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Zingelman S, Wallace SJ, Kim J, Mosalski S, Faux SG, Cadilhac DA, Alexander T, Lannin NA, Olaiya MT, Clifton R, Shiner CT, Starr S, Kilkenny MF. Is communication key in stroke rehabilitation and recovery? National linked stroke data study. Top Stroke Rehabil 2024; 31:325-335. [PMID: 37965905 DOI: 10.1080/10749357.2023.2279804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/01/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Information on the characteristics or long-term outcomes of people with communication support needs post-stroke is limited. We investigated associations between communication gains in rehabilitation and long-term outcomes (quality-of-life [EuroQOL-ED-3 L], mortality) by post-stroke communication support need status. METHODS Retrospective cohort study using person-level linked data from the Australian Stroke Clinical Registry and the Australasian Rehabilitation Outcomes Centre (2014-2017). Communication support needs were assessed using the Functional Independence Measure™ comprehension and expression items recorded on admission indicated by scores one (total assistance) to five (standby prompting). Multivariable multilevel and Cox regression models were used to determine associations with long-term outcomes. RESULTS Of 8,394 patients who received in-patient rehabilitation after stroke (42% female, median age 75.6 years), two-thirds had post-stroke communication support needs. Having aphasia (odds ratio [OR] 4.34, 95% CI 3.67-5.14), being aged ≥65 years (OR 1.21, 95% CI 1.08-1.36), greater stroke severity (unable to walk on admission; OR 1.48, 95% CI 1.32-1.68) and previous stroke (OR 1.25, 95% CI 1.11-1.41) were associated with increased likelihoods of having communication support needs. One-point improvement in FIM™ expression was associated with reduced likelihood of self-reporting problems related to mobility (OR 0.85, 95% CI: 0.80-0.90), self-care (OR 0.79, 95% CI: 0.74-0.86) or usual activities (OR 0.84, 95% CI: 0.75-0.94) at 90-180 days. Patients with communication support needs had greater mortality rates within one-year post-stroke (adjusted hazard ratio 1.99, 95% CI: 1.65-2.39). CONCLUSIONS Two-thirds of patients with stroke require communication support to participate in healthcare activities. Establishing communication-accessible stroke care environments is a priority.
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Affiliation(s)
- Sally Zingelman
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, St Lucia, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, St Lucia, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Simon Mosalski
- Department of Rehabilitation, St Vincent's Hospital, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
- School of Medicine, Sydney Campus, The University of Notre Dame, Notre Dame, New South Wales, Australia
| | - Steven G Faux
- Department of Rehabilitation, St Vincent's Hospital, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
- School of Medicine, Sydney Campus, The University of Notre Dame, Notre Dame, New South Wales, Australia
| | - Dominique A Cadilhac
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Tara Alexander
- Australasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, Australia
| | - Natasha A Lannin
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Ross Clifton
- Australasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, Australia
| | - Christine T Shiner
- Department of Rehabilitation, St Vincent's Hospital, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Susan Starr
- Department of Speech Pathology, Braeside Hospital, Sydney, Australia
| | - Monique F Kilkenny
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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Harvey S, Stone M, Zingelman S, Copland DA, Kilkenny MF, Godecke E, Cadilhac DA, Kim J, Olaiya MT, Rose ML, Breitenstein C, Shrubsole K, O'Halloran R, Hill AJ, Hersh D, Mainstone K, Mainstone P, Unsworth CA, Brogan E, Short KJ, Burns CL, Baker C, Wallace SJ. Comprehensive quality assessment for aphasia rehabilitation after stroke: protocol for a multicentre, mixed-methods study. BMJ Open 2024; 14:e080532. [PMID: 38514146 PMCID: PMC10961567 DOI: 10.1136/bmjopen-2023-080532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/27/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION People with aphasia following stroke experience disproportionally poor outcomes, yet there is no comprehensive approach to measuring the quality of aphasia services. The Meaningful Evaluation of Aphasia SeRvicES (MEASuRES) minimum dataset was developed in partnership with people with lived experience of aphasia, clinicians and researchers to address this gap. It comprises sociodemographic characteristics, quality indicators, treatment descriptors and outcome measurement instruments. We present a protocol to pilot the MEASuRES minimum dataset in clinical practice, describe the factors that hinder or support implementation and determine meaningful thresholds of clinical change for core outcome measurement instruments. METHODS AND ANALYSIS This research aims to deliver a comprehensive quality assessment toolkit for poststroke aphasia services in four studies. A multicentre pilot study (study 1) will test the administration of the MEASuRES minimum dataset within five Australian health services. An embedded mixed-methods process evaluation (study 2) will evaluate the performance of the minimum dataset and explore its clinical applicability. A consensus study (study 3) will establish consumer-informed thresholds of meaningful change on core aphasia outcome constructs, which will then be used to establish minimal important change values for corresponding core outcome measurement instruments (study 4). ETHICS AND DISSEMINATION Studies 1 and 2 have been registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12623001313628). Ethics approval has been obtained from the Royal Brisbane and Women's Hospital (HREC/2023/MNHB/95293) and The University of Queensland (2022/HE001946 and 2023/HE001175). Study findings will be disseminated through peer-reviewed publications, conference presentations and engagement with relevant stakeholders including healthcare providers, policy-makers, stroke and rehabilitation audit and clinical quality registry custodians, consumer support organisations, and individuals with aphasia and their families.
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Affiliation(s)
- Sam Harvey
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Marissa Stone
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Sally Zingelman
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Monique F Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Joosup Kim
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Muideen T Olaiya
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Miranda L Rose
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Caterina Breitenstein
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Kirstine Shrubsole
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Robyn O'Halloran
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Annie J Hill
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Deborah Hersh
- Curtin School of Allied Health and EnAble Institute, Curtin University, Perth, Western Australia, Australia
- Australian Aphasia Association, Perth, Western Australia, Australia
| | - Kathryn Mainstone
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Penelope Mainstone
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Carolyn A Unsworth
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Institute of Health and Wellbeing, Federation University, Ballarat, Victoria, Australia
| | - Emily Brogan
- Edith Cowan University, Joondalup, Western Australia, Australia
- Fiona Stanley Fremantle Hospitals Group, South Metropolitan Health Service, Palmyra, Western Australia, Australia
| | - Kylie J Short
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Clare L Burns
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Caroline Baker
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- Speech Pathology Department, Monash Health, Clayton, Victoria, Australia
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
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Bam K, Kilkenny MF, Kim J, Cadilhac DA, Pearce C, Andrew NE, Sanders L, Thrift AG, Nelson MR, Gall S, Daraganova G, Olaiya MT. Age and sex disparities in cardiovascular risk factor management prior to stroke: Linked registry and general practice data. Neuroepidemiology 2024:000538067. [PMID: 38447549 DOI: 10.1159/000538067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/25/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION There is limited evidence about the management of cardiovascular risk factors within 12 months before stroke/transient ischaemic attack (TIA) in Australian general practices. We evaluated whether age and sex disparities in cardiovascular risk factor management for primary prevention exist in general practice. METHODS A retrospective cohort study using data from the Australian Stroke Clinical Registry (2014-2018) linked with general practice data from three primary health networks in Victoria, Australia. We included adults who had ≥2 encounters with a general practitioner within 12 months immediately before the first stroke/TIA. Cardiovascular risk factor management within 12 months before stroke/TIA was evaluated in terms of: assessment of risk factors (blood pressure [BP], serum lipids, blood glucose, body weight); prescription of prevention medications (BP, lipid-, glucose-lowering, antithrombotic agents); and attainment of risk factor targets. RESULTS Of 2,880 patients included (median age 76.5 years, 48.4% women), 80.9% were assessed for BP, 49.9% serum lipids, 46.8% blood glucose, and 39.3% body weight. Compared to patients aged 65-84 years, those aged <65 or ≥85 years were less often assessed for risk factors, with women aged ≥85 years assessed for significantly fewer risk factors than their male counterparts. The most prescribed prevention medications were BP-lowering (64.9%) and lipid-lowering agents (42.0%). There were significant sex differences among those aged <65 years (34.7% women vs. 40.2% men) and ≥85 years (34.0% women vs. 44.3% men) for lipid-lowering agents. Risk factor target attainment was generally poorer in men than women, especially among those aged <65 years. CONCLUSION Age-sex disparity exists in risk factor management for primary prevention in general practice, and this was more pronounced among younger patients and older women.
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Kim J, Olaiya MT, De Silva DA, Norrving B, Bosch J, De Sousa DA, Christensen HK, Ranta A, Donnan GA, Feigin V, Martins S, Schwamm LH, Werring DJ, Howard G, Owolabi M, Pandian J, Mikulik R, Thayabaranathan T, Cadilhac DA. Global stroke statistics 2023: Availability of reperfusion services around the world. Int J Stroke 2024; 19:253-270. [PMID: 37853529 PMCID: PMC10903148 DOI: 10.1177/17474930231210448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Disparities in the availability of reperfusion services for acute ischemic stroke are considerable globally and require urgent attention. Contemporary data on the availability of reperfusion services in different countries are used to provide the necessary evidence to prioritize where access to acute stroke treatment is needed. AIMS To provide a snapshot of published literature on the provision of reperfusion services globally, including when facilitated by telemedicine or mobile stroke unit services. METHODS We searched PubMed to identify original articles, published up to January 2023 for the most recent, representative, and relevant patient-level data for each country. Keywords included thrombolysis, endovascular thrombectomy and telemedicine. We also screened reference lists of review articles, citation history of articles, and the gray literature. The information is provided as a narrative summary. RESULTS Of 11,222 potentially eligible articles retrieved, 148 were included for review following de-duplications and full-text review. Data were also obtained from national stroke clinical registry reports, Registry of Stroke Care Quality (RES-Q) and PRE-hospital Stroke Treatment Organization (PRESTO) repositories, and other national sources. Overall, we found evidence of the provision of intravenous thrombolysis services in 70 countries (63% high-income countries (HICs)) and endovascular thrombectomy services in 33 countries (68% HICs), corresponding to far less than half of the countries in the world. Recent data (from 2019 or later) were lacking for 35 of 67 countries with known year of data (52%). We found published data on 74 different stroke telemedicine programs (93% in HICs) and 14 active mobile stroke unit pre-hospital ambulance services (80% in HICs) around the world. CONCLUSION Despite remarkable advancements in reperfusion therapies for stroke, it is evident from available patient-level data that their availability remains unevenly distributed globally. Contemporary published data on availability of reperfusion services remain scarce, even in HICs, thereby making it difficult to reliably ascertain current gaps in the provision of this vital acute stroke treatment around the world.
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Affiliation(s)
- Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Deidre A De Silva
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jackie Bosch
- School of Rehabilitation Science, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Diana A De Sousa
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Hanne K Christensen
- Department of Neurology, University of Copenhagen and Bispebjerg Hospital, Copenhagen, Denmark
| | - Anna Ranta
- Department of Medicine, University of Otago, Wellington, Wellington, New Zealand
| | - Geoffrey A Donnan
- Melbourne Brain Centre, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Sheila Martins
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - George Howard
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Robert Mikulik
- Health Management Institute, Brno, Czech Republic
- Neurology Department, Bata Hospital, Zlin, Czech Republic
| | - Tharshanah Thayabaranathan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
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Orman Z, Olaiya MT, Thrift AG, Cadilhac DA, Phan T, Nelson MR, Ung D, Srikanth VK, Bladin CF, Gerraty RP, Phillipos J, Kim J. Cost-effectiveness of an individualised management program after stroke: a trial-based economic evaluation. Neuroepidemiology 2024:000535638. [PMID: 38359812 DOI: 10.1159/000535638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/20/2023] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Evidence on the cost-effectiveness of comprehensive post-stroke programs is limited. We assessed the cost-effectiveness of an individualised management program (IMP) for stroke or transient ischaemic attack (TIA). METHODS A cost-utility analysis alongside a randomised controlled trial with a 2-year follow-up, from both societal and health system perspectives, was conducted. Adults with stroke/TIA discharged from hospitals were randomised by primary care practice to receive either usual care (UC) or an IMP in addition to UC. An IMP included at-home stroke-specific nurse-led education and a specialist review of care plans at baseline, 3, and 12 months, and telephone reviews by nurses at 6 and 18 months. Costs in 2021 Australian dollars (AUD) and quality-adjusted life years (QALYs) were discounted by 5%. The probability of cost-effectiveness of the intervention was determined by quantifying 10,000 bootstrapped iterations of incremental costs and QALYs below the threshold of AUD50,000/QALY. RESULTS Among the 502 participants (65% male, median age 69 years), 251 (50%) were in the intervention group. From a health system perspective, the incremental cost per QALY gained was AUD53,175 with an IMP compared to UC alone. At a willingness-to-pay threshold of AUD50,000/QALY, an IMP was preferred in 46.7% of iterations. From a societal perspective, the intervention was dominant in 52.7% of iterations with mean per-patient costs of AUD49,045 and 1.352 QALYs compared to mean per-patient costs of AUD51,394 and 1.324 QALYs in the UC group. The probability of cost-effectiveness of an IMP, from a societal perspective, was 60.5%. CONCLUSIONS Care for people with stroke/TIA using an IMP was cost-effective from a societal perspective over two years. Economic evaluations of prevention programs need sufficient time horizons and consideration of costs beyond direct health care utilisation to demonstrate their value to society.
