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Wong HJ, Harith S, Lua PL, Ibrahim KA. Lipid profiles and lifestyle habits of stroke survivors in the east coast region of peninsular Malaysia: Preliminary findings. Nutr Health 2023; 29:695-705. [PMID: 35763460 DOI: 10.1177/02601060221097459] [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] [Indexed: 11/17/2022]
Abstract
Background: Stroke survivors are at high risk for recurrent cardiovascular events if no prevention strategies are undertaken. Aim: This study aimed to investigate the fasting serum lipid profiles and lifestyle habits in stroke survivors, and the factors associated with suboptimal lipid profiles. Methods: A cross-sectional retrospective study was conducted in three public hospitals in Malaysia. Stroke survivors' data regarding the socio-demographic characteristics, clinical profiles, fasting serum lipid profiles, dietary adherence, and physical activity levels were acquired. Binary logistic regression was used to examine the factors associated with suboptimal lipid goals. Results: A total of 104 stroke survivors were recruited from patients attending the neurology and rehabilitation departments. Only 22% of the stroke survivors attained the targeted low-density lipoprotein cholesterol level (LDL-C < 1.8 mmol/L). Meanwhile, more than two thirds of patients achieved the targeted total cholesterol, triglyceride, and high-density lipoprotein cholesterol goals. Patients with a longer stroke duration (Adjusted odds ratio, AOR 3.33, 95% confidence intervals, CI: 1.09, 10.13, p = 0.034), elevated blood pressure (AOR 4.74, 95% CI: 1.65, 13.62, p = 0.004), chronic kidney disease (AOR 3.30, 95% CI: 1.05, 10.34, p = 0.041), abdominal obesity (AOR 3.14, 95% CI: 1.20, 8.21, p = 0.020), excessive energy intake (AOR 2.72, 95% CI: 1.07, 6.91, p = 0.036), and excessive saturated fatty acids intake (AOR 2.85, 95% CI: 1.02, 7.93, p = 0.045) were significantly associated with suboptimal lipid profiles. Conclusion: The lipid goals attainment was low, particularly the LDL-C levels among Malaysian stroke survivors. Greater efforts are warranted to fully utilise the lipid-lowering therapy and the lifestyle changes in these high-risk patients.
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Affiliation(s)
- Hui Jie Wong
- Postgraduate student, School of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, 21300 Kuala Nerus, Terengganu, Malaysia
| | - Sakinah Harith
- Professor, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, 21300 Kuala Nerus, Terengganu, Malaysia
| | - Pei Lin Lua
- Professor, Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Besut Campus, 22200 Besut, Terengganu, Malaysia
| | - Khairul Azmi Ibrahim
- Neurologist, Neurology Unit, Department of Medicine, Hospital Sultanah Nur Zahirah, Jalan Sultan Mahmud, 20400 Kuala Terengganu, Ministry of Health, Malaysia
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Phong PD, Tung BN, Hung PM, Quang NN, Hoai NTT, Dung NV, Nguyen TN, Phuong DV, Ton MD. Prevalence and Factors Associated with Atrial Fibrillation in Patients with Transient Ischemic Attack or Ischemic Stroke in Northern Vietnam. J Clin Med 2023; 12:5516. [PMID: 37685583 PMCID: PMC10488041 DOI: 10.3390/jcm12175516] [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: 08/05/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The prevalence and risk factors of atrial fibrillation (AF) in patients with transient ischemic attack (TIA) or ischemic stroke in Northern Vietnam are not well understood. This study aimed to estimate the prevalence and identify factors associated with AF in this population. METHODS A cross-sectional study was conducted on 2038 consecutive patients with TIA or ischemic stroke admitted to Bach Mai Hospital. AF was diagnosed using an electrocardiogram or Holter monitor. Logistic regression analyses were performed to determine the association between AF and risk factors. RESULTS Among the patients, 18.1% (95% CI: 16.46 to 19.85) had AF. Older age, renal dysfunction, valvular heart disease (VHD), and low ejection fraction were significantly associated with AF. Advanced age (per 10 years) (adjusted OR, aOR 1.39; 95% CI, 1.23 to 1.57), estimated glomerular filtration ratio decrease (per 10 mL/min/1.73 m2) (aOR 1.12; 95% CI, 1.06 to 1.17), VHD (aOR 9.59; 95% CI, 7.10 to 12.95), and low ejection fraction (<50%) (aOR 2.61; 95% CI, 1.62 to 4.21) had notable odds ratios for AF. CONCLUSIONS Atrial fibrillation is prevalent among patients with TIA or ischemic stroke in Northern Vietnam, surpassing rates in other Southeast Asian countries. Age, renal dysfunction, VHD, and low ejection fraction were significant risk factors for AF in this population.
