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Enriquez BAB, Skattør TH, Laugesen NG, Truelsen T, Lund CG, Nome T, Beyer MK, Skjelland M, Aamodt AH. External validation of clinical risk prediction score for elderly treated with endovascular thrombectomy. J Neurol 2024:10.1007/s00415-024-12535-6. [PMID: 38954035 DOI: 10.1007/s00415-024-12535-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/29/2024] [Accepted: 06/23/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND AND AIM The thrombectomy in the elderly prediction score (TERPS) for functional outcome after anterior circulation endovascular therapy (EVT) in patients ≥ 80 years was recently developed. The aim of this study was to assess predictors of functional outcome in the elderly and validate the prediction model. METHODS Consecutive patients treated with EVT from the Oslo Acute Reperfusion Stroke Study were evaluated for inclusion. Clinical and radiological parameters were used to calculate the TERPS, and functional outcome were assessed at 3-month follow-up. RESULTS Out of 1028 patients who underwent EVT for acute ischemic stroke from January 2017 to July 2022, 218 (21.2%) patients ≥ 80 years with anterior ischemic stroke were included. Fair outcome, defined as modified Rankin scale ≤ 3 (mRS), was achieved in 117 (53.7%). In bivariate analyses, male sex (p 0.035), age (p 0.025), baseline National Institute of Health Stroke Scale (NIHSS, p < 0.001), pre-stroke mRS (p 0.002) and Alberta Stroke Program Early Computed Tomography score (ASPECTS, p 0.001) were associated with fair outcome. Significant predictors for fair outcome in regression analyses were lower pre-stroke mRS, adjusted odd ratio, (aOR) 0.67 (95% CI 0.50-0.91, p 0.01), NIHSS, aOR 0.92 (95% CI 0.87-0.97, p 0.002), and higher ASPECTS, aOR 1.22 (95% CI 1.03-1.44, p 0.023). The area under the curve (AUC) using TERPS was 0.74 (95% CI 0.67-0.80). CONCLUSIONS The risk prediction score TERPS showed moderate performance in this external validation. Other variables may still be included to improve the model and validation using other cohorts is recommended. TRIAL REGISTRATION NCT06220981.
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Affiliation(s)
- Brian Anthony B Enriquez
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thor Håkon Skattør
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Thomas Truelsen
- Department of Neurology, Stroke Center Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, The University of Copenhagen, Copenhagen, Denmark
| | | | - Terje Nome
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Mona K Beyer
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
- Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway.
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Mavridis A, Reinholdsson M, Sunnerhagen KS, Abzhandadze T. Predictors of functional outcome after stroke: Sex differences in older individuals. J Am Geriatr Soc 2024; 72:2100-2110. [PMID: 38741476 DOI: 10.1111/jgs.18963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/21/2024] [Accepted: 04/19/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Sex differences in stroke are well documented, with females being older at onset, with more severe strokes and worse outcomes than males. Females receive less comprehensive stroke unit treatment. Similarly, older individuals receive poorer quality care than younger ones. There is limited research on sex differences in factors that impact 3-month poststroke functional outcome in people older than 80 years. METHODS This register-based and cross-sectional study analyzed data from two stroke quality registers in Sweden from 2014 through 2019. The study included patients aged ≥80 with a diagnosis of ischemic or hemorrhagic stroke. Sociodemographic features, prestroke condition, stroke severity on admission (National Institutes of Health Stroke Scale [NIHSS]), stroke unit care, rehabilitation plans, and 3-month poststroke functional outcome measured with the modified Rankin Scale were analyzed. Ordinal regression analyses stratified by sex were conducted to assess sex differences in factors that impact poststroke functional outcome 3 months after the stroke. RESULTS A total of 2245 patients were studied with the majority (59.2%) being females. Females experienced more severe strokes (NIHSS median 4 vs. 3, p = 0.01) and were older at stroke onset than males (87.0 vs. 85.4, p < 0.001). Females were also less independent prestroke (69.9% vs. 77.4%, p < 0.001) and a higher proportion of females lived alone (78.2% vs. 44.2%, p < 0.001). Males received intravenous thrombolysis more often than females (16.3% vs. 12.0%, p = 0.005). Regarding 3-month functional outcome, males benefited more from thrombolysis (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.30-0.83), whereas females benefited more from thrombectomy (OR 0.40, 95% CI 0.20-0.71). CONCLUSION Stroke care should be adapted to sex disparities in older individuals, while clinicians should be aware of these sex disparities. Further research could clarify the mechanisms behind these disparities and lead to a more personalized approach to stroke care of the older population.
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Affiliation(s)
- Anastasios Mavridis
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Malin Reinholdsson
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
- Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tamar Abzhandadze
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Chou A, Beach SR, Lutz BJ, Rodakowski J, Terhorst L, Freburger JK. Moderating Effects of Informal Care on the Relationship Between ADL Limitations and Adverse Outcomes in Stroke Survivors. Stroke 2024; 55:1554-1561. [PMID: 38660796 DOI: 10.1161/strokeaha.123.045427] [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: 10/06/2023] [Accepted: 03/29/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Stroke survivors with limitations in activities of daily living (ADL) have a greater risk of experiencing falls, hospitalizations, or physical function decline. We examined how informal caregiving received in hours per week by stroke survivors moderated the relationship between ADL limitations and adverse outcomes. METHODS In this retrospective cohort, community-dwelling participants were extracted from the National Health and Aging Trends Study (2011-2020; n=277) and included if they had at least 1 formal or informal caregiver and reported an incident stroke in the prior year. Participants reported the amount of informal caregiving received in the month prior (low [<5.8], moderate [5.8-27.1], and high [27.2-350.4] hours per week) and their number of ADL limitations (ranging from 0 to 7). Participants were surveyed 1 year later to determine the number of adverse outcomes (ie, falls, hospitalizations, and physical function decline) experienced over the year. Poisson regression coefficients were converted to average marginal effects and estimated the moderating effects of informal caregiving hours per week on the relationship between ADL limitations and adverse outcomes. RESULTS Stroke survivors were 69.7% White, 54.5% female, with an average age of 80.5 (SD, 7.6) years and 1.2 adverse outcomes at 2 years after the incident stroke. The relationships between informal caregiving hours and adverse outcomes and between ADL limitations and adverse outcomes were positive. The interaction between informal caregiving hours per week and ADL limitations indicated that those who received the lowest amount of informal caregiving had a rate of 0.12 more adverse outcomes per ADL (average marginal effect, 0.12 [95% CI, 0.005-0.23]; P=0.041) than those who received the highest amounts. CONCLUSIONS Informal caregiving hours moderated the relationship between ADL limitations and adverse outcomes in this sample of community-based stroke survivors. Higher amounts relative to lower amounts of informal caregiving hours per week may be protective by decreasing the rate of adverse outcomes per ADL limitation.
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Affiliation(s)
- Aileen Chou
- Departments of Physical Therapy (A.C., J.K.F.), University of Pittsburgh, PA
| | | | - Barbara J Lutz
- School of Nursing, College of Health and Human Services, University of North Carolina-Wilmington, NC (B.J.L.)
| | | | - Lauren Terhorst
- Occupational Therapy (J.R., L.T.), University of Pittsburgh, PA
| | - Janet K Freburger
- Departments of Physical Therapy (A.C., J.K.F.), University of Pittsburgh, PA
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Mayer‐Suess L, Marto JP, Strambo D, Ntaios G, Nguyen T, Kiechl S, Pechlaner R, Nogueira R, Michel P, Knoflach M. Sex differences in acute stroke metrics and outcome dependent on COVID status. Eur J Neurol 2024; 31:e16221. [PMID: 38288522 PMCID: PMC11235762 DOI: 10.1111/ene.16221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/10/2023] [Accepted: 01/09/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND PURPOSE Biological sex is known to have an impact on quality metrics of acute stroke. We aimed to determine whether COVID positivity accentuates this effect and constitutes worse outcome. METHODS The present analysis was based on the Global COVID-19 Stroke Registry, a retrospective, international, cohort study of consecutive ischemic stroke patients receiving intravenous thrombolysis and/or endovascular thrombectomy between 1 March 2020 and 30 June 2021. We investigated differences between the sexes in patient characteristics, acute stroke metrics as well as post-stroke outcome in COVID-positive and COVID-negative stroke patients undergoing acute revascularization procedures. RESULTS A total of 15,128 patients from 106 centers were recorded in the Global COVID-19 Stroke Registry, 853 (5.6%) of whom were COVID-positive. Overall, COVID-positive individuals were treated significantly slower according to every acute stroke metric compared to COVID-negative patients. We were able to show that key quality indicators in acute stroke treatment were unfavorable for COVID-negative women compared to men (last-seen-well-to-door time + 11 min in women). Furthermore, COVID-negative women had worse 3-month outcomes (3-month modified Rankin Scale score [interquartile range] 3.0 [4.0] vs. 2.0 [3.0]; p < 0.01), even after adjusting for confounders. In COVID-positive individuals no such difference between the sexes, either in acute management metrics or in 3-month outcome, was seen. CONCLUSION Known sex-related differences in acute stroke management exist and extend to times of crisis. Nevertheless, if patients were COVID-19-positive at stroke onset, women and men were treated the same, which could be attributed to structured treatment pathways.