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Orman Z, Cadilhac DA, Andrew NE, Kilkenny MF, Olaiya MT, Thrift AG, Ung D, Dalli LL, Churilov L, Sundararajan V, Lannin NA, Nelson MR, Srikanth V, Kim J. Cost-effectiveness of a government policy to incentivise chronic disease management following stroke: a modelling study. Neuroepidemiology 2024:000536224. [PMID: 38290479 DOI: 10.1159/000536224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Little is known about the cost-effectiveness of government policies that support primary care physicians to provide comprehensive chronic disease management (CDM). AIMS To estimate the potential cost-effectiveness of CDM policies, over a lifetime, in long-time survivors of stroke. METHODS A Markov model, using three health states (stable, hospitalised, dead), was developed to simulate the costs and benefits of CDM policies over 30 years (with 1-year cycles). Transition probabilities and costs from a health system perspective were obtained from the linkage of data between the Australian Stroke Clinical Registry (cohort n=12,368, 42% female, median age 70 years, 45% had a claim) and government-held hospital, Medicare, and pharmaceutical claims datasets. Quality-adjusted life years (QALYs) were obtained from a comparable cohort (n=512, 34% female, median age 69.6 years, 52% had a claim) linked with Medicare claims and death data. A 3% discount rate was applied to costs in Australian dollars (AUD, 2016) and QALYs beyond 12 months. Probabilistic sensitivity analyses were used to understand uncertainty. RESULTS Per-person average total lifetime costs were AUD142,939 and 8.97 QALYs for those with a claim, and AUD103,889 and 8.98 QALYs for those without a claim. This indicates that these CDM policies were costlier without improving QALYs. The probability of cost-effectiveness of CDM was 26.1%, at a willingness-to-pay threshold of AUD50,000/QALY. CONCLUSION CDM policies, designed to encourage comprehensive care, are unlikely to be cost-effective for stroke compared to care without CDM. Further research to understand how to deliver such care in a cost-effective manner is needed.
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Kilkenny MF, Olaiya MT, Cameron J, Lannin NA, Andrew NE, Thrift AG, Hackett M, Kneebone I, Drummond A, Thijs V, Brancatisano O, Kim J, Reyneke M, Hancock S, Allan L, Ellery F, Cloud G, Grimley RS, Middleton S, Cadilhac DA. Statistical analysis plan for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke randomised controlled clinical trial. Trials 2024; 25:78. [PMID: 38263172 PMCID: PMC10804563 DOI: 10.1186/s13063-023-07864-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/30/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Unplanned hospital presentations may occur post-stroke due to inadequate preparation for transitioning from hospital to home. The Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial was designed to test the effectiveness of receiving a 12-week, self-management intervention, comprising personalised goal setting with a clinician and aligned educational/motivational electronic messages. Primary outcome is as follows: self-reported unplanned hospital presentations (emergency department/admission) within 90-day post-randomisation. We present the statistical analysis plan for this trial. METHODS/DESIGN Participants are randomised 1:1 in variable block sizes, with stratification balancing by age and level of baseline disability. The sample size was 890 participants, calculated to detect a 10% absolute reduction in the proportion of participants reporting unplanned hospital presentations/admissions, with 80% power and 5% significance level (two sided). Recruitment will end in December 2023 when funding is expended, and the sample size achieved will be used. Logistic regression, adjusted for the stratification variables, will be used to determine the effectiveness of the intervention on the primary outcome. Secondary outcomes will be evaluated using appropriate regression models. The primary outcome analysis will be based on intention to treat. A p-value ≤ 0.05 will indicate statistical significance. An independent Data Safety and Monitoring Committee has routinely reviewed the progress and safety of the trial. CONCLUSIONS This statistical analysis plan ensures transparency in reporting the trial outcomes. ReCAPS trial will provide novel evidence on the effectiveness of a digital health support package post-stroke. TRIAL REGISTRATION ClinicalTrials.gov ACTRN12618001468213. Registered on August 31, 2018. SAP version 1.13 (October 12 2023) Protocol version 1.12 (October 12, 2022) SAP revisions Nil.
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Affiliation(s)
- Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Janette Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Nadine E Andrew
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Clayton, Australia
- National Centre for Healthy Ageing, Monash University, Frankston, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Maree Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ian Kneebone
- Graduate School of Health, Faculty of Health, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Avril Drummond
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Vincent Thijs
- Department of Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Olivia Brancatisano
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Megan Reyneke
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Shaun Hancock
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Liam Allan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Fiona Ellery
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Geoffrey Cloud
- Department of Neuroscience, Central Clinical School, Monash University, Clayton, Australia
- Stroke Services, Alfred Health, Melbourne, Australia
| | - Rohan S Grimley
- School of Medicine and Dentistry, Griffith University, Birtinya, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney and Australian Catholic University, Sydney, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.
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Dharan AS, Dalli LL, Olaiya MT, Cadilhac DA, Nedkoff L, Kim J, Andrew NE, Sundararajan V, Thrift AG, Faux SG, Grimley R, Kilkenny MF, Kuhn L. Risk Factors Associated with Major Adverse Cardiovascular Events after Ischemic Stroke: A Linked Registry Study. Neuroepidemiology 2023; 58:134-142. [PMID: 38113865 PMCID: PMC10997250 DOI: 10.1159/000535872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Survivors of stroke are at risk of experiencing subsequent major adverse cardiovascular events (MACE). We aimed to determine the incidence of, and risk factors for, MACE after first-ever ischemic stroke, by age group (18-64 years vs. ≥65 years). METHODS Observational cohort study using patient-level data from the Australian Stroke Clinical Registry (2009-2013), linked with hospital administrative data. We included adults with first-ever ischemic stroke who had no previous acute cardiovascular admissions and followed these patients for 2 years post-discharge, or until the first post-stroke MACE event. A Fine-Gray sub-distribution hazard model, accounting for the competing risk of non-cardiovascular death, was used to determine factors for incident post-stroke MACE. RESULTS Among 5,994 patients with a first-ever ischemic stroke (median age 73 years, 45% female), 17% were admitted for MACE within 2 years (129 events per 1,000 person-years). The median time to first post-stroke MACE was 117 days (89 days if aged <65 years vs. 126 days if aged ≥65 years; p = 0.025). Among patients aged 18-64 years, receiving intravenous thrombolysis (sub-distribution hazard ratio [SHR] 0.51 [95% CI, 0.28-0.92]) or being discharged to inpatient rehabilitation (SHR 0.65 [95% CI, 0.46-0.92]) were associated with a reduced incidence of post-stroke MACE. In those aged ≥65 years, being unable to walk on admission (SHR 1.33 [95% CI 1.15-1.54]), and history of smoking (SHR 1.40 [95% CI 1.14-1.71]) or atrial fibrillation (SHR 1.31 [95% CI 1.14-1.51]) were associated with an increased incidence of post-stroke MACE. Acute management in a large hospital (>300 beds) for the initial stroke event was associated with reduced incidence of post-stroke MACE, irrespective of age group. CONCLUSIONS MACE is common within 2 years of stroke, with most events occurring within the first year. We have identified important factors to consider when designing interventions to prevent MACE after stroke, particularly among those aged <65 years.
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Affiliation(s)
- Ajay S Dharan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Lachlan L Dalli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia,
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Lee Nedkoff
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, Washington, Australia
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Clayton, Victoria, Australia
- National Centre for Healthy Ageing, Frankston, Victoria, Australia
| | - Vijaya Sundararajan
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Steven G Faux
- St Vincent's Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Rohan Grimley
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- School of Medicine and Dentistry, Griffith University, Birtinya, Queensland, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Lisa Kuhn
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia
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9
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Westworth SE, Ung D, Dalli LL, Barnden R, Kilkenny MF, Srikanth V, Lannin NA, Lodge ME, Cadilhac DA, Olaiya MT, Andrew NE. Factors Associated With Transition From Community to Permanent Residential Aged Care Following Stroke: A Linked Registry Data Study. Stroke 2023; 54:3117-3127. [PMID: 37955141 DOI: 10.1161/strokeaha.123.043972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Understanding factors that influence the transition to permanent residential aged care following a stroke or transient ischemic attack may inform strategies to support people to live at home longer. We aimed to identify the demographic, clinical, and system factors that may influence the transition from living in the community to permanent residential care in the 6 to 18 months following stroke/transient ischemic attack. METHODS Linked data cohort analysis of adults from Queensland and Victoria aged ≥65 years and registered in the Australian Stroke Clinical Registry (2012-2016) with a clinical diagnosis of stroke/transient ischemic attack and living in the community in the first 6 months post-hospital discharge. Participant data were linked with primary care, pharmaceutical, aged care, death, and hospital data. Multivariable survival analysis was performed to determine demographic, clinical, and system factors associated with the transition to permanent residential care in the 6 to 18 months following stroke, with death modeled as a competing risk. RESULTS Of 11 176 included registrants (median age, 77.2 years; 44% female), 520 (5%) transitioned to permanent residential care between 6 and 18 months. Factors most associated with transition included the history of urinary tract infections (subhazard ratio [SHR], 1.41 [95% CI, 1.16-1.71]), dementia (SHR, 1.66 [95% CI, 1.14-2.42]), increasing age (65-74 versus 85+ years; SHR, 1.75 [95% CI, 1.31-2.34]), living in regional Australia (SHR, 31 [95% CI, 1.08-1.60]), and aged care service approvals: respite (SHR, 4.54 [95% CI, 3.51-5.85]) and high-level home support (SHR, 1.80 [95% CI, 1.30-2.48]). Protective factors included being dispensed antihypertensive medications (SHR, 0.68 [95% CI, 0.53-0.87]), seeing a cardiologist (SHR, 0.72 [95% CI, 0.57-0.91]) following stroke, and less severe stroke (SHR, 0.71 [95% CI, 0.58-0.88]). CONCLUSIONS Our findings provide an improved understanding of factors that influence the transition from community to permanent residential care following stroke and can inform future strategies designed to delay this transition.
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Affiliation(s)
- Sarah E Westworth
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia (S.E.W., D.U., R.B., V.S., M.E.L.)
| | - David Ung
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia (S.E.W., D.U., R.B., V.S., M.E.L.)
- National Centre for Healthy Ageing, Peninsula Health and Monash University, Frankston, Victoria, Australia (D.U., R.B., V.S., M.E.L., N.E.A.)
| | - Lachlan L Dalli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (L.L.D., M.F.K., D.A.C., M.T.O.)
| | - Rebecca Barnden
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia (S.E.W., D.U., R.B., V.S., M.E.L.)
- National Centre for Healthy Ageing, Peninsula Health and Monash University, Frankston, Victoria, Australia (D.U., R.B., V.S., M.E.L., N.E.A.)
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (L.L.D., M.F.K., D.A.C., M.T.O.)
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia (M.F.K., D.A.C.)
| | - Velandai Srikanth
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia (S.E.W., D.U., R.B., V.S., M.E.L.)
- National Centre for Healthy Ageing, Peninsula Health and Monash University, Frankston, Victoria, Australia (D.U., R.B., V.S., M.E.L., N.E.A.)
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia (N.A.L.)
- Alfred Health, Melbourne, Victoria, Australia (N.A.L., M.E.L.)
| | - Margot E Lodge
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia (S.E.W., D.U., R.B., V.S., M.E.L.)
