Reduction in Stroke After Transient Ischemic Attack in a Province-Wide Cohort Between 2003 and 2015

2020 ◽  
pp. 1-9
Author(s):  
Ryan Wang ◽  
Arunima Kapoor ◽  
Patrice Lindsay ◽  
Cristina Goia ◽  
Amy Y. X. Yu ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Mortality Rates ◽  
Canadian Institute ◽  
Trends Over Time ◽  
Level 1 ◽  
Ischemic Attack ◽  
Event Rates ◽  
Linear Regressions ◽  
Over Time

ABSTRACT: Background: Improvements in management of transient ischemic attack (TIA) have decreased stroke and mortality post-TIA. Studies examining trends over time on a provincial level are limited. We analyzed whether efforts to improve management have decreased the rate of stroke and mortality after TIA from 2003 to 2015 across an entire province. Methods: Using administrative data from the Canadian Institute for Health Information’s (CIHI) databases from 2003 to 2015, we identified a cohort of patients with a diagnosis of TIA upon discharge from the emergency department (ED). We examined stroke rates at Day 1, 2, 7, 30, 90, 180, and 365 post-TIA and 1-year mortality rates and compared trends over time between 2003 and 2015. Results: From 2003 to 2015 in Ontario, there were 61,710 patients with an ED diagnosis of TIA. Linear regressions of stroke after the index TIA showed a significant decline between 2003 and 2015, decreasing by 25% at Day 180 and 32% at 1 year (p < 0.01). The 1-year stroke rate decreased from 6.0% in 2003 to 3.4% in 2015. Early (within 48 h) stroke after TIA continued to represent approximately half of the 1-year event rates. The 1-year mortality rate after ED discharge following a TIA decreased from 1.3% in 2003 to 0.3% in 2015 (p < 0.001). Interpretation: At a province-wide level, 1-year rates of stroke and mortality after TIA have declined significantly between 2003 and 2015, suggesting that efforts to improve management may have contributed toward the decline in long-term risk of stroke and mortality. Continued efforts are needed to further reduce the immediate risk of stroke following a TIA.

Trends Over Time in the Risk of Stroke After an Incident Transient Ischemic Attack

Stroke ◽  
2014 ◽  
Vol 45 (11) ◽  
pp. 3214-3218 ◽  
Author(s):  
Vijaya Sundararajan ◽  
Amanda G. Thrift ◽  
Thanh G. Phan ◽  
Philip M. Choi ◽  
Ben Clissold ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Trends Over Time ◽  
Ischemic Attack ◽  
Over Time

scholarly journals Long-term morbidity and mortality in patients without early complications after stroke or transient ischemic attack

2017 ◽  
Vol 189 (29) ◽  
pp. E954-E961 ◽  
Author(s):  
Jodi D. Edwards ◽  
Moira K. Kapral ◽  
Jiming Fang ◽  
Richard H. Swartz
Keyword(s):  
Transient Ischemic Attack ◽  
Morbidity And Mortality ◽  
Early Complications ◽  
Ischemic Attack

scholarly journals Investigating the Broken-Heart Effect: a Model for Short-Term Dependence between the Remaining Lifetimes of Joint Lives

2012 ◽  
Vol 7 (2) ◽  
pp. 236-257 ◽  
Author(s):  
Jaap Spreeuw ◽  
Iqbal Owadally
Keyword(s):  
Mortality Rates ◽  
Short Term ◽  
Numerical Work ◽  
Data Set ◽  
Multiple State ◽  
Multiple State Model ◽  
Insurance Data ◽  
Over Time ◽  
Assurance Contracts

AbstractWe analyze the mortality of couples by fitting a multiple state model to a large insurance data set. We find evidence that mortality rates increase after the death of a partner and, in addition, that this phenomenon diminishes over time. This is popularly known as a “broken-heart” effect and we find that it affects widowers more than widows. Remaining lifetimes of joint lives therefore exhibit short-term dependence. We carry out numerical work involving the pricing and valuation of typical contingent assurance contracts and of a joint life and survivor annuity. If insurers ignore dependence, or mis-specify it as long-term dependence, then significant mis-pricing and inappropriate provisioning can result. Detailed numerical results are presented.

