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Asikainen A, Korja M, Kaprio J, Rautalin I. Sex Differences in Case Fatality of Aneurysmal Subarachnoid Hemorrhage: A Systematic Review. Neuroepidemiology 2024:1-14. [PMID: 38599189 DOI: 10.1159/000538562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Aneurysmal subarachnoid hemorrhage (SAH) is more common in women than in men, contrary to most cardiovascular diseases. However, it is unclear whether the case fatality rate (CFR) of SAH also differs by sex. Thus, we performed a systematic review to address the relationship between sex and SAH CFRs. METHODS We conducted a systematic literature search in PubMed, Scopus, and Cochrane library databases. We focused on population-based studies that included both nonhospitalized and hospitalized SAHs and had either reported 1-month (28-31 day) SAH CFRs separately for men and women or calculated risk estimates for SAH CFR by sex. For quality classification, we used the Cochrane Collaboration Handbook and Critical Appraisal Skills Program guidelines. We pooled the study cohorts and calculated relative risk ratios (RRs) with 95% confidence intervals (CIs) for SAH death between women and men using a random-effects meta-analysis model. RESULTS The literature search yielded 5,592 initial publications, of which 33 study cohorts were included in the final review. Of the 33 study cohorts, only three reported significant sex differences, although the findings were contradictory. In the pooled analysis of all 53,141 SAH cases (60.3% women) from 26 countries, the 1-month CFR did not differ (RR = 0.99 [95% CI: 0.93-1.05]) between women (35.5%) and men (35.0%). According to our risk-of-bias evaluation, all 33 study cohorts were categorized as low quality. The most important sources of bias risks were related to the absence of proper confounding control (all 33 study cohorts), insufficient sample size (27 of 33 study cohorts), and poor/unclear diagnostic accuracy (27 of 33 study cohorts). CONCLUSION Contrary to SAH incidence rates, the SAH CFRs do not seem to differ between men and women. However, since none of the studies were specifically designed to examine the sex differences in SAH CFRs, future studies on the topic are warranted.
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Affiliation(s)
- Aleksanteri Asikainen
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaakko Kaprio
- Institute for Molecular Medicine FIMM, University of Helsinki, Helsinki, Finland
| | - Ilari Rautalin
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- The National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
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Asikainen A, Korja M, Kaprio J, Rautalin I. Case Fatality of Aneurysmal Subarachnoid Hemorrhage Varies by Geographic Region Within Finland: A Nationwide Register-Based Study. Neurology 2023; 101:e1950-e1959. [PMID: 37775314 PMCID: PMC10662974 DOI: 10.1212/wnl.0000000000207850] [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: 04/24/2023] [Accepted: 08/03/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Previous studies have reported a substantial between-country variation in the case fatality rates (CFRs) of aneurysmal subarachnoid hemorrhage (SAH). However, contrary to comparisons among countries, nationwide comparisons within countries that focus on populations with equal access to health care and include out-of-hospital deaths in analyses are lacking. Thus, we aimed to investigate whether the SAH CFRs vary between geographic regions within Finland. METHODS We identified all hospitalized and nonhospitalized (sudden-death) cases with aneurysmal SAH in Finland during 1998-2017 through 2 externally validated nationwide registers. According to the municipality of residence, we divided the cases with SAH into 5 geographic regions: Southern, Central, Western, Northern, and Eastern Finland, each served by a University Central Hospital with a neurosurgical service. In addition to overall 30-day CFRs, we computed sudden death rates and 30-day CFRs after hospitalization for each region. Using logistic and Poisson regression models, we calculated regional age-adjusted, sex-adjusted, and year-adjusted odds ratios and annual percent changes with 95% CIs for CFRs. RESULTS During 1998-2017, we identified a total of 9,443 cases with SAH, of which 3,484 (36.9%) occurred in Southern Finland. In comparison with the overall 30-day CFR of Southern Finland (35.1%), the age-adjusted, sex-adjusted, and study year-adjusted odds of SAH death were 32% (16%-50%) higher in Central Finland (42.7%), 39% (23%-58%) higher in Eastern Finland (43.4%), and 52% (33%-74%) higher in Western Finland (47.1%). The regional differences were present among both sexes, in all age groups, in sudden death rates, and in 30-day CFRs after hospitalization. Between 1998 and 2017, the overall 30-day CFRs decreased in Central (2.4% [1.0%-3.8%] per year) and Southern (1.2% [0.2%-2.2%] per year) Finland, whereas CFRs remained stable in the other regions. In the last 4 years of the study period (2014-2017), Southern Finland had the lowest 30-day CFR (16.5%) among hospitalized patients. DISCUSSION SAH CFRs seem to vary significantly even within a country with relatively equal access to health care. Future studies with detailed individual-level data are needed to explore whether health inequities explain the reported findings.