- National Centre for Healthy Ageing, Peninsula Health and Monash University, Frankston, Victoria, Australia (D.U., R.B., V.S., M.E.L., N.E.A.)
- Alfred Health, Melbourne, Victoria, Australia (N.A.L., M.E.L.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (L.L.D., M.F.K., D.A.C., M.T.O.)
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia (M.F.K., D.A.C.)
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (L.L.D., M.F.K., D.A.C., M.T.O.)
| | - Nadine E Andrew
- National Centre for Healthy Ageing, Peninsula Health and Monash University, Frankston, Victoria, Australia (D.U., R.B., V.S., M.E.L., N.E.A.)
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10
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Dalli LL, Burns C, Kilkenny MF, Gall SL, Hou WH, Hoffmann TC, Olaiya MT, Cameron J, Purvis T, Thrift AG, Nelson MR, Sanders A, Viney K, Phan HT, Freak-Poli R. In Search of a Gold Standard Tool for Assessing Knowledge of Stroke: A Systematic Review. Neuroepidemiology 2023; 58:75-91. [PMID: 37980894 DOI: 10.1159/000535292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/12/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Knowledge of stroke is essential to empower people to reduce their risk of these events. However, valid tools are required for accurate and reliable measurement of stroke knowledge. We aimed to systematically review contemporary stroke knowledge assessment tools and appraise their content validity, feasibility, and measurement properties. METHODS The protocol was registered in PROSPERO (CRD42023403566). Electronic databases (MEDLINE, PsycInfo, CINAHL, Embase, Scopus, Web of Science) were searched to identify published articles (1 January 2015-1 March 2023), in which stroke knowledge was assessed using a validated tool. Two reviewers independently screened titles and abstracts prior to undertaking full-text review. COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methods guided the appraisal of content validity (relevance, comprehensiveness, comprehensibility), feasibility, and measurement properties. RESULTS After removing duplicates, the titles and abstracts of 718 articles were screened; 323 reviewed in full; with 42 included (N = 23 unique stroke knowledge tools). For content validity, all tools were relevant, two were comprehensive, and seven were comprehensible. Validation metrics were reported for internal consistency (n = 20 tools), construct validity (n = 17 tools), cross-cultural validity (n = 15 tools), responsiveness (n = 9 tools), reliability (n = 7 tools), structural validity (n = 3 tools), and measurement error (n = 1 tool). The Stroke Knowledge Test met all content validity criteria, with validation data for six measurement properties (n = 3 rated "Sufficient"). CONCLUSION Assessment of stroke knowledge is not standardised and many tools lacked validated content or measurement properties. The Stroke Knowledge Test was the most comprehensive but requires updating and further validation for endorsement as a gold standard.
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Affiliation(s)
- Lachlan L Dalli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Catherine Burns
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Seana L Gall
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital/Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Jan Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Kayla Viney
- Stroke Foundation, Melbourne, Victoria, Australia
| | - Hoang T Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Rosanne Freak-Poli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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11
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Allan LP, Beilei L, Cameron J, Olaiya MT, Silvera-Tawil D, Adcock AK, English C, Gall SL, Cadilhac DA. A Scoping Review of mHealth Interventions for Secondary Prevention of Stroke: Implications for Policy and Practice. Stroke 2023; 54:2935-2945. [PMID: 37800373 DOI: 10.1161/strokeaha.123.043794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Secondary prevention is a major priority for those living with stroke and may be improved through the use of mobile Health (mHealth) interventions. While evidence for the effectiveness of mHealth interventions for secondary prevention of stroke is growing, little attention has been given to the translation of these interventions into real-world use. In this review, we aimed to provide an update on the effectiveness of mHealth interventions for secondary prevention of stroke, and investigate their translation into real-world use. Four electronic databases and the gray literature were searched for randomized controlled trials of mHealth interventions for secondary prevention of stroke published between 2010 and 2023. Qualitative and mixed-methods evaluations of the trials were also included. Data were extracted regarding study design, population, mHealth technology involved, the intervention, and outcomes. Principal researchers from these trials were also contacted to obtain further translational information. From 1151 records, 13 randomized controlled trials and 4 evaluations were identified; sample sizes varied widely (median, 56; range, 24-4298). Short message service messages (9/13) and smartphone applications (6/13) were the main technologies used to deliver interventions. Primary outcomes of feasibility of the intervention were achieved in 4 trials, and primary outcomes of changes in risk factors, lifestyle behaviors, and adherence to medication improved in 6 trials. Only 1 trial had a hard end point (ie, stroke recurrence) as a primary outcome, and no significant differences were observed between groups. There was evidence for only 1 intervention being successfully translated into real-world use. Further evidence is required on the clinical effectiveness of mHealth interventions for preventing recurrent stroke, and the associated delivery costs and cost-effectiveness, before adoption into real-world settings.
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Affiliation(s)
- Liam P Allan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
- Australian e-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation, New South Wales, Australia (L.P.A., D.S.-T.)
| | - Lin Beilei
- The Nursing and Health School, Zhengzhou University, Henan, China (L.B.)
| | - Jan Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
- Australian Centre for Heart Health, Royal Melbourne Hospital, Victoria, Australia (J.C.)
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
| | - David Silvera-Tawil
- Australian e-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation, New South Wales, Australia (L.P.A., D.S.-T.)
| | - Amelia K Adcock
- Cerebrovascular Division, Department of Neurology, West Virginia University, Morgantown (A.K.A.)
| | - Coralie English
- School of Health Sciences, University of Newcastle, New South Wales, Australia (C.E.)
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New South Wales, Australia (C.E.)
- NHMRC Centre of Research Excellence to Accelerate Stroke Trial Innovation and Translation (C.E., D.A.C.)
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.L.G.)
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Victoria, Australia (S.L.G.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia (D.A.C.)
- NHMRC Centre of Research Excellence to Accelerate Stroke Trial Innovation and Translation (C.E., D.A.C.)
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12
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Purvis T, Cadilhac DA, Hill K, Reyneke M, Olaiya MT, Dalli LL, Kim J, Murphy L, Campbell BC, Kilkenny MF. Twenty years of monitoring acute stroke care in Australia through the national stroke audit programme (1999-2019): A cross-sectional study. J Health Serv Res Policy 2023; 28:252-261. [PMID: 37212454 DOI: 10.1177/13558196231174732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND National organisational surveys and clinical audits to monitor and guide improvements to the delivery of evidence-based acute stroke care have been undertaken in Australia since 1999. This study aimed to determine the association between repeated national audit cycles on stroke service provision and care delivery from 1999 to 2019. METHODS Cross-sectional study using data from organisational surveys (1999, 2004, 2007-2019) and clinical data from the biennial National Stroke Acute Audit (2007-2019). Age-, sex-, and stroke severity-adjusted proportions were reported for adherence to guideline-recommended care processes. Multivariable, logistic regression models were performed to determine the association between repeated audit cycles and service provision (organisational) and care delivery (clinical). RESULTS Overall, 197 hospitals provided organisational survey data (1999-2019), with 24,996 clinical cases from 136 hospitals (around 40 cases per audit) (2007-2019). We found significant improvements in service organisation between 1999 and 2019 for access to stroke units (1999: 42%, 2019: 81%), thrombolysis services (1999: 6%, 2019: 85%), and rapid assessment/management for patients with transient ischaemic attack (1999: 11%, 2019: 61%). Analyses of patient-level audits for 2007 to 2019 found the odds of receiving care processes per audit cycle to have significantly increased for thrombolysis (2007: 3%, 2019: 11%; OR 1.15, 95% CI 1.13, 1.17), stroke unit access (2007: 52%, 2019: 69%; OR 1.15, 95% CI 1.14, 1.17), risk factor advice (2007: 40%, 2019: 63%; OR 1.10, 95% CI 1.09, 1.12), and carer training (2007: 24%, 2019: 51%; OR 1.12, 95% CI 1.10, 1.15). CONCLUSIONS Between 1999 and 2019, the quality of acute stroke care in Australia has improved in line with best practice evidence. Standardised monitoring of stroke care can inform targeted efforts to reduce identified gaps in best practice, and illustrate the evolution of the health system for stroke.
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Affiliation(s)
- Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Kelvin Hill
- Stroke Foundation, Melbourne, VIC, Australia
| | - Megan Reyneke
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Lachlan L Dalli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Lisa Murphy
- Stroke Foundation, Melbourne, VIC, Australia
| | - Bruce Cv Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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13
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Kilkenny MF, Sanders A, Burns C, Sanders LM, Ryan O, Read C, Lum On M, Ranta A, Purvis T, Inman C, Cadilhac DA, Carter H, Rowlands S, Nedkoff L, Olaiya MT. Stroke clinical coding education program in Australia and New Zealand. HEALTH INF MANAG J 2023:18333583231184004. [PMID: 37417466 DOI: 10.1177/18333583231184004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Accurate coded diagnostic data are important for epidemiological research of stroke. OBJECTIVE To develop, implement and evaluate an online education program for improving clinical coding of stroke. METHOD The Australia and New Zealand Stroke Coding Working Group co-developed an education program comprising eight modules: rationale for coding of stroke; understanding stroke; management of stroke; national coding standards; coding trees; good clinical documentation; coding practices; and scenarios. Clinical coders and health information managers participated in the 90-minute education program. Pre- and post-education surveys were administered to assess knowledge of stroke and coding, and to obtain feedback. Descriptive analyses were used for quantitative data, inductive thematic analysis for open-text responses, with all results triangulated. RESULTS Of 615 participants, 404 (66%) completed both pre- and post-education assessments. Respondents had improved knowledge for 9/12 questions (p < 0.05), including knowledge of applicable coding standards, coding of intracerebral haemorrhage and the actions to take when coding stroke (all p < 0.001). Majority of respondents agreed that information was pitched at an appropriate level; education materials were well organised; presenters had adequate knowledge; and that they would recommend the session to colleagues. In qualitative evaluations, the education program was beneficial for newly trained clinical coders, or as a knowledge refresher, and respondents valued clinical information from a stroke neurologist. CONCLUSION Our education program was associated with increased knowledge for clinical coding of stroke. To continue to address the quality of coded stroke data through improved stroke documentation, the next stage will be to adapt the educational program for clinicians.
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Affiliation(s)
- Monique F Kilkenny
- Monash University, Australia
- The Florey Institute of Neuroscience and Mental Health, Australia
| | | | | | - Lauren M Sanders
- St Vincent's Hospital Melbourne, Australia
- University of Melbourne, Australia
| | - Olivia Ryan
- Monash University, Australia
- The Florey Institute of Neuroscience and Mental Health, Australia
| | - Carla Read
- The Victorian Agency for Health Information, Australia
| | - Miriam Lum On
- Australian Institute of Health and Welfare, Australia
| | - Anna Ranta
- University of Otago-Wellington, New Zealand
| | | | | | - Dominique A Cadilhac
- Monash University, Australia
- The Florey Institute of Neuroscience and Mental Health, Australia
| | - Helen Carter
- The Florey Institute of Neuroscience and Mental Health, Australia
| | | | - Lee Nedkoff
- The University of Western Australia, Australia
- Victor Chang Cardiac Research Institute, Australia
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14
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Wedekind LE, Mahajan A, Hsueh WC, Chen P, Olaiya MT, Kobes S, Sinha M, Baier LJ, Knowler WC, McCarthy MI, Hanson RL. The utility of a type 2 diabetes polygenic score in addition to clinical variables for prediction of type 2 diabetes incidence in birth, youth and adult cohorts in an Indigenous study population. Diabetologia 2023; 66:847-860. [PMID: 36862161 PMCID: PMC10036431 DOI: 10.1007/s00125-023-05870-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/29/2022] [Indexed: 03/03/2023]
Abstract
AIMS/HYPOTHESIS There is limited information on how polygenic scores (PSs), based on variants from genome-wide association studies (GWASs) of type 2 diabetes, add to clinical variables in predicting type 2 diabetes incidence, particularly in non-European-ancestry populations. METHODS For participants in a longitudinal study in an Indigenous population from the Southwestern USA with high type 2 diabetes prevalence, we analysed ten constructions of PS using publicly available GWAS summary statistics. Type 2 diabetes incidence was examined in three cohorts of individuals without diabetes at baseline. The adult cohort, 2333 participants followed from age ≥20 years, had 640 type 2 diabetes cases. The youth cohort included 2229 participants followed from age 5-19 years (228 cases). The birth cohort included 2894 participants followed from birth (438 cases). We assessed contributions of PSs and clinical variables in predicting type 2 diabetes incidence. RESULTS Of the ten PS constructions, a PS using 293 genome-wide significant variants from a large type 2 diabetes GWAS meta-analysis in European-ancestry populations performed best. In the adult cohort, the AUC of the receiver operating characteristic curve for clinical variables for prediction of incident type 2 diabetes was 0.728; with the PS, 0.735. The PS's HR was 1.27 per SD (p=1.6 × 10-8; 95% CI 1.17, 1.38). In youth, corresponding AUCs were 0.805 and 0.812, with HR 1.49 (p=4.3 × 10-8; 95% CI 1.29, 1.72). In the birth cohort, AUCs were 0.614 and 0.685, with HR 1.48 (p=2.8 × 10-16; 95% CI 1.35, 1.63). To further assess the potential impact of including PS for assessing individual risk, net reclassification improvement (NRI) was calculated: NRI for the PS was 0.270, 0.268 and 0.362 for adult, youth and birth cohorts, respectively. For comparison, NRI for HbA1c was 0.267 and 0.173 for adult and youth cohorts, respectively. In decision curve analyses across all cohorts, the net benefit of including the PS in addition to clinical variables was most pronounced at moderately stringent threshold probability values for instituting a preventive intervention. CONCLUSIONS/INTERPRETATION This study demonstrates that a European-derived PS contributes significantly to prediction of type 2 diabetes incidence in addition to information provided by clinical variables in this Indigenous study population. Discriminatory power of the PS was similar to that of other commonly measured clinical variables (e.g. HbA1c). Including type 2 diabetes PS in addition to clinical variables may be clinically beneficial for identifying individuals at higher risk for the disease, especially at younger ages.
