One-year readmission and mortality following ischaemic stroke by diabetes status, sex, and socioeconomic disadvantage: An analysis of 27,802 strokes from 2012 to 2017

2022 ◽  
pp. 120149
Author(s):  
Jedidiah I. Morton ◽  
Jenni Ilomäki ◽  
Stephen J. Wood ◽  
J. Simon Bell ◽  
Jonathan E. Shaw ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Socioeconomic Disadvantage ◽  
Diabetes Status ◽  
One Year

Libman-Sacks endocarditis in a Bangladeshi patient suffering from rhupus

2019 ◽  
Vol 49 (4) ◽  
pp. 309-311 ◽  
Author(s):  
Shahana Zaman ◽  
Muhammad Abdur Rahim ◽  
Lima Asrin Sayami ◽  
Shaila Nabi ◽  
AKM Monwarul Islam ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Lupus Erythematosus ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Cardiac Lesions ◽  
One Year ◽  
Echocardiographic Evidence

Libman-Sacks endocarditis (LSE) is one of the most characteristic cardiac lesions in systemic lupus erythematosus (SLE). Patients may remain asymptomatic, while symptomatic patients often suffer with systemic emboli. These commonly test positive for anti-phospholipid antibody (aPA). The association of LSE with an overlap of rheumatoid arthritis (RA) and lupus (also known as ‘rhupus’) is rare. We report such a patient, who had been diagnosed as having RA seven years before and had suffered an acute ischaemic stroke one year previously and had echocardiographic evidence of LSE found during routine evaluation. However, she tested negative for aPA.

scholarly journals The Impact of Ischaemic Stroke Subtype on 30-day Hospital Readmissions

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Anna Therese Bjerkreim ◽  
Andrej Netland Khanevski ◽  
Henriette Aurora Selvik ◽  
Ulrike Waje-Andreassen ◽  
Lars Thomassen ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Cox Regression ◽  
Recurrent Stroke ◽  
Hospital Readmissions ◽  
Large Artery ◽  
Stroke Subtype ◽  
Increased Risk ◽  
One Year ◽  
The Impact

Background. Stroke aetiology may affect the risk and causes of readmission after ischaemic stroke (IS) and transient ischaemic attack (TIA) due to differences in risk factors, functional outcome, and treatment. We aimed to examine frequencies, causes, and risk of 30-day readmission by stroke subtype, determine predictors of 30-day readmission, and study the impact of 30-day readmissions on one-year mortality. Methods. All surviving patients admitted with IS or TIA from July 2007 to December 2013 were followed by review of medical records for all unplanned readmissions within 30 days after discharge. Stroke subtype was classified as large-artery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), stroke of other determined aetiology (SOE), or stroke of undetermined aetiology (SUE). Cox regression analyses were performed to assess the risk of 30-day readmission for the stroke subtypes and identify predictors of 30-day readmission, and its impact on one-year mortality. Results. Of 1874 patients, 200 (10.7%) were readmitted within 30 days [LAA 42/244 (17.2%), CE 75/605 (12.4%), SVO 12/205 (5.9%), SOE 6/32 (18.8%), SUE 65/788 (8.3%)]. The most frequent causes of readmissions were stroke-related event, infection, recurrent stroke/ TIA, and cardiac disease. After adjusting for age, sex, functional outcome, length of stay, and the risk factor burden, patients with LAA and SOE subtype had significantly higher risks of readmission for any cause, recurrent stroke or TIA, and stroke-related events. Predictors of 30-day readmission were higher age, peripheral arterial disease, enteral feeding, and LAA subtype. Thirty-day readmission was an independent predictor of one-year mortality. Conclusions. Patients with LAA or SOE have a high risk of 30-day readmission, possibly caused by an increased risk of recurrent stroke and stroke-related events. Awareness of the risk of readmission for different causes and appropriate handling according to stroke subtype may be useful for preventing some readmissions after stroke.