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Affiliation(s)
- Aleksanteri Asikainen
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital, Finland; Department of Public Health (A.A.) and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland; and National Institute for Stroke and Applied Neurosciences (I.R.), Auckland University of Technology, New Zealand.
| | - Miikka Korja
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital, Finland; Department of Public Health (A.A.) and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland; and National Institute for Stroke and Applied Neurosciences (I.R.), Auckland University of Technology, New Zealand
| | - Jaakko Kaprio
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital, Finland; Department of Public Health (A.A.) and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland; and National Institute for Stroke and Applied Neurosciences (I.R.), Auckland University of Technology, New Zealand
| | - Ilari Rautalin
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital, Finland; Department of Public Health (A.A.) and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland; and National Institute for Stroke and Applied Neurosciences (I.R.), Auckland University of Technology, New Zealand
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Asikainen A, Korja M, Kaprio J, Rautalin I. Case Fatality in Patients With Aneurysmal Subarachnoid Hemorrhage in Finland: A Nationwide Register-Based Study. Neurology 2023; 100:e348-e356. [PMID: 36257709 DOI: 10.1212/wnl.0000000000201402] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although single-center studies have reported declining case fatality rates (CFRs) of aneurysmal subarachnoid hemorrhage (SAH), nationwide reports that also include sudden-death SAHs with long uninterrupted study periods have remained limited. Moreover, little is known about whether the time-dependent trends of SAH CFR differ by age and/or sex. Thus, we aimed to characterize the nationwide changes of SAH CFRs in Finland between 1998 and 2017. METHODS We used 2 externally validated nationwide registers to identify all hospitalized and nonhospitalized (sudden-death) aneurysmal SAH events in Finland during 1998-2017. In addition to overall 30-day CFRs, we determined annual proportions of sudden-death and 30-day CFRs among hospitalized patients with SAH. To estimate time-dependent trends, we calculated annual age-adjusted and sex-adjusted CFR changes (percent with 95% CIs). RESULTS Between 1998 and 2017, we identified 9,443 cases with SAH (57.6% women), of which 2,245 (23.8%) died before hospitalization and 3,715 (39.3%) died within 30 days after SAH. Among the 7,198 hospitalized patients with SAH, the 30-day CFR was 20.4%. During the study period, the overall age-adjusted and sex-adjusted CFR declined by an average of 1.8% (1.1%-2.6%) per year. The decreases were especially notable in the proportion of sudden deaths among middle-aged (aged 40-64 years) and older (aged 65 years or older) women (2.9% [1.1%-4.7%] and 2.3% [0.7%-4.0%] per year, respectively) and in the CFRs of hospitalized young (younger than 40 years) and middle-aged women (9.1% [2.3%-15.7%] and 4.3% [2.3%-6.5%] per year, respectively). On the contrary, the 30-day CFR of older (aged 65 years or older) hospitalized men increased by 3.5% (0.7%-6.3%) per year, while the proportions of older men who died before hospitalization remained unchanged. DISCUSSION The overall CFR of SAH seems to be decreasing, at least among women. The continued high CFR of hospitalized older men requires attention from clinicians and epidemiologists, especially if this trend is also common in other countries.
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Affiliation(s)
- Aleksanteri Asikainen
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital; Department of Public Health (A.A.), University of Helsinki; and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland.
| | - Miikka Korja
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital; Department of Public Health (A.A.), University of Helsinki; and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland
| | - Jaakko Kaprio
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital; Department of Public Health (A.A.), University of Helsinki; and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland
| | - Ilari Rautalin
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital; Department of Public Health (A.A.), University of Helsinki; and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland
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Sung SB, Kim YD, Ban SP, Lee YJ, Kwon OK. Initial severity of aneurysmal subarachnoid hemorrhage (SAH): Trend over time. J Cerebrovasc Endovasc Neurosurg 2022; 24:349-355. [PMID: 36104959 PMCID: PMC9829564 DOI: 10.7461/jcen.2022.e2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The trend in the initial severity of aneurysmal subarachnoid hemorrhage (SAH) is unclear. This study aimed to evaluate whether there was an improvement in the initial severity of SAH over time. METHODS From January 1, 2005, to December 31, 2020, we identified patients who visited the emergency department of our institution with SAH due to intracranial aneurysm rupture. We identified the Hunt Hess (HH) grade and modified Fisher grade of each patient from the medical records, and the Mann-Kendal method was used to estimate the trend of each grade system. RESULTS A total of 547 patients with SAH were identified. The mean age of the patients was 59.3 years (standard deviation (SD), 14.6). The mean aneurysm size was 6.9 mm (SD, 4.6 mm). The most frequent aneurysm location was the anterior communicating artery (28.7%). In the Mann-Kendal estimates for the analysis of the trend, there was no statistically significant grade throughout the HH and modified Fisher grades. Similarly, there was no improvement throughout all grades in the modified Fisher grade over time. CONCLUSIONS The initial severity of SAH due to cerebral aneurysm rupture did not improve over time.