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Affiliation(s)
- Lauren E Wedekind
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA.
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Anubha Mahajan
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Genentech, San Francisco, CA, USA
| | - Wen-Chi Hsueh
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Peng Chen
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
- College of Basic Medical Sciences, Jilin University, Changchun, China
| | - Muideen T Olaiya
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
- School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Sayuko Kobes
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Madhumita Sinha
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Leslie J Baier
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - William C Knowler
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Mark I McCarthy
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Genentech, San Francisco, CA, USA
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Headington, UK
| | - Robert L Hanson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
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Tjokrowijoto P, Stolwyk RJ, Ung D, Kneebone I, Kilkenny MF, Kim J, Olaiya MT, Dalli LL, Cadilhac DA, Nelson MR, Lannin NA, Andrew NE. Receipt of Mental Health Treatment in People Living With Stroke: Associated Factors and Long-Term Outcomes. Stroke 2023; 54:1519-1527. [PMID: 36951051 DOI: 10.1161/strokeaha.122.041355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Untreated poststroke mood problems may influence long-term outcomes. We aimed to investigate factors associated with receiving mental health treatment following stroke and impacts on long-term outcomes. METHODS Observational cohort study derived from the Australian Stroke Clinical Registry (AuSCR; Queensland and Victorian registrants: 2012-2016) linked with hospital, primary care billing and pharmaceutical dispensing claims data. Data from registrants who completed the AuSCR 3 to 6 month follow-up survey containing a question on anxiety/depression were analyzed. We assessed exposures at 6 to 18 months and outcomes at 18 to 30 months. Factors associated with receiving treatment were determined using staged multivariable multilevel logistic regression models. Cox proportional hazards regression models were used to assess the impact of treatment on outcomes. RESULTS Among 7214 eligible individuals, 39% reported anxiety/depression at 3 to 6 months following stroke. Of these, 54% received treatment (88% antidepressant medication). Notable factors associated with any mental health treatment receipt included prestroke psychological support (odds ratio [OR], 1.80 [95% CI, 1.37-2.38]) or medication (OR, 17.58 [95% CI, 15.05-20.55]), self-reported anxiety/depression (OR, 2.55 [95% CI, 2.24-2.90]), younger age (OR, 0.98 [95% CI, 0.97-0.98]), and being female (OR, 1.30 [95% CI, 1.13-1.48]). Those who required interpreter services (OR, 0.49 [95% CI, 0.25-0.95]) used a health benefits card (OR, 0.73 [95% CI, 0.59-0.92]) or had continuity of primary care visits (ie, with a consistent physician; OR, 0.78 [95% CI, 0.62-0.99]) were less likely to access mental health services. Among those who reported anxiety/depression, those who received mental health treatment had an increased risk of presenting to hospital (hazard ratio, 1.06 [95% CI, 1.01-1.11]) but no difference in survival (hazard ratio, 1.04 [95% CI, 0.58-1.27]). CONCLUSIONS Nearly half of the people living with mood problems following stroke did not receive mental health treatment. We have highlighted subgroups who may benefit from targeted mood screening and factors that may improve treatment access.
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Affiliation(s)
- Priscilla Tjokrowijoto
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia (P.T., R.J.S.)
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia (P.T., R.J.S.)
| | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia (P.T., R.J.S.)
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia (P.T., R.J.S.)
| | - David Ung
- Peninsula Clinical School, Central Clinical School, Monash University and National Centre for Healthy Ageing, Frankston, Australia (D.U., M.T.O., N.E.A.)
| | - Ian Kneebone
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Australia (I.K.)
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia (I.K.)
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., L.L.D., D.A.C.)
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Australia (M.F.K., J.K., D.A.C.)
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., L.L.D., D.A.C.)
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Australia (M.F.K., J.K., D.A.C.)
| | - Muideen T Olaiya
- Peninsula Clinical School, Central Clinical School, Monash University and National Centre for Healthy Ageing, Frankston, Australia (D.U., M.T.O., N.E.A.)
| | - Lachlan L Dalli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., L.L.D., D.A.C.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., L.L.D., D.A.C.)
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Australia (M.F.K., J.K., D.A.C.)
| | - Mark R Nelson
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia (M.R.N.)
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.R.N.)
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Frankston, Australia (N.A.L.)
- Alfred Health, Melbourne, Australia (N.A.L.)
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University and National Centre for Healthy Ageing, Frankston, Australia (D.U., M.T.O., N.E.A.)
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Andrew NE, Ung D, Olaiya MT, Dalli LL, Kim J, Churilov L, Sundararajan V, Thrift AG, Cadilhac DA, Nelson MR, Lannin NA, Barnden R, Srikanth V, Kilkenny MF. The population effect of a national policy to incentivize chronic disease management in primary care in stroke: a population-based cohort study using an emulated target trial approach. The Lancet Regional Health - Western Pacific 2023. [DOI: 10.1016/j.lanwpc.2023.100723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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Dalli LL, Olaiya MT, Kim J, Andrew NE, Cadilhac DA, Ung D, Lindley RI, Sanfilippo FM, Thrift AG, Nelson MR, Gall SL, Kilkenny MF. Antihypertensive Medication Adherence and the Risk of Vascular Events and Falls After Stroke: A Real-World Effectiveness Study Using Linked Registry Data. Hypertension 2023; 80:182-191. [PMID: 36330805 DOI: 10.1161/hypertensionaha.122.19883] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Real-world evidence is limited on whether antihypertensive medications help avert major adverse cardiovascular events (MACE) after stroke without increasing the risk of falls. We investigated the association of adherence to antihypertensive medications on the incidence of MACE and falls requiring hospitalization after stroke. METHODS A retrospective cohort study of adults who were newly dispensed antihypertensive medications after an acute stroke (Australian Stroke Clinical Registry 2012-2016; Queensland and Victoria). Pharmaceutical dispensing records were used to determine medication adherence according to the proportion of days covered in the first 6 months poststroke. Outcomes between 6 and 18 months postdischarge included: (i) MACE, a composite outcome of all-cause death, recurrent stroke or acute coronary syndrome; and (ii) falls requiring hospitalization. Estimates were derived using Cox models, adjusted for >30 confounders using inverse probability treatment weights. RESULTS Among 4076 eligible participants (median age 68 years; 37% women), 55% had a proportion of days covered ≥80% within 6 months postdischarge. In the subsequent 12 months, 360 (9%) participants experienced a MACE and 337 (8%) experienced a fall requiring hospitalization. After achieving balance between groups, participants with a proportion of days covered ≥80% had a reduced risk of MACE (hazard ratio: 0.68; 95% CI: 0.54-0.84) and falls requiring hospitalization (subdistribution hazard ratio: 0.78; 95% CI: 0.62-0.98) than those with a proportion of days covered <80%. CONCLUSIONS High adherence to antihypertensive medications within 6 months poststroke was associated with reduced risks of both MACE and falls requiring hospitalization. Patients should be encouraged to adhere to their antihypertensive medications to maximize poststroke outcomes.
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Affiliation(s)
- Lachlan L Dalli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.T.O., J.K., D.A.C., A.G.T., S.L.G., M.F.K.)
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.T.O., J.K., D.A.C., A.G.T., S.L.G., M.F.K.)
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.T.O., J.K., D.A.C., A.G.T., S.L.G., M.F.K.).,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, VIC, Australia (J.K., D.A.C., M.F.K.)
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, VIC, Australia (N.E.A., D.U.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.T.O., J.K., D.A.C., A.G.T., S.L.G., M.F.K.).,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, VIC, Australia (J.K., D.A.C., M.F.K.)
| | - David Ung
- Peninsula Clinical School, Central Clinical School, Monash University, VIC, Australia (N.E.A., D.U.)
| | - Richard I Lindley
- Faculty of Medicine and Health, The University of Sydney, NSW, Australia (R.I.L.)
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia (F.M.S.)
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.T.O., J.K., D.A.C., A.G.T., S.L.G., M.F.K.)
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (M.R.N., S.L.G.)
| | - Seana L Gall
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.T.O., J.K., D.A.C., A.G.T., S.L.G., M.F.K.).,Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (M.R.N., S.L.G.)
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.T.O., J.K., D.A.C., A.G.T., S.L.G., M.F.K.).,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, VIC, Australia (J.K., D.A.C., M.F.K.)
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18
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Kilkenny MF, Dalli LL, Sanders A, Olaiya MT, Kim J, Ung D, Andrew NE. Comparison of comorbidities of stroke collected in administrative data, surveys, clinical trials and cohort studies. HEALTH INF MANAG J 2022:18333583221124371. [PMID: 36378556 DOI: 10.1177/18333583221124371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Administrative data are used extensively for research purposes, but there remains limited information on the quality of these data for identifying comorbidities related to stroke. OBJECTIVE To compare the prevalence of comorbidities of stroke identified using International Classification Diseases, Australian Modification (ICD-10-AM) or Anatomical Therapeutic Chemical codes, with those from (i) self-reported data and (ii) published studies. METHOD The cohort included patients with stroke or transient ischaemic attack admitted to hospitals (2012-2016; Victoria and Queensland) in the Australian Stroke Clinical Registry (N = 26,111). Data were linked with hospital and pharmaceutical datasets to ascertain comorbidities using published algorithms. The sensitivity, specificity, and positive predictive value of these comorbidities were compared with survey responses from 623 patients (reference standard). An indirect comparison was also performed with clinical data from published stroke studies. RESULTS The sensitivity of hospital ICD-10-AM data was poor for most comorbidities, except for diabetes (93.0%). Specificity was excellent for all comorbidities (87-96%), except for hypertension (70.5%). Compared to published stroke studies (3 clinical trials and 1 incidence study), the prevalence of diabetes and atrial fibrillation in our cohort was similar using ICD-10-AM codes, but lower for dyslipidaemia and anxiety/depression. Whereas in the pharmaceutical dispensing data, the sensitivity was excellent for dyslipidaemia (94%) and modest for anxiety/depression (77%). In the pharmaceutical data, specificity was modest for hypertension (78%) and anxiety or depression (76%), but specificity was poor for dyslipidaemia (19%) and heart disease (46%). CONCLUSION Variation was observed in the reporting of comorbidities of stroke in administrative data, and consideration of multiple sources of data may be necessary for research. Further work is needed to improve coding and clinical documentation for reporting of comorbidities in administrative data.