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Affiliation(s)
- Lukas Mayer‐Suess
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - João Pedro Marto
- Department of NeurologyHospital de Egas Moniz, Centro Hospitalar Lisboa OcidentalLisbonPortugal
| | - Davide Strambo
- Stroke Centre, Neurology Service, Department of Neurological SciencesLausanne University HospitalLausanneSwitzerland
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health SciencesUniversity of ThessalyLarissaGreece
| | - Thanh Nguyen
- Department of Neurology, Radiology, Boston Medical CenterBoston University School of MedicineBostonMassachusettsUSA
| | - Stefan Kiechl
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
- VASCageResearch Center on Vascular Ageing and StrokeInnsbruckAustria
| | - Raimund Pechlaner
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Raul Nogueira
- Departments of Radiology, Neurology and NeurosurgeryGrady Memorial HospitalAtlantaGeorgiaUSA
| | - Patrik Michel
- Stroke Centre, Neurology Service, Department of Neurological SciencesLausanne University HospitalLausanneSwitzerland
| | - Michael Knoflach
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
- VASCageResearch Center on Vascular Ageing and StrokeInnsbruckAustria
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Tanaka K, Yamagami H, Qureshi MM, Uchida K, Siegler JE, Nogueira RG, Yoshimura S, Sakai N, Martinez-Majander N, Nagel S, Demeestere J, Puetz V, Haussen DC, Abdalkader M, Olive-Gadea M, Mohammaden MH, Marto JP, Dusart A, Winzer S, Tomppo L, Caparros F, Henon H, Bellante F, Ramos JN, Ortega-Gutierrez S, Sheth SA, Nannoni S, Kaesmacher J, Vandewalle L, Salazar-Marioni S, Farooqui M, Virtanen P, Ventura R, Zaidi S, Castonguay AC, Puri AS, Farzin B, Masoud HE, Klein P, Jesser J, Requena M, Dobrocky T, Kaiser DP, Peltola E, Strambo D, Möhlenbruch MA, Lin E, Ringleb PA, Zaidat OO, Cordonnier C, Roy D, Lemmens R, Ribo M, Strbian D, Fischer U, Michel P, Raymond J, Nguyen TN. Endovascular Therapy in the Extended Time Window for Large Vessel Occlusion in Patients With Pre-Stroke Disability. J Stroke 2024; 26:269-279. [PMID: 38836274 PMCID: PMC11164586 DOI: 10.5853/jos.2023.04259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND PURPOSE We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without pre-stroke disability. METHODS In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0-4 and LVO who underwent EVT 6-24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0-2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2-4) and those without (mRS score 0-1). RESULTS A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P<0.001). In multivariable logistic regression analysis with inverse probability of treatment weighting, pre-stroke disability was not associated with significantly lower odds of achieving FI or RoR (adjusted odds ratio 0.73, 95% confidence interval 0.43-1.25). Symptomatic intracranial hemorrhage occurred in 6.3% of both groups (P=0.995). CONCLUSION A considerable proportion of patients with late-presenting LVO and pre-stroke disability regained pre-stroke mRS scores after EVT. EVT may be appropriate for patients with pre-stroke disability presenting in the extended time window.
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Affiliation(s)
- Kanta Tanaka
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
- Stroke Center, Kindai University Hospital, Osakasayama, Japan
| | - Hiroshi Yamagami
- Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Muhammad M. Qureshi
- Department of Radiology, Radiation Oncology, Boston Medical Center, Boston, MA, USA
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - James E. Siegler
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Raul G. Nogueira
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical General Hospital, Kobe, Japan
| | | | - Simon Nagel
- Department of Neurology, Klinikum Ludwigshafen, Heidelberg University Hospital, Ludwigshafen, Germany
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jelle Demeestere
- Department of Neurology, Leuven University Hospital, Leuven, Belgium
| | - Volker Puetz
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Dresden Neurovascular Center, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Diogo C. Haussen
- Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | | | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Anne Dusart
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Simon Winzer
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Liisa Tomppo
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Francois Caparros
- Department of Neurology, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France
| | - Hilde Henon
- Department of Neurology, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France
| | - Flavio Bellante
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - João Nuno Ramos
- Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | | | - Sunil A. Sheth
- Department of Neurology, UTHealth Houston, Houston, TX, USA
| | - Stefania Nannoni
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland
| | | | | | | | - Pekka Virtanen
- Department of Radiology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Rita Ventura
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Syed Zaidi
- Department of Neurology, University of Toledo, Toledo, OH, USA
| | | | - Ajit S. Puri
- Division of Interventional Neuroradiology, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - Behzad Farzin
- Department of Radiology, Centre Hospitalier de l’Universite de Montreal, Montreal, Canada
| | - Hesham E. Masoud
- Department of Neurology, State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Piers Klein
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jessica Jesser
- Department of Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Manuel Requena
- Department of Neurology, Hospital Vall d’Hebron, Barcelona, Spain
| | - Tomas Dobrocky
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Daniel P.O. Kaiser
- Department of Diagnostic and Interventional Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Erno Peltola
- Department of Radiology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Davide Strambo
- Department of Neurology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Eugene Lin
- Neuroscience and Stroke Program, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH, USA
| | - Peter A. Ringleb
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Osama O. Zaidat
- Neuroscience and Stroke Program, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH, USA
| | - Charlotte Cordonnier
- Department of Neurology, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France
| | - Daniel Roy
- Department of Radiology, Centre Hospitalier de l’Universite de Montreal, Montreal, Canada
| | - Robin Lemmens
- Department of Neurology, Leuven University Hospital, Leuven, Belgium
| | - Marc Ribo
- Department of Neurology, Hospital Vall d’Hebron, Barcelona, Spain
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Urs Fischer
- Department of Neurology, University Hospital Basel, Switzerland
- Department of Neurology, University Hospital Bern, Switzerland
| | - Patrik Michel
- Department of Neurology, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean Raymond
- Department of Radiology, Centre Hospitalier de l’Universite de Montreal, Montreal, Canada
| | - Thanh N. Nguyen
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Nozoe M, Inoue T, Ogino T, Okuda K, Yamamoto K. The added value of frailty assessment as the premorbid stroke status on activities of daily living in patients with acute stroke, stratified by stroke severity. J Nutr Health Aging 2024; 28:100201. [PMID: 38460317 DOI: 10.1016/j.jnha.2024.100201] [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: 01/17/2024] [Revised: 02/10/2024] [Accepted: 02/11/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND The modified Rankin scale (mRS) is extensively used for premorbid evaluation in patients with stroke; however, its limited capacity to assess functional status highlights the need for additional indicators such as frailty. AIMS This study aimed to assess the impact of the premorbid mRS score and frailty on daily living (ADL) activities at hospital discharge, focusing on varying stroke severities. METHODS This single-centre, prospective cohort study included patients with acute stroke aged ≥60 years. Key metrics included the frailty index for frailty assessment or mRS for functional status premorbid and the functional independence measure of the motor domain (FIM-M) at discharge for ADL outcomes. The patients were categorized into mild (0-4), moderate (5-15), and severe (16-42) groups based on the National Institute of Health Stroke Scale. Multiple hierarchical linear regression analyses were performed for each group to evaluate the influence of mRS and frailty on FIM-M scores. RESULTS In the mild stroke group, significant associations were observed with premorbid mRS3 (β = -0.183, p = 0.004), mRS4 (β = -0.234, p < 0.001), and frailty status (β = -0.227, p = 0.005) and FIM-M scores. Premorbid frailty did not show a significant association with the FIM-M scores in the moderate or severe stroke group. Frailty status notably contributed to changes in R², particularly in the mild stroke group (R² change = 0.031, p = 0.002). However, such changes were not evident in the other stroke severity groups. CONCLUSION This study emphasizes the importance of incorporating frailty assessments into premorbid evaluations, particularly when considering ADL outcomes in patients with mild stroke. Conversely, the significance of frailty in moderate-to-severe stroke was less evident.
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Affiliation(s)
- Masafumi Nozoe
- Department of Physical Therapy, Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan.
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Tomoyuki Ogino
- Department of Physical Therapy,Faculty of Rehabilitation, Hyogo Medical University, Kobe, Japan
| | - Kazuki Okuda
- Department of Rehabilitation, Konan Medical Center, Kobe, Japan
| | - Kenta Yamamoto
- Department of Rehabilitation, Konan Medical Center, Kobe, Japan
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7
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Naftali J, Tsur G, Auriel E, Barnea R, Findler M, Raphaeli G, Brauner R, Pardo K, Perlow A, Weinstein G, Weiss P, Glik A, Keret O. Impact of dementia status on intravenous thrombolysis and endovascular treatment for acute ischemic stroke: Retrospective study. J Neurol Sci 2024; 459:122954. [PMID: 38461762 DOI: 10.1016/j.jns.2024.122954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/13/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Individuals with dementia are underrepresented in interventional studies for acute ischemic stroke (AIS). This research gap creates a bias against their treatment in clinical practice. Our goal was to compare the safety and efficacy of intravenous-thrombolysis (t-PA) and endovascular treatment (EVT) in individuals with or without pre-AIS dementia. METHOD A retrospective study of AIS patients receiving t-PA or EVT between 2019 and 2022. Patients were classified as dementia on a case-by-case review of baseline assessment. Additional variables included demographic, vascular risk factors, AIS severity and treatment. Outcomes of interest were intracerebral hemorrhage, mortality in 90-days, and the difference in modified rankin scale (mRS) before AIS and in 90-days follow-up. Outcomes were compared across non-matched groups and following propensity-score matching. RESULTS Altogether, 628 patients were included, of which 68 had pre-AIS dementia. Compared to non-dementia group, dementia group were older, had a higher rate of vascular risk factors, higher pre-stroke mRS and higher baseline NIHSS. Individuals with dementia had higher rates of mortality (25% vs.11%,p < 0.01) on non-matched comparison. All cohort and restricted t-PA EVT matched analysis showed no difference in any outcome. Regression analysis confirmed that AIS severity at presentation and its treatment, not dementia, were the chief contributors to patients' outcomes. DISCUSSION Our results indicate that pre-AIS dementia does not impact the efficacy or safety of EVT or t-PA for AIS. We thus call for more inclusive research on stroke therapy with regards to baseline cognitive status. Such studies are urgently required to inform stroke guidelines and enhance care.
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Affiliation(s)
- Jonathan Naftali
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
| | - Gal Tsur
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Eitan Auriel
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Rani Barnea
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Michael Findler
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Interventional Neuroradiology Unit, Rabin Medical Center, Petach Tikva, Israel
| | - Guy Raphaeli
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Interventional Neuroradiology Unit, Rabin Medical Center, Petach Tikva, Israel
| | - Ran Brauner
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Interventional Neuroradiology Unit, Rabin Medical Center, Petach Tikva, Israel
| | - Keshet Pardo
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Alain Perlow
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Interventional Neuroradiology Unit, Rabin Medical Center, Petach Tikva, Israel
| | | | - Penina Weiss
- Occupational Therapy Department, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Amir Glik
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Cognitive Neurology Clinic, Rabin Medical Center, Petach Tikva, Israel
| | - Ophir Keret
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Cognitive Neurology Clinic, Rabin Medical Center, Petach Tikva, Israel
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Fluck A, Fry CH, Affley B, Kakar P, Sharma P, Fluck D, Han TS. Sex-specific independent risk factors of urinary incontinence in acute stroke patients: A multicentre registry-based cohort study. Neurourol Urodyn 2024; 43:818-825. [PMID: 38451041 DOI: 10.1002/nau.25440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/02/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND The presence of urinary incontinence (UI) in acute stroke patients indicates poor outcomes in men and women. However, there is a paucity and inconsistency of data on UI risk factors in this group and hence we conducted a sex-specific analysis to identify risk factors. METHODS Data were collected prospectively (2014-2016) from the Sentinel Stroke National Audit Program for patients admitted to four UK hyperacute stroke units. Relevant risk factors for UI were determined by stepwise multivariable logistic regression, presented as odds ratios (OR) and 95% confidence intervals (CI). RESULTS The mean (±SD) age of UI onset in men (73.9 year ± 13.1; n = 1593) was significantly earlier than for women (79.8 year ± 12.9; n = 1591: p < 0.001). Older age between 70 and 79 year in men (OR = 1.61: CI = 1.24-2.10) and women (OR = 1.55: CI = 1.12-2.15), or ≥80 year in men (OR = 2.19: CI = 1.71-2.81), and women (OR = 2.07: CI = 1.57-2.74)-reference: <70 year-both predicted UI. In addition, intracranial hemorrhage (reference: acute ischemic stroke) in men (OR = 1.64: CI = 1.22-2.20) and women (OR = 1.75: CI = 1.30-2.34); and prestroke disability (mRS scores ≥ 4) in men (OR = 1.90: CI = 1.02-3.5) and women (OR = 1.62: CI = 1.05-2.49) (reference: mRS scores < 4); and stroke severity at admission: NIHSS scores = 5-15 in men (OR = 1.50: CI = 1.20-1.88) and women (OR = 1.72: CI = 1.37-2.16), and NIHSS scores = 16-42 in men (OR = 4.68: CI = 3.20-6.85) and women (OR = 3.89: CI = 2.82-5.37) (reference: NIHSS scores = 0-4) were also significant. Factors not selected were: a history of congestive heart failure, hypertension, atrial fibrillation, diabetes and previous stroke. CONCLUSIONS We have identified similar risk factors for UI after stroke in men and women including age >70 year, intracranial hemorrhage, prestroke disability and stroke severity.
