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Miranda LA, Luvizutto GJ, Bessornia PAC, Furlan NE, Winckler FC, Ferreira NC, Hamamoto Filho PT, de Souza JT, Martin LC, Zanati Bazan SG, Pinheiro Modolo G, de Freitas CCM, Vidal EIDO, Bazan R. To what extent does frailty mediate the association between age and the outcomes of brain reperfusion following acute ischemic stroke? Front Aging Neurosci 2024; 16:1305803. [PMID: 38333676 PMCID: PMC10850226 DOI: 10.3389/fnagi.2024.1305803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Objective We evaluated the extent to which frailty mediated the association between age, poor functional outcomes, and mortality after acute ischemic stroke when patients were treated with brain reperfusion (thrombolytic therapy and/or thrombectomy). Materials and methods This retrospective cohort study included patients diagnosed with ischemic stroke who had undergone intravenous cerebral reperfusion therapy and/or mechanical thrombectomy. We created a mediation model by analyzing the direct natural effect of an mRS score > 2 and death on age-mediated frailty according to the Frailty Index. Results We enrolled 292 patients with acute ischemic stroke who underwent brain reperfusion. Their mean age was 67.7 ± 13.1 years. Ninety days after the stroke ictus, 54 (18.5%) participants died, and 83 (28.4%) lived with moderate to severe disability (2 < mRS < 6). In the mediation analysis of the composite outcome of disability (mRS score > 2) or death, frailty accounted for 28% of the total effect of age. The models used to test for the interaction between age and frailty did not show statistically significant interactions for either outcome, and the addition of the interaction did not significantly change the direct or indirect effects, nor did it improve model fit. Conclusion Frailty mediated almost one-third of the effect of age on the composite outcome of disability or death after acute ischemic stroke.
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Affiliation(s)
- Luana Aparecida Miranda
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Pedro Augusto Cândido Bessornia
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Natalia Eduarda Furlan
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Fernanda Cristina Winckler
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Natalia Cristina Ferreira
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Pedro Tadao Hamamoto Filho
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Juli Thomaz de Souza
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Luis Cuadrado Martin
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Silméia Garcia Zanati Bazan
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Gabriel Pinheiro Modolo
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Carlos Clayton Macedo de Freitas
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
| | | | - Rodrigo Bazan
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil
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Amalia L. Does the Implementation of a National Health Insurance Program Result in Rationing Care for Ischemic Stroke Management? Analysis of the Indonesian National Health Insurance Program. Risk Manag Healthc Policy 2023; 16:455-461. [PMID: 37007298 PMCID: PMC10065421 DOI: 10.2147/rmhp.s405986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Background There are 2.2 million stroke patients in Indonesia, and ischemic stroke represents 87% of all strokes. Ischemic stroke is one of the covered diseases (INA-CBGs) in the National Health Insurance (JKN). Based on the Indonesian Ministry of Health's data, stroke uses up 1% of the yearly budget. This study compares clinical outcomes and treatment patterns before and during the JKN era. Methods A cross-sectional analytical study of ischemic stroke medical records treated at Hasan Sadikin Hospital in 2013 and 2015 as representatives of the before and during JKN era. Chi-Square is used for data processing relationship analysis. Results 164 ischemic stroke patients were treated, 75 before implementing the JKN program and 89 after implementing the JKN program. There was a significant difference between treatment patterns (p<0.001) and clinical outcomes (p=0.046) of ischemic stroke patients before and after implementing The Indonesian National Health Insurance. There was no significant difference in length of stay (LOS). Conclusion There is significant different between treatment pattern and clinical outcome of ischemic stroke patients before and after implementing The Indonesian National Health Insurance. This program has improved clinical outcomes concerning the purpose of the JKN program to provide social protection and welfare in terms of health.
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Affiliation(s)
- Lisda Amalia
- Department of Neurology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Correspondence: Lisda Amalia, Department of Neurology, Faculty of Medicine, Universitas Padjadjaran, Jl. Eykman 38, Bandung, 40161, Indonesia, Email
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Han JM, Jang BH. Educational interventions for promoting stroke literacy in the general public. Hippokratia 2021. [DOI: 10.1002/14651858.cd014640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ji Min Han
- Ministry of Health and Welfare National Rehabilitation Center; Seoul Korea, South
| | - Bo-Hyoung Jang
- College of Korean Medicine, Kyung Hee University; Seoul Korea, South
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Taylor-Rowan M, Cuthbertson G, Keir R, Shaw R, Drozdowska B, Elliott E, Stott D, Quinn TJ. The prevalence of frailty among acute stroke patients, and evaluation of method of assessment. Clin Rehabil 2019; 33:1688-1696. [DOI: 10.1177/0269215519841417] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective:We aimed to determine prevalence of pre-stroke frailty in acute stroke and describe validity of a Frailty Index–based assessment.Design:Cross-sectional.Setting:Single UK urban teaching hospital.Subjects:Consecutive acute stroke unit admissions, recruited in four waves (May 2016–August 2018). We performed the assessments within first week and attempted to include all admissions.Main measures:Our primary measure was a Frailty Index, based on cumulative disorders. A proportion of participants were also assessed with the ‘Frail non-disabled’ questionnaire. We evaluated concurrent validity of Frailty Index against variables associated with frailty in non-stroke populations. We described predictive validity of Frailty Index for stroke severity and delirium. We described convergent validity, quantifying agreement between frailty assessments and a measure of pre-stroke disability (modified Rankin Scale) using kappa statistics and correlations.Results:We included 546 patients. A Frailty Index–defined frailty syndrome was observed in 427 of 545 patients (78%), of whom, 151 (28%) had frank frailty and 276 (51%) were pre-frail. Phenotypic frailty was observed in 72 of 258 patients (28%). We demonstrated concurrent validity via significant associations with all variables (all p < 0.01). We demonstrated predictive validity for stroke severity and delirium ( p < 0.01). Agreement between the frailty measures was poor (kappa = –0.06) and convergent validity was moderate (Frail non-disabled ‘Cramer’s V’ = 0.25; modified Rankin Scale ‘Cramer’s V’ = 0.47).Conclusion:Frailty is present in around one in four patients with acute stroke; if pre-frailty is included, then a frailty syndrome is seen in three out of four patients. The Frailty Index is a valid measure of frailty in stroke; however, there is little agreement between this scale and other measurements of frailty.