Abstract P35: The Trend of Stroke Rehabilitation Utilization Between 2014- 2019 in a Community Based Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Daniel Uhm ◽  
Esther Olasoji ◽  
Alexis N Simpkins ◽  
Carolyn Geis ◽  
Keyword(s):  
Clinical Practice ◽  
Trend Analysis ◽  
Significant Proportion ◽  
Inpatient Rehabilitation ◽  
Outpatient Rehabilitation ◽  
Rehabilitation Services ◽  
Institutional Review ◽  
Ischemic Attack ◽  
Over Time

Introduction: Stroke is the leading cause of long-term disability in adults, resulting in significant impairments in motor, sensory, and/ or cognitive that often requires continued rehabilitation services, which vary from intensive acute inpatient rehabilitation to outpatient rehabilitation services. Efforts to reduce disability have advanced rapidly over the past several years. Our data analysis was undertaken to assess whether recent changes in clinical practice have impacted the proportion of stroke patients receiving inpatient versus outpatient rehabilitation over time between 2014-2019 at our institution, which serves a diverse mix of rural, suburban, and urban populations. Methods: Our Institutional Review Board approved retrospective stroke database, including adult patients discharged to receive rehabilitation services data from 2014-2019, was used for analysis. Cochran-Armitage trend analysis was used to assess for differences type of rehabilitation services used over time and regression analysis was used to identify clinical factors associated with discharge type over time. Results: A total of 3467 patients were included in the analysis, 50% woman, 1% Asian, 20% Black, 75% White, 4% undetermined race, 17% intracerebral hemorrhage, 65% ischemic stroke, 11% subarachnoid hemorrhage, 3% transient ischemic attack, 3% other cerebrovascular disease. In this community population, 65% were discharged to inpatient rehab. Trend analysis demonstrated a significant increase in the proportion of patients being discharged home with rehab services, p<.0001. In comparison to those discharged home, patients discharged to rehab were older (odds ratio (OR) 1.02, confidence interval (CI) 1.02-1.03), with a higher NIHSS (OR 1.16, CI 1.14-1.18), discharged in 2014 (OR 1.72, CI 1.23-2.39) or 2016 (OR 1.46, CI 1.05-2.05) versus 2019. There was no association with race, gender, or discharge in 2015, 2017, or 2018. Discussion: Our findings demonstrate the community impact of recent changes in clinical practice guidelines for stroke. The increasing trend of home discharges is encouraging, but the significant proportion of those still not discharged home suggests there is still more work to be done to reduce stroke associated disability in adults.

Abstract TP387: Abcd 2 Score Predicts The Long-term Risk Of Stroke After Transient Ischemic Attack: Fukuoka Stroke Registry

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Yasuhiro Kumai ◽  
Takuya Kiyohara ◽  
Masahiro Kamouchi ◽  
Sohei Yoshimura ◽  
Hiroshi Sugimori ◽  
...  
Keyword(s):  
High Risk ◽  
Transient Ischemic Attack ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Rank Test ◽  
Moderate Risk ◽  
Stroke Registry ◽  
Ischemic Attack

Background and Purpose— ABCD 2 score has been developed to predict the early risk of stroke after transient ischemic attack (TIA). The aim of this study was to clarify whether ABCD 2 score predicts the occurrence of stroke in the long term after TIA. Methods— Fukuoka Stroke Registry (FSR) is a multicenter epidemiological study database on acute stoke. From June 2007 to June 2011, 496 (305 males, 70 ± 13 years of age) patients who had suffered from TIA and were hospitalized in the 7 stroke centers within 7 days after the onset of TIA were enrolled in this study. The patients were divided into three groups according to the risk: low-risk (ABCD 2 score 0-3; n=72), moderate-risk (4-5; n=229) and high-risk group (6-7; n=195). They were followed up prospectively for up to 3 years. Cox proportional hazard regression model was used to elucidate whether ABCD 2 score was a predictor for stroke after TIA after adjusting for confounding factors. Results— Among three groups, there were significant differences in age, hypertension, diabetes mellitus and the decrease in estimated glomerular filtration rate (P<0.01, significantly). During a mean follow-up of 1.3 years, Kaplan-Meier analysis demonstrated that the stroke rate in TIA patients was significantly lower in low-risk group than in moderate-risk or high-risk group (log rank test, p<0.001). The