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Affiliation(s)
- Monique F Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health, 2541Monash University,2541 Clayton, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, VIC, Australia
| | - Lachlan L Dalli
- Department of Medicine, School of Clinical Sciences at Monash Health, 2541Monash University,2541 Clayton, VIC, Australia
| | - Ailie Sanders
- Department of Medicine, School of Clinical Sciences at Monash Health, 2541Monash University,2541 Clayton, VIC, Australia
| | - Muideen T Olaiya
- Department of Medicine, School of Clinical Sciences at Monash Health, 2541Monash University,2541 Clayton, VIC, Australia
| | - Joosup Kim
- Department of Medicine, School of Clinical Sciences at Monash Health, 2541Monash University,2541 Clayton, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, VIC, Australia
| | - David Ung
- Peninsula Clinical School, Central Clinical School, 5644Monash University, Frankston, VIC, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, 5644Monash University, Frankston, VIC, Australia
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Thayabaranathan T, Kim J, Cadilhac DA, Thrift AG, Donnan GA, Howard G, Howard VJ, Rothwell PM, Feigin V, Norrving B, Owolabi M, Pandian J, Liu L, Olaiya MT. Global stroke statistics 2022. Int J Stroke 2022; 17:946-956. [PMID: 35975986 PMCID: PMC9980380 DOI: 10.1177/17474930221123175] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contemporary data on stroke epidemiology and the availability of national stroke clinical registries are important for providing evidence to improve practice and support policy decisions. AIMS To update the most current incidence, case-fatality, and mortality rates on stroke and identify national stroke clinical registries worldwide. METHODS We searched multiple databases (based on our existing search strategy) to identify new original papers, published between 1 November 2018 and 15 December 2021, that met ideal criteria for data on stroke incidence and case-fatality, and added these to the studies reported in our last review. To identify national stroke clinical registries, we updated our last search, using PubMed, from 6 February 2015 until 6 January 2022. We also screened reference lists of review papers, citation history of papers, and the gray literature. Mortality codes for International Classification of Diseases (ICD)-9 and ICD-10 were extracted from the World Health Organization (WHO) for each country providing these data. Population denominators were obtained from the United Nations (UN) or WHO (when data were unavailable in the UN database). Crude and adjusted stroke mortality rates were calculated using country-specific population denominators, and the most recent years of mortality data available for each country. RESULTS Since our last report in 2020, there were two countries (Chile and France) with new incidence studies meeting criteria for ideal population-based studies. New data on case-fatality were found for Chile and Kenya. The most current mortality data were available for the year 2014 (1 country), 2015 (2 countries), 2016 (11 countries), 2017 (10 countries), 2018 (19 countries), 2019 (36 countries), and 2020 (29 countries). Four countries (Libya, Solomon Islands, United Arab Emirates, and Lebanon) reported mortality data for the first time. Since our last report on registries in 2017, we identified seven more national stroke clinical registries, predominantly in high-income countries. These newly identified registries yielded limited information. CONCLUSIONS Up-to-date data on stroke incidence, case-fatality, and mortality continue to provide evidence of disparities and the scale of burden in low- and middle-income countries. Although more national stroke clinical registries were identified, information from these newly identified registries was limited. Highlighting data scarcity or even where a country is ranked might help facilitate more research or greater policy attention in this field.
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Affiliation(s)
- Tharshanah Thayabaranathan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia,Stroke theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia,Stroke theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Geoffrey A Donnan
- Melbourne Brain Centre, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Polhill E, Kilkenny MF, Cadilhac DA, Lannin NA, Dalli LL, Purvis T, Andrew NE, Thrift AG, Sundararajan V, Olaiya MT. Factors Associated with Receiving a Discharge Care Plan After Stroke in Australia: A Linked Registry Study. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2310328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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21
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Olaiya MT, Andrew NE, Dalli LL, Ung D, Kim J, Sundararajan V, Cadilhac DA, Thrift AG, Nelson MR, Churilov L, Kilkenny MF. Does a History of Cancer Influence the Effectiveness of Statins on Outcomes After Stroke? Stroke 2022; 53:3202-3205. [PMID: 36065808 DOI: 10.1161/strokeaha.122.038829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Evidence is growing on anticancer effects of statins. We investigated whether the effectiveness of treatment with statins after ischemic stroke on mortality is influenced by a history of cancer. METHODS Analyses of 90-day survivors of ischemic stroke (2012-2016; 45 hospitals) using linked registry and administrative data. Dispense of statins within 90 days postdischarge was determined from pharmaceutical records. Participants were followed from 91 days postdischarge until death or June 30, 2018. History of cancer was determined from hospital data. Propensity score-adjusted Cox proportional hazards regression model was used to determine the association between being dispensed statins and survival. The influence of history of cancer on this association was assessed based on the concepts of (1) statistical interaction and (2) biological interaction using 3 indices: relative excess risk due to interaction>0, attributable proportion due to interaction >0, or synergy index >1. RESULTS Among 9948 eligible participants (median age=72 years, 42% female), there were 1463 deaths. In adjusted analyses, there was no statistical interaction between being dispensed statins and history of cancer on mortality (P=0.156). However, being dispensed statins had a significant positive biological interaction with having a history of cancer on mortality: relative excess risk due to interaction, 2.80 (95% CI, 1.56-5.05), attributable proportion due to interaction, 0.45 (95% CI, 0.23-0.66), and synergy index, 2.14 (95% CI, 1.32-3.49). CONCLUSIONS Treatment with statins after ischemic stroke may confer additional survival benefits for people who also have had cancer.
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Affiliation(s)
- Muideen T Olaiya
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.)
| | - Nadine E Andrew
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.).,National Centre for Healthy Ageing, Frankston, Australia (N.E.A)
| | - Lachlan L Dalli
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.)
| | - David Ung
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.)
| | - Joosup Kim
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.).,The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (J.K., D.A.C., L.C., M.F.K.)
| | | | - Dominique A Cadilhac
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.).,The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (J.K., D.A.C., L.C., M.F.K.)
| | - Amanda G Thrift
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.)
| | - Mark R Nelson
- Menzies Institute for Medical Research, Hobart TAS, Australia (M.R.N.)
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (J.K., D.A.C., L.C., M.F.K.)
| | - Monique F Kilkenny
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.).,The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (J.K., D.A.C., L.C., M.F.K.)
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22
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Bam K, Olaiya MT, Cadilhac DA, Donnan GA, Murphy L, Kilkenny MF. Enhancing primary stroke prevention: a combination approach. The Lancet Public Health 2022; 7:e721-e724. [DOI: 10.1016/s2468-2667(22)00156-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 01/13/2023] Open
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Olaiya MT, Andrew NE, Dalli LL, Ung D, Kim J, Cadilhac DA, Wood P, May J, Clissold B, Kilkenny MF. Real-world effectiveness of lipid-lowering medications on outcomes after stroke: potential implications of the new-user design. Neuroepidemiology 2022; 56:365-372. [PMID: 35863320 DOI: 10.1159/000526071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Observational studies are increasingly being used to provide evidence on the real-world effectiveness of medications for preventing vascular diseases, such as stroke. We investigated whether the real-world effectiveness of treatment with lipid-lowering medications after ischemic stroke is affected by prevalent user bias. METHODS An observational cohort study of 90-day survivors of ischemic stroke, using person-level data from the Australian Stroke Clinical Registry (2012-2016; 45 hospitals) linked to administrative (pharmaceutical, hospital, death) records. Use of, and adherence to (proportion of days covered <80% [poor adherence] vs. ≥80% [good adherence]), lipid-lowering medications within 90 days post-discharge was determined from pharmaceutical records. Users were further classified as prevalent (continuing) or new-users, based dispensing within 90 days prior to stroke. Propensity score-adjusted Cox regression was used to evaluate the effectiveness of lipid-lowering medications on outcomes (all-cause mortality, all-cause and cardiovascular disease readmission) within the subsequent year. Analyses were undertaken using prevalent-user (all users vs. non-users) and new-user designs (new-users vs. non-users). RESULTS Of 11,217 eligible patients (median age 72 years, 42% female), 9,294 (83%) used lipid-lowering medications within 90 days post-discharge, including 5,479 new-users. In both prevalent-user and new-user designs, non-users (vs. users) had significantly greater rates of mortality (hazard ratio [HR] 2.35, 95% CI 1.89-2.92) or all-cause readmissions (HR 1.22, CI 1.05-1.40), but not cardiovascular disease readmission. In contrast, associations between having poor (vs. good) adherence on outcomes were stronger among new-users than all-users. Among new-users, having poor adherence was associated with greater rates of mortality (HR 1.48, CI 1.12-1.96), all-cause readmission (HR 1.14, CI 1.02-1.27), and cardiovascular disease readmission (HR 1.20, CI 1.01-1.42). CONCLUSIONS The real-world effectiveness of treatment with lipid-lowering medications after stroke is attenuated when evaluated based on prevalent-user rather than new-user design. These findings may have implications for designing studies on the real-world effectiveness of secondary prevention medications.
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Affiliation(s)
- Muideen T Olaiya
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Nadine E Andrew
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Frankston, Victoria, Australia
| | - Lachlan L Dalli
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - David Ung
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Joosup Kim
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Peter Wood
- Division of Medicine, Queensland Health, Brisbane, Queensland, Australia
| | - Janet May
- Latrobe Regional Hospital, Traralgon West, Victoria, Australia
| | - Ben Clissold
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Monique F Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
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Adeoye AM, Adebusoye LA, Fakunle AG, Aderonmu OI, Adebayo OM, Michael OS, Adetona MO, Thrift AG, Olaiya MT, Owolabi MO. Day and night blood pressure variability among older persons in South-Western Nigeria. Niger Postgrad Med J 2022; 29:206-213. [PMID: 35900456 DOI: 10.4103/npmj.npmj_24_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Hypertension is the largest contributor to the global burden of disease. Emerging risk factors for cardiovascular disease include blood pressure variability (BPV), but evidence on BPV is lacking among older Nigerians. We reported BPV in a cohort of older persons at the University College Hospital (UCH), Ibadan. METHODS We conducted a retrospective cohort study of respondents aged >50 years within the Ibadan Ambulatory Blood Pressure Registry at the UCH, Ibadan, Nigeria. Socio-demographic characteristics, lifestyle habits and anthropometric measurements were obtained. RESULTS Among 639 respondents, 332 (52.0%) were female. The blood pressure (BP) variables were strongly associated with age. Compared with younger age groups, mean diastolic BP (DBP) was less at an older age, whereas mean pulse pressure was greater. During the wake-up and sleep periods, mean DBP and mean arterial BP were less with each increasing age category, whereas mean pulse pressure was larger with each increasing age category. BP dipping, systolic, diastolic and mean arterial BP decreased with age. Overall, timed BPV increased significantly with increasing age. The prevalence of white-coat hypertension was greater among older participants than younger participants. Most respondents in the 50-59 years' age group were non-dippers (55.8%), whereas 33.7% of older respondents were reverse-dippers. CONCLUSION Older persons experienced a greater abnormal circadian blood variation and greater BPV than younger people. In Nigeria, follow-up data are needed to determine the prognostic significance of these data in this population.
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Affiliation(s)
| | | | | | | | | | - Obaro S Michael
- Department of Pharmacology and Therapeutic, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Muideen T Olaiya
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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Wills AC, Arreola EV, Olaiya MT, Curtis JM, Hellgren MI, Hanson RL, Knowler WC. Cardiorespiratory Fitness, BMI, Mortality, and Cardiovascular Disease in Adults with Overweight/Obesity and Type 2 Diabetes. Med Sci Sports Exerc 2022; 54:994-1001. [PMID: 35175249 PMCID: PMC9117407 DOI: 10.1249/mss.0000000000002873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION We estimated the effects of cardiorespiratory fitness (CRF) and body mass index (BMI) at baseline on mortality and cardiovascular disease events in people with type 2 diabetes who participated in the Look AHEAD randomized clinical trial. METHODS Look AHEAD compared effects of an intensive lifestyle intervention with diabetes support and education on cardiovascular disease events in 5145 adults age 45-76 yr with overweight/obesity and type 2 diabetes. In 4773 participants, we performed a secondary analysis of the association of baseline CRF during maximal treadmill test (expressed as metabolic equivalents (METs)) on mortality and cardiovascular disease events during a mean follow-up of 9.2 yr. RESULTS The mean (SD) CRF was 7.2 (2.0) METs. Adjusted for age, sex, race/ethnicity, BMI, intervention group, and β-blocker use, all-cause mortality rate was 30% lower per SD greater METs (hazard ratio (HR) = 0.70 (95% confidence interval, 0.60 to 0.81); rate difference (RD), -2.71 deaths/1000 person-years (95% confidence interval, -3.79 to -1.63)). Similarly, an SD greater METs predicted lower cardiovascular disease mortality (HR, 0.45; RD, -1.65 cases/1000 person-years) and a composite cardiovascular outcome (HR, 0.72; RD, -6.38). Effects of METs were homogeneous on the HR scale for most baseline variables and outcomes but heterogeneous for many on the RD scale, with greater RD in subgroups at greater risk of the outcomes. For example, all-cause mortality was lower by 7.6 deaths/1000 person-years per SD greater METs in those with a history of cardiovascular disease at baseline but lower by only 1.6 in those without such history. BMI adjusted for CRF had little or no effect on these outcomes. CONCLUSIONS Greater CRF is associated with reduced risks of mortality and cardiovascular disease events.
