Factors associated with early hospital arrival in acute ischemic stroke patients

Background: Stroke is the second leading cause of death in Korea and the prevalence of acute ischemic stroke among older adults continues to grow, which is known to be related to delayed hospital arrival after the onset of symptoms. Thus, decreasing the incidence of elderly stroke is a major health promotion objective in Korea, yet little is reported about the factors associated with the delayed medical care seeking behavior among elderly stroke patients in Korea. Purpose: The purpose of this study was to understand factors of delayed medical care seeking among elderly stroke patients in order to develop intervention strategies to improve the health of this population. Methods: A cross-sectional, descriptive study was conducted in a convenience sample of 233 hospitalized elderly patients with acute ischemic stroke using a self-administered survey. Descriptive statistics and chi-square test were used for data analysis. Results: More than half of them were male (60.5%) with age of 61 and older (76.9%), and relied on the opinion of their children or friends when deciding medical care for stroke (58.3%). Regarding the reasons of seeking medical care, there was no statistical significance between individuals who arrived at a hospital within three hours of the onset of symptoms and who arrived after three hours. Reasons for delayed hospital arrival were significantly different between groups (individuals of hospital arrival within three hours vs. individuals with hospital arrival after three hours), which include lack of knowledge about the severity of stroke and unawareness of symptoms (χ2 = 24.1), or inconvenience of a hospital visit, waiting for the effects of alternative medications, and stroke during sleep (χ2 = 55.1) with p <0.001. Conclusions: In conclusion, this study helped identify factors delaying hospital arrival after the onset of symptoms among Korean elderly stroke patients. Interventions should include stroke education focusing on the severity of stroke and related symptoms. The stroke education should target not only elderly stroke patients but their family members and friends. It may result in overall national health by decreasing prevalence of stroke among Korean elderly population.

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Abstract 1122‐000214: Clinical Factors Associated rTPA Administration in Acute Ischemic Stroke Patients with History of Atrial Fibrillation

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000214 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Chase A Rathfoot ◽

Camron Edressi ◽

Carolyn B Sanders ◽

Krista Knisely ◽

Nicolas Poupore ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Medical History ◽

Clinical Decision Making ◽

Past Medical History ◽

Clinical Factors ◽

Stroke Patients ◽

Factors Associated ◽

History Of

Introduction : Previous research into the administration of rTPA therapy in acute ischemic stroke patients has largely focused on the general population, however the comorbid clinical factors held by stroke patients are important factors in clinical decision making. One such comorbid condition is Atrial Fibrillation. The purpose of this study is to determine the clinical factors associated with the administration of rtPA in Acute Ischemic Stroke (AIS) patients specifically with a past medical history of Atrial Fibrillation (AFib). Methods : The data for this analysis was collected at a regional stroke center from January 2010 to June 2016 in Greenville, SC. It was then analyzed retrospectively using a multivariate logistic regression to identify factors significantly associated with the inclusion or exclusion receiving rtPA therapy in the AIS/AFib patient population. This inclusion or exclusion is presented as an Odds Ratio and all data was analyzed using IBM SPSS. Results : A total of 158 patients with Atrial Fibrillation who had Acute Ischemic Strokes were identified. For the 158 patients, the clinical factors associated with receiving rtPA therapy were a Previous TIA event (OR = 12.155, 95% CI, 1.125‐131.294, P < 0.040), the administration of Antihypertensive medication before admission (OR = 7.157, 95% CI, 1.071‐47.837, P < 0.042), the administration of Diabetic medication before admission (OR = 13.058, 95% CI, 2.004‐85.105, P < 0.007), and serum LDL level (OR = 1.023, 95% CI, 1.004‐1.042, P < 0.16). Factors associated with not receiving rtPA therapy included a past medical history of Depression (OR = 0.012, 95% CI, 0.000‐0.401, P < 0.013) or Obesity (OR = 0.131, 95% CI, 0.034‐0.507, P < 0.003), Direct Admission to the Neurology Floor (OR = 0.179, 95% CI, 0.050‐0.639, P < 0.008), serum Lipid level (OR = 0.544, 95% CI, 0.381‐0.984, P < 0.044), and Diastolic Blood Pressure (OR = 0.896, 95% CI, 0.848‐0.946, P < 0.001). Conclusions : The results of this study demonstrate that there are significant associations between several clinical risk factors, patient lab values, and hospital admission factors in the administration of rTPA therapy to AIS patients with a past medical history of Atrial Fibrillation. Further research is recommended to determine the extent and reasoning behind of these associations as well as their impact on the clinical course for AIS/AFib patients.