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Affiliation(s)
- Phan Dinh Phong
- Vietnam National Heart Institute, Bach Mai Hospital, 78 Giai Phong St, Phương Mai Ward, Dong Da District, Hanoi 10000, Vietnam; (P.D.P.); (B.N.T.); (P.M.H.); (N.N.Q.); (N.T.T.H.); (N.V.D.)
- Department of Cardiology, Hanoi Medical University, Hanoi 10000, Vietnam;
| | - Bui Nguyen Tung
- Vietnam National Heart Institute, Bach Mai Hospital, 78 Giai Phong St, Phương Mai Ward, Dong Da District, Hanoi 10000, Vietnam; (P.D.P.); (B.N.T.); (P.M.H.); (N.N.Q.); (N.T.T.H.); (N.V.D.)
- Department of Cardiology, Hanoi Medical University, Hanoi 10000, Vietnam;
| | - Pham Manh Hung
- Vietnam National Heart Institute, Bach Mai Hospital, 78 Giai Phong St, Phương Mai Ward, Dong Da District, Hanoi 10000, Vietnam; (P.D.P.); (B.N.T.); (P.M.H.); (N.N.Q.); (N.T.T.H.); (N.V.D.)
- Department of Cardiology, Hanoi Medical University, Hanoi 10000, Vietnam;
| | - Nguyen Ngoc Quang
- Vietnam National Heart Institute, Bach Mai Hospital, 78 Giai Phong St, Phương Mai Ward, Dong Da District, Hanoi 10000, Vietnam; (P.D.P.); (B.N.T.); (P.M.H.); (N.N.Q.); (N.T.T.H.); (N.V.D.)
- Department of Cardiology, Hanoi Medical University, Hanoi 10000, Vietnam;
| | - Nguyen Thi Thu Hoai
- Vietnam National Heart Institute, Bach Mai Hospital, 78 Giai Phong St, Phương Mai Ward, Dong Da District, Hanoi 10000, Vietnam; (P.D.P.); (B.N.T.); (P.M.H.); (N.N.Q.); (N.T.T.H.); (N.V.D.)
- Department of Internal Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi 10000, Vietnam
| | - Nguyen Viet Dung
- Vietnam National Heart Institute, Bach Mai Hospital, 78 Giai Phong St, Phương Mai Ward, Dong Da District, Hanoi 10000, Vietnam; (P.D.P.); (B.N.T.); (P.M.H.); (N.N.Q.); (N.T.T.H.); (N.V.D.)
- Department of Internal Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi 10000, Vietnam
| | - Thanh N. Nguyen
- Department of Neurology and Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA;
| | - Dao Viet Phuong
- Department of Cardiology, Hanoi Medical University, Hanoi 10000, Vietnam;
- Department of Stroke and Cerebrovascular Disease, University of Medicine and Pharmacy, Vietnam National University, Hanoi 10000, Vietnam
- Stroke Center, Bach Mai Hospital, Giai Phong St., Phương Mai Ward, Dong Da District, Hanoi 10000, Vietnam
| | - Mai Duy Ton
- Department of Cardiology, Hanoi Medical University, Hanoi 10000, Vietnam;
- Department of Stroke and Cerebrovascular Disease, University of Medicine and Pharmacy, Vietnam National University, Hanoi 10000, Vietnam
- Stroke Center, Bach Mai Hospital, Giai Phong St., Phương Mai Ward, Dong Da District, Hanoi 10000, Vietnam
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Danial M, Izwani Mohdradzi NS, Khan AH, Ch'ng ASH, Irene L. Survivability of patients admitted for stroke in a primary stroke center, Penang, Malaysia: a retrospective 5-year study. BMC Pharmacol Toxicol 2023; 24:28. [PMID: 37131240 PMCID: PMC10152713 DOI: 10.1186/s40360-023-00669-8] [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: 01/16/2023] [Accepted: 04/07/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Stroke is one of the most common noncommunicable diseases, with significant public health implications both globally and in Malaysia. The aim of this study was to evaluate post-stroke survivability as well as the major drug classes prescribed for hospitalized stroke patients. METHODS A 5-year retrospective study was carried out on the survival of stroke patients admitted to Hospital Seberang Jaya, a main stroke center in the state of Penang, Malaysia. Patients admitted for stroke were first identified using the local stroke registry database, and their medical records were then accessed for data collection, which included demographic information, comorbid conditions, and medications prescribed during admission. RESULTS The Kaplan-Meier overall survivability analysis performed indicated 50.5% survival for the duration of 10 days (p < 0.001) post-stroke. Ten-day survivability differences (p < 0.05) were observed for the categories of type of stroke (ischemic stroke (60.9%) and hemorrhagic stroke (14.1%)); stroke episodes (first (61.1%) and recurrent (39.6%)); anti-platelets (prescribed (46.2%) and not