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Affiliation(s)
- Martin Taylor-Rowan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gillian Cuthbertson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ruth Keir
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Robert Shaw
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Bogna Drozdowska
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Emma Elliott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - David Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Han KT, Kim SJ, Kim SJ, Yoo JW, Park EC. Do Reduced Copayments Affect Mortality after Surgery due to Stroke? An Interrupted Time Series Analysis of a National Cohort Sampled in 2003-2012. J Stroke Cerebrovasc Dis 2018; 27:1502-1510. [PMID: 29467088 DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/18/2017] [Accepted: 12/24/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The South Korean government introduced a policy in 2 phases, in September 2005 and in January 2010, for reducing copayments for patients with critical diseases, including stroke, to prevent excessive medical expenditures and to ease economic barriers. Previous studies of the effect of this policy were focused primarily on cancer. Therefore, we investigated the relationship between this policy and 1-year mortality after surgery among patients with stroke. METHODS We used data from the Korean National Health Insurance sampling cohort (n = 2173 in 2003-2012) and performed an interrupted time series analysis. RESULTS Approximately 26% of the patients died within 1 year after surgery. The time trends after reducing copayments from 10% to 5% (phase 2) were inversely associated with risk of 1-year mortality (relative risk = .855, 95% confidence interval: .749-.975; P = .0196). In addition, this inverse association was greater in patients with low incomes, of older ages, and with higher Charlson comorbidity indices. CONCLUSIONS The introduction of a policy for reducing copayments to ease excessive cost burdens for patients with stroke was positively associated with a reduced risk of 1-year mortality after surgical treatment due to stroke. On the basis of our results, health policy makers should make an effort to identify vulnerable populations and to overcome economic barriers for providing effective alternatives to ensure patients receive optimal health care.
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Affiliation(s)
- Kyu-Tae Han
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Seung Ju Kim
- Department of Nursing, College of Nursing, Eulji University, Seongnam, Republic of Korea
| | - Sun Jung Kim
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, Nevada
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Park JH, Lee JH. Carotid Artery Stenting. Korean Circ J 2018; 48:97-113. [PMID: 29171201 PMCID: PMC5861011 DOI: 10.4070/kcj.2017.0208] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 09/16/2017] [Accepted: 09/19/2017] [Indexed: 01/01/2023] Open
Abstract
Carotid artery stenosis is relatively common and is a significant cause of ischemic stroke, but carotid revascularization can reduce the risk of ischemic stroke in patients with significant symptomatic stenosis. Carotid endarterectomy has been and remains the gold standard treatment to reduce the risk of carotid artery stenosis. Carotid artery stenting (CAS) (or carotid artery stent implantation) is another method of carotid revascularization, which has developed rapidly over the last 30 years. To date, the frequency of use of CAS is increasing, and clinical outcomes are improving with technical advancements. However, the value of CAS remains unclear in patients with significant carotid artery stenosis. This review article discusses the basic concepts and procedural techniques involved in CAS.
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Affiliation(s)
- Jae Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Hwan Lee
- Department of Cardiology in Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Korea.
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Kim SM, Hwang SW, Oh EH, Kang JK. Determinants of the length of stay in stroke patients. Osong Public Health Res Perspect 2013; 4:329-41. [PMID: 24524022 PMCID: PMC3922104 DOI: 10.1016/j.phrp.2013.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 10/31/2013] [Accepted: 10/31/2013] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES The study objective was to identify the factors that influence the length of stay (LOS) in hospital for stroke patients and to provide data for managing hospital costs by managing the LOS. METHODS This study used data from the Discharge Injury Survey of the Korea Centers for Disease Control and Prevention, which included 17,364 cases from 2005 to 2008. RESULT The LOS for stroke, cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage was 18.6, 15.0, 28.9, and 25.3 days, respectively. Patients who underwent surgery had longer LOS. When patients were divided based on whether they had surgery, there was a 2.4-time difference in the LOS for patients with subarachnoid hemorrhage, 2.0-time difference for patients with cerebral infarction, and 1.4-time difference for patients with intracerebral hemorrhage. The emergency route of admission and other diagnosis increased LOS, whereas hypertension and diabetic mellitus reduced LOS. CONCLUSION In the present rapidly changing hospital environments, hospitals approach an efficient policy for LOS, to maintain their revenues and quality of assessment. If LOS is used as the indicator of treatment expenses, there is a need to tackle factors that influence the LOS of stroke patients for each disease group who are divided based on whether surgery is performed or not for the proper management of the LOS.
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Affiliation(s)
- Sang Mi Kim
- Department of Health Administration, Yonsei University, Wonju, Korea
| | - Sung Wan Hwang
- Department of Health Administration, Baekseok Art University, Seoul, Korea
| | - Eun-Hwan Oh
- Department of Health Management, Hyupsung University, Suwon, Korea
| | - Jung-Kyu Kang
- Department of Healthcare Management, Cheongju University, Cheongju, Korea
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