and 261 women for 1984 years (mean 7.6 years). In men, the distribution to anticoagulants (AC) (warfarin treatment) was 18%, antiplatelet therapy (APT) usually ASA 75 mg/day 54%, untreated 27%, unknown 2%. In women, the distribution to AC was 15%, APT 60%, untreated 23%, unknown 2%, respectively. Mortality rates at 1 year, 10 years, and 25 years for men were 21%, 67%, and 93%, respectively, versus the rates in women of 24%, 71%, and 90%, respectively. Survival curves showed markedly increased risk of death compared to the normal population. AC treatment was more favorable for men regarding the annual risk of stroke, compared with APT (9.4% vs. 9.8%), as well as the risks of MI, (5.6% vs. 6.7%), and death (8.1% vs. 10.3%), compared to women for stroke (11.6% vs. 8.8%) and MI (5.3% vs. 3.7%) but not for death (8.3% vs. 8.4%). The risk of fatal bleeding was 0.86% annually on AC compared to 0.17% on APT. According to Cox regression analysis included patients with TIA/ischemic stroke, first-line treatment had beneficial effects on survival: AC OR 0.67 (0.5-0.9), APT 0.67 (0.52-0.88) versus untreated. CONCLUSIONS Patients with a history of TIA/stroke had a higher mortality rate versus controls, providing support for both primary and secondary prophylaxis regarding vascular risk factors for death. This study also provided support for secondary prophylactic treatment with either AC or ASA (75 mg once daily) to reduce the vascular risk of death unless there are contraindications.
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Affiliation(s)
- Sven-Erik Eriksson
- Division of Neurology Department of Medicine Falun Hospital Falun Sweden
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Klaer J, Mähler A, Scherbakov N, Klug L, von Haehling S, Boschmann M, Doehner W. Longer-term impact of hemiparetic stroke on skeletal muscle metabolism-A pilot study. Int J Cardiol 2016; 230:241-247. [PMID: 28063669 DOI: 10.1016/j.ijcard.2016.12.143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hemiparetic stroke leads to structural and metabolic alterations of skeletal muscle tissue, thereby contributing to functional impairment associated with stroke. In situ metabolic processes at tissue level in skeletal muscle have not been investigated. We hypothesize that muscular metabolic capacity is limited after hemiparetic stroke, and that changes affect rather the paretic than non-paretic limb. METHODS Nine male hemiparetic stroke survivors (age, 62±8years; BMI, 28±4kg/m2; median stroke latency, 23months ranging from 7 to 34months poststroke) underwent dynamic in situ measurements of carbohydrate and lipid metabolism at fasting condition and during oral glucose tolerance testing, using bilateral microdialysis. Results were compared to 8 healthy male subjects of similar age and BMI. RESULTS Tissue perfusion, fasting and postprandial profiles of interstitial metabolites glucose, pyruvate, lactate and glycerol did not differ between paretic and non-paretic muscle. Patients displayed higher fasting and postprandial dialysate glycerol levels compared to controls (P<0.001) with elevated plasma FFA (fasting FFA; 0.63±0.23 vs. 0.29±0.17mmol/L; P=0.004). Glycolytic activity was higher in patients vs. controls, with increased lactate production upon glucose load (P<0.001). CONCLUSIONS An elevated lipolytic and glycolytic activity on tissue level suggests an impaired substrate metabolism with blunted oxidative metabolism in bilateral skeletal muscle in patients after hemiparetic stroke. Muscular metabolic properties did not differ between paretic and non-paretic leg. Further work is needed to investigate the clinical impact of this impaired muscular metabolic capacity in post-stroke patients.