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Affiliation(s)
- Adam Fluck
- Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UK
| | - David Fluck
- Department of Cardiology, Ashford & St Peter's NHS Foundation Trust, Chertsey, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK
- Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
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Egle M, Wang WC, Fann YC, Johansen MC, Lee JT, Yeh CH, Jason Lin CH, Jeng JS, Sun Y, Lien LM, Gottesman RF. Sex Differences in the Role of Multimorbidity on Poststroke Disability: The Taiwan Stroke Registry. Neurology 2024; 102:e209140. [PMID: 38330286 PMCID: PMC11067697 DOI: 10.1212/wnl.0000000000209140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/28/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Multimorbidity is common in patients who experience stroke. Less is known about the effect of specific multimorbidity patterns on long-term disability in patients with stroke. Furthermore, given the increased poststroke disability frequently seen in female vs male patients, it is unknown whether multimorbidity has a similar association with disability in both sexes. We assessed whether specific multimorbidity clusters were associated with greater long-term poststroke disability burden overall and by sex. METHODS In the Taiwan Stroke Registry, an ongoing nationwide prospective registry, patients with first-ever ischemic stroke were enrolled; this analysis is restricted to those individuals surviving to at least 6 months poststroke. Using a hierarchical clustering approach, clusters of prestroke multimorbidity were generated based on 16 risk factors; the algorithm identified 5 distinct clusters. The association between clusters and 12-month poststroke disability, defined using the modified Rankin Scale (mRS), was determined using logistic regression models, with additional models stratified by sex. The longitudinal association between multimorbidity and functional status change was assessed using mixed-effects models. RESULTS Nine-thousand eight hundred eighteen patients with first-ever ischemic stroke were included. The cluster with no risk factors was the reference, "healthier" risk group (N = 1,373). Patients with a cluster profile of diabetes, peripheral artery disease (PAD), and chronic kidney disease (CKD) (N = 1882) had significantly greater disability (mRS ≥ 3) at 1 month (OR [95% CI] = 1.36 [1.13-1.63]), 3 months (OR [95% CI] = 1.27 [1.04-1.55]), and 6 months (OR [95% CI] = 1.30 [1.06-1.59]) but not at 12 months (OR [95% CI] = 1.16 [0.95-1.42]) than patients with a healthier risk factor profile. In the sex-stratified analysis, the associations with this risk cluster remained consistent in male patients (OR [95% CI] = 1.42 [1.06-1.89]) at 12 months, who also had a higher comorbidity burden, but not in female patients (OR [95% CI] = 0.95 [0.71-1.26]), who had higher proportions of severe strokes and severe disability (p-interaction = 0.04). DISCUSSION Taiwanese patients with multimorbidity, specifically the concurrent presence of diabetes, PAD, and CKD, had higher odds of a worse functional outcome in the first 6 months poststroke. Clusters of multimorbidity may be less informative for long-term disability in female patients. Further studies should evaluate other mechanisms for worse disability in female patients poststroke.
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Affiliation(s)
- Marco Egle
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Wei-Chun Wang
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Yang C Fann
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Michelle C Johansen
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Jiunn-Tay Lee
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chung-Hsin Yeh
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chih-Hao Jason Lin
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Yu Sun
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Li-Ming Lien
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Rebecca F Gottesman
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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10
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Du J, Zhai Y, Dong W, Che B, Miao M, Peng Y, Ju Z, Xu T, He J, Zhang Y, Zhong C. One-Year Disability Trajectories and Long-Term Cardiovascular Events, Recurrent Stroke, and Mortality After Ischemic Stroke. J Am Heart Assoc 2024; 13:e030702. [PMID: 38240201 PMCID: PMC11056157 DOI: 10.1161/jaha.123.030702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/19/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Patients with stroke are often affected by varying degrees of functional disability and have different evolution patterns in functional disability. However, little is known about the predictive usefulness of disability changes after stroke. We aimed to describe 1-year disability trajectories and to assess the associations of longitudinal disability trajectories with 24-month clinical outcomes after ischemic stroke. METHODS AND RESULTS A total of 3533 patients with ischemic stroke from CATIS (China Antihypertensive Trial in Acute Ischemic Stroke) were studied. Distinct trajectories of disability were identified by the group-based trajectory model, as measured by modified Rankin Scale score within 12 months. Cox proportional hazards regression models were used to examine the associations of disability trajectories with 24-month cardiovascular events and all-cause mortality. We identified 4 distinct disability trajectories: no significant disability (562 participants [15.9%]), slight disability to recovery (1575 participants [44.6%]), severe to moderate disability (1087 participants [30.8%]), and persistent severe disability (309 participants [8.7%]). Compared with no significant disability trajectory, the multivariable adjusted hazard ratios (95% CIs) of patients within the persistent heavy-severe trajectory were 2.63 (1.20-5.76) for cardiovascular events, 2.55 (1.12-5.79) for recurrent stroke, and 6.10 (2.22-16.72) for all-cause mortality; notably, the hazard ratios (95% CIs) for patients within the severe to moderate disability trajectory were 1.99 (1.01-3.94) for cardiovascular events and 1.85 (1.03-3.33) for the composite outcome of cardiovascular events and all-cause mortality. CONCLUSIONS Functional disability trajectories within 12 months after stroke onset were associated with the risk of 24-month adverse outcomes. Patients with persistent severe disability or severe to moderate disability had higher risk of cardiovascular events and all-cause mortality. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01840072.
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Affiliation(s)
- Jigang Du
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
- Department of Medical ManagementGansu Provincial HospitalLanzhouChina
| | - Yujia Zhai
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
| | - Wenjing Dong
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
| | - Bizhong Che
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
| | - Mengyuan Miao
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
| | - Yanbo Peng
- Department of NeurologyAffiliated Hospital of North China University of Science and TechnologyTangshanHebeiChina
| | - Zhong Ju
- Department of NeurologyKerqin District First People’s Hospital of Tongliao CityTongliaoChina
| | - Tan Xu
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
| | - Jiang He
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
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11
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de Rooij AM, Maier AB, Trompet S, Meskers CGM. Pre-stroke activities of daily living do not predict functional decline after stroke in a cohort of community dwelling older subjects at risk for vascular disease. Arch Gerontol Geriatr 2024; 117:105174. [PMID: 37677863 DOI: 10.1016/j.archger.2023.105174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/10/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND & PURPOSE Pre-stroke impairment of activities of daily living (ADL) is considered a major determinant for functional outcome after stroke. However, findings are based on studies in stroke patients in which pre-stroke information is gathered retrospectively, with inherent risks of selection and recall bias. The objective of this study was to verify the predictive value of pre-stroke ADL with respect to ADL decline in a large prospective cohort of community dwelling older subjects with known vascular risk factors or vascular disease, thereby minimizing selection and recall bias. METHODS Within the four-year study follow-up of a cohort including 5,804 community dwelling older subjects from three countries at risk for vascular disease, incident stroke survivors were identified. Incident myocardial infarction (MI) survivors and the remaining study survivors without incident vascular events served as comparison groups. Multivariate logistic regression analyses for each of the aforementioned groups were performed to assess associations between pre-stroke ADL by the Barthel Index (BI) and Instrumental Activities of Daily Living (IADL) scale and risk for ADL decline. RESULTS In stroke survivors, neither pre-event BI (n = 230, OR 1.00 (95% CI 0.83-1.23)) nor IADL (OR 1.07 (95% CI 0.94 - 1.20)) predicted risk of post-stroke ADL decline in contrast to ADL decline after MI (n = 443, OR 0.83 (95% CI 0.70-0.98) and 0.87 (95% CI 0.78-0.97) respectively) and the group without vascular events (n = 4336, OR 0.85 (95% CI 0.78-0.92) and 0.87 (95% CI 0.83-0.92) respectively). CONCLUSIONS In the present prospective cohort of community dwelling older subjects with known vascular risk factors, pre-stroke ADL measured by BI and IADL scale did not predict post-stroke ADL decline.
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Affiliation(s)
- Annetje M de Rooij
- Department of Rehabilitation Medicine, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore
| | - Stella Trompet
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam Movement Sciences, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
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Chaychi MTM, Muzammil MA, Ahmed MK. Letter to the editor regarding "Impact of age on mechanical thrombectomy and clinical outcome in patients with acute ischemic stroke". J Stroke Cerebrovasc Dis 2023; 32:107330. [PMID: 37751653 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
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Song YY, Sun WJ, Wang C, Tian YM, Liu H, Jiang Y. Effects of multicomponent exercise on quality of life, depression and anxiety among stroke survivors: A systematic review and meta-analysis. J Clin Nurs 2023; 32:7677-7690. [PMID: 37727891 DOI: 10.1111/jocn.16853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Current guidelines stress the importance of exercise, especially multicomponent exercise to older adults with chronic conditions. AIM To critically synthesise evidence that evaluates the effects of multicomponent exercise on quality of life, depression and anxiety after stroke. DESIGN Systematic review and meta-analysis followed the PRISMA 2020 statement. METHODS A systematic search of PubMed, Embase, Web of Science, Cochrane Library, CINAHL and PsycINFO from inception to 12 June 2023 was performed. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2). Meta-analyses were conducted using Review Manager 5.4 and narrative syntheses were adopted whenever meta-analysis was inappropriate. The overall certainty of the evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS Of 15,351 records identified, nine were eligible and data were available for seven randomised controlled trials, three of which were identified as having a high risk of bias, one as low risk, and five as having some concerns. Subgroup pooled analyses indicated that multicomponent exercise engaged in longer exercise sessions (>60 min) was effective in improving quality of life immediately post-intervention and through 3-6 months post-intervention. However, multicomponent exercise did not significantly affect depression and anxiety. CONCLUSIONS Multicomponent exercise with longer duration of exercise sessions has promising effects on both short- to medium-term quality of life among stroke survivors. PATIENT OR PUBLIC CONTRIBUTION This does not apply to our work as it is a review paper. RELEVANCE TO CLINICAL PRACTICE Healthcare providers could consider encouraging the patients to participate in multicomponent exercise sessions for more than 60 min. It is important to note that stroke survivors should be supervised by trained personnel at the beginning of the training. REGISTRATION The protocol was registered on PROSPERO.