PP1.7 – 1983 Quality of life one year after arterial ischaemic stroke in a population-based cohort

2013 ◽  
Vol 17 ◽  
pp. S33
Author(s):  
AA Mallick ◽  
V Ganesan ◽  
FJ Kirkham ◽  
P Fallon ◽  
T Hedderly ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ischaemic Stroke ◽  
Population Based ◽  
Arterial Ischaemic Stroke ◽  
One Year

scholarly journals Long-term mortality and recurrent vascular events in lacunar versus non-lacunar ischaemic stroke: A cohort study

2021 ◽  
pp. 239698732110620
Author(s):  
Suzanne Portegijs ◽  
Ariel Y Ong ◽  
Nynke Halbesma ◽  
Aidan Hutchison ◽  
Cathie LM Sudlow ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischaemic Stroke ◽  
Cox Regression ◽  
Small Vessel Disease ◽  
Recurrent Stroke ◽  
Vascular Events ◽  
All Cause Mortality ◽  
One Year ◽  
Long Term Mortality

Introduction Studies of differences in very long-term outcomes between people with lacunar/small vessel disease (SVD) versus other types of ischaemic stroke report mixed findings, with limited data on myocardial infarction (MI). We investigated whether long-term mortality, recurrent stroke and MI risks differ in people with versus without lacunar/SVD ischaemic stroke. Patients and methods We included first-ever strokes from a hospital-based stroke cohort study recruited in 2002–2005. We compared risks of death, recurrent stroke and MI during follow-up among lacunar/SVD versus other ischaemic stroke subtypes using Cox regression, adjusting for confounding factors. Results We included 812 participants, 283 with lacunar/SVD ischaemic stroke and 529 with other stroke. During a median of 9.2 years (interquartile range 3.1–11.8), there were 519 deaths, 181 recurrent strokes and 79 MIs. Lacunar/SVD stroke was associated with lower mortality (adjusted HR 0.79, 95% CI 0.65 to 0.95), largely due to markedly lower all-cause mortality in the first year. From one year onwards this difference attenuated, with all-cause mortality only slightly and not statistically significantly lower in the lacunar/SVD group (0.86, 95% CI 0.70 to 1.05). There was no clear difference in risk of recurrent stroke (HR 0.84, 95% CI 0.61–1.15) or MI (HR 0.83, 95% CI 0.52–1.34). Conclusion Long-term risks of all-cause mortality, recurrent stroke and MI are similar, or only slightly lower, in patients with lacunar/SVD as compared to other ischaemic stroke. Patients and physicians should be as vigilant in optimising short- and long-term secondary prevention of vascular events in lacunar/SVD as for other stroke types.

scholarly journals TP5.2.9 Mortality following major lower extremity amputation in people with and without diabetes in Scotland 2004-2013

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ellen Murgitroyd ◽  
Xuehan Yao ◽  
Jan Kerssens ◽  
Jeremy Walker ◽  
Sarah Wild
Keyword(s):  
Lower Extremity ◽  
Economic Status ◽  
Population Based ◽  
Lower Extremity Amputation ◽  
Logistic Regression Models ◽  
Diabetes Status ◽  
Diabetic Population ◽  
One Year ◽  
Extremity Amputation

Abstract Aim To describe short and longer-term mortality following major lower extremity amputation (LEA) by diabetes status over two time periods. Methods A retrospective cohort study of patients who underwent major LEA between 2004 and 2013 was conducted based on linkage of national population-based hospital records and a register of people with diagnosed diabetes. Post-operative mortality was estimated at 30 days, one year and where available, five years. Using logistic regression models, we estimated the odds of death associated with diabetes adjusted for age, sex and socio-economic status within these time points compared to the non-diabetic population stratified by type of diabetes and five-year calendar periods. Results There were a total of 5436 people who received an amputation during the study period of whom approximately 40% had diabetes. Overall mortality for the 2004-8 and 2009-13 cohorts respectively was not significantly different at 7.9% and 7.3% at 30 days and 31% and 27% at one year. Almost 64% of the 2004-8 cohort were dead within five years. The only statistically significantly associations between diabetes and mortality were observed within five year follow-up of the 2004-8 cohort with odds ratios (95% CI) compared to the non-diabetic population of 1.62 (1.17, 2.26) for type 1 diabetes and 1.38 (1.14, 1.66) for type 2 diabetes. Conclusions An adverse association between diabetes and mortality after LEA only became apparent in longer term follow-up.