prescribed (41.5%)); statins (prescribed (68.7%) and not prescribed (28.1%)); anti-hypertensive (prescribed (65.4%) and not prescribed (45.9%)); and anti-infectives (prescribed (42.5%) and not prescribed (59.6%)) respectively. Higher risks of mortality were observed among patients with hemorrhagic stroke (HR: 10.61, p = 0.004); with 3 or more comorbidities (HR:6.60, p = 0.020); and not prescribed with statins and anti-diabetic. Patients prescribed anti-infectives, on the other hand, had a higher risk of mortality when compared to patients who did not receive anti-infectives (HR: 13.10, p = 0.019). The major drug classes prescribed for stroke patients were antiplatelet drugs (86.7%), statins (84.4%), and protein pump inhibitors (75.6%). CONCLUSION The findings of the study are intended to encourage more non-stroke hospitals in Malaysia to increase their efforts in treating stroke patients, as early treatment can help reduce the severity of the stroke. With the incorporation of evidence-based data, this study also contributes to local data for comparison and improves the implementation of regularly prescribed stroke medication.
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Affiliation(s)
- Monica Danial
- Clinical Research Centre (CRC) Hospital Seberang Jaya, Institute for Clinical Research, Ministry of Health Malaysia (MOH), Penang, Malaysia.
| | - Nurul Shahira Izwani Mohdradzi
- Clinical Research Centre (CRC) Hospital Seberang Jaya, Institute for Clinical Research, Ministry of Health Malaysia (MOH), Penang, Malaysia
| | - Amer Hayat Khan
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Alan Swee Hock Ch'ng
- Clinical Research Centre (CRC) Hospital Seberang Jaya, Institute for Clinical Research, Ministry of Health Malaysia (MOH), Penang, Malaysia
- Medical Department, Hospital Seberang Jaya, Ministry of Health Malaysia (MOH), Penang, Malaysia
| | - Looi Irene
- Clinical Research Centre (CRC) Hospital Seberang Jaya, Institute for Clinical Research, Ministry of Health Malaysia (MOH), Penang, Malaysia
- Medical Department, Hospital Seberang Jaya, Ministry of Health Malaysia (MOH), Penang, Malaysia
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Ni H, Lin Y, Peng Y, Li S, Huang X, Chen L. Relationship Between Family Functioning and Medication Adherence in Chinese Patients With Mechanical Heart Valve Replacement: A Moderated Mediation Model. Front Pharmacol 2022; 13:817406. [PMID: 35273498 PMCID: PMC8902640 DOI: 10.3389/fphar.2022.817406] [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: 11/18/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Medication adherence is crucial for patients with mechanical heart valve replacement. Although families functioning is positively associated with medication adherence, little is known about the underlying mechanisms. Objective: To test whether family functioning affects medication adherence through illness perceptions and whether this mediating effect was moderated by medication literacy. Methods: 319 patients after mechanical heart valve replacement were included in this cross-sectional study from June 2021 to October 2021. Data regarding family functioning, illness perceptions, medication adherence, and medication literacy were collected through questionnaires. The moderated mediation model was examined by Hayes's PROCESS macro, based on the bootstrapping method. Results: The results revealed illness perceptions partially mediated the association of family functioning on medication adherence [β = 0.08, 95% confidence intervals: (0.04, 0.12)], and this effect was stronger for patients with low medication literacy than those with high literacy [β = -0.36, 95% CI: (-0.50, -0.22)]. Furthermore, the relationship between family functioning and medication adherence was only significant in patients with low medication literacy [β = 0.36, 95% CI: (0.23, 0.50)]. Conclusion: The mediating effect of illness perceptions between family functioning and medication adherence was moderated by medication literacy. Efforts to improve medication adherence by targeting at improving family functioning may be more effective when considering illness perceptions, especially for patients with limited medication literacy.