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Affiliation(s)
- Yuan-Yuan Song
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wen-Jing Sun
- Department of Neurosurgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Cong Wang
- Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yong-Ming Tian
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Huan Liu
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yan Jiang
- Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, China
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Chen J, Lin Y, Li J, Zhang P, Wang Y, Chen Y, Zhang C, Li C. Efficacy and safety of short-term high dosage dual antiplatelet therapy after 0.6 mg/kg rt-PA intravenous thrombolysis for acute ischemic stroke. Medicine (Baltimore) 2023; 102:e35099. [PMID: 37682162 PMCID: PMC10489488 DOI: 10.1097/md.0000000000035099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 08/16/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of short-term high-dose of dual antiplatelet therapy after 0.6 mg/kg rt-PA intravenous thrombolysis for acute ischemic stroke (AIS). METHODS All 208 patients with AIS were randomized into group 1 (103 cases, after 0.6 mg/kg rt-PA, 300 mg of oral aspirin(ASP) q.d. and 225 mg of oral clopidogrel (CLO) q.d. for for 5 days, then 100 mg of oral ASP q.d. for the next 85 days and 75 mg of oral CLO q.d. for the next 16 days) and group 2 (105 cases, after 0.9 mg/kg rt-PA, 100 mg of oral ASP q.d. for 90 days and 75 mg of oral CLO q.d. for 21 days).The efficacy index was the mRS score, NIHSS score and recurrence risk of stroke, while the safety index was the incidence of bleeding events and mortality. All parameters were evaluated at 30 and 90 days after thrombolysis. Patients whose characteristics may provide the best treatment benefit were further analyzed using the logistic regression model in group 1. RESULTS The proportion of mRS scores between 0 and 1 in group 1 was higher than that in group 2 at both 30 days (44.7% vs 32.4%, P < .05) and 90 days (50.5% vs 35.2%, P < .05). Compared to group 2, the proportion of NIHSS scores less than 4 was significantly higher in group 1 at both 30 days (37.9% vs 25.7%, P < .05) and 90 days (46.6% vs 30.5%, P < .05). At 90 days, Group 1 had a lower stroke recurrence risk than Group 2 (3.9% vs 10.5%, P < .05). The incidence of SICH was significantly different between the 2 groups at both 30 days (2.9% vs 9.5%, P < .05) and 90 days (2.9% vs 10.5%, P < .05). However, other bleeding events and mortality rates were not significantly different between the 2 groups. The lower the baseline NIHSS score and the shorter the OTT, the more favorable the outcomes obtained at 90 days. CONCLUSIONS Compared to standard doses, short term high-dose dual antiplatelet therapy after 0.6 mg/kg rt-PA intravenous thrombolysis may be a good choice for AIS patients.
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Affiliation(s)
- Jing Chen
- Department of Neurology, Characteristic Medical Centre of People’s Armed Police Force, Tianjin, P.R. China
- Tianjin Medical University, Tianjin, P.R. China
| | - Yanchen Lin
- Department of Rehabilitation, Characteristic Medical Centre of People’s Armed Police Force, Tianjin, P.R. China
- Army Medical University, Chongqing, P. R. China
| | - Jingjing Li
- Department of Pharmacy, Tianjin Fourth Central Hospital, Tianjin, P. R. China
| | - Peilan Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, P.R. China
| | - Yuxin Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, P.R. China
| | - Yan Chen
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, P.R. China
| | - Chenhao Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, P.R. China
| | - Chenhua Li
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, P.R. China
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15
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Waddell KJ, Myers LJ, Perkins AJ, Sico JJ, Sexson A, Burrone L, Taylor S, Koo B, Daggy JK, Bravata DM. Development and validation of a model predicting mild stroke severity on admission using electronic health record data. J Stroke Cerebrovasc Dis 2023; 32:107255. [PMID: 37473533 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE Initial stroke severity is a potent modifier of stroke outcomes but this information is difficult to obtain from electronic health record (EHR) data. This limits the ability to risk-adjust for evaluations of stroke care and outcomes at a population level. The purpose of this analysis was to develop and validate a predictive model of initial stroke severity using EHR data elements. METHODS This observational cohort included individuals admitted to a US Department of Veterans Affairs hospital with an ischemic stroke. We extracted 65 independent predictors from the EHR. The primary analysis modeled mild (NIHSS score 0-3) versus moderate/severe stroke (NIHSS score ≥4) using multiple logistic regression. Model validation included: (1) splitting the cohort into derivation (65%) and validation (35%) samples and (2) evaluating how the predicted stroke severity performed in regard to 30-day mortality risk stratification. RESULTS The sample comprised 15,346 individuals with ischemic stroke (n = 10,000 derivation; n = 5,346 validation). The final model included 15 variables and correctly classified 70.4% derivation sample patients and 69.4% validation sample patients. The areas under the curve (AUC) were 0.76 (derivation) and 0.76 (validation). In the validation sample, the model performed similarly to the observed NIHSS in terms of the association with 30-day mortality (AUC: 0.72 observed NIHSS, 0.70 predicted NIHSS). CONCLUSIONS EHR data can be used to construct a surrogate measure of initial stroke severity. Further research is needed to better differentiate moderate and severe strokes, enhance stroke severity classification, and how to incorporate these measures in evaluations of stroke care and outcomes.
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Affiliation(s)
- Kimberly J Waddell
- VA Center for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center; Philadelphia, PA, USA; Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania; Philadelphia, PA, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania; Philadelphia, PA, USA.
| | - Laura J Myers
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center; Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine; Indianapolis, IN, USA; Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA; Regenstrief Institute; Indianapolis, IN, USA
| | - Anthony J Perkins
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center; Indianapolis, IN, USA; Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA; Department of Biostatistics and Health Data Science, Indiana University School of Medicine & Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Jason J Sico
- Neurology Service, VA Connecticut Healthcare System; West Haven, CT, USA; Departments of Neurology and Internal Medicine, Yale School of Medicine; New Haven, CT, USA; Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System; West Haven, CT, USA
| | - Ali Sexson
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center; Indianapolis, IN, USA
| | - Laura Burrone
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System; West Haven, CT, USA
| | - Stanley Taylor
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center; Indianapolis, IN, USA; Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
| | - Brian Koo
- Neurology Service, VA Connecticut Healthcare System; West Haven, CT, USA; Departments of Neurology and Internal Medicine, Yale School of Medicine; New Haven, CT, USA; Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System; West Haven, CT, USA
| | - Joanne K Daggy
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center; Indianapolis, IN, USA; Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA; Department of Biostatistics and Health Data Science, Indiana University School of Medicine & Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Dawn M Bravata
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center; Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine; Indianapolis, IN, USA; Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA; Department of Neurology, Indiana University School of Medicine; Indianapolis, IN, USA; Regenstrief Institute; Indianapolis, IN, USA
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16
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Bala F, Beland B, Mistry E, Almekhlafi MA, Goyal M, Ganesh A. Endovascular treatment of acute ischemic stroke in patients with pre-morbid disability: a meta-analysis. J Neurointerv Surg 2023; 15:343-349. [PMID: 35292569 DOI: 10.1136/neurintsurg-2021-018573] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/06/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Trials of endovascular thrombectomy (EVT) for acute stroke have excluded patients with pre-morbid disability. Observational studies may help inform consideration of EVT in this population. We aimed to assess the effectiveness and safety of EVT in patients with pre-morbid disability. METHODS According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE and Embase for studies describing outcomes in patients with pre-morbid disability (modified Rankin Scale (mRS) 2-5), treated with EVT or medical management (MM). Random-effects meta-analysis was used to pool outcomes including 90-day return to baseline mRS, symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. RESULTS We analyzed 14 studies of patients with pre-morbid disability (mRS 2-5, 1373 EVT and 253 MM). The rate of return to baseline mRS was 30.0% (95% CI 25.3% to 34.7%) in patients treated with EVT. Compared with medical therapy, EVT was associated with a higher likelihood of return to baseline mRS (OR 2.37, 95% CI 1.39 to 4.04) and a trend towards lower mortality (OR 0.68, 95% CI 0.46 to 1.02), with similar odds of sICH (OR 1.01, 95% CI 0.49 to 2.08). In studies comparing patients with versus without pre-morbid disability treated with EVT, similar results were found except that pre-morbid disability, when defined more strictly as mRS 3-5, was associated with mortality (OR 3.49, p<0.001). CONCLUSION In eligible patients with pre-morbid disability, observational studies suggest that EVT carries a higher chance of return to baseline mRS compared with patients treated with MM or without pre-morbid disability, although with higher mortality than patients without pre-morbid disability. These findings argue against the routine exclusion of such patients from EVT and merit validation with randomized trials.
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Affiliation(s)
- Fouzi Bala
- Calgary Stroke Program, Departments of Clinical Neurosciences, Community Health Sciences, and Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Benjamin Beland
- Calgary Stroke Program, Departments of Clinical Neurosciences, Community Health Sciences, and Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Eva Mistry
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Mohammed A Almekhlafi
- Calgary Stroke Program, Departments of Clinical Neurosciences, Community Health Sciences, and Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Mayank Goyal
- Calgary Stroke Program, Departments of Clinical Neurosciences, Community Health Sciences, and Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Aravind Ganesh
- Calgary Stroke Program, Departments of Clinical Neurosciences, Community Health Sciences, and Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada .,Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Chronic Phase Survival Rate in Stroke Patients With Severe Functional Limitations According to the Frequency of Rehabilitation Treatment. Arch Phys Med Rehabil 2023; 104:251-259. [PMID: 36087805 DOI: 10.1016/j.apmr.2022.08.973] [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: 06/29/2021] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the chronic phase survival rate according to the frequency of rehabilitation treatment in the acute and subacute phases in stroke patients with severe functional limitations. DESIGN A retrospective longitudinal cohort study. SETTING Population-based study using the Korean National Health Insurance Database from 2007 to 2018. PARTICIPANTS We enrolled 593 patients who experienced stroke in 2009 with national disability registration (NDR) grade of 3 or less (N=593). INTERVENTION Not applicable. MAIN OUTCOME MEASURES The frequencies of rehabilitation treatment within 24 months after stroke were categorized into none, 1-50, 51-200, 201-400, and >400 treatments based on requests made to the Health Insurance Review and Assessment Service. As a dependent variable, we assessed all-cause mortality from 24 to 120 months after stroke. RESULTS The study enrolled 283 patients in NDR grade 1 (the most severe), 158 in grade 2, and 152 in grade 3. Groups with more severe functional limitations showed a lower chronic phase survival rate (P<.001). The groups with higher frequencies of rehabilitation treatment in the acute and subacute phases showed a higher chronic phase survival rate (P<.001). In the Cox regression analysis, a higher degree of functional limitation, lower frequency of rehabilitation treatment, older age, male sex, and chronic kidney disease were independent risk factors for chronic phase mortality in stroke patients with severe functional limitations. CONCLUSIONS A high frequency of rehabilitation treatment in the acute and subacute phases was associated with the long-term survival of stroke patients with severe functional limitations.