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Affiliation(s)
- Jennifer Klaer
- Center for Stroke Research Berlin, Charité Medical School Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Anja Mähler
- Experimental and Clinical Research Center-a joint co-operation between Charité Medical School Berlin and Max Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Nadja Scherbakov
- Center for Stroke Research Berlin, Charité Medical School Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Lars Klug
- Experimental and Clinical Research Center-a joint co-operation between Charité Medical School Berlin and Max Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Stephan von Haehling
- Division of Innovative Clinical Trials, Department of Cardiology, University Medical Center Göttingen (UMG), RobertKochStr. 40, 37075 Göttingen, Germany
| | - Michael Boschmann
- Experimental and Clinical Research Center-a joint co-operation between Charité Medical School Berlin and Max Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Wolfram Doehner
- Center for Stroke Research Berlin, Charité Medical School Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; Department of Cardiology, Charité Medical School Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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Pasterkamp G, den Ruijter HM, Libby P. Temporal shifts in clinical presentation and underlying mechanisms of atherosclerotic disease. Nat Rev Cardiol 2016; 14:21-29. [DOI: 10.1038/nrcardio.2016.166] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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D'Ascenzo F, Quadri G, Cerrato E, Calcagno A, Omedè P, Grosso Marra W, Abbate A, Bonora S, Biondi Zoccai G, Moretti C, Gaita F. A meta-analysis investigating incidence and features of stroke in HIV-infected patients in the highly active antiretroviral therapy era. J Cardiovasc Med (Hagerstown) 2016; 16:839-43. [PMID: 24979113 DOI: 10.2459/jcm.0b013e328365ca31] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Recent studies have suggested a close biological and clinical association between HIV infection and risk of myocardial infarction, whereas contrasting data have been reported about incidence of stroke and its clinical predictors. DESIGN AND SETTING Studies including HIV-infected patients developing a cerebral ischemic event were systematically searched for in MEDLINE/PubMed. PATIENTS AND MAIN OUTCOME MEASURES Baseline, treatment and outcome data were appraised and pooled with random-effects methods computing summary estimates (95% confidence intervals). RESULTS Five studies comprising 89,713 participants were included: they were young [46 (46-50) years, mainly male (70% (68-79)] with a moderate prevalence of diabetes [19% (14-21)]. Atrial fibrillation and history of previous coronary artery disease were observed in 3% (2-5) and 18% (15-22), respectively. All patients were on highly active antiretroviral therapy (HAART) and had been treated for a mean of 5 (2-6) years. After a median of 4 (3-5) years of follow-up, 1245 ischemic strokes occurred [1.78% (0.75-2.81)]. Traditional risk factors such as age (five studies), hypertension (three studies), smoking (two studies), hyperlipidemia (one study), atrial fibrillation (one study) and diabetes (one study) were identified as independent predictors of stroke. In one study, RNA viral load [log of odds ratio = 1.10 (1.04-1.17)] and CD4+ cell count less than 200/μl were clinically related to stroke, whereas HAART therapy showed a neutral effect. CONCLUSION Stroke represents a relatively common complication in young, HAART-treated HIV patients. Apart from traditional cardiovascular risk factors, HIV-RNA viral load may help to target and manage patients at risk.
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Affiliation(s)
- Fabrizio D'Ascenzo
- aDivision of Cardiology, University of Turin, Turin bDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy cVCU Pauley Heart Center, Richmond, Virginia, USA dUnit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin eMeta-analysis and Evidence Based Medicine Training in Cardiology (METCARDIO), Ospedaletti, Italy
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Kazlauskas HA, Raskauskiene N, Radziuviene R, Janusonis V. Twenty years trends in mortality rates from stroke in Klaipeda. Brain Behav 2016; 6:e00499. [PMID: 27547501 PMCID: PMC4893389 DOI: 10.1002/brb3.499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 04/02/2016] [Accepted: 04/27/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND During the past decades, mortality from stroke decreased in many western European countries; however, changes concerning long-term stroke mortality in eastern European countries are less evident. OBJECTIVE To assess age- and gender-specific trends in stroke mortality in Klaipeda (Lithuania) from 1994 to 2013. DESIGN Descriptive epidemiological study. SETTING/SUBJECTS Permanent population of Klaipeda. METHODS Data on 2509 permanent residents of Klaipeda aged 35-79 years who died from stroke between 1994 and 2013 were gathered. Directly, age-standardized (European population) stroke mortality rates were analyzed using joinpoint regression separately for specific age groups (35-64, 65-79, and 35-79 years) and by gender. Annual percentage change (APC) and 95% CIs were presented. RESULTS Stroke mortality in the 35- to 79-year-old age group peaked in 1994-1997, it then decreased by -9.9% (95% CI: -18.7, -0.2) yearly up until 2001 and leveled off by -0.2% (-5.1, 4.9) between 2001 and 2013. Among men aged 35-64 years, mortality decreased substantially by 12.8% (-21.5, -3.3) per year from 1994 to 2001 and turned positive by 6.3% (0.8, 12.1) between 2000 and 2013. Among women aged 35-64 years, mortality decreased significantly by 15.5% (-28.1, -0.7) from 1994 to 2000. There was evidence of recent plateauing of trends for 35- to 64-year-old women between 2000 and 2013. In the 65- to 79-year-old age group, mortality decreased from 1994 onward yearly by -5.5% (-7.9, -3.0) in women and by -3.3% (-5.6, -0.9) in men. CONCLUSIONS Joinpoint regression revealed steadily decreasing trend in stroke mortality between 1994 and 2001. The decline in death rates flattened out in the recent decade. Mortality rates varied among age groups and were more pronounced in adults aged 35-64 years. It is essential to monitor and manage stroke risk factors, especially among middle-aged population.
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Affiliation(s)
- Henrikas A. Kazlauskas
- Department of Neurology and RehabilitationKlaipeda University HospitalKlaipedaLithuania
- Behavioral Medicine Institute Lithuanian University of Health SciencesPalangaLithuania
| | - Nijole Raskauskiene
- Behavioral Medicine Institute Lithuanian University of Health SciencesPalangaLithuania
| | - Rima Radziuviene
- Behavioral Medicine Institute Lithuanian University of Health SciencesPalangaLithuania
| | - Vinsas Janusonis
- Klaipeda University HospitalKlaipeda UniversityKlaipedaLithuania
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