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Abstract P253: Readmission in Acute Ischemic Stroke Patients Undergoing Endovascular Treatment

Stroke ◽

10.1161/str.52.suppl_1.p253 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Saqib Chaudhry ◽

Ibrahim Laleka ◽

Zelalem Bahiru ◽

Hassan S Gill ◽

Mohammad Rauf Chaudhry ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Intracranial Hemorrhage ◽

Stroke Patients ◽

Factors Associated ◽

Representative Study ◽

Post Procedure ◽

Icd 10 ◽

Nationally Representative

Background: Recent trials have demonstrated a reduction in death or disability with endovascular treatment in patients with acute ischemic strokes. However, readmission rates and predictors are not known. Objective: To identify rates and factors associated with 30-day readmission after endovascular treatment in ischemic stroke patients. Methods: Nationwide Readmissions Data (NRD) between 2010 and 2017 was utilized to identify endovascular treatment in acute ischemic stroke patients using ICD-9 and ICD-10 codes. We used hierarchical logistic regression model to identify factors associated with 30-day readmissions. Results: Among 17, 562 acute ischemic stroke patients who survived to discharge after endovascular treatment, 2334 (13.29%) were readmitted within 30-days. Age => 65 years (odds ratio [OR]: 1.23, 95% confidence interval [CI]: 1.09 to 1.39, p =0.0005), chronic kidney disease (OR: 1.28, 95%CI: 1.12 to 1.47, p = 0.0004), congestive heart failure (OR: 1.25, 95%CI: 1.13 to 1.39, p <.0001), post procedure intracranial hemorrhage (OR: 1.09, 95%CI: 0.99 to 1.20, p = 0.04) and diabetes mellitus (OR: 1.09, 95%CI: 0.99 to 1.20, p = .09) during the index hospitalization were associated with readmission within 30 days. Conclusion: In this large nationally representative study, nearly one in 10 patients were readmitted within 30 days after discharge in acute ischemic stroke patients undergoing endovascular treatment. Medical comorbidities and post procedure intracranial hemorrhage were associated with 30-day readmission.

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Assessment and provision of rehabilitation among patients hospitalized with acute ischemic stroke in China: Findings from the China National Stroke Registry II

International Journal of Stroke ◽

10.1177/1747493017701945 ◽

2017 ◽

Vol 12 (3) ◽

pp. 254-263 ◽

Cited By ~ 8

Author(s):

Janet Prvu Bettger ◽

Zixiao Li ◽

Ying Xian ◽

Liping Liu ◽

Xingquan Zhao ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Multivariable Analysis ◽

Thrombosis Prophylaxis ◽

Stroke Patients ◽

Multivariable Logistic Regression Model ◽

Recommended Care ◽

Stroke Registry ◽

Factors Associated ◽

Rehabilitation Assessment

Background Stroke rehabilitation improves functional recovery among stroke patients. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation among patients with acute ischemic stroke. Aims We examined the frequency and determinants of an assessment for rehabilitation among acute ischemic stroke patients from the China National Stroke Registry II. Methods Data for 19,294 acute ischemic stroke patients admitted to 219 hospitals from June 2012 to January 2013 were analyzed. The multivariable logistic regression model with the generalized estimating equation method accounting for in-hospital clustering was used to identify patient and hospital factors associated with having a rehabilitation assessment during the acute hospitalization. Results Among 19,294 acute ischemic stroke patients, 11,451 (59.4%) were assessed for rehabilitation. Rates of rehabilitation assessment varied among 219 hospitals (IQR 41.4% vs 81.5%). In the multivariable analysis, factors associated with increased likelihood of a rehabilitation assessment ( p < 0.05) included disability prior to stroke, higher NIHSS on admission, receipt of a dysphagia screen, deep venous thrombosis prophylaxis, carotid vessel imaging, longer length of stay, and treatment at a hospital with a higher number of hospital beds (per 100 units). In contrast, patients with a history of atrial fibrillation and hospitals with higher number of annual stroke discharges (per 100 patients) were less likely to receive rehabilitation assessment during the acute stroke hospitalization. Conclusions Rehabilitation assessment among acute ischemic stroke patients was suboptimal in China. Rates varied considerably among hospitals and support the need to improve adherence to recommended care for stroke survivors.

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Acute Kidney Injury after Endovascular Treatment in Patients with Acute Ischemic Stroke

Journal of Clinical Medicine ◽

10.3390/jcm9051471 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1471

Author(s):

Joonsang Yoo ◽

Jeong-Ho Hong ◽

Seong-Joon Lee ◽

Yong-Won Kim ◽

Ji Man Hong ◽

...