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18
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Association between premorbid sarcopenia and neurological deterioration in patients with acute ischemic stroke. Clin Neurol Neurosurg 2022; 224:107527. [PMID: 36455301 DOI: 10.1016/j.clineuro.2022.107527] [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: 05/22/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Sarcopenia is associated with poor outcomes in patients with stroke. This study aimed to investigate the association between premorbid sarcopenia and neurological deterioration (ND) in patients with acute ischemic stroke. To the best of our knowledge, there have been no studies on this topic. METHODS In this prospective longitudinal study, we assessed premorbid sarcopenia using the SARC-F questionnaire, and the incidence of ND was defined by an increase of ≥ 1 point on the National Institutes of Health Stroke Scale (NIHSS) or the occurrence of any new neurological symptoms/signs. Logistic regression analysis was used to investigate the relationship between premorbid sarcopenia and ND. RESULTS Of the 290 patients enrolled, 46 and 244 patients experienced and did not experience ND 1 week after admission (ND and non-ND groups, respectively). The prevalence of sarcopenia was significantly higher in the ND group than in the non-ND group (39% vs. 17%). In the adjusted model, premorbid sarcopenia was significantly associated with ND (adjusted odds ratio: 3.06, 95% confidence interval: 1.11-8.40; p = 0.03). CONCLUSION Premorbid sarcopenia is independently associated with ND in patients with acute ischemic stroke. Therefore, it is necessary to detect premorbid sarcopenia to predict ND in these patients.
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19
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Yang JC, Bao QJ, Guo Y, Chen SJ, Zhang JT, Zhang Q, Zhou P, Yang MF. Endovascular thrombectomy in acute ischemic stroke patients with prestroke disability (mRS ≥2): A systematic review and meta-analysis. Front Neurol 2022; 13:971399. [PMID: 36188370 PMCID: PMC9520304 DOI: 10.3389/fneur.2022.971399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022] Open
Abstract
Objective The effect of endovascular thrombectomy (EVT) in acute ischemic stroke patients with prestroke disability (modified Rankin Scale score, mRS) ≥2) has not been well-studied. This study aimed to assess the safety and benefit of EVT in patients with prestroke disability. Methods According to PRISMA guidelines, literature searching was performed using PubMed, Embase, and Cochrane databases, for a series of acute ischemic stroke patients with prestroke mRS ≥2 treated by EVT. Random-effects meta-analysis was used to pool the rate of return to prestroke mRS and mortality at 3-month follow-up. Results In total, 13 observational studies, with 2,625 patients, were analyzed. The rates of return to prestroke mRS in patients with prestroke mRS of 2–4 were 20% (120/588), 27% (218/827), and 31% (34/108), respectively. Patients with prestroke disability treated by EVT had a higher likelihood of return to prestroke mRS (relative risk, RR, 1.86; 95% CI 1.28–2.70) and a lower likelihood of mortality (RR 0.75; 95%CI 0.58–0.97) compared with patients with standard medical treatment. Successful recanalization (Thrombolysis in Cerebral Infarction grade 2b-3) after EVT gave a higher likelihood of return to prestroke mRS (RR 2.04; 95% CI 1.17–3.55) and lower mortality (RR 0.72; 95% CI 0.62–0.84) compared with unsuccessful reperfusion. Conclusions Acute ischemic stroke patients with prestroke disability may benefit from EVT. Withholding EVT on the sole ground of prestroke disabilities may not be justified. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Jin-Cai Yang
- Graduate School, Qinghai University, Xining, China
| | - Qiang-Ji Bao
- Graduate School, Qinghai University, Xining, China
| | - Yu Guo
- Graduate School, Qinghai University, Xining, China
| | - Shu-Jun Chen
- Graduate School, Qinghai University, Xining, China
| | | | - Qiang Zhang
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, China
| | - Ping Zhou
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, China
| | - Ming-Fei Yang
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, China
- *Correspondence: Ming-Fei Yang
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20
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Ganesh A, Fladt J, Singh N, Goyal M. Efficacy and safety of mechanical thrombectomy in acute stroke patients with pre-morbid disability. Expert Rev Med Devices 2022; 19:641-648. [PMID: 36093630 DOI: 10.1080/17434440.2022.2124109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION – Patients with pre-morbid disability have been generally excluded from randomized controlled trials of mechanical thrombectomy for acute ischemic stroke. However, stroke physicians commonly encounter such patients in practice, and face challenging treatment decisions when caring for them. AREAS COVERED – We review the literature on the safety and efficacy of thrombectomy in patients with pre-morbid disability. Recent clinical-epidemiological studies have highlighted the adverse outcomes that come with each increment of additional post-stroke disability in these patients. Several observational studies - both case series and registry-based studies - have helped demonstrate the comparable safety of thrombectomy in patients with pre-morbid disability as in those without, complementing similar data on thrombolysis. These data also suggest similar rates of successful recanalization, symptomatic intracerebral hemorrhage, and return to pre-stroke level of disability when treated with mechanical thrombectomy, although they have higher mortality. EXPERT OPINION – In the absence of high-quality evidence, we recommend pursuing shared decision-making with patients or family members and being upfront about the uncertain evidence. Available observational data underline the potential for a substantial proportion of these patients to return to their pre-morbid state, do not indicate a greater rate of treatment-related complications, and do not support routinely excluding these patients from thrombectomy.
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Affiliation(s)
- Aravind Ganesh
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Hotchkiss Brain Institute and the Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Joachim Fladt
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nishita Singh
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Mayank Goyal
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Hotchkiss Brain Institute and the Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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21
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Automatic Segmentation and Quantitative Assessment of Stroke Lesions on MR Images. Diagnostics (Basel) 2022; 12:diagnostics12092055. [PMID: 36140457 PMCID: PMC9497525 DOI: 10.3390/diagnostics12092055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 12/20/2022] Open
Abstract
Lesion studies are crucial in establishing brain-behavior relationships, and accurately segmenting the lesion represents the first step in achieving this. Manual lesion segmentation is the gold standard for chronic strokes. However, it is labor-intensive, subject to bias, and limits sample size. Therefore, our objective is to develop an automatic segmentation algorithm for chronic stroke lesions on T1-weighted MR images. Methods: To train our model, we utilized an open-source dataset: ATLAS v2.0 (Anatomical Tracings of Lesions After Stroke). We partitioned the dataset of 655 T1 images with manual segmentation labels into five subsets and performed a 5-fold cross-validation to avoid overfitting of the model. We used a deep neural network (DNN) architecture for model training. Results: To evaluate the model performance, we used three metrics that pertain to diverse aspects of volumetric segmentation, including shape, location, and size. The Dice similarity coefficient (DSC) compares the spatial overlap between manual and machine segmentation. The average DSC was 0.65 (0.61−0.67; 95% bootstrapped CI). Average symmetric surface distance (ASSD) measures contour distances between the two segmentations. ASSD between manual and automatic segmentation was 12 mm. Finally, we compared the total lesion volumes and the Pearson correlation coefficient (ρ) between the manual and automatically segmented lesion volumes, which was 0.97 (p-value < 0.001). Conclusions: We present the first automated segmentation model trained on a large multicentric dataset. This model will enable automated on-demand processing of MRI scans and quantitative chronic stroke lesion assessment.
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22
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Fluck D, Fry CH, Rankin S, Gulli G, Affley B, Robin J, Kakar P, Sharma P, Han TS. Comparison of characteristics, management and outcomes in hospital-onset and community-onset stroke: a multi-centre registry-based cohort study of acute stroke. Neurol Sci 2022; 43:4853-4862. [PMID: 35322338 PMCID: PMC9349089 DOI: 10.1007/s10072-022-06015-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Objective
Hospital-onset stroke (HOS) is associated with poorer outcomes than community-onset stroke (COS). Previous studies have variably documented patient characteristics and outcome measures; here, we compare in detail characteristics, management and outcomes of HOS and COS.
Methods
A total of 1656 men (mean age ± SD = 73.1 years ± 13.2) and 1653 women (79.3 years ± 13.0), with data prospectively collected (2014–2016) from the Sentinel Stroke National Audit Programme, were admitted with acute stroke in four UK hyperacute stroke units (HASU). Associations between variables were examined by chi-squared tests and multivariable logistic regression (COS as reference).
Results
There were 272 HOS and 3037 COS patients with mean ages of 80.2 years ± 12.5 and 76.4 years ± SD13.5 and equal sex distribution. Compared to COS, HOS had higher proportions ≥ 80 years (64.0% vs 46.4%), congestive heart failure (16.9% vs 4.9%), atrial fibrillation (25.0% vs 19.7%) and pre-stroke disability (9.6% vs 5.1%), and similar history of stroke, hypertension, diabetes, stroke type and severity of stroke. After age, sex and co-morbidities adjustments, HOS had greater risk of pneumonia: OR (95%CI) = 1.9 (1.3–2.6); malnutrition: OR = 2.2 (1.7–2.9); immediate thrombolysis complications: OR = 5.3 (1.5–18.2); length of stay on HASU > 3 weeks: OR = 2.5 (1.8–3.4); post-stroke disability: OR = 1.8 (1.4–2.4); and in-hospital mortality: OR = 1.8 (1.2–2.4), as well as greater support at discharge including palliative care: OR = 1.9 (1.3–2.8); nursing care: OR = 2.0 (1.3–4.0), help for daily living activities: OR = 1.6 (1.1–2.2); and joint-care planning: OR = 1.5 (1.1–1.9).
Conclusions
This detailed analysis of underlying differences in subject characteristics between patients with HOS or COS and adverse consequences provides further insights into understanding poorer outcomes associated with HOS.