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Affiliation(s)
- Seung Bin Sung
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Deok Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea,Correspondence to Young Deok Kim Department of Neurosurgery, Seoul National University Bundang Hospital 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea Tel +82-31-787-7171 Fax +82-31-787-4097 E-mail
| | - Seung Pil Ban
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Jae Lee
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - O-Ki Kwon
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
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Nichols L, Gall S, Stankovich J, Stirling C. Associations between socioeconomic status and place of residence with survival after aneurysmal subarachnoid haemorrhage. Intern Med J 2020; 51:2095-2103. [PMID: 32893943 DOI: 10.1111/imj.15044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aims to understand early (< 24 h post ictus) and late (up to 12 months) survival post aneurysmal subarachnoid haemorrhage (aSAH), with a focus on rurality and socioeconomic status. METHODS A statewide population-based cohort of aSAH cases in Tasmania, Australia, was established from 2010-2014 utilising multiple overlapping sources. Clinical data were collected from medical records and the Tasmanian Death Registry, with area-level rurality and socioeconomic status geocoded to participants' residential address. RESULTS From a cohort of 237 (70% women, 36% disadvantaged, 38% rural) individuals over a 5-year period, 12-month mortality was 52.3% with 54.0% of these deaths occurring within 24 h post ictus. In univariable analysis of 12-month survival, outcome was not influenced by socioeconomic status but rural geographical location was associated with a non-significant increase in death (HR 1.22 95% CI 0.85-1.75) along with hypertension (HR 1.78 95% CI 1.07-2.98) and hypercholesterolemia (HR 1.70 95% CI 0.99-2.91). Multivariable analysis demonstrated a statistically significant increase in death to 12 months after aSAH for both hypertension (HR 1.81 95% CI 1.08-3.03) and hypercholesterolemia (HR 1.71 95% CI 1.00-2.94) but not socioeconomic status or geographic location. CONCLUSION We found high early death in this population-based aSAH Australian population. Survival to 12 months after aSAH was not related to either geographical location or socioeconomic status but modifiable risk factors increased the risk of death. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Linda Nichols
- School of Nursing, University of Tasmania, 71 Brooker Ave Glebe, 7001, Hobart, Tasmania, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania
| | - Jim Stankovich
- Department of Neuroscience, Central Clinical School, Monash University
| | - Christine Stirling
- School of Nursing, University of Tasmania, 71 Brooker Ave Glebe, 7001, Hobart, Tasmania, Australia
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Øie LR, Solheim O, Majewska P, Nordseth T, Müller TB, Carlsen SM, Jensberg H, Salvesen Ø, Gulati S. Incidence and case fatality of aneurysmal subarachnoid hemorrhage admitted to hospital between 2008 and 2014 in Norway. Acta Neurochir (Wien) 2020; 162:2251-2259. [PMID: 32601806 PMCID: PMC7415018 DOI: 10.1007/s00701-020-04463-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/13/2020] [Indexed: 01/23/2023]
Abstract
Background To provide age- and sex-specific incidence and case fatality rates for non-traumatic aneurysmal subarachnoid hemorrhage (aSAH) in Norway. We also studied time trends in incidence and case fatality, as well as predictors of death following aSAH. Methods A nationwide study using discharge data for patients admitted with aSAH between 2008 and 2014. Results A total of 1732 patients with aSAH were included. The mean age was 60 years (SD 14) and 63% were females. Crude annual incidence was 5.7 per 100,000 person-years (95% CI 5.4–6.0) and was higher in females (6.3 per 100,000, 95% CI 5.9–6.7) compared with males (4.9 per 100,000, 95% CI 4.5–5.3). The annual decline in aSAH incidence was 3.2% per year (p = 0.007). The cumulative proportions of fatalities at days 30, 90, and 1 year were 22%, 25%, and 37%, respectively. The 30-day mortality rate did not change during the study period. Age (HR 0.7–2.2) and aneurysms in the posterior circulation (HR 1.7, 95% CI 1.3–2.3, p = 0.001) were associated with higher 30-day case fatality following aSAH, while aneurysm repair (HR 0.2, 95% CI 0.2–0.3, p < 0.001) was associated with lower risk. Conclusions The incidence of aSAH declined in Norway between 2008 and 2014. Case fatality following aSAH continues to be high, and the 30-day mortality during the study period was unchanged. Increasing age and aneurysms in the posterior circulation were associated with increased risk of death within 30 days following aSAH.
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Affiliation(s)
- Lise R. Øie
- Department of Neurology, St. Olavs hospital, Trondheim University Hospital, 7006 Trondheim, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ole Solheim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Neurosurgery, St.Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Paulina Majewska
- Department of Neurosurgery, St.Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Trond Nordseth
- Department of Anesthesiology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tomm B. Müller
- Department of Neurosurgery, St.Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sven M. Carlsen
- Department of Endocrinology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Heidi Jensberg
- Department of Health Registries, Directorate of Health, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sasha Gulati
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Neurosurgery, St.Olavs hospital, Trondheim University Hospital, Trondheim, Norway
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Li J, Chen S, Fan J, Zhang G, Ren R. Minocycline Attenuates Experimental Subarachnoid Hemorrhage in Rats. Open Life Sci 2019; 14:595-602. [PMID: 33817197 PMCID: PMC7874754 DOI: 10.1515/biol-2019-0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022] Open
Abstract
Backgroud The aim of this study was to evaluate the therapeutic effect of minocycline on treating experimental subarachnoid hemorrhage (SAH) in rats and to explore its possible molecular mechanism. Methods SAH was induced in male Sprague-Dawley rats by endovascular perforation. The rats were treated with minocycline (25 mg/kg or 50 mg/kg) or saline at 2 hand 12 h post SAH. Neurological function, cerebral hemorrhage, and edema were scored at 48 h post SAH. Cell death and P2X4 receptor (P2X4R) expression were observed in the prefrontal cortex (PFC). Results Treatment with a highdose of minocycline significantly improved the neurological function score, and attenuated cerebral hemorrhage and edema. Low-dose minocycline could reduce hemorrhage, but the effect on neurological deficits and brain edema was not obvious. Minocycline treatment could alleviate neuronal apoptosis in the PFC, which was related to reduced expression of inflammatory cytokines. Immunofluorescence showed that P2X4R on microglia was activated after SAH. Minocycline treatment inhibited P2X4R activation and further suppressed the phosphorylation of downstream p38 MAPK. Conclusions Minocycline plays a neuroprotective role by attenuating early brain injury after experimental SAH. The therapeutic mechanism of minocycline may be mediated by the inhibition of P2X4R on microglia.
