Perioperative Stroke: Risk Assessment, Prevention and Treatment

In 2017, Hypertension Canada removed advanced age and frailty as considerations for caution when deciding on intensive therapy in their guidelines for the diagnosis, risk assessment, prevention, and treatment of hypertension in adults. Dementia is not mentioned. In this commentary, we review why advanced age and frailty were removed, and examine what is currently known about the relationship between hypertension and both incident and prevalent dementia. We make the case that the presence of frailty (especially when severe) and dementia should be considered when deciding on intensive therapy in future iterations of Hypertension Canada guidelines.

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Abstract 2652: Carotid Revascularization Provides Similar Outcomes in Symptomatic and Asymptomatic Patients with <70 Years

Stroke ◽

10.1161/str.43.suppl_1.a2652 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Paola De Rango ◽

Fabio Verzini ◽

Piergiorgio Cao ◽

Enrico Cieri ◽

Giuseppe Giordano ◽

...

Keyword(s):

Stroke Risk ◽

Young Patients ◽

The Elderly ◽

Carotid Stenting ◽

Stroke Incidence ◽

Perioperative Stroke ◽

Carotid Revascularization ◽

Asymptomatic Patients ◽

Effect Of Age ◽

Stroke Death

Absolute stroke risk and perioperative stroke risk during carotid revascularization are higher in patients with symptomatic than in those with asymptomatic carotid stenosis. Age is one of the main risk factors for stroke and trials have shown a significant age interaction after carotid stenting (CAS). This study aims to analyze the effect of age on outcomes of carotid revascularization using the 70-year threshold as suggested by CREST. Methods: From 2001 to 2010 patients receiving carotid revascularization, either by CAS or by endarterectomy (CEA) were reviewed. Perioperative stroke-death rates and 72-month survival and late stroke incidence were compared in symptomatic and asymptomatic patients with less and more than 70years. Results: 2196 procedures, 1080 by CAS 1116 by CEA, were reviewed;684 were performed for carotid referable symptoms. Symptomatic patients showed higher perioperative stroke/death risks (3.5% vs 1.9%, p=0.034) and lower 72-months survival (74% vs 82%, p=0.0001) or freedom from late stroke (93% vs 97%, p=0.002) than asymptomatic patients with similar differences detected within CEA or CAS procedure. When only the group of 949 youngsters (≤70y) was analyzed, symptomatic and asymptomatic patients shared similar low perioperative stroke/death risks: 2.1% vs 1.3%, p=0.39. For young symptomatic patients, perioperative stroke/death risk was comparably low in CAS and CEA: 1.8% vs 1.2%. At 72 months, survival (98% vs 97%, p=0.49) and freedom from stroke (89% vs 89%, p=0.33) rates were similarly high in symptomatic and asymptomatic young patients. Comparable risks between the symptomatic and asymptomatic youngsters were found after each CAS (perioperative stroke/death: p=0.64; survival: p=0.10; late stroke: p=0.50) and CEA (perioperative stroke/death: p=0.49; survival: p=0.91; late stroke: p=0.64) procedure. Higher perioperative and late risks were confirmed for symptomatic patients in the elderly (>70y) subgroup (n=1247) regardless of the procedure. Conclusions: Outcomes following carotid revascularization are related to patient age. For younger ages (≤70years) symptomatic and asymptomatic patients may share similarly low perioperative and late risks of stroke and death after carotid revascularization whichever the procedure applied.

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Abstract TP138: Chronic Kidney Disease in Heart Failure Patients is Associated with Increased Prevalence of Atrial Fibrillation or Atrial Flutter as well as CVA/TIA

Stroke ◽

10.1161/str.51.suppl_1.tp138 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Christopher Lu ◽

Jack Chan ◽

Zejia Yu ◽

Paula Anzenberg ◽

Mikhail Torosoff

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Risk Assessment ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Atrial Flutter ◽

Stroke Risk ◽

Multivariate Logistic Regression Analysis ◽

History Of ◽

Get With The Guidelines

Background: The CHADS-VASC score does not incorporate renal dysfunction in stroke risk assessment in patients with atrial fibrillation and the prevalence of atrial fibrillation, atrial flutter, and cerebrovascular accidents (CVA) in patients with concurrent CHF and CKD is not well investigated. Objective: Evaluate the prevalence of history of stroke, atrial fibrillation, atrial flutter in patients with CHF and CKD. Methods: Data from the single institution Get With The Guidelines- Heart Failure (GWG-HF) cohort of 2938 consecutive inpatients with known GFR was utilized. CHADS-VASC score was calculated from the GWG-HF variables. Chronic kidney disease (CKD) was defined as GFR <60 ml/min. Results: An overwhelming majority (95%) of GWG-HF patients had elevated >1 CHADS-VASC score, which was also significantly more common in patients with CKD (97.6% vs. 91.7% in patients without CKD, p<0.0001). Average CHADS-VASC score was also significantly increased in patients with CKD (4+/-1.3 vs. 3.3+/-1.4, p<0.0001). Furthermore, CKD was associated with increased prevalence of atrial fibrillation and/or flutter (45.6% vs. 35.3%, p<0.0001) and stroke history (17.5% vs. 12.3%, p=0.002). When stroke and TIA histories were removed from the CHADS-VASC score ("CHAD-VASC score"), the remaining variables were strongly predictive of stroke or TIA (14.2% vs. 3.8%, p<0.0001). In multivariate logistic regression analysis, both CHAD-VASC score (OR 2.6, 95%CI 1.3-5.4, p=0.009) and CKD (OR 1.5, 95%CI 1.2-1.8, p=0.001) were associated significantly increased odds of prior stroke or TIA. Conclusions: In patients admitted with heart failure, CKD is associated with increased prevalence of atrial fibrillation or atrial flutter as well as increased prevalence of CVA/TIA. Further prospective studies are warranted to examine whether CKD history should be included in stroke risk assessment in patients with atrial fibrillation or atrial flutter, in conjunction with existing risk assessment frameworks.