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Affiliation(s)
- Andrew C. Wills
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Elsa Vazquez Arreola
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Muideen T. Olaiya
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Jeffrey M. Curtis
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
- Valleywise Community Health Center, Phoenix, AZ
| | - Margareta I. Hellgren
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
- The Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Robert L. Hanson
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - William C. Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
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Orman Z, Thrift AG, Olaiya MT, Ung D, Cadilhac DA, Phan T, Nelson MR, Srikanth VK, Vuong J, Bladin CF, Gerraty RP, Fitzgerald SM, Frayne J, Kim J. Quality of life after stroke: a longitudinal analysis of a cluster randomized trial. Qual Life Res 2022; 31:2445-2455. [DOI: 10.1007/s11136-021-03066-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
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Kilkenny MF, Olaiya MT, Dalli LL, Kim J, Andrew NE, Sanfilippo FM, Thrift AG, Nelson M, Pearce C, Sanders L, Dewey H, Clissold B, Grimley R, Cadilhac DA. Treatment with Multiple Therapeutic Classes of Medication is Associated with Survival after Stroke. Neuroepidemiology 2021; 56:66-74. [PMID: 34758474 DOI: 10.1159/000520823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/31/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Treatment with several therapeutic classes of medication is recommended for secondary prevention of stroke. We analysed the associations between the number of classes of prevention medications supplied within 90 days post-discharge for ischemic stroke (IS)/transient ischemic attack (TIA) and survival. PATIENTS AND METHODS Retrospective cohort study of adults with first-ever IS/TIA (2010-2014) from the Australian Stroke Clinical Registry individually linked with data from national pharmaceutical and Medicare claims. Exposure was the number of classes of recommended medications, i.e. blood pressure-lowering, antithrombotic or lipid-lowering agents, supplied to patients within 90 days post-discharge for IS/TIA. The longitudinal association between the number of classes of medications and survival was evaluated with Cox proportional hazards regression models using the landmark approach. A landmark date of 90 days post-hospital discharge was used to separate exposure and outcome periods and only patients who survived until this date were included. RESULTS Of 8,429 patients (43% female, median age 74 years, 80% IS), 607 (7%) died in the year following 90 days post-discharge. Overall, 56% of patients were supplied all three classes of medications, 28% two classes of medications, 11% one class of medications, and 5% no class of medications. Compared to patients supplied all three medication classes, adjusted hazard ratios for all-cause mortality ranged from 1.43 (95% confidence interval [CI]: 1.18-1.72) in those supplied two medication classes to 2.04 (CI: 1.44-2.88) in those supplied with no medication class. CONCLUSION Treatment with all three classes of guideline-recommended medications within 90 days post-discharge was associated with better survival. Ongoing efforts are required to ensure optimal pharmacological intervention for secondary prevention of stroke.
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Affiliation(s)
- Monique F Kilkenny
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Muideen T Olaiya
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Lachlan L Dalli
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Joosup Kim
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, Washington, Australia
| | - Amanda G Thrift
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Lauren Sanders
- Department of Neurosciences, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Helen Dewey
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Benjamin Clissold
- Neurosciences Department, Monash Health, Clayton, Victoria, Australia
- Neurosciences Department, Barwon Health, Geelong, Victoria, Australia
| | - Rohan Grimley
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- School of Medicine, Griffith University, Birtinya, Queensland, Australia
| | - Dominique A Cadilhac
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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Ung D, Kilkenny MF, Olaiya MT, Kim J, Phan T, Cadilhac DA, Ma H, Dewey HM, Nelson MR, Srikanth VK, Bladin CF, Fitzgerald SM, Thrift AG. Longer duration on a Chronic Disease Management plan is associated with long-term adherence to antihypertensive and antithrombotic medications following stroke. Int J Popul Data Sci 2020. [DOI: 10.23889/ijpds.v5i5.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introduction and PurposeChronic Disease Management (CDM) plans are used by general practitioners to manage chronic diseases such as stroke. However, there is limited evidence that being on these plans improve adherence to secondary prevention medications after stroke. We aimed to assess the association of the duration on a CDM plan in improving adherence to secondary prevention medications following stroke.
MethodsAustralian survivors of stroke or transient ischaemic attack were participants from the STAND FIRM trial. Patients were individually linked with claims for CDM plans from Medicare and dispensings of secondary prevention medications from the Pharmaceutical Benefits Scheme. We estimated (1) duration on a CDM plan based on the timing and Medicare items claimed and (2) the proportion of days that patients would have been covered by these medications (PDC), while accounting for deaths and instances of over-supply. Dosage for each quantity of medication was determined by the regularity in which patients returned for a refill. Logistic regression was used to evaluate factors associated with ≥80% adherence, up to 3 years after stroke, for each of antihypertensive, antithrombotic and lipid-modifying drugs.
ResultsThe median PDC for 563 patients (median age 70yrs; 36% female) ranged from 92% to 95% among the three classes of medications. Approximately 27% did not take up a CDM plan, 33% were on plans for <1.5 years and 40% for 1.5-3 years. Duration on a CDM plan (quintiles) was associated with adherence for antihypertensive (Odds Ratio (OR) 1.18, 95% confidence interval (95%CI) 1.00-1.40, p=0.029) and antithrombotic medications (OR 1.22, 95%CI 1.03-1.46, p=0.024), but not for lipid-lowering medications.
ConclusionPeople on a CDM plan for longer had better adherence to antihypertensive and antithrombotic medications in the long-term after stroke. Use and ongoing reviews of CDM plans should be encouraged to improve adherence to secondary prevention medications after stroke.
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Olaiya MT, Knowler WC, Sinha M, Kobes S, Nelson RG, Baier LJ, Muller YL, Hanson RL. Weight tracking in childhood and adolescence and type 2 diabetes risk. Diabetologia 2020; 63:1753-1763. [PMID: 32424540 PMCID: PMC9519170 DOI: 10.1007/s00125-020-05165-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/31/2020] [Indexed: 12/16/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to examine the associations of average weight and weight velocity in three growth periods from birth through adolescence with type 2 diabetes incidence. METHODS Child participants were selected from a 43 year longitudinal study of American Indians to represent three growth periods: pre-adolescence (birth to ~8 years); early adolescence (~8 to ~13 years); and late adolescence (~13 to ~18 years). Age-, sex- and height-standardised weight z score mean and weight z score velocity (change/year) were computed for each period. Participants were followed for up to 25 years from the end of each growth period until they developed diabetes. Associations of weight z score mean or weight z score velocity with diabetes incidence were determined with sex-, birth date- and maternal diabetes-adjusted Poisson regression models. RESULTS Among 2100 participants representing the pre-adolescence growth period, 1558 representing the early adolescence period and 1418 representing the late adolescence period, there were 290, 315 and 380 incident diabetes cases, respectively. During the first 10 years of follow-up, the diabetes incidence rate ratio (95% CI) was 1.72 (1.40, 2.11)/SD of log10 weight z score mean in pre-adolescence, 2.09 (1.68, 2.60)/SD of log10 weight z score mean in early adolescence and 1.85 (1.58, 2.17)/SD of log10 weight z score mean in late adolescence. The diabetes incidence rate ratio (95% CI) was 1.79 (1.49, 2.17)/SD of log10 weight z score velocity in pre-adolescence, 1.13 (0.91, 1.41)/SD of log10 weight z score velocity in early adolescence and 1.29 (1.09, 1.51)/SD of log10 weight z score velocity in late adolescence. There were strong correlations in the weight z score means and weak correlations in the weight z score velocities between successive periods. CONCLUSIONS/INTERPRETATION Higher weight and accelerated weight gain in all growth periods associate with increased type 2 diabetes risk. Importantly, higher weight and greater weight velocity during pre-adolescence jointly associate with the highest type 2 diabetes risk. Graphical abstract.
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Affiliation(s)
- Muideen T Olaiya
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA.
| | - William C Knowler
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
| | - Madhumita Sinha
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
| | - Sayuko Kobes
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
| | - Robert G Nelson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
| | - Leslie J Baier
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
| | - Yunhua L Muller
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
| | - Robert L Hanson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
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Chambers M, Reddy SP, Olaiya MT, Dunnigan DL, Wasak D, Hoskin MA, Knowler WC, Sinha M. Provider Preference for Growth Charts in Tracking Children with Obesity. J Pediatr 2020; 219:259-262. [PMID: 31932017 PMCID: PMC7096271 DOI: 10.1016/j.jpeds.2019.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/31/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
A web-based survey of pediatric care providers revealed differences in their preference for clinical charts that monitor growth in children with obesity. These findings are attributed to pediatric specialty training. Very few providers believe the currently available Centers for Disease Control and Prevention 2000 body mass index-for-age charts adequately track growth in children with obesity.
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Affiliation(s)
- Melissa Chambers
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ.
| | - Sanil P. Reddy
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Phoenix, AZ
| | - Muideen T. Olaiya
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Phoenix, AZ
| | - Diana L Dunnigan
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Phoenix, AZ
| | - Dorota Wasak
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Phoenix, AZ
| | - Mary A. Hoskin
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Phoenix, AZ
| | - William C. Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Phoenix, AZ
| | - Madhumita Sinha
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Phoenix, AZ
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Olaiya MT, Wedekind LE, Hanson RL, Sinha M, Kobes S, Nelson RG, Baier LJ, Knowler WC. Birthweight and early-onset type 2 diabetes in American Indians: differential effects in adolescents and young adults and additive effects of genotype, BMI and maternal diabetes. Diabetologia 2019; 62:1628-1637. [PMID: 31111170 PMCID: PMC6679754 DOI: 10.1007/s00125-019-4899-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/23/2019] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to estimate the impact of birthweight on early-onset (age <40 years) type 2 diabetes. METHODS A longitudinal study of American Indians, aged ≥5 years, was conducted from 1965 to 2007. Participants who had a recorded birthweight were followed until they developed diabetes or their last examination before the age of 40 years, whichever came first. Age- and sex-adjusted diabetes incidence rates were computed and Poisson regression was used to model the effect of birthweight on diabetes incidence, adjusted for sex, BMI, a type 2 diabetes susceptibility genetic risk score (GRS) and maternal covariates. RESULTS Among 3039 participants, there were 652 incident diabetes cases over a median follow-up of 14.3 years. Diabetes incidence increased with age and was greater in the lowest and highest quintiles of birthweight. Adjusted for covariates, the effect of birthweight on diabetes varied over time, with a non-linear effect at 10-19 years (p < 0.001) and a negative linear effect at older age intervals (20-29 years, p < 0.001; 30-39 years, p = 0.003). Higher GRS, greater BMI and maternal diabetes had additive but not interactive effects on the association between birthweight and diabetes incidence. CONCLUSIONS/INTERPRETATION In this high-risk population, both low and high birthweights were associated with increased type 2 diabetes risk in adolescence (age 10-19 years) but only low birthweight was associated with increased risk in young adulthood (20-39 years). Higher type 2 diabetes GRS, greater BMI and maternal diabetes added to the risk of early-onset diabetes.