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Affiliation(s)
- Jingbo Li
- Neurocritical Care Unit, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, P.R. China
| | - Shuda Chen
- Neurocritical Care Unit, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, P.R. China
| | - Jing Fan
- Neurocritical Care Unit, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, P.R. China
| | - Gao Zhang
- Neurocritical Care Unit, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, P.R. China
| | - Reng Ren
- Neurocritical Care Unit, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, P.R. China
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La Pira B, Singh TD, Rabinstein AA, Lanzino G. Time Trends in Outcomes After Aneurysmal Subarachnoid Hemorrhage Over the Past 30 Years. Mayo Clin Proc 2018; 93:1786-1793. [PMID: 30522593 DOI: 10.1016/j.mayocp.2018.06.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/09/2018] [Accepted: 06/13/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To analyze trends in mortality rates, functional outcomes, and treatment in patients with aneurysmal subarachnoid hemorrhage (aSAH) over the past 3 decades. PATIENTS AND METHODS We conducted a retrospective review of consecutive patients with aSAH treated at Mayo Clinic in Rochester, Minnesota, between January 1, 1985, and December 31, 2014. RESULTS A total of 1173 patients identified were grouped by decade of treatment: 1985 to 1994, n=274; 1995 to 2004, n=461; and 2005 to 2014, n=438. Overall, the use of endovascular techniques increased progressively from 5.1% (14) in 1985 to 1994 to 65.5% (287) in 2005 to 2014. This corresponded to a progressive decrease in the rate of clipping from 78.8% (216) in 1985 to 2004 to 21.5% (94) in 2005 to 2014 (P<.001). The percentage of patients admitted with poor clinical grade also increased from 22.3% (61) in 1985 to 1994 to 24.1% (111) in 1995 to 2004 and 29.5% (129) in 2005 to 2014 (P=.06). The in-hospital mortality rate decreased from 22.6% (62) in 1985 to 1994 to 16.3% (75) in 1995 to 2004 and remained relatively constant at 16.7% (73) in 2005 to 2014. Good functional outcome at 3- to 6-month follow-up improved significantly from 64.8% (173) in 1985 to 1994 to 72% (332) in 1995 to 2004 and 78.8% (345) in 2005 to 2014 (P<.001). CONCLUSION Outcomes in patients with aSAH have markedly improved over the past 3 decades, in terms of both in-hospital survival and functional recovery of survivors. Higher rates of endovascular coiling over time paralleled these improvements in clinical outcomes. More detailed investigation is necessary to determine whether this or other factors may directly explain the favorable trends in survival and functional recovery over time.
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Affiliation(s)
- Biagia La Pira
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Radiology, Mayo Clinic, Rochester, MN.
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Socioeconomic Disadvantage Is Associated with a Higher Incidence of Aneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2018; 27:660-668. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 11/20/2022] Open
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Hammond M, Clark AB, Cahn AP, Chilvers ER, Fraser WD, Livermore DM, Maher TM, Parfrey H, Swart AM, Stirling S, Thickett D, Whyte M, Wilson A. The Efficacy and Mechanism Evaluation of Treating Idiopathic Pulmonary fibrosis with the Addition of Co-trimoxazole (EME-TIPAC): study protocol for a randomised controlled trial. Trials 2018; 19:89. [PMID: 29402332 PMCID: PMC5800095 DOI: 10.1186/s13063-018-2453-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 12/28/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND We hypothesise, based upon the findings from our previous trial, that the addition of co-trimoxazole to standard therapy is beneficial to patients with moderate to severe idiopathic pulmonary fibrosis (IPF). We aim to investigate this by assessing unplanned hospitalisation-free survival (defined as time from randomisation to first non-elective hospitalisation, lung transplant or death) and to determine whether any effect relates to changes in infection and/or markers of disease control and neutrophil activity. METHODS/DESIGN The EME-TIPAC trial is a double-blind, placebo-controlled, randomised, multicentre clinical trial. A total of 330 symptomatic patients, aged 40 years old or older, with IPF diagnosed by a multidisciplinary team (MDT) according to international guidelines and a FVC ≤ 75% predicted will be enrolled. Patients are randomised equally to receive either two tablets of co-trimoxazole 480 mg or two placebo tablets twice daily over a median treatment period of 27 (range 12-42) months. All patients receive folic acid 5 mg daily whilst on the trial IMP to reduce the risk of bone marrow depression. The primary outcome for the trial is a composite endpoint consisting of the time to death, transplant or first non-elective hospital admission and will be determined from adverse event reporting, hospital databases and the Office of National Statistics with active tracing of patients missing appointments. Secondary outcomes include the individual components of the primary outcome, (1) King's Brief Interstitial Lung Disease Questionnaire, (2) MRC Dyspnoea Score, (3) EQ5D, (4) spirometry, (5) total lung-diffusing capacity and (6) routine sputum microbiology. Blood will be taken for cell count, biochemistry and analysis of biomarkers including C-reactive protein and markers of disease. The trial will last for 4 years. Recruitment will take place in a network of approximately 40 sites throughout the UK (see Table 1 for a full list of participating sites). We expect recruitment for 30 months, follow-up for 12 months and trial analysis and reporting to take 4 months. DISCUSSION The trial is designed to test the hypothesis that treating IPF patients with co-trimoxazole will increase the time to death (all causes), lung transplant or first non-elective hospital admission compared to standard care ( https://www.nice.org.uk/guidance/cg163 ), in patients with moderate to severe disease. The mechanistic aims are to investigate the effect on lung microbiota and other measures of infection, markers of epithelial injury and markers of neutrophil activity. TRIAL REGISTRATION International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ID: 17464641 . Registered on 29 January 2015.