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Affiliation(s)
- David Fluck
- Department of Cardiology, Ashford and St Peter’s NHS Foundation Trust, Chertsey, GU9 0PZ UK
| | - Christopher H. Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD UK
| | - Suzanne Rankin
- Department of Cardiology, Ashford and St Peter’s NHS Foundation Trust, Chertsey, GU9 0PZ UK
| | - Giosue Gulli
- Department of Stroke, Ashford and St Peter’s NHS Foundation Trust, Chertsey, GU9 0PZ UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter’s NHS Foundation Trust, Chertsey, GU9 0PZ UK
| | - Jonathan Robin
- Department of Acute Medicine, Ashford and St Peter’s NHS Foundation Trust, Chertsey, GU9 0PZ UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom, KT18 7EG UK
| | - Pankaj Sharma
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, W6 8RF UK
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX UK
| | - Thang S. Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX UK
- Department of Endocrinology, Ashford and St Peter’s NHS Foundation Trust, Chertsey, GU9 0PZ UK
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23
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Kamo A, Nozoe M, Kubo H, Shimada S. Care-needs certification in the national long-term care insurance is useful for assessment of premorbid function in older Japanese patients with stroke. J Stroke Cerebrovasc Dis 2022; 31:106493. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/03/2022] [Indexed: 11/30/2022] Open
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Nozoe M, Noguchi M, Kubo H, Kanai M, Shimada S. Association between the coexistence of premorbid sarcopenia, frailty, and disability and functional outcome in older patients with acute stroke. Geriatr Gerontol Int 2022; 22:642-647. [PMID: 35848637 DOI: 10.1111/ggi.14432] [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: 04/21/2022] [Revised: 05/26/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
AIM To investigate the effects of coexisting conditions such as premorbid sarcopenia, frailty, and disability on functional outcomes in older patients with acute stroke. METHODS This prospective cohort study included older patients (aged ≥65 years) hospitalized for acute stroke at a single neurosurgical hospital. Premorbid sarcopenia, frailty, and disability were diagnosed using the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire, frailty index, and modified Rankin Scale (mRS) on admission. The primary outcome was the mRS score 3 months after stroke, and a poor outcome was defined as mRS ≥4. RESULTS This study included 317 older patients with acute stroke (median [interquartile range] age: 76 [12] years). Premorbid sarcopenia, frailty, and disability (mRS = 2 or 3) were identified in 59 (19%), 27 (9%), and 54 (17%) patients, respectively. Two coexisting conditions were observed in 26 patients (8%), and three were observed in 18 patients (6%). Adjusted logistic regression analysis revealed that coexisting conditions were independently associated with poor outcomes (one condition, adjusted OR: 3.20 [95%CI: 0.98-10.45]; two conditions, adjusted OR: 6.57 [95%CI: 1.74-24.87]; three conditions, adjusted OR: 12.70 [95%CI: 2.65-60.91]). CONCLUSIONS The coexistence of premorbid sarcopenia, frailty, and disability was associated with poor functional outcomes in older patients with acute stroke. Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Madoka Noguchi
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Hiroki Kubo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Masashi Kanai
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
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Adamou A, Gkana A, Mavrovounis G, Beltsios ET, Kastrup A, Papanagiotou P. Outcome of Endovascular Thrombectomy in Pre-stroke Dependent Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:880046. [PMID: 35572918 PMCID: PMC9097509 DOI: 10.3389/fneur.2022.880046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/05/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction Endovascular thrombectomy (EVT) is a well-established and effective therapeutic option for patients that meet certain criteria. However, this modality is not well studied in patients with pre-existing disability. The aim of the present study was to investigate the impact of mechanical thrombectomy in patients with acute onset ischemic stroke and pre-stroke dependency (PSD) in regard to their clinical outcome and mortality. Materials and Methods The MEDLINE, Scopus, and Cochrane Library databases were comprehensively searched with a cut-off date of December 11th, 2021. We performed meta-analysis to investigate the 90-day clinical outcome, the 90-day mortality, and the rate of symptomatic intracerebral hemorrhage (sICH) between the PSD (modified Rankin Scale score ≥ 3) and non-PSD (modified Rankin Scale score = 0-2) groups who underwent EVT for acute onset ischemic stroke. Results Six studies were included in the meta-analysis involving 4,543 cases with no PSD and 591 cases with PSD. The non-PSD group showed a statistically significant better clinical outcome at 90 days compared to the PSD group [RR (95% CI) = 1.44 (1.06, 1.85); p z = 0.02]. The non-PSD group demonstrated a statistically significant lower risk of death at 90 days in comparison to the PSD group [RR (95% CI) = 0.45 (0.41, 0.50); p z < 0.01]. Lastly, the rate of sICH was comparable between the two groups [RR (95% CI) = 0.89 (0.64, 1.24); p z = 0.48]. Discussion We report a higher rate of unfavorable clinical outcome and a higher mortality rate in patients with PSD undergoing EVT compared to those with no previous disability. However, there was a significant proportion of PSD cases who fared well post-procedurally, indicating that PSD patients should not be routinely excluded from mechanical thrombectomy. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021284181, identifier: CRD42021284181.
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Affiliation(s)
- Antonis Adamou
- Department of Radiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Androniki Gkana
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Georgios Mavrovounis
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Eleftherios T. Beltsios
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Andreas Kastrup
- Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
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Ganesh A, Fraser JF, Gordon Perue GL, Amin-Hanjani S, Leslie-Mazwi TM, Greenberg SM, Couillard P, Asdaghi N, Goyal M. Endovascular Treatment and Thrombolysis for Acute Ischemic Stroke in Patients With Premorbid Disability or Dementia: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2022; 53:e204-e217. [PMID: 35343235 DOI: 10.1161/str.0000000000000406] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Patients with premorbid disability or dementia have generally been excluded from randomized controlled trials of reperfusion therapies such as thrombolysis and endovascular therapy for acute ischemic stroke. Consequently, stroke physicians face treatment dilemmas in caring for such patients. In this scientific statement, we review the literature on acute ischemic stroke in patients with premorbid disability or dementia and propose principles to guide clinicians, clinician-scientists, and policymakers on the use of acute stroke therapies in these populations. Recent clinical-epidemiological studies have demonstrated challenges in our concept and measurement of premorbid disability or dementia while highlighting the significant proportion of the general stroke population that falls under this umbrella, risking exclusion from therapies. Such studies have also helped clarify the adverse long-term clinical and health economic consequences with each increment of additional poststroke disability in these patients, underscoring the importance of finding strategies to mitigate such additional disability. Several observational studies, both case series and registry-based studies, have helped demonstrate the comparable safety of endovascular therapy in patients with premorbid disability or dementia and in those without, complementing similar data on thrombolysis. These data also suggest that such patients have a substantial potential to retain their prestroke level of disability when treated, despite their generally worse prognosis overall, although this remains to be validated in higher-quality registries and clinical trials. By pairing pragmatic and transparent decision-making in clinical practice with an active pursuit of high-quality research, we can work toward a more inclusive paradigm of patient-centered care for this often-neglected patient population.
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Pre-fracture Mobility Using Standardized Scale as an Early Indicator of High Health Risk in Patients with a Hip Fracture. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-021-09468-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractHip fracture in older adults is associated with poor prognosis. We tested the hypothesis that a single standardized measure, pre-fracture mobility, can be used as an early indicator of patients at high health risk after a hip fracture. Analysis of prospectively collected data of older adults admitted with a hip fracture between April-2009 and June-2019 in a single NHS hospital, UK. Pre-fracture mobility status (freely mobile, mobilising outdoors with one aid or with two aids, and limited to indoors), was used to predict length of stay (LOS) and mortality in hospital, and discharge destination. Among 3073 (2231 women, 842 men) admitted from their own home (mean ± SD age = 82.7 ± 9.3 yr), 159 died and 2914 survived to discharge: 1834 back to their home, 772 to rehabilitation, 66 to residential care, 141 to nursing care and 101 to unknown destinations. Compared with LOS of 15.9 ± 15.6 days in patients who mobilised freely before fracture (reference), those who were able to mobilise outdoors with one aid stayed 3.5 days, and those with two aids or confined to indoor mobility stayed one week longer in hospital. In-patient mortality was increased among patients who mobilised outdoors with two aids: OR = 2.1 (95%CI = 1.3–3.3), and those limited to indoors: OR = 2.1 (1.3–1.5). Finally, a change in residence on discharge was more likely in those who mobilised outdoors with two aids (OR = 1.8, 95%CI = 1.2–2.6), and those limited to indoors (OR = 1.9, 95%CI = 1.2–2.9). In conclusion, pre-fracture mobility may be a useful early indicator for identifying patients at increased risk of adverse outcomes after an acute hip fracture.
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Rosa JL, Alves M, Ferreira P, Papoila AL, Nunes AP. Previous Disability and Benefit of Acute Phase Therapy in Functional Prognosis of Selected Patients with Ischemic Stroke. J Stroke Cerebrovasc Dis 2021; 31:106183. [PMID: 34717228 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106183] [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: 07/13/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Patients' previous disability (PD) is a key factor when considering acute stroke therapy. PD's exact impact on functional prognosis of patients with acute ischemic stroke remains not entirely clarified. We aimed to analyze PD's influence on functional outcome three months after ischemic stroke. MATERIALS AND METHODS Retrospective analysis of prospectively collected data concerning patients with acute ischemic stroke admitted to Stroke Unit of a tertiary center who underwent acute phase therapy between 2017 and 2019. Modified Rankin Scale (mRS) was used to define PD (with previous mRS≥3). Patients with PD were selected for treatment based on similar baseline characteristics to patients without PD. Patients were classified into two groups according to previous mRS: mRS<3 and mRS≥3. We defined bad outcome at three months after stroke as mRS≥3 for patients with previous mRS<3, and as a higher score than baseline mRS for patients with previous mRS≥3. RESULTS We identified 1169 eligible patients - 1016 patients with previous mRS<3 and 153 patients with previous mRS≥3. Most baseline characteristics did not differ significantly between them. For patients ≤75 years old, PD was associated with worse outcome (odds ratio estimate [OR] 4.50, p < 0.001). For patients >75 years old, PD was protective against worse outcome (OR 0.42, p < 0.001). In patients with previous mRS≥3 and >75 years old, there was a higher proportion of women (p = 0.005). CONCLUSIONS PD might not be a relevant factor when considering acute stroke therapy in selected patients >75 years old, especially women. Further studies are needed to clarify these findings.