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Affiliation(s)
- Hong Ni
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yanjuan Lin
- Department of Nursing, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yanchun Peng
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Sailan Li
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xizhen Huang
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
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Sidek NN, Kamalakannan S, Tengku Ismail TA, Musa KI, Ibrahim KA, Abdul Aziz Z, Papachristou Nadal I. Experiences and needs of the caregivers of stroke survivors in Malaysia-A phenomenological exploration. Front Neurol 2022; 13:996620. [PMID: 36212650 PMCID: PMC9539245 DOI: 10.3389/fneur.2022.996620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/29/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Informal caregivers play a crucial role in supporting the activities of daily living, rehabilitation, and the road to recovery for stroke survivors. However, these informal caregivers are often reported as experiencing neglect and lack of recognition despite their primary contribution to stroke recovery. This study investigated the experiences of the caregivers of stroke survivors and access to stroke care in Malaysia. Method This qualitative study with a phenomenological approach utilized in-depth interviews, including ten primary caregivers, one formal caregiver, and stroke healthcare providers as the participants. The interviews were done until the data saturation was achieved, and the data was analyzed using thematic analysis. Result Three primary themes and 14 subthemes were identified from the interviews. The role of primary caregivers of stroke survivors had tremendous physical, mental and social impact on the caregivers. Caregivers had two primary needs. The need for information about comprehensive stroke care at home and the need for psychological support to themselves. The key internal driver for providing care was identified to be the motivation level of the stroke survivor and the external driver was identified to be the societal support with access to comprehensive stroke care. Conclusion The role of informal caregivers becomes critical for continuum of stroke care. As caregivers take up the roles and responsibilities of those who contribute to stroke rehabilitation single-handedly soon after hospital discharge. Results of this study highlights the needs for providing systematic support to caregivers for engaging them in effective stroke care, particularly in the community. Stroke service providers, policy makers and program planners must be sensitized to empower caregivers of stroke survivors in effectively supporting stroke survivor in their family on the road of recovery.
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Affiliation(s)
- Norsima Nazifah Sidek
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Clinical Research Centre, Hospital Sultanah Nur Zahirah, Kuala Lumpur, Terengganu, Malaysia
| | - Sureshkumar Kamalakannan
- Department of Social Work Education and Community wellbeing - Northumbria University, London, United Kingdom.,Department of Non-communicable Disease and Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tengku Alina Tengku Ismail
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Khairul Azmi Ibrahim
- Department of Medicine, Hospital Sultanah Nur Zahirah, Kuala Lumpur, Terengganu, Malaysia
| | - Zariah Abdul Aziz
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Kuala Lumpur, Terengganu, Malaysia.,Department of Medicine, Hospital Sultanah Nur Zahirah, Kuala Lumpur, Terengganu, Malaysia
| | - Iliatha Papachristou Nadal
- Department of Non-communicable Disease and Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Ang SH, Hwong WY, Bots ML, Sivasampu S, Abdul Aziz AF, Hoo FK, Vaartjes I. Risk of 28-day readmissions among stroke patients in Malaysia (2008-2015): Trends, causes and its associated factors. PLoS One 2021; 16:e0245448. [PMID: 33465103 PMCID: PMC7815148 DOI: 10.1371/journal.pone.0245448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/31/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Risk of readmissions is an important quality indicator for stroke care. Such information is limited among low- and middle-income countries. We assessed the trends for 28-day readmissions after a stroke in Malaysia from 2008 to 2015 and evaluated the causes and factors associated with readmissions in 2015. METHODS Using the national hospital admission records database, we included all stroke patients who were discharged alive between 2008 and 2015 for this secondary data analysis. The risk of readmissions was described in proportion and trends. Reasons were coded according to the International Classification of Diseases, 10th Edition. Multivariable logistic regression was performed to identify factors associated with readmissions. RESULTS Among 151729 patients, 11 to 13% were readmitted within 28 days post-discharge from their stroke events each year. The trend was constant for ischemic stroke but decreasing for hemorrhagic stroke. The leading causes for readmissions were recurrent stroke (32.1%), pneumonia (13.0%) and sepsis (4.8%). The risk of 28-day readmission was higher among those with stroke of hemorrhagic (adjusted odds ratio (AOR): 1.52) and subarachnoid hemorrhage (AOR: 2.56) subtypes, and length of index admission >3 days (AOR: 1.48), but lower among younger age groups of 35-64 (AORs: 0.61-0.75), p values <0.001. CONCLUSION The risk of 28-day readmission remained constant from 2008 to 2015, where one in eight stroke patients required readmission, mainly attributable to preventable causes. Age, ethnicity, stroke subtypes and duration of the index admission influenced the risk of readmission. Efforts should focus on minimizing potentially preventable admissions, especially among those at higher risk.