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Abstract 66: Current Attitudes and Practice Patterns of Using New and Emerging Therapies to Manage Patients with Atrial Fibrillation (AF): a National Assessment of Cardiologists and Primary Care Physicians

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a66 ◽

2012 ◽

Vol 5 (suppl_1) ◽

Author(s):

Gregory D Salinas ◽

Caroline O Robinson ◽

Nancy Roepke ◽

B. S Burton ◽

Debi Susalka ◽

...

Keyword(s):

Risk Assessment ◽

Primary Care ◽

Clinical Practice ◽

Primary Care Physicians ◽

Stroke Risk ◽

Case Vignette ◽

Independent Evidence ◽

Patient Chart ◽

Emerging Therapies ◽

Chart Audits

Introduction: Stroke prevention is a cornerstone in the management of patients with AF at higher risk for ischemic events. This study assessed physician barriers to management of AF patients, including gaps in clinical knowledge and application of tools and guidelines for reducing stroke risk. Awareness, perception, and confidence in adopting newer anticoagulants were investigated, particularly related to balancing risk with treatment goals, and knowledge sources sought by physicians. Methods: The data for this study, conducted from March 2011 to May 2011, were collected through the use of a nationally-distributed case vignette survey to cardiologists and primary care physicians (PCPs), as well as patient chart audits nested within the physician sample. Each component of this study was reviewed and approved by the Western Institutional Review Board (WIRB). Results: Surveys from 142 cardiologists and 250 PCPs, and 632 patient chart audits, were analyzed. Nearly half of cardiologists and more than 75% of PCPs surveyed identified uncertainty regarding stroke risk assessment and lack of awareness of tools to guide risk assessment as barriers to determining appropriate antithrombotic therapy. Case vignette assessment found that 44% of PCPs familiar with the CHADS2 risk assessment tool were unable to appropriately assign a risk score, and they were less likely than cardiologists (53% vs 85%) to use this tool in clinical practice. Consistent with their greater familiarity, 65% of cardiologists are very confident in using emerging anticoagulants, while only 40% of PCPs have comparable confidence. The most frequently sought and valued resources for information about emerging anticoagulants were clinical practice guidelines, journal articles, CME activities, and communication with physician peers. Conclusion: Knowledge gaps and clinical barriers exist among physicians for stroke risk assessment, anticoagulation management, and use of emerging therapies in patients with AF. Physicians seek independent evidence-based information when deciding how to incorporate new anticoagulants into practice. The data suggest that physicians value education on safety and efficacy of therapies as well as practical guidance on applying clinical data to practice.

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A Descriptive Study to Assess the Risk of Stroke among Patients with Hypertension and Type 2 Diabetes Mellitus at a Selected Hospital, Bangalore

International Journal of Science and Healthcare Research ◽

10.52403/ijshr.20210767 ◽

2021 ◽

Vol 6 (3) ◽

pp. 407-412

Author(s):

Leena Dorothy W ◽

Pavithra C ◽

Umadevi A K

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Risk Assessment ◽

Type 2 Diabetes Mellitus ◽

Stroke Risk ◽

Family Type ◽

Survey Method ◽

Risk Category

Objective: Stroke is a major public health problem, both in developed and developing countries. Stroke is becoming an important cause of early death and disability in India due to increasing prevalence of the major key modifiable risk factors like type 2 diabetes mellitus and hypertension. Hence there is an urgent need for recognition of stroke risk factors and its warning signs. With this intention the present study aimed to assess the risk of stroke among patients with hypertension and type 2 diabetes mellitus. Methods: A non-experimental, descriptive survey method was adopted. Samples were selected by using quota sampling technique and 60 hypertensive and type 2 diabetes mellitus patients who met the inclusion criteria were selected for the study. Data were collected by an interview technique using a modified stroke risk assessment tool by the National Stroke Association, USA. Results: Out of 60 samples 48.3% of them were in high-risk category, 28.3% were in caution and 23.3% in low-risk category. There was a significant association found in relation to socio demographic variables such as education qualification, type of family, type of diet, weight and complications of hypertension (P<0.05). Discussion: The findings of the study suggested that there is an increased risk of stroke in hypertension and type 2 diabetes patients which can be aggravated by other risk factors and co-morbid conditions. Hence modifying these risk factors by changing lifestyle can help in prevention of stroke. Keywords: Stroke, risk assessment, hypertension and type 2 diabetes mellitus, comorbid conditions.

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