Associations of age at menopause with postmenopausal bone mineral density and fracture risk in women

2021 ◽  
Author(s):  
Albert Shieh ◽  
Kristine M Ruppert ◽  
Gail A Greendale ◽  
Yinjuan Lian ◽  
Jane A Cauley ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Alcohol Intake ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Chronological Age ◽  
Cigarette Use ◽  
Mineral Density ◽  
Diabetes Status ◽  
One Year

Abstract Context Menopause before age 45 is a risk factor for fractures, but menopause occurs at age 45 or later in ~90% of women. Objective To determine, in women with menopause at age 45 or later, whether: 1) years since the FMP is more strongly associated with postmenopausal bone mineral density (BMD) than chronological age; and 2) lower age at FMP is related to more fractures. Design and Setting The Study of Women’s Health Across the Nation, a longitudinal cohort study of the menopause transition (MT). Participants A diverse cohort of ambulatory women (pre- or early perimenopausal at baseline, with 15 near-annual follow-up assessments). Main Outcome Measures 1) Postmenopausal lumbar spine (LS) or femoral neck (FN) BMD (N=1,038); 2) Time to fracture (N=1,554). Results Adjusted for age, BMI, cigarette use, alcohol intake, baseline LS or FN BMD, baseline MT stage, and study site using multivariable linear regression, each additional year after the FMP was associated with 0.006 (p<0.0001) and 0.004 (p<0.0001) g/cm 2 lower postmenopausal LS and FN BMD, respectively. Age was not related to FN BMD independent of years since FMP. In Cox proportional hazards regression, accounting for race/ethnicity, BMI, cigarette use, alcohol intake, prior fracture, diabetes status, exposure to bone-modifying medications/supplements, and study site, the hazard for incident fracture was 5% greater for each one-year decrement in age at FMP (p=0.02). Conclusions Years since the FMP is more strongly associated with postmenopausal BMD than chronological age, and earlier menopause is associated with more fractures.

Transient atrial fibrillation and risk of stroke after acute myocardial infarction

2011 ◽  
Vol 106 (11) ◽  
pp. 877-884 ◽  
Author(s):  
Rema Bishara ◽  
Gregory Telman ◽  
Fadel Bahouth ◽  
Jonathan Lessick ◽  
Doron Aronson
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Ischaemic Stroke ◽  
Hospital Discharge ◽  
Oral Anticoagulants ◽  
Antiplatelet Agents ◽  
Increased Risk ◽  
One Year ◽  
The Impact

SummaryAtrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI). In the AMI setting, AF is frequently brief and attributed to acute haemodynamic changes, inflammation or ischaemia. However, it remains uncertain whether transient AF episodes are associated with a subsequent increased risk of ischaemic stroke. We studied the impact of transient new-onset AF on the one-year risk of ischaemic stroke or transient ischaemic attack (TIA) in a retrospective cohort of 2,402 patients with AMI. Patients with previous AF or AF at hospital discharge were excluded. Transient AF occurred in 174 patients (7.2%) during the initial hospitalisation. During one year follow-up after hospital discharge, stroke or TIA occurred in 16 (9.2%) and 58 (2.6%) patients with and without transient AF, respectively (p< 0.0001). Compared with patients without transient AF, the adjusted hazard ratio for stroke or TIA in patients with transient AF was 3.03 (95% CI 1.73–5.32; p< 0.0001). Stroke or TIA occurred in 2.6% of patients without AF, 6.3% of patients with transient AF treated with oral anticoagulants, and 9.9% of patients with transient AF treated with antiplatelet agents. The incidence of recurrent AF after hospital discharge was markedly higher in patients with transient AF during the index hospitalisation (22.8% vs. 2.0%, p< 0.0001). In conclusion, transient AF complicating AMI is associated with an increased future risk of ischaemic stroke and TIA, particularly in patients treated with antiplatelet agents alone. High AF recurrence rates in these patients also suggest that oral anticoagulants should be strongly considered.