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Affiliation(s)
- Swee Hung Ang
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Wen Yea Hwong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Aznida Firzah Abdul Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Selangor, Malaysia
| | - Fan Kee Hoo
- Neurology Unit, Department of Medicine, Faculty of Medicine, Universiti Putra Malaysia, Selangor, Malaysia
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Mohammed M, Zainal H, Tangiisuran B, Harun SN, Ghadzi SM, Looi I, Sidek NN, Yee KL, Aziz ZA. Impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke. Pharm Pract (Granada) 2020; 18:1760. [PMID: 32256900 PMCID: PMC7092711 DOI: 10.18549/pharmpract.2020.1.1760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/09/2020] [Indexed: 01/01/2023] Open
Abstract
Background: Stroke is a leading cause of death worldwide. The cases of acute ischemic stroke are on the increase in the Asia Pacific, particularly in Malaysia. Various health organizations have recommended guidelines for managing ischemic stroke, but adherence to key performance indicators (KPI) from the guidelines and impact on patient outcomes, particularly mortality, are rarely explored. Objective: This study aims to evaluate the impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke. Methods: We included all first-ever ischemic stroke patients enrolled in the multiethnic Malaysian National Neurology Registry (NNeuR) - a prospective cohort study and followed-up for six months. Patients’ baseline clinical characteristics, risk factors, neurological findings, treatments, KPI and mortality outcome were evaluated. The KPI nonadherence (NAR) and relationship with mortality were evaluated. NAR>25% threshold was considered suboptimal. Results: A total of 579 first-ever ischemic stroke patients were included in the final analysis. The overall mortality was recorded as 23 (4.0%) in six months, with a median (interquartile) age of 65 (20) years. Majority of the patients (dead or alive) had partial anterior circulation infarct, PACI (43.5%; 34.0%) and total anterior circulation infarct, TACI (26.1%; 8.8%). In addition, DVT prophylaxis (82.8%), anticoagulant for atrial fibrillation (AF) patients (48.8%) and rehabilitation (26.2%) were considered suboptimal. NAR < 2 was significantly associated with a decrease in mortality (odds ratio 0.16; 0.02-0.12) compared to NAR>2. Survival analysis showed that death is more likely in patients with NAR>2 (p=0.05). Conclusions: KPI nonadherence was associated with mortality among ischemic stroke patients. The adherence to the KPI was sub-optimal, particularly in DVT prophylaxis, anticoagulant for AF patients and rehabilitation. These findings reflect the importance of continuous quality measurement and implementation of evidence recommendations in healthcare delivery to achieve optimal outcome among stroke patients.
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Affiliation(s)
- Mustapha Mohammed
- School of Pharmaceutical Sciences. University of Science Malaysia. Pulau Pinang (Malaysia).
| | - Hadzliana Zainal
- School of Pharmaceutical Sciences. University of Science Malaysia. Pulau Pinang (Malaysia).
| | | | - Sabariah N Harun
- School of Pharmaceutical Sciences. University of Science Malaysia. Pulau Pinang (Malaysia).
| | - Siti M Ghadzi
- School of Pharmaceutical Sciences. University of Science Malaysia. Pulau Pinang (Malaysia).
| | - Irene Looi
- Clinical Research Centre, Hospital Seberang Jaya, Pulau Pinang (Malaysia).
| | - Norsima N Sidek
- Clinical Research Centre, Hospital Sultanah Nur Zahirah. Terengganu (Malaysia).
| | - Keng L Yee
- National Institute of Health, Ministry of Health. Selangor (Malaysia).
| | - Zariah A Aziz
- Clinical Research Centre, Hospital Sultanah Nur Zahirah. Terengganu (Malaysia).