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Affiliation(s)
| | | | | | | | | | | | - Toby M. Maher
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Helen Parfrey
- Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Krishnamurthi RV, Barker-Collo S, Parag V, Parmar P, Witt E, Jones A, Mahon S, Anderson CS, Barber PA, Feigin VL. Stroke Incidence by Major Pathological Type and Ischemic Subtypes in the Auckland Regional Community Stroke Studies: Changes Between 2002 and 2011. Stroke 2017; 49:3-10. [PMID: 29212738 DOI: 10.1161/strokeaha.117.019358] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 10/31/2017] [Accepted: 11/09/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Major pathological stroke types (ischemic stroke [IS], primary intracerebral hemorrhage [ICH], and subarachnoid hemorrhage) and IS subtypes, have differing risk factors, management, and prognosis. We report changes in major stroke types and IS subtypes incidence during 10 years using data from the ARCOS (Auckland Regional Community Stroke Study) III performed during 12 months in 2002 to 2003 and the fourth ARCOS study (ARCOS-IV) performed in 2011 to 2012. METHODS ARCOS-III and ARCOS-IV were population-based registers of all new strokes in the greater Auckland region (population aged >15 years, 1 119 192). Strokes were classified into major pathological types (IS, ICH, subarachnoid hemorrhage, and undetermined type). Crude annual age-, sex-, and ethnic-specific stroke incidence with 95% confidence intervals was calculated. ISs were subclassified using TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria into 5 etiologic groups. Rate ratios with 95% confidence intervals were calculated for differences in age-standardized rates between the 2 studies. RESULTS In ARCOS-IV, there were 1329 (81%) ISs, 211 (13%) ICHs, 79 (5%) subarachnoid hemorrhages, and 24 (1%) undetermined type strokes. The proportional distribution of IS subtypes was 29% cardioembolism, 21% small-vessel occlusion, 15% large-artery atherosclerosis, 5% other determined etiology, and 31% undetermined type. Between 2002 and 2011, age-standardized incidence decreased for subarachnoid hemorrhage (rate ratios, 0.73; 95% confidence intervals, 0.54-0.99) and undetermined type (rate ratios, 0.14; 95% confidence intervals, 0.09-0.22). Rates were stable for IS and ICH. Among IS subtypes, large-artery atherosclerosis and small-vessel occlusion rates increased significantly. The frequency of all risk factors increased in IS. Ethnic differences were observed for both stroke subtype rates and their risk factor frequencies. CONCLUSIONS A lack of change in IS and ICH incidence may reflect a trend toward increased incidence of younger strokes. Increased rates of large-artery atherosclerosis and small-vessel occlusion are associated with increased smoking and high blood pressure. Ethnic differences in the proportional distribution of pathological stroke subtypes suggest differential exposure and susceptibility to risk factors.
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Affiliation(s)
- Rita V Krishnamurthi
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Suzanne Barker-Collo
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Varsha Parag
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Priyakumari Parmar
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Emma Witt
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Amy Jones
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Susan Mahon
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Craig S Anderson
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - P Alan Barber
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Valery L Feigin
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.).
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12
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Dubosh NM, Edlow JA. Diagnosis of Subarachnoid Hemorrhage: Time for a Paradigm Shift? Acad Emerg Med 2017; 24:1514-1516. [PMID: 28767186 DOI: 10.1111/acem.13267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Nicole M. Dubosh
- Department of Emergency Medicine; Harvard Medical School; Department of Emergency Medicine; Beth Israel Deaconess Medical Center; Boston MA
| | - Jonathan A. Edlow
- Department of Emergency Medicine; Harvard Medical School; Department of Emergency Medicine; Beth Israel Deaconess Medical Center; Boston MA
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Mejdoubi M, Schertz M, Zanolla S, Mehdaoui H, Piotin M. Transoceanic Management and Treatment of Aneurysmal Subarachnoid Hemorrhage: A 10-Year Experience. Stroke 2017; 49:127-132. [PMID: 29162651 DOI: 10.1161/strokeaha.117.017436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 10/14/2017] [Accepted: 10/18/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Because of the small number of yearly cases of ruptured cerebral aneurysms, endovascular treatment is not performed in Martinique. Therefore, patients from Martinique are sent 7000 km to Paris on commercial flights as soon as possible, where treatment is performed. Nontransportable patients are treated locally with either surgery or symptomatic care. The objective of our study was to assess patient outcomes and safety of this treatment strategy. METHODS We retrospectively examined all cases of aneurysmal subarachnoid hemorrhage in Martinique diagnosed during 2004 to 2013. Medical case records were searched for the type and location of treatment, clinical status, and transfer duration. RESULTS A total of 119 patients had an aneurysmal subarachnoid hemorrhage during the 10-year period. Of these, 91 were transferred to Paris, 12 were surgically treated locally, and 16 received symptomatic treatment. None of the transferred patients experienced any hemorrhagic recurrence, and none suffered a significant complication related to the air transportation. The median time between aneurysmal subarachnoid hemorrhage diagnosis and arrival at the referral center was 32 hours. The 30-day case fatality rate for treated cases was 14.6% (8.8% for those treated in Paris and 58.3% for those treated locally). CONCLUSIONS Our treatment strategy for aneurysmal subarachnoid hemorrhage resulted in a 30-day case fatality rate similar to those observed elsewhere, despite an 8-hour flight and a median treatment delay of 32 hours. This strategy therefore seems to be safe and reliable for isolated regions with small populations.