scholarly journals How good are we in detecting and screening for diabetes? Results from community-based survey in rural Puducherry, South India

2019 ◽  
Vol 6 (11) ◽  
pp. 4876
Author(s):  
Chithra Boovaragasamy ◽  
Sinthu Sarathamani ◽  
Suguna Anbazhagan ◽  
Surekha Anbazhagan ◽  
Pruthu Thekkur
Keyword(s):  
Rural Areas ◽  
Linear Models ◽  
Community Based ◽  
Cross Sectional ◽  
Innovative Strategies ◽  
Individual Level ◽  
Diabetes Status ◽  
Regional Estimates ◽  
One Year ◽  
The Individual

Background: Early diagnosis is the mainstay for reducing complications associated with diabetes. Though blood sugar testing was made freely available, there is gap in utilization of the same. Hence, the current study was conducted to assess the detection gap in diabetes compared to regional estimates. Also, to assess the extent of screening and factors associated with not getting screened.Methods: A community based cross-sectional analytical study was conducted in the selected rural areas of Puducherry. House to house enumeration survey was conducted in the purposively selected rural areas during September-2016 to February-2017. Information on diabetes status, status of screening in last one year was collected from individuals aged more than eighteen years. Data was entered in Epidata 3.1 and analyzed using Stata 12 software. Percentages with 95% CI were used to estimate the detection gap in diabetes on comparing with regional estimates given by IDF (8.6%). Generalized Linear Models were used to assess the individual level characteristics associated with not screening for diabetes.Results: Of the total 1844 enumerated individuals, 1423 (78.6%) were above 18 years of age. The detection gap for diabetics based on IDF was 39% and based on DLHS-4 was 69.8%. Of the eligible individuals for screening 81.9% (95% CI: 79.7%-83.9%) were not screened for diabetes in last one year.Conclusions: With high detection gap and low utilization of screening, there is need for developing innovative strategies like task shifting, ICT utilization for screening and targeted screening. 

scholarly journals Long-term outcomes of ischaemic stroke patients with diabetes in a multi-ethnic cohort in Singapore

2021 ◽  
Vol 50 (1) ◽  
pp. 16-25 ◽  
Author(s):  
Ei Zune The ◽  
Mei Yen Ng ◽  
Geelyn JL Ng ◽  
Bernadette GC Er ◽  
Amy ML Quek ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Coronary Artery ◽  
Ischaemic Stroke ◽  
Body Mass ◽  
Cardiovascular Events ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Diabetes Status ◽  
Patients With Diabetes

ABSTRACT Introduction: Diabetes increases the risk of ischaemic stroke especially among Asians. This study aims to investigate contemporaneous long-term cardiovascular outcomes of ischaemic stroke patients with diabetes in a multi-ethnic Asian cohort. Methods: Consecutive patients with ischaemic stroke were recruited from the National University Hospital, Singapore. Data on age, gender, ethnicity, risk factors (including diabetes status and body mass index [BMI]), stroke severity and mechanisms were collected. These patients were followed up until the day of the first cardiovascular event or July 2016, whichever was earlier. The primary endpoint was the time from enrolment to the first occurrence of a composite of cerebrovascular and coronary artery events. Results: Between July 2011 and December 2013, 720 patients (mean age 60.6 years, 71% men, 43% with diabetes, median National Institute Health Stroke Severity scale 2) were enrolled and followed up. A total of 175 cardiovascular events occurred during a median follow-up of 3.25 years (6.90 events per 1,000 person-month), comprising 163 cerebrovascular and 42 coronary artery events. The adjusted hazard ratio of diabetes was 1.50 (95% CI 1.08–2.10). In a multivariable Cox proportional hazards model, Malay and Indian ethnicities, BMI <23kg/m2 and a prior diagnosis of diabetes were identified as independent predictors of recurrent cardiovascular events. Conclusion: Our study provides quantitative data on the event rates of ischaemic stroke patients with diabetes. These findings provide insights on stroke predictors in a multi-ethnic Asian population, which may have implications in the design of future interventional studies. Keywords: Asian, body mass index, cardiovascular, stroke phenotype

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