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Chen XW, Shafei MN, Aziz ZA, Sidek NN, Musa KI. Trends in stroke outcomes at hospital discharge in first-ever stroke patients: Observations from the Malaysia National Stroke Registry (2009-2017). J Neurol Sci 2019; 401:130-135. [PMID: 31000206 DOI: 10.1016/j.jns.2019.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/19/2019] [Accepted: 04/09/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Stroke outcomes could be a quality indicator across the continuum of care and inform stroke management policymaking. However, this topic has rarely to date been studied directly. AIMS We sought to investigate recent trends in stroke outcomes at hospital discharge among first-ever stroke patients. METHODS This was an analysis of data from the Malaysia National Stroke Registry. Patients aged 18 years or older documented as having a first episode of stroke in the registry were recruited. Subsequently, the comparison of proportions for overall and sex-specific stroke outcomes between years (from 2009 to 2017) was conducted. The primary outcome was modified Rankin Scale score, which was assessed at hospital discharge, and each patient was categorized as follows: 1) functional independence, 2) functional dependence, or 3) death for analysis. RESULTS This study included 9361 first-ever stroke patients. Approximately 36.2% (3369) were discharged in an independence state, 53.1% (4945) experienced functional dependence, and 10.8% (1006) patients died at the time of hospital discharge. The percentage of patients who were discharged independently increased from 23.3% in 2009 to 46.5% in 2017, while that of patients discharged in a disabled state fell from 56.0% in 2009 to 45.6% in 2017. The percentage of death at discharge was reduced from 20.7% in 2009 to 7.8% in 2017. These findings suggest that the proportions of stroke outcomes at hospital discharge have changed significantly over time (p < 0.001), and there was a significant sex-related difference in stroke outcomes at hospital discharge following first stroke episode (p < 0.001). CONCLUSIONS Our data indicate there has been a significant change in stroke outcomes over the past nine years in Malaysia. This information ought to be considered in ongoing efforts of tertiary stroke prevention.
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Affiliation(s)
- Xin Wee Chen
- Public Health Medicine Department, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, Sungai Buloh 47000, Selangor, Malaysia; Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohd Nazri Shafei
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zariah Abdul Aziz
- Neurology Unit, General Medicine Department, Hospital Sultanah Nur Zahirah, Jalan Sultan Mahmud, 20400 Terengganu, Malaysia
| | - Norsima Nazifah Sidek
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Jalan Sultan Mahmud, 20400 Terengganu, Malaysia
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
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HMG-CoA Reductase Inhibitors Attenuate Neuronal Damage by Suppressing Oxygen Glucose Deprivation-Induced Activated Microglial Cells. Neural Plast 2019; 2019:7675496. [PMID: 30911291 PMCID: PMC6397982 DOI: 10.1155/2019/7675496] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/03/2018] [Accepted: 10/22/2018] [Indexed: 12/16/2022] Open
Abstract
Ischemic stroke is usually followed by inflammatory responses mediated by microglia. However, the effect of statins on directly preventing posthypoxia microglia inflammatory factors to prevent injury to surrounding healthy neurons is unclear. Atorvastatin and rosuvastatin, which have different physical properties regarding their lipid and water solubility, are the most common HMG-CoA reductase inhibitors (statins) and might directly block posthypoxia microglia inflammatory factors to prevent injury to surrounding neurons. Neuronal damage and microglial activation of the peri-infarct areas were investigated by Western blotting and immunofluorescence after 24 hours in a middle cerebral artery occlusion (MCAO) rat model. The decrease in neurons was in accordance with the increase in microglia, which could be reversed by both atorvastatin and rosuvastatin. The effects of statins on blocking secretions from posthypoxia microglia and reducing the secondary damage to surrounding normal neurons were studied in a coculture system in vitro. BV2 microglia were cultured under oxygen glucose deprivation (OGD) for 3 hours and then cocultured following reperfusion for 24 hours in the upper wells of transwell plates with primary neurons being cultured in the bottom wells. Inflammatory cytokines, including tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and cyclooxygenase-2 (COX2), which are activated by the nuclear factor-kappa B (NF-κB) signaling pathway in OGD-induced BV2 microglia, promoted decreased release of the anti-inflammatory cytokine IL-10 and apoptosis of neurons in the coculture systems according to ELISA and Western blotting. However, pretreatment with atorvastatin or rosuvastatin significantly reduced neuronal death, synaptic injury, and amyloid-beta (Aβ) accumulation, which might lead to increased low-density lipoprotein receptors (LDLRs) in BV2 microglia. We concluded that the proinflammatory mediators released from postischemia damage could cause damage to surrounding normal neurons, while HMG-CoA reductase inhibitors prevented neuronal apoptosis and synaptic injury by inactivating microglia through blocking the NF-κB signaling pathway.
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