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Affiliation(s)
- Muideen T Olaiya
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA.
| | - Lauren E Wedekind
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Robert L Hanson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
| | - Madhumita Sinha
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
| | - Sayuko Kobes
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
| | - Robert G Nelson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
| | - Leslie J Baier
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
| | - William C Knowler
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014, USA
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Olaiya MT, Hanson RL, Kavena KG, Sinha M, Clary D, Horton MB, Nelson RG, Knowler WC. Use of graded Semmes Weinstein monofilament testing for ascertaining peripheral neuropathy in people with and without diabetes. Diabetes Res Clin Pract 2019; 151:1-10. [PMID: 30922942 PMCID: PMC6544471 DOI: 10.1016/j.diabres.2019.03.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/19/2019] [Accepted: 03/15/2019] [Indexed: 11/23/2022]
Abstract
AIMS To assess peripheral neuropathy (PN) using graded Semmes Weinstein monofilaments (SWMs) and determine factors associated with PN among adult volunteers with and without diabetes. METHODS Adult volunteers were assessed for distal sensory PN using three graded SWMs. Four PN levels were defined: 0 (no PN; felt all three filaments), 1 (subclinical PN; insensate to 1-g filament), 2 (insensate to 10-g), or 3 (insensate to 75-g). Levels 2-3 were considered clinical PN. Associations with PN were determined using ordinal logistic regression. RESULTS In 1564 subjects (median age 41.9 years, 50.1% women), PN was subclinical or worse in 68.9% and clinical in 11.2%. Age-sex-race-adjusted prevalence of clinical PN was greater in people with diabetes (15.3%) than without (6.1%; P < 0.001). Associated factors included older age, male sex, greater BMI, greater heart rate, lower mean arterial pressure, and family history of diabetes or cardiovascular diseases. Higher PN levels associated with worse albuminuria and retinopathy. Only older age and male sex associated with PN both in people with and without diabetes. CONCLUSIONS PN is common in our sample, notably in those without diabetes, although diabetes greatly increases its risk. Using graded SWMs may have a prognostic value as it permits the identification of subclinical PN.
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Affiliation(s)
- Muideen T Olaiya
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States.
| | - Robert L Hanson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States
| | - Karen G Kavena
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States
| | - Madhumita Sinha
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States
| | - Dawn Clary
- Indian Health Service-Joslin Vision Network Teleophthalmology Program, Indian Health Service, Phoenix, AZ, United States
| | - Mark B Horton
- Indian Health Service-Joslin Vision Network Teleophthalmology Program, Indian Health Service, Phoenix, AZ, United States
| | - Robert G Nelson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States
| | - William C Knowler
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States
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Ung D, Gerraty RP, Frayne J, Olaiya MT, Kim J, Srikanth VK, Phan T, Cadilhac DA, Nelson MR, Bladin CF, Thrift AG. Abstract TP396: Accuracy of Administrative Hospital, Emergency Department and Death Records. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Hospital, emergency presentation and death databases are frequently used to research outcomes after stroke. The reliability of diagnostic coding for cardiovascular disease (CVD) in these administrative data remains uncertain. We aimed to determine the reliability of these data in Australia using an existing clinical trial cohort.
Methods:
Patients with stroke/TIA who participated in the Shared Team Approach between Nurses and Doctors For Improved Risk factor Management (STAND FIRM) trial (n = 563, recruited from 4 hospitals within Victoria). We used diagnostic ICD-10-AM coded data from hospital, emergency department and death databases within 2 years after stroke/TIA. Medical records for these potential CVD-related events were reviewed by two independent stroke specialists and adjudicated according to strict criteria. We then estimated sensitivity and specificity of using either primary or both primary and secondary diagnoses fields (obtained for all adjudicated records), against the events adjudicated by the specialists (gold standard). False positives were CVD-events defined by ICD-10-AM diagnostic codes that were adjudicated as not being a CVD-event. False negatives were true CVD-events that were misclassified as not being CVD-related when using ICD-10-AM codes.
Results:
We identified 261 events for medical review. After adjudication, 65 were classified as CVD-events (cases) and 196 were not CVD-events. Using both primary and secondary diagnoses, 55 true positives were correctly identified among the cases (sensitivity = 84.6%) and 129 true negatives among the non-cases (specificity = 65.8%). Using only primary diagnoses, 48 true positives were identified (sensitivity = 73.9%) and 171 true negatives (specificity = 87.2%). Using both primary and secondary diagnoses had an increased sensitivity, but decreased specificity (area under the Receiver Operating Characteristic curve (AUC) = 0.75; 95% CI, 0.70, 0.81) when compared with using only primary diagnoses (AUC = 0.81; 95% CI, 0.75, 0.86; p = 0.028).
Conclusion:
Both primary and secondary diagnoses should be used to identify true CVD-events and minimise misclassifying these in administrative databases.
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Affiliation(s)
- David Ung
- Dept of Medicine, Sch of Clinical Sciences at Monash Health, Monash Univ, Clayton, Victoria, Australia, Melbourne, Australia
| | - Richard P Gerraty
- Dept of Medicine, Epworth Healthcare, Richmond, Victoria, Australia, Melbourne, Australia
| | - Judith Frayne
- Dept of Neurology, Alfred Hosp, Melbourne, Victoria, Australia, Melbourne, Australia
| | - Muideen T Olaiya
- Dept of Medicine, Sch of Clinical Sciences at Monash Health, Monash Univ, Clayton, Victoria, Australia, Melbourne, Australia
| | - Joosup Kim
- Dept of Medicine, Sch of Clinical Sciences at Monash Health, Monash Univ, Clayton, Victoria, Australia, Melbourne, Australia
| | - Velandai K Srikanth
- Dept of Medicine, Sch of Clinical Sciences at Monash Health, Monash Univ, Clayton, Victoria, Australia, Melbourne, Australia
| | - Thanh Phan
- Dept of Medicine, Sch of Clinical Sciences at Monash Health, Monash Univ, Clayton, Victoria, Australia, Melbourne, Australia
| | - Dominique A Cadilhac
- Dept of Medicine, Sch of Clinical Sciences at Monash Health, Monash Univ, Clayton, Victoria, Australia, Melbourne, Australia
| | - Mark R Nelson
- Dept of Epidemiology and Preventative Medicine, Monash Univ, Clayton, Victoria, Australia, Melbourne, Australia
| | - Christopher F Bladin
- Dept of Neurosciences, Box Hill Hosp, Box Hill, Victoria, Australia, Melbourne, Australia
| | - Amanda G Thrift
- Dept of Medicine, Sch of Clinical Sciences at Monash Health, Monash Univ, Clayton, Victoria, Australia, Melbourne, Australia
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Olaiya MT, Cadilhac DA, Kim J, Srikanth VK, Ung D, Thrift AG. Abstract WP186: The Quality of Secondary Prevention after Stroke or Transient Ischemic Attack is Worse in Survivors With Disability. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.wp186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Severity of stroke impacts functional outcomes after stroke, but the role of this disability on secondary prevention is unclear. We investigated the effect of disability status on secondary prevention outcomes, such as the management of risk factors, knowledge regarding secondary prevention, and long-term unmet needs.
Methods:
Post-hoc analysis of a clinical trial of community-dwelling adults with stroke/TIA in Melbourne, Australia. Demographic/clinical data were obtained from hospital records, while standardised assessments were conducted for disability, cardiovascular risk, and mood. Disability was defined using the modified Rankin Scale (mRS): no disability (mRS=0), no significant disability (mRS=1), or slight to severe disability (mRS 2-5). Two-year outcomes included the standardized cardiovascular Framingham risk score, unmet needs, and knowledge of risk factors and medications prescribed for secondary prevention. Multivariable regression models were used to determine the effect of disability status on outcomes.
Results:
From January 2010 to November 2013, 563 survivors of stroke/TIA were recruited: median age 70.1 years, 65% males, 79% ischemic stroke, and 29% with no disability. After a 2-year follow-up, 86% provided outcome data. In the multivariable regression analyses, when compared to participants with no significant disability, those with slight/severe disability had greater cardiovascular risk scores (odds ratio 1.33, 95% CI 1.00-1.76). A dose-response effect was found for disability status and long-term unmet needs, with more unmet needs reported among those with no significant disability (incidence risk ratio 1.55, 95% CI 1.21-1.99) or with slight/severe disability (incidence risk ratio 1.64, 95% CI 1.24-2.16), than in those with no disability. We found no effect of disability status on knowledge of risk factors or medications.
Conclusions:
After a 24-month follow-up, survivors of stroke/TIA with disability had worse risk profiles and more unmet needs than those with no disability, and may benefit from targeted care post-discharge.
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Affiliation(s)
| | - Dominique A Cadilhac
- Dept of Medicine, Sch of Clinical Sciences at Monash Health, Monash Univ, Clayton, Australia
| | - Joosup Kim
- Dept of Medicine, Sch of Clinical Sciences at Monash Health, Monash Univ, Clayton, Australia
| | - Velandai K Srikanth
- Dept of Medicine, Sch of Clinical Sciences at Monash Health, Monash Univ, Clayton, Australia
| | - David Ung
- Dept of Medicine, Sch of Clinical Sciences at Monash Health, Monash Univ, Clayton, Australia
| | - Amanda G Thrift
- Dept of Medicine, Sch of Clinical Sciences at Monash Health, Monash Univ, Clayton, Australia
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Olaiya MT, Cadilhac DA, Kim J, Nelson MR, Srikanth VK, Gerraty RP, Bladin CF, Fitzgerald SM, Phan T, Frayne J, Thrift AG. Community-Based Intervention to Improve Cardiometabolic Targets in Patients With Stroke. Stroke 2017; 48:2504-2510. [DOI: 10.1161/strokeaha.117.017499] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Muideen T. Olaiya
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (M.T.O., D.A.C., J.K., V.K.S., T.P., A.G.T.) and Department of Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Clayton, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, Tasmania, Australia (M.R.N., V.K.S.); Department of Medicine,
| | - Dominique A. Cadilhac
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (M.T.O., D.A.C., J.K., V.K.S., T.P., A.G.T.) and Department of Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Clayton, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, Tasmania, Australia (M.R.N., V.K.S.); Department of Medicine,
| | - Joosup Kim
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (M.T.O., D.A.C., J.K., V.K.S., T.P., A.G.T.) and Department of Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Clayton, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, Tasmania, Australia (M.R.N., V.K.S.); Department of Medicine,
| | - Mark R. Nelson
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (M.T.O., D.A.C., J.K., V.K.S., T.P., A.G.T.) and Department of Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Clayton, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, Tasmania, Australia (M.R.N., V.K.S.); Department of Medicine,
| | - Velandai K. Srikanth
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (M.T.O., D.A.C., J.K., V.K.S., T.P., A.G.T.) and Department of Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Clayton, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, Tasmania, Australia (M.R.N., V.K.S.); Department of Medicine,
| | - Richard P. Gerraty
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (M.T.O., D.A.C., J.K., V.K.S., T.P., A.G.T.) and Department of Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Clayton, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, Tasmania, Australia (M.R.N., V.K.S.); Department of Medicine,
| | - Christopher F. Bladin
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (M.T.O., D.A.C., J.K., V.K.S., T.P., A.G.T.) and Department of Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Clayton, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, Tasmania, Australia (M.R.N., V.K.S.); Department of Medicine,
| | - Sharyn M. Fitzgerald
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (M.T.O., D.A.C., J.K., V.K.S., T.P., A.G.T.) and Department of Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Clayton, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, Tasmania, Australia (M.R.N., V.K.S.); Department of Medicine,
| | - Thanh Phan
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (M.T.O., D.A.C., J.K., V.K.S., T.P., A.G.T.) and Department of Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Clayton, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, Tasmania, Australia (M.R.N., V.K.S.); Department of Medicine,
| | - Judith Frayne
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (M.T.O., D.A.C., J.K., V.K.S., T.P., A.G.T.) and Department of Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Clayton, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, Tasmania, Australia (M.R.N., V.K.S.); Department of Medicine,
| | - Amanda G. Thrift
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (M.T.O., D.A.C., J.K., V.K.S., T.P., A.G.T.) and Department of Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Clayton, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, Tasmania, Australia (M.R.N., V.K.S.); Department of Medicine,
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Olaiya MT, Cadilhac DA, Kim J, Nelson MR, Srikanth VK, Andrew NE, Bladin CF, Gerraty RP, Fitzgerald SM, Phan T, Frayne J, Thrift AG. Long-term unmet needs and associated factors in stroke or TIA survivors. Neurology 2017; 89:68-75. [DOI: 10.1212/wnl.0000000000004063] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 04/03/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:To extensively investigate long-term unmet needs in survivors of stroke or TIA and to identify factors associated with these unmet needs.Methods:Community-dwelling adults were invited to participate in a survey ≥2 years after discharge for stroke/TIA. Unmet needs were assessed across 5 domains: activities and participation, environmental factors, body functions, post–acute care, and secondary prevention. Factors associated with unmet needs were determined with multivariable negative binomial regression.Results:Of 485 participants invited to complete the survey, 391 (81%) responded (median age 73 years, 67% male). Most responders (87%) reported unmet needs in ≥1 of the measured domains, particularly in secondary prevention (71%). Factors associated with fewer unmet needs included older age (incident rate ratio [IRR] 0.62, 95% confidence interval [CI] 0.50–0.77), greater functional ability (IRR 0.33, 95% CI 0.17–0.67), and reporting that the general practitioner was the most important in care (IRR 0.69, 95% CI 0.57–0.84). Being depressed (IRR 1.61, 95% CI 1.23–2.10) and receiving community services after stroke (IRR 1.45, 95% CI 1.16–1.82) were associated with more unmet needs.Conclusions:Survivors of stroke/TIA reported considerable unmet needs ≥2 years after discharge, particularly in secondary prevention. The factors associated with unmet needs could help guide policy decisions, particularly for tailoring care and support services provided after discharge.