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Affiliation(s)
- Mehdi Mejdoubi
- From the Departments of Neuroradiology (M.M., M.S.) and Emergency and Critical Care Medicine (S.Z., H.M.), University Hospital of Martinique, Fort-de-France, French West Indies, France; and Department of Interventional Neuroradiology, Rothschild Hospital, Paris, France (M.P.).
| | - Mathieu Schertz
- From the Departments of Neuroradiology (M.M., M.S.) and Emergency and Critical Care Medicine (S.Z., H.M.), University Hospital of Martinique, Fort-de-France, French West Indies, France; and Department of Interventional Neuroradiology, Rothschild Hospital, Paris, France (M.P.)
| | - Sylvia Zanolla
- From the Departments of Neuroradiology (M.M., M.S.) and Emergency and Critical Care Medicine (S.Z., H.M.), University Hospital of Martinique, Fort-de-France, French West Indies, France; and Department of Interventional Neuroradiology, Rothschild Hospital, Paris, France (M.P.)
| | - Hossein Mehdaoui
- From the Departments of Neuroradiology (M.M., M.S.) and Emergency and Critical Care Medicine (S.Z., H.M.), University Hospital of Martinique, Fort-de-France, French West Indies, France; and Department of Interventional Neuroradiology, Rothschild Hospital, Paris, France (M.P.)
| | - Michel Piotin
- From the Departments of Neuroradiology (M.M., M.S.) and Emergency and Critical Care Medicine (S.Z., H.M.), University Hospital of Martinique, Fort-de-France, French West Indies, France; and Department of Interventional Neuroradiology, Rothschild Hospital, Paris, France (M.P.)
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Worthington JM, Goumas C, Jalaludin B, Gattellari M. Decreasing Risk of Fatal Subarachnoid Hemorrhage and Other Epidemiological Trends in the Era of Coiling Implementation in Australia. Front Neurol 2017; 8:424. [PMID: 28912747 PMCID: PMC5583507 DOI: 10.3389/fneur.2017.00424] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 08/07/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Subarachnoid hemorrhage (SAH) is associated with a high risk of mortality and disability in survivors. We examined the epidemiology and burden of SAH in our population during a time services were re-organized to facilitate access to evidence-based endovascular coiling and neurosurgical care. METHODS SAH hospitalizations from 2001 to 2009, in New South Wales, Australia, were linked to death registrations to June 30, 2010. We assessed the variability of admission rates, fatal SAH rates and case fatality over time and according to patient demographic characteristics. RESULTS There were 4,945 eligible patients admitted to hospital with SAH. The risk of fatal SAH significantly decreased by 2.7% on average per year (95% CI = 0.3-4.9%). Case fatality at 2, 30, 90, and 365 days significantly declined over time. The average annual percentage reduction in mortality ranged from 4.4% for 30-day mortality (95% CI -6.1 to -2.7) (P < 0.001) to 4.7% for mortality within 2 days (-7.1 to -2.2) (P < 0.001) (Table 3). Three percent of patients received coiling at the start of the study period, increasing to 28% at the end (P-value for trend <0.001). Females were significantly more likely to be hospitalized for a SAH compared to males [incident rate ratio (IRR) = 1.33, 95% CI = 1.23-1.44] (P < 0.001) and to die from SAH (IRR = 1.40, 95% CI = 1.24-1.59) (P < 0.001). People born in South-East Asia and the Oceania region had a significantly increased risk of SAH, while the risk of fatal SAH was greater in South-East and North-East Asian born residents. People residing in areas of least disadvantage had the lowest risk of hospitalization (IRR = 0.83, 95% CI = 0.74-0.92) and also the lowest risk of fatal SAH (0.81, 95% CI = 0.66-1.00) (P < 0.001 and P = 0.003, respectively). For every 100 SAH admissions, 20 and 15 might be avoided in males and females, respectively, if the risk of SAH in our population equated to that of the most socio-economically advantaged. CONCLUSION Our study reports reductions in mortality risk in SAH corresponding to identifiable changes in health service delivery and evolving treatments such as coiling. Addressing inequities in SAH risk and mortality may require the targeting of prevalent and modifiable risk factors to improve population outcomes.