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Affiliation(s)
- José Lourenço Rosa
- Neurology Department, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, Lisbon 1169-050, Portugal.
| | - Marta Alves
- Epidemiology and Statistics Unit, Research Center, Centro Hospitalar Universitário de Lisboa Central, NOVA Medical School/Faculdade de Ciências Médicas, Center of Statistics and its Applications, University of Lisbon, Lisbon, Portugal
| | - Patrícia Ferreira
- Stroke Unit, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Luísa Papoila
- Epidemiology and Statistics Unit, Research Center, Centro Hospitalar Universitário de Lisboa Central, NOVA Medical School/Faculdade de Ciências Médicas, Center of Statistics and its Applications, University of Lisbon, Lisbon, Portugal
| | - Ana Paiva Nunes
- Stroke Unit, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Han TS, Fry CH, Fluck D, Gulli G, Affley B, Robin J, Kakar P, Sharma P. Predicting Stroke Complications in Hospital and Functional Status at Discharge by Clustering of Cardiovascular Diseases a Multi-Centre Registry-Based Study of Acute Stroke. J Stroke Cerebrovasc Dis 2021; 31:106162. [PMID: 34689050 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106162] [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: 08/17/2021] [Revised: 09/25/2021] [Accepted: 10/03/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Indicators for outcomes following acute stroke are lacking. We have developed novel evidence-based criteria for identifying outcomes of acute stroke using the presence of clusters of coexisting cardiovascular disease (CVD). MATERIALS AND METHODS Analysis of prospectively collected data from the Sentinel Stroke National Audit Programme (SSNAP). A total of 1656 men (mean age ±SD=73.1yrs±13.2) and 1653 women (79.3yrs±13.0) were admitted with acute stroke (83.3% ischaemic, 15.7% intracranial haemorrhagic), 1.0% unspecified) in four major UK hyperacute stroke units (HASU) between 2014 and 2016. Four categories from cardiovascular disease Congestive heart failure, Atrial fibrillation, pre-existing Stroke and Hypertension (CASH).were constructed: CASH-0 (no coexisting CVD); CASH-1 (any one coexisting CVD); CASH-2 (any two coexisting CVD); CASH-3 (any three or all four coexisting CVD). These were tested against outcomes, adjusted for age and sex. RESULTS Compared to CASH-0, individuals with CASH-3 had greatest risks of in-hospital mortality (11.1% vs 24.5%, OR=1.8, 95%CI=1.3-2.7) and disability (modified Rankin Scale score ≥4) at discharge (24.2% vs 46.2%, OR=1.9, 95%CI=1.4-2.7), urinary tract infection (3.8% vs 14.6%, OR= 3.3, 95%CI= 1.9-5.5), and pneumonia (7.1% vs 20.6%, OR= 2.6, 95%CI= 1.7-4.0); length of stay on HASU >14 days (29.8% vs 39.3%, OR=1.8, 95%CI=1.3-2.6); and joint-care planning (20.9% vs 29.8%, OR=1.4, 95%CI=1.0-2.0). CONCLUSIONS We present a simple tool for estimating the risk of adverse outcomes of acute stroke including death, disability at discharge, nosocomial infections, prolonged length of stay, as well as any joint care planning. CASH-0 indicates a low level and CASH-3 indicates a high level of risk of such complications after stroke.
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Affiliation(s)
- Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK.
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD UK.
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
| | - Giosue Gulli
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
| | - Jonathan Robin
- Department of Acute Medicine, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom KT18 7EG, UK.
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK; Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London W6 8RF, UK.
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30
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Fluck D, Fry CH, Gulli G, Affley B, Robin J, Kakar P, Sharma P, Han TS. Association of risk of malnutrition with adverse outcomes and early support on discharge in acute stroke patients without prestroke disability: A multicenter, registry-based cohort study. Nutr Clin Pract 2021; 37:1233-1241. [PMID: 34664741 DOI: 10.1002/ncp.10790] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Malnutrition in hospitals remains highly prevalent. As part of quality improvement initiatives, the Royal College of Physicians recommends nutrition screening for all patients admitted with acute stroke. We aimed to examine the associations of patients at risk of malnutrition with poststroke outcomes. METHODS We analyzed prospectively collected data from four hyperacute stroke units (HASUs) (2014-2016). Nutrition status was screened in 2962 acute stroke patients without prestroke disability (1515 men, [mean ± SD] 73.5 years ± 13.1; 1447 women, 79.2 ± 13.0 years). The risk of malnutrition was tested against stroke outcomes and adjusted for age, sex, and comorbidities. RESULTS Risk of malnutrition was identified in 25.8% of patients). Compared with well-nourished patients, those at risk of malnutrition had, within 7 days of admission, increased risk of stay on the HASU of >14 days (odds ratio [OR]: 9.9 [7.3-11.5]), disability on discharge (OR: 8.1 [6.6-10.0]), worst level of consciousness in the first 7 days (score ≥ 1) (OR: 7.5 [6.1-9.3]), mortality (OR: 5.2 [4.0-6.6], pneumonia (OR: 5.1 [3.9-6.7]), and urinary tract infection (OR: 1.5 [1.1-2.0]). They also required palliative care (OR: 12.3 [8.5-17.8]), discharge to new care home (OR: 3.07 [2.18-4.3]), activities of daily living support (OR: 1.8 [1.5-2.3]), planned joint care (OR: 1.5 [1.2-1.8]), and weekly visits (OR: 1.4 [1.1-1.8]). CONCLUSION Patients at risk of malnutrition more commonly have multiple adverse outcomes after acute stroke and greater need for early support on discharge.
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Affiliation(s)
- David Fluck
- Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Giosue Gulli
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Jonathan Robin
- Department of Acute Medicine, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK.,Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK
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31
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Nozoe M, Kubo H, Kanai M, Yamamoto M. Relationships between Pre-Stroke SARC-F Scores, Disability, and Risk of Malnutrition and Functional Outcomes after Stroke-A Prospective Cohort Study. Nutrients 2021; 13:nu13103586. [PMID: 34684587 PMCID: PMC8537569 DOI: 10.3390/nu13103586] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/30/2021] [Accepted: 10/09/2021] [Indexed: 12/24/2022] Open
Abstract
SARC-F is a screening tool for sarcopenia; however, it has not yet been established whether SARC-F scores predict functional outcomes. Therefore, we herein investigated the relationship between SARC-F scores and functional outcomes in stroke patients. The primary outcome in the present study was the modified Rankin Scale (mRS) 3 months after stroke. The relationship between SARC-F scores and poor functional outcomes was examined using a logistic regression analysis. Furthermore, the applicability of SARC-F scores to the assessment of poor functional outcomes was analyzed based on the area under the receiver operating curve (ROC). Eighty-one out of the 324 patients enrolled in the present study (25%) had poor functional outcomes (mRS ≥ 4). The results of the multivariate analysis revealed a correlation between SARC-F scores (OR = 1.29, 95% CI = 1.05–1.59, p = 0.02) and poor functional outcomes. A cut-off SARC-F score ≥ 4 had low-to-moderate sensitivity (47.4%) and high specificity (87.3%). The present results suggest that the measurement of pre-stroke SARC-F scores is useful for predicting the outcomes of stroke patients.
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Affiliation(s)
- Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women’s University, Kobe 658-0001, Japan;
- Correspondence: ; Tel.: +81-78-413-3584
| | - Hiroki Kubo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami 664-0028, Japan; (H.K.); (M.Y.)
| | - Masashi Kanai
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women’s University, Kobe 658-0001, Japan;
| | - Miho Yamamoto
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami 664-0028, Japan; (H.K.); (M.Y.)
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Fluck D, Murray P, Robin J, Fry CH, Han TS. Early emergency readmission frequency as an indicator of short-, medium- and long-term mortality post-discharge from hospital. Intern Emerg Med 2021; 16:1497-1505. [PMID: 33367951 PMCID: PMC8354916 DOI: 10.1007/s11739-020-02599-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/02/2020] [Indexed: 01/13/2023]
Abstract
Frequent emergency readmissions, an indicator of quality of care, has been rising in England but the underlying reasons remain unclear. We examined the association of early readmissions with subsequent mortality in adults, taking into account the underlying presenting diagnoses and hospital length of stay (LOS). Data of alive-discharge episodes were prospectively collected between 01/04/2017 and 31/03/2019 in an National Health Service hospital, comprising 32,270 patients (46.1% men) aged 18-107 years (mean = 64.0, ± SD = 20.5 years). The associations of readmission frequency within 28 days of discharge and mortality within 30 days and 6 months of hospital discharge, and over a 2-year period were evaluated, adjusted for presenting diagnoses, LOS, age and sex during the first admission. Analysis of all patients 18-107 years (reference: no readmission) showed mortality within 30 days was increased for 1 readmission: event rate = 9.2%, odds ratio (OR) = 3.4 (95% confidence interval (CI) = 2.9-4.0), and ≥ 2 readmissions: event rate = 10.0%, OR = 2.6 (95%CI = 2.0-3.3), and within 6 months for 1 readmission: event rate = 19.6%, OR = 3.0 (95%CI = 2.7-3.4), and ≥ 2 readmissions: event rate = 27.4%, OR = 3.4 (95%CI = 2.9-4.0), and over a 2-year period for 1 readmission: event rate = 25.5%, hazard ratio = 2.2 (95%CI = 2.0-2.4), and ≥ 2 readmissions: event rate = 36.1%, hazard ratio = 2.5 (95%CI = 2.2-2.8). Within the age groups 18-49, 50-59, 60-69, 70-79 and ≥ 80 years, readmissions were also associated with increased risk of mortality within 3 months and 6 months of discharge, and over 2-year period. In conclusion, early hospital readmission predicts short-, medium- and long-term mortality post-discharge from hospital in adults aged 18-107 years, independent of underlying presenting conditions, LOS, age and sex. Further research focussing on safe discharge and follow-up patient care may help reduce preventable readmissions and post-discharge mortality.
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Affiliation(s)
- David Fluck
- Department of Cardiology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK
| | - Paul Murray
- Department of Respiratory Medicine, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK
| | - Jonathan Robin
- Acute Medical Unit, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK
| | - Christopher Henry Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK
| | - Thang Sieu Han
- Department of Endocrinology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK.
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK.