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Olaiya MT, Cadilhac DA, Kim J, Ung D, Nelson MR, Srikanth VK, Bladin CF, Gerraty RP, Fitzgerald SM, Phan T, Frayne J, Thrift AG. Effectiveness of an Intervention to Improve Risk Factor Knowledge in Patients With Stroke: A Randomized Controlled Trial. Stroke 2017; 48:1101-1103. [PMID: 28250198 DOI: 10.1161/strokeaha.116.016229] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/03/2017] [Accepted: 01/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Despite the benefit of risk awareness in secondary prevention, survivors of stroke are often unaware of their risk factors. We determined whether a nurse-led intervention improved knowledge of risk factors in people with stroke or transient ischemic attack. METHODS Prospective study nested within a randomized controlled trial of risk factor management in survivors of stroke or transient ischemic attack. INTERVENTION 3 nurse education visits and specialist review of care plans. OUTCOME unprompted knowledge of risk factors of stroke or transient ischemic attack at 24 months. Effect of intervention on knowledge and factors associated with knowledge were determined using multivariable regression models. RESULTS Knowledge was assessed in 268 consecutive participants from the main trial, 128 in usual care and 140 in the intervention. Overall, 34% of participants were unable to name any risk factor. In adjusted analyses, the intervention group had better overall knowledge than controls (incidence risk ratio, 1.26; 95% confidence interval, 1.00-1.58). Greater functional ability and polypharmacy were associated with better knowledge and older age and having more comorbidities associated with poorer knowledge. CONCLUSIONS Overall knowledge of risk factors of stroke or transient ischemic attack was better in the intervention group than controls. However, knowledge was generally poor. New and more effective strategies are required, especially in subgroups identified as having poor knowledge. CLINICAL TRIAL REGISTRATION URL: http://www.anzctr.org.au. Unique identifier: ACTRN12608000166370.
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Affiliation(s)
- Muideen T Olaiya
- From the Departments of Medicine (M.T.O., D.A.C., J.K., D.U., V.K.S., T.P., A.G.T.) and Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Melbourne, VIC, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, TAS, Australia (M.R.N., V.K.S.); Department of Neurosciences, Box Hill Hospital, VIC, Australia (C.F.B.); Department of Medicine, Epworth Healthcare, Richmond, VIC, Australia (R.P.G.); and Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia (J.F.)
| | - Dominique A Cadilhac
- From the Departments of Medicine (M.T.O., D.A.C., J.K., D.U., V.K.S., T.P., A.G.T.) and Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Melbourne, VIC, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, TAS, Australia (M.R.N., V.K.S.); Department of Neurosciences, Box Hill Hospital, VIC, Australia (C.F.B.); Department of Medicine, Epworth Healthcare, Richmond, VIC, Australia (R.P.G.); and Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia (J.F.)
| | - Joosup Kim
- From the Departments of Medicine (M.T.O., D.A.C., J.K., D.U., V.K.S., T.P., A.G.T.) and Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Melbourne, VIC, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, TAS, Australia (M.R.N., V.K.S.); Department of Neurosciences, Box Hill Hospital, VIC, Australia (C.F.B.); Department of Medicine, Epworth Healthcare, Richmond, VIC, Australia (R.P.G.); and Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia (J.F.)
| | - David Ung
- From the Departments of Medicine (M.T.O., D.A.C., J.K., D.U., V.K.S., T.P., A.G.T.) and Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Melbourne, VIC, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, TAS, Australia (M.R.N., V.K.S.); Department of Neurosciences, Box Hill Hospital, VIC, Australia (C.F.B.); Department of Medicine, Epworth Healthcare, Richmond, VIC, Australia (R.P.G.); and Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia (J.F.)
| | - Mark R Nelson
- From the Departments of Medicine (M.T.O., D.A.C., J.K., D.U., V.K.S., T.P., A.G.T.) and Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Melbourne, VIC, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, TAS, Australia (M.R.N., V.K.S.); Department of Neurosciences, Box Hill Hospital, VIC, Australia (C.F.B.); Department of Medicine, Epworth Healthcare, Richmond, VIC, Australia (R.P.G.); and Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia (J.F.)
| | - Velandai K Srikanth
- From the Departments of Medicine (M.T.O., D.A.C., J.K., D.U., V.K.S., T.P., A.G.T.) and Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Melbourne, VIC, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, TAS, Australia (M.R.N., V.K.S.); Department of Neurosciences, Box Hill Hospital, VIC, Australia (C.F.B.); Department of Medicine, Epworth Healthcare, Richmond, VIC, Australia (R.P.G.); and Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia (J.F.)
| | - Christopher F Bladin
- From the Departments of Medicine (M.T.O., D.A.C., J.K., D.U., V.K.S., T.P., A.G.T.) and Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Melbourne, VIC, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, TAS, Australia (M.R.N., V.K.S.); Department of Neurosciences, Box Hill Hospital, VIC, Australia (C.F.B.); Department of Medicine, Epworth Healthcare, Richmond, VIC, Australia (R.P.G.); and Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia (J.F.)
| | - Richard P Gerraty
- From the Departments of Medicine (M.T.O., D.A.C., J.K., D.U., V.K.S., T.P., A.G.T.) and Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Melbourne, VIC, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, TAS, Australia (M.R.N., V.K.S.); Department of Neurosciences, Box Hill Hospital, VIC, Australia (C.F.B.); Department of Medicine, Epworth Healthcare, Richmond, VIC, Australia (R.P.G.); and Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia (J.F.)
| | - Sharyn M Fitzgerald
- From the Departments of Medicine (M.T.O., D.A.C., J.K., D.U., V.K.S., T.P., A.G.T.) and Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Melbourne, VIC, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, TAS, Australia (M.R.N., V.K.S.); Department of Neurosciences, Box Hill Hospital, VIC, Australia (C.F.B.); Department of Medicine, Epworth Healthcare, Richmond, VIC, Australia (R.P.G.); and Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia (J.F.)
| | - Thanh Phan
- From the Departments of Medicine (M.T.O., D.A.C., J.K., D.U., V.K.S., T.P., A.G.T.) and Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Melbourne, VIC, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, TAS, Australia (M.R.N., V.K.S.); Department of Neurosciences, Box Hill Hospital, VIC, Australia (C.F.B.); Department of Medicine, Epworth Healthcare, Richmond, VIC, Australia (R.P.G.); and Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia (J.F.)
| | - Judith Frayne
- From the Departments of Medicine (M.T.O., D.A.C., J.K., D.U., V.K.S., T.P., A.G.T.) and Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Melbourne, VIC, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, TAS, Australia (M.R.N., V.K.S.); Department of Neurosciences, Box Hill Hospital, VIC, Australia (C.F.B.); Department of Medicine, Epworth Healthcare, Richmond, VIC, Australia (R.P.G.); and Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia (J.F.)
| | - Amanda G Thrift
- From the Departments of Medicine (M.T.O., D.A.C., J.K., D.U., V.K.S., T.P., A.G.T.) and Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Melbourne, VIC, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, TAS, Australia (M.R.N., V.K.S.); Department of Neurosciences, Box Hill Hospital, VIC, Australia (C.F.B.); Department of Medicine, Epworth Healthcare, Richmond, VIC, Australia (R.P.G.); and Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia (J.F.).
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Olaiya MT, Cadilhac DA, Kim J, Ung D, Nelson MR, Srikanth VK, Bladin CF, Gerraty RP, Fitzgerald SM, Phan TG, Frayne J, Thrift AG. Nurse-Led Intervention to Improve Knowledge of Medications in Survivors of Stroke or Transient Ischemic Attack: A Cluster Randomized Controlled Trial. Front Neurol 2016; 7:205. [PMID: 27917150 PMCID: PMC5114293 DOI: 10.3389/fneur.2016.00205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/02/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Limited evidence exists on effective interventions to improve knowledge of preventive medications in patients with chronic diseases, such as stroke. We investigated the effectiveness of a nurse-led intervention, where a component was to improve knowledge of prevention medications, in patients with stroke or transient ischemic attack (TIA). METHODS Prospective sub-study of the Shared Team Approach between Nurses and Doctors for Improved Risk Factor Management, a randomized controlled trial of risk factor management. We recruited patients aged ≥18 years and hospitalized for stroke/TIA. The intervention comprised an individualized management program, involving nurse-led education, and management plan with medical specialist oversight. The outcome, participants' knowledge of secondary prevention medications at 12 months, was assessed using questionnaires. A score of ≥5 was considered as good knowledge. Effectiveness of the intervention on knowledge of medications was determined using logistic regression. RESULTS Between May 2014 and January 2015, 142 consecutive participants from the main trial were included in this sub-study, 64 to usual care and 78 to the intervention (median age 68.9 years, 68% males, and 79% ischemic stroke). In multivariable analyses, we found no significant difference between intervention groups in knowledge of medications. Factors independently associated with good knowledge (score ≥5) at 12 months included higher socioeconomic position (OR 4.79, 95% CI 1.76, 13.07), greater functional ability (OR 1.69, 95% CI 1.17, 2.45), being married/living with a partner (OR 3.12, 95% CI 1.10, 8.87), and using instructions on pill bottle/package as an administration aid (OR 4.82, 95% CI 1.76, 13.22). Being aged ≥65 years was associated with poorer knowledge of medications (OR 0.24, 95% CI 0.08, 0.71), while knowledge was worse among those taking three medications (OR 0.15, 95% CI 0.03, 0.66) or ≥4 medications (OR 0.09, 95% CI 0.02, 0.44), when compared to participants taking fewer (≤2) prevention medications. CONCLUSION There was no evidence that the nurse-led intervention was effective for improving knowledge of secondary prevention medications in patients with stroke/TIA at 12 months. However, older patients and those taking more medications should be particularly targeted for more intensive education. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12688000166370).
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Affiliation(s)
- Muideen T. Olaiya
- Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dominique A. Cadilhac
- Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Joosup Kim
- Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - David Ung
- Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, Hobart, TAS, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Velandai K. Srikanth
- Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Menzies Institute for Medical Research, Hobart, TAS, Australia
| | | | | | - Sharyn M. Fitzgerald
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Thanh G. Phan
- Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Judith Frayne
- Department of Neurology, Alfred Hospital, Prahan, VIC, Australia
| | - Amanda G. Thrift
- Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Thrift AG, Olaiya MT, Phan TG, Cadilhac DA, Nelson MR, Srikanth VK. Statistical analysis plan (SAP) for Shared Team Approach between Nurses and Doctors For Improved Risk Factor Management (STANDFIRM): a randomised controlled trial. Int J Stroke 2015; 10:770-2. [PMID: 25808855 DOI: 10.1111/ijs.12482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/02/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Amanda G Thrift
- Epidemiology & Prevention Division, Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic., Australia.,The Florey Institute of Neuroscience and Mental Health, Melbourne University, Heidelberg, Vic., Australia
| | - Muideen T Olaiya
- Epidemiology & Prevention Division, Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic., Australia
| | - Thanh G Phan
- Epidemiology & Prevention Division, Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic., Australia
| | - Dominique A Cadilhac
- Epidemiology & Prevention Division, Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic., Australia.,The Florey Institute of Neuroscience and Mental Health, Melbourne University, Heidelberg, Vic., Australia
| | - Mark R Nelson
- Menzies Research Institute Tasmania, Hobart, Tas., Australia.,School of Medicine, University of Tasmania, Hobart, Tas., Australia
| | - Velandai K Srikanth
- Epidemiology & Prevention Division, Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic., Australia.,Menzies Research Institute Tasmania, Hobart, Tas., Australia
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