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Affiliation(s)
- John Mark Worthington
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,South Western Sydney Clinical School UNSW, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Chris Goumas
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Melina Gattellari
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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15
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30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012): A Multi-Ethnic Population-Based Series of Studies. PLoS One 2015; 10:e0134609. [PMID: 26291829 PMCID: PMC4546383 DOI: 10.1371/journal.pone.0134609] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/12/2015] [Indexed: 11/29/2022] Open
Abstract
Background Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years. Methods Four stroke incidence population-based register studies were undertaken in adult residents (aged ≥15 years) of Auckland NZ in 1981–1982, 1991–1992, 2002–2003 and 2011–2012. All used standard World Health Organization (WHO) diagnostic criteria and multiple overlapping sources of case-ascertainment for hospitalised and non-hospitalised, fatal and non-fatal, new stroke events. Ethnicity was consistently self-identified into four major groups. Crude and age-adjusted (WHO world population standard) annual incidence and mortality with corresponding 95% confidence intervals (CI) were calculated per 100,000 people, assuming a Poisson distribution. Results 5400 new stroke patients were registered in four 12 month recruitment phases over the 30-year study period; 79% were NZ/European, 6% Māori, 8% Pacific people, and 7% were of Asian or other origin. Overall stroke incidence and 1-year mortality decreased by 23% (95% CI 5%-31%) and 62% (95% CI 36%-86%), respectively, from 1981 to 2012. Whilst stroke incidence and mortality declined across all groups in NZ from 1991, Māori and Pacific groups had the slowest rate of decline and continue to experience stroke at a significantly younger age (mean ages 60 and 62 years, respectively) compared with NZ/Europeans (mean age 75 years). There was also a decline in 28-day stroke case fatality (overall by 14%, 95% CI 11%-17%) across all ethnic groups from 1981 to 2012. However, there were significant increases in the frequencies of pre-morbid hypertension, myocardial infarction, and diabetes mellitus, but a reduction in frequency of current smoking among stroke patients. Conclusions In this unique temporal series of studies spanning 30 years, stroke incidence, early case-fatality and 1-year mortality have declined, but ethnic disparities in risk and outcome for stroke persisted suggesting that primary stroke prevention remains crucial to reducing the burden of this disease.
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Thorne K, Williams JG, Akbari A, Roberts SE. The impact of social deprivation on mortality following acute myocardial infarction, stroke or subarachnoid haemorrhage: a record linkage study. BMC Cardiovasc Disord 2015; 15:71. [PMID: 26187051 PMCID: PMC4506594 DOI: 10.1186/s12872-015-0045-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 06/01/2015] [Indexed: 12/20/2022] Open
Abstract
Background The impact of social deprivation on mortality following acute myocardial infarction (AMI), stroke and subarachnoid haemorrhage (SAH) is unclear. Our objectives were, firstly, to determine, for each condition, whether there was higher mortality following admission according to social deprivation and secondly, to determine how any higher mortality for deprived groups may be correlated with factors including patient demographics, timing of admission and hospital size. Methods Routinely collected, linked hospital inpatient, mortality and primary care data were analysed for patients admitted as an emergency to hospitals in Wales between 2004 and 2011 with AMI (n = 30,663), stroke (37,888) and SAH (1753). Logistic regression with Bonferroni correction was used to examine, firstly, any significant increases in mortality with social deprivation quintile and, secondly, the influence of patient demographics, timing of admission and hospital characteristics on any higher mortality among the most socially deprived groups. Results Mortality was 14.3 % at 30 days for AMI, 21.4 % for stroke and 35.6 % for SAH. Social deprivation was significantly associated with higher mortality for AMI (25 %; 95 % CI = 12 %, 40 %) higher for quintile V compared with I), stroke (24 %; 14 %, 34 %), and non-significantly for SAH (32 %; −7 %, 87 %). The higher mortality at 30 days with increased social deprivation varied significantly according to patient age for AMI patients and time period for SAH. It was also highest for both AMI and stroke patients, although not significantly for female patients, for admissions on weekdays and during autumn months. Conclusions We have demonstrated a positive association between social deprivation and higher mortality following emergency admissions for both AMI and stroke. The study findings also suggest that the influence of patient demographics, timing of admission and hospital size on social inequalities in mortality are quite similar for AMI and stroke. Electronic supplementary material The online version of this article (doi:10.1186/s12872-015-0045-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kymberley Thorne
- College of Medicine, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
| | - John G Williams
- College of Medicine, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
| | - Ashley Akbari
- College of Medicine, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
| | - Stephen E Roberts
- College of Medicine, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
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17
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Derrey S, Penchet G, Thines L, Lonjon M, David P, Bataille B, Emery E, Lubrano V, Laguarrigue J, Bresson D, Pelissou I, Irthum B, Lejeune JP, Proust F. French collaborative group series on giant intracranial aneurysms: Current management. Neurochirurgie 2014; 61:371-7. [PMID: 24647149 DOI: 10.1016/j.neuchi.2013.