Keyword(s):

Acute Kidney Injury ◽

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Odds Ratio ◽

Functional Outcomes ◽

Kidney Injury ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Factors Associated

Acute kidney injury (AKI) is often associated with the use of contrast agents. We evaluated the frequency of AKI, factors associated with AKI after endovascular treatment (EVT), and associations with AKI and clinical outcomes. We retrospectively analyzed consecutively enrolled patients with acute ischemic stroke who underwent EVT at three stroke centers in Korea. We compared the characteristics of patients with and without AKI and independent factors associated with AKI after EVT. We also investigated the effects of AKI on functional outcomes and mortality at 3 months. Of the 601 patients analyzed, 59 patients (9.8%) developed AKI and five patients (0.8%) started renal replacement therapy after EVT. In the multivariate analysis, diabetes mellitus (odds ratio (OR), 2.341; 95% CI, 1.283–4.269; p = 0.005), the contrast agent dose (OR, 1.107 per 10 mL; 95% CI, 1.032–1.187; p = 0.004), and unsuccessful reperfusion (OR, 1.909; 95% CI, 1.019–3.520; p = 0.040) were independently associated with AKI. The presence of AKI was associated with a poor functional outcome (OR, 5.145; 95% CI, 2.177–13.850; p < 0.001) and mortality (OR, 8.164; 95% CI, 4.046–16.709; p < 0.001) at 3 months. AKI may also affect the outcomes of ischemic stroke patients undergoing EVT. When implementing EVT, practitioners should be aware of these risk factors.

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Clinical factors associated with statins prescription in acute ischemic stroke patients: findings from the Lombardia Stroke Registry

BMC Neurology ◽

10.1186/1471-2377-14-53 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 5

Author(s):

Isabella Canavero ◽

Anna Cavallini ◽

Patrizia Perrone ◽

Mauro Magoni ◽

Lucia Sacchi ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Factors ◽

Stroke Patients ◽

Stroke Registry ◽

Factors Associated

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Risk Scores for Predicting Post–thrombolysis Intracerebral Hemorrhage

US Neurology ◽

10.17925/usn.2010.05.02.39 ◽

2010 ◽

Vol 05 (02) ◽

pp. 39 ◽

Cited By ~ 3

Author(s):

James S McKinney ◽

Brett Cucchiara ◽

◽

Keyword(s):

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Acute Ischemic Stroke ◽

Clinical Assessment ◽

Scoring Systems ◽

Risk Scores ◽

Stroke Patients ◽

Factors Associated

Post-thrombolysis hemorrhage is a major concern for physicians treating acute ischemic stroke. Two scoring systems that incorporate factors associated with post-thrombolysis hemorrhage have been developed in an attempt to estimate the risk of developing post-thrombolysis hemorrhage among stroke patients. In this article we discuss these scoring systems and their utility in the clinical assessment of stroke patients.

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Social factors influencing hospital arrival time in acute ischemic stroke patients

Neuroradiology ◽

10.1007/s00234-011-0884-9 ◽

2011 ◽

Vol 54 (4) ◽

pp. 361-367 ◽

Cited By ~ 12

Author(s):

Christina Iosif ◽

Mathilda Papathanasiou ◽

Eleftherios Staboulis ◽

Athanasios Gouliamos

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Social Factors ◽

Arrival Time ◽

Stroke Patients ◽

Hospital Arrival ◽

Factors Influencing

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Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke

10.21203/rs.3.rs-20274/v2 ◽

2020 ◽

Author(s):

Sang Hee Ha ◽

Yeon-Jung Kim ◽

Sung Hyuk Heo ◽

Dae-il Chang ◽

Bum joon Kim

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Patients ◽

Nihss Score ◽

Factors Associated ◽

Vein Thrombosis ◽

Asian Patients ◽

Stroke Mechanism ◽

Deep Vein ◽

D Dimer

Abstract Background: Deep vein thrombosis (DVT) is an important complication of ischemic stroke, although the incidence of DVT is regarded as being lower in Asian than in non-Asian patients. Here, we investigated the incidence and factors associated with DVT in Asian patients with ischemic stroke.Methods: Acute ischemic stroke patients received lower extremity ultrasonography (LEUS) to diagnose the presence of DVT. Clinical characteristics and laboratory results, including D-dimer level, were compared between patients with and without DVT. Independent risk factors for DVT were investigated using multivariable analysis. Similar analysis was performed to identify factors associated with elevated D-dimer level (>0.5 mg/dl) in acute ischemic stroke patients.Results: During the study period, 289 patients were enrolled, and 38 (13.1%) showed DVT. Female sex (OR=2.579, 95% CI=1.224–5.432; p=0.013) and a high National Institutes of Health Stroke Scale (NIHSS) score (OR=1.191 95% CI=1.095–1.294; p=0.005) were independently associated with the presence of DVT, although D-dimer level was not. Stroke mechanism, especially cardioembolic stroke (OR=3.777, 95% CI=1.532–9.313; p=0.004; reference: large artery atherosclerosis), NIHSS score (OR=1.087, 95% CI=1.002–1.179; p=0.001) and thrombolysis (OR=12.360, 95% CI 2.456-62.213; p=0.002) were independently associated with elevated abnormal D-dimer levels.Conclusion: The severity of ischemic stroke, but not the D-dimer level, was associated with the presence of DVT in Asian ischemic stroke patients. D-dimer level was influenced by the stroke mechanism. LEUS in patients with severe neurological deficit, rather than screening with D-dimer, may be more beneficial for diagnosing DVT in Asian patients with acute ischemic stroke.

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