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Prognostic factors of functional outcome in post-acute stroke in the rehabilitation unit. J Formos Med Assoc 2021; 121:670-678. [PMID: 34303583 DOI: 10.1016/j.jfma.2021.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND/PURPOSE This retrospective study aimed to determine which factors, such as cognition, motor recovery, swallowing function, and bladder and bowel functions, significantly predicted independence in the activities of daily living (ADL) at hospital discharge in a domestic population of patients experiencing post-acute stroke who received in-hospital rehabilitation. METHODS We reviewed medical records that were retrieved from the Integrated Medical Database, National Taiwan University Hospital (NTUH-iMD) of 3000 patients who suffered from stroke and were admitted to NTUH from 2014 to 2017. The main outcome measure was independence in the basic ADL (modified Barthel index [mBI]) at discharge. Regression analyses were used to identify prognostic factors for the basic ADL (mBI). RESULTS The total mBI improved from 40.7 ± 33.0 to 63.1 ± 34.1 in eligible 2538 patients during their hospital stay. The baseline daily activity function (R2 change = 0.042) was the most important prognostic factor associated with independence at discharge, followed by dependence in sitting up (R2 change = 0.014), impaired sitting balance (R2 change = 0.010), the Brunnstrom stage of hemiplegic lower limb (R2 change = 0.006), and the presence of bladder incontinence (R2 change = 0.006) assessed by physician upon rehabilitation admission (R2 = 0.53, p < 0.05). Dependency in sitting up, impaired sitting balance, and the presence of urinary incontinence were negative prognostic factors of ADL independence at discharge (p < 0.05). By contrast, the Brunnstrom stage of hemiplegic lower limb and baseline mBI scores at rehabilitation admission were positive prognostic factors of ADL independence at discharge (p < 0.05). CONCLUSION Baseline ADL function was the most important prognostic factor of functional independence in post-acute stroke. Moreover, the activity limitation of dependency on sitting up and motor function impairment of hemiplegic lower limb prognosticated functional independence.
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Adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke. J Thromb Thrombolysis 2021; 53:218-227. [PMID: 34255266 PMCID: PMC8791861 DOI: 10.1007/s11239-021-02523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 10/27/2022]
Abstract
Complications following thrombolysis for stroke are well documented, and mostly concentrated on haemorrhage. However, the consequences of patients who experience any immediate thrombolysis-related complications (TRC) compared to patients without immediate TRC have not been examined. Prospectively collected data from the Sentinel Stroke National Audit Programme were analysed. Thrombolysis was performed in 451 patients (52.1% men; 75.3 years ± 13.2) admitted with acute ischaemic stroke (AIS) in four UK centres between 2014 and 2016. Adverse consequences following immediate TRC were assessed using logistic regression, adjusted for age, sex and co-morbidities. Twenty-nine patients (6.4%) acquired immediate TRC. Compared to patients without, individuals with immediate TRC had greater adjusted risks of: moderately-severe or severe stroke (National Institutes of Health for Stroke Scale score ≥ 16) at 24-h (5.7% vs 24.7%, OR 3.9, 95% CI 1.4-11.1); worst level of consciousness (LOC) in the first 7 days (score ≥ 1; 25.0 vs 60.7, OR 4.6, 95% CI 2.1-10.2); urinary tract infection or pneumonia within 7-days of admission (13.5% vs 39.3%, OR 3.2, 95% CI 1.3-7.7); length of stay (LOS) on hyperacute stroke unit (HASU) ≥ 2 weeks (34.7% vs 66.7%, OR 5.2, 95% CI 1.5-18.4); mortality (13.0% vs 41.4%, OR 3.7, 95% CI 1.6-8.4); moderately-severe or severe disability (modified Rankin Scale score ≥ 4) at discharge (26.8% vs 65.5%, OR 4.7, 95% CI 2.1-10.9); palliative care by discharge date (5.1% vs 24.1%, OR 5.1, 95% CI 1.7-15.7). The median LOS on the HASU was longer (7 days vs 30 days, Kruskal-Wallis test: χ2 = 8.9, p = 0.003) while stroke severity did not improve (NIHSS score at 24-h post-thrombolysis minus NIHSS score at arrival = - 4 vs 0, χ2 = 24.3, p < 0.001). In conclusion, the risk of nosocomial infections, worsening of stroke severity, longer HASU stay, disability and death is increased following immediate TRC. The management of patients following immediate TRC is more complex than previously thought and such complexity needs to be considered when planning an increased thrombolysis service.
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Fry CH, Fluck D, Han TS. Frequent identical admission-readmission episodes are associated with increased mortality. Clin Med (Lond) 2021; 21:e351-e356. [PMID: 35192477 PMCID: PMC8313203 DOI: 10.7861/clinmed.2020-0930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Frequent emergency readmissions may associate with health consequences. We examined the association between readmissions within 28 days of hospital discharge and mortality in 32,270 alive-discharge episodes (18-107 years). Data collected between 1 April 2017 and 31 March 2019 are presented as age- and sex-adjusted hazard ratios (HR) with 95% confidence interval (CI).Compared with no readmission, mortality risk over a 2-year period was increased with one non-identical admission-readmission (AR) episode: HR = 2.4 (2.2-2.7), two or more non-identical AR episodes: HR = 3.0 (2.7-3.4), one identical AR episode: HR = 4.7 (3.6-6.1) and two or more identical AR episodes: HR = 5.0 (3.8-6.7). Eight conditions associated with AR episodes had increased risk of mortality including congestive heart failure: HR = 2.7 (2.2-3.2), chronic pulmonary obstructive disease: HR = 3.0 (2.5-3.6), pneumonia: HR = 2.0 (1.8-2.3), sepsis: HR = 2.2 (1.9-2.5), endocrine disorders: HR = 1.9 (1.6-2.3), urinary tract infection: HR = 1.5 (1.3-1.7), psychiatric disorders: HR = 1.5 (1.1-2.1) and haematological disorders: HR = 1.5 (1.2-1.9). Frequent identical AR episodes, particularly from chronic and age-related conditions, are associated with increased mortality.
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Affiliation(s)
- Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, UK
| | - Thang S Han
- Department of Endocrinology, Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, UK, and senior lecturer, Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, UK
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Noguchi M, Kubo H, Kanai M, Nozoe M, Shimada S. Relationship between pre-stroke frailty status and short-term functional outcome in older patients with acute stroke–A mediation analysis-. Arch Gerontol Geriatr 2021; 94:104370. [DOI: 10.1016/j.archger.2021.104370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/22/2021] [Accepted: 01/31/2021] [Indexed: 12/31/2022]
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Heppleston E, Fry CH, Kelly K, Shepherd B, Wright R, Jones G, Robin J, Murray P, Fluck D, Han TS. LACE index predicts age-specific unplanned readmissions and mortality after hospital discharge. Aging Clin Exp Res 2021; 33:1041-1048. [PMID: 32504318 PMCID: PMC8084827 DOI: 10.1007/s40520-020-01609-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022]
Abstract
Background The LACE index scoring tool (Length of stay, Acuity of admission, Co-morbidities and Emergency department visits) has been designed to predict hospital readmissions. We evaluated the ability of the LACE index to predict age-specific frequent admissions and mortality. Methods Analysis of prospectively collected data of alive-discharge episodes between 01/04/2017 and 31/03/2019 in an NHS hospital. Data on 14,878 men and 17,392 women of mean age 64.0 years, SD = 20.5, range 18.0–106.7 years were analysed. The association of the LACE index with frequency of all-cause readmissions within 28 days of discharge and over a 2-year period, and with all-cause mortality within 30 days or within 6 months after discharge from hospital were evaluated. Results Within LACE index scores of 0–4, 5–9 or ≥ 10, the proportions of readmission ≥ 2 times within 28 days of discharge were 0.1, 1.3 and 9.2% (χ2 = 3070, p < 0.001) and over a 2-year period were 1.7, 4.8 and 19.1% (χ2 = 3364, p < 0.001). Compared with a LACE index score of 0–4, a score ≥ 10 increased the risk (adjusted for age, sex and frequency of admissions) of death within 6 months of discharge by 6.8-fold (5.1–9.0, p < 0.001) among all ages, and most strongly in youngest individuals (18.0–49.9 years): adjusted odds ratio = 16.1 (5.7–45.8, p < 0.001). For those aged 50–59.9, 60–69.9, 70–79.9 and ≥ 80 years, odds ratios reduced progressively to 9.6, 7.7, 5.1 and 2.3, respectively. Similar patterns were observed for the association of LACE index with mortality within 30 days of hospital discharge. Conclusions The LACE index predicts short-term and long-term frequent admissions and short-term and medium-term mortality, most pronounced among younger individuals, after hospital discharge.
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Affiliation(s)
- Erica Heppleston
- Quality Department, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK
| | - Kevin Kelly
- Digital Services, Department, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Beth Shepherd
- Quality Department, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Ria Wright
- Quality Department, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Gareth Jones
- Quality Department, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Jonathan Robin
- Department of Medicine, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Paul Murray
- Department of Respiratory, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Thang S Han
- Department of Endocrinology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK.
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, TW20 0EX, Surrey, UK.
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[Influence of prior ischemic events on the nutritional status of patients hospitalized for stroke]. NUTR HOSP 2021; 38:773-779. [PMID: 33993699 DOI: 10.20960/nh.03479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Background and aims: a poor nutritional status may worsen the prognosis of stroke. We assessed which factors were associated with a worse nutritional status in patients with stroke at the time of hospitalization. Methods: a cross-sectional study in patients with stroke needing enteral nutritional support, from January 2014 to September 2016. Nutritional status was evaluated by the Mini-Nutritional Assessment tool, and the Subjective Global Assessment. We performed a multivariate regression analysis including demographic, baseline disability (modified Rankin scale), and clinical and anthropometric variables, and we stratified the sample based on median age. Results: we included 226 patients, 58.3 % male, with a median age of 77 (66.7-83) years. Forty-four percent were at risk of malnutrition, and 24 % were malnourished. The factors that were associated with a worse nutritional status were age (odds ratio (OR): 1.03; 95 % CI: 1.01-1.08) and modified Rankin scale score (OR: 1.96; 95 % CI: 1.32-2.67). In the stratified analysis, associated factors were, in the subgroup of patients older than 77 years, the baseline degree of disability (OR: 1.88; 95 % CI: 1.26-2.80), whereas in the subgroup of patients younger than 77 years, it was a prior history of ischemic events (OR: 2.86; 95 % CI: 1.01-8.16). Conclusion: in patients hospitalized due to stroke, older age and worse functional status were associated with a worse nutritional status at the time of hospitalization. In elderly patients, the main factor was prior functional status, while in younger patients it was a prior history of ischemic events.
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Bruno A, Nichols FT. Letter by Bruno and Nichols Regarding Article, “Prestroke Disability Predicts Adverse Poststroke Outcome: A Registry-Based Prospective Cohort Study of Acute Stroke”. Stroke 2020; 51:e116. [DOI: 10.1161/strokeaha.120.029653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Askiel Bruno
- Department of Neurology, Medical College of Georgia, Augusta University
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Han TS, Sharma P. Response by Han and Sharma to Letter Regarding Article, "Prestroke Disability Predicts Adverse Poststroke Outcome: A Registry-Based Prospective Cohort Study of Acute Stroke". Stroke 2020; 51:e117. [PMID: 32397938 DOI: 10.1161/strokeaha.120.029952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, United Kingdom
| | - Pankaj Sharma
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, United Kingdom
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