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 08/31/2013] [Accepted: 11/13/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Giant intracranial aneurysms represent a major therapeutic challenge for each surgical team. The aim of our study was to extensively review the French contemporary experience in treating giant intracranial aneurysms in order to assess the current management. PATIENTS AND METHODS This retrospective multicenter study concerned consecutive patients treated for giant intracranial aneurysms (2004-2008) in different French university hospitals (Bordeaux, Caen, Clermont-Ferrand, Lille, Lyon, Nice, Paris-Lariboisière, Rouen et Toulouse). Different variables were analyzed: the diagnostic circumstances, the initial clinical status based on the WFNS scale, aneurysmal features and exclusion procedure. At 6 months, the outcome was evaluated according to the modified Rankin Scale (mRS): favorable (mRS 0-2) and unfavorable (mRS 3-6). A multivariate logistic regression model included all the independent variables with P<0.25 in the univariate analysis (P<0.05). RESULTS A total of 79 patients with a mean age of 51.5 ± 1.6 years (median: 52 years; range: 16-79) were divided into two groups, with the ruptured group (n=26, 32.9%) significantly younger (P<0.05, Student's-t-test) than the unruptured group (n=53, 67.1%). After SAH, the initial clinical status was good in 12 patients (46.2%), and in the unruptured group, the predominant diagnosis circumstance was a pseudo-tumor syndrome occurring in 22 (41.5%). The first procedure of aneurysm treatment in the global population was endovascular in 42 patients (53.1%), microsurgical in 29 (36.7%) and conservative in 8 (10.2). An immediate neurological deterioration was reported in 38 patients (48.1%) after endovascular treatment in 19 (45.2% of endovascular procedures), after miscrosurgical in 15 (51.7% of microsurgical procedures) and after conservative in 4 (the half). At 6 months, the outcome was favorable in 45 patients (57%) and after multivariate analysis, the predictive factors of favorable outcome after management of giant cerebral aneurysm were the initial good clinical status in cases of SAH (P<0.002), the endovascular treatment (P<0.005), and the absence of neurological deterioration (P<0.006). The endovascular procedure was obtained as a predictive factor because of the low risk efficacy of indirect procedures, in particular a parent vessel occlusion. CONCLUSION The overall favorable outcome rate concerned 57% of patients at 6 months despite 53.8% of poor initial clinical status in cases of rupture. The predictive factors for favorable outcome were good clinical status, endovascular treatment and the absence of postoperative neurological deterioration. Endovascular treatment should be integrated into the therapeutic armenmatarium against giant cerebral aneurysms but the durability of exclusion should be taken into account during the multidisciplinary discussion by the neurovascular team.
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Affiliation(s)
- S Derrey
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - G Penchet
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - L Thines
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - M Lonjon
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - P David
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - B Bataille
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - E Emery
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - V Lubrano
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - J Laguarrigue
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - D Bresson
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - I Pelissou
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - B Irthum
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - J-P Lejeune
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - F Proust
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
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Alcalá-Cerra G, Young AMH, Paternina-Caicedo Á, Ribas ESC. Trends in the mortality of non-traumatic subarachnoid hemorrhage in Colombia: a 10-year analysis of a nationwide registry. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 71:841-5. [PMID: 24394868 DOI: 10.1590/0004-282x20130164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 06/20/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess trends in mortality from 1999 to 2008 resulting from non-traumatic subarachnoid hemorrhage (SAH) in the Colombian population. METHOD This population-based study analyzed all deaths by assuming a Poisson model. RESULTS Subarachnoid hemorrhage-related deaths showed a statistically significant increase of 1.6% per year (p<0.001). The age-standardized analysis demonstrated an increased mortality trend of 3.3% per year (p<0.001) in people older than 70 years, but a decreased mortality trend in people younger than 50. It remained stable in patients 50-69 years old. CONCLUSION The overall SAH-related mortality rate in Colombia has increased because increased mortality among the elderly has been counterbalanced by reduced mortality rates in younger age groups. These disparities may reflect epidemiologic transition, treatment inequities, or a less favorable comorbid profile.
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Affiliation(s)
- Gabriel Alcalá-Cerra
- Health Sciences and Neurosciences Research Group-CISNEURO, Cartagena de Indias, Colombia
| | - Adam M H Young
- Department of Neurosurgery, Harvard Medical School, Massachusetts General Hospital, BostonMassachusetts
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Abstracts of the British Neurovascular Group meeting held in February 2012 and hosted by the Wessex Neurological Centre (Southampton). Br J Neurosurg 2012. [DOI: 10.3109/02688697.2012.692529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Derrey S, Curey S, Hannequin P, Castel H, Langlois O, Tollard E, Fréger P, Proust F. Elderly patients with aneurysmal subarachnoid hemorrhage: Coils but also clips. Neurochirurgie 2012; 58:140-5. [PMID: 22464899 DOI: 10.1016/j.neuchi.2012.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Accepted: 02/08/2012] [Indexed: 11/19/2022]
Abstract
The ageing of the population in good health or without severe morbidity expose them to the occurrence of a subarachnoid hemorrhage (SAH) and requires effective management. Currently, the pertinence of cerebral aneurysm treatment by clipping or coiling is accepted for patients in the 8th or 9th decade of life, and the risk of postoperative morbidity induced by our therapeutic alternative must be carefully assessed. In these decades, the female/male sex ratio for aneurysmal SAH was greater in female who had a 1.6 times higher ratio than in male. The initial clinical status did not appear worse with age despite the frequent severity of bleeding observed on CT scan probably due to the large subarachnoid space. The aneurysm distribution and size were similar to those classically reported in the global population. The endovascular (EV) coiling appears as the first option with a favorable outcome rate estimated at 48% to 63%. Nevertheless, the benefit of EV coiling compared to microsurgical clipping for treatment of ruptured aneurysm in the elderly has not been demonstrated in a large randomized study. This is the reason why the vascular section of the French Society of Neurosurgery developed a prospective and randomized study of the aneurysmal SAH (PHRC 2007-042/HP) on the elderly patients.
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Affiliation(s)
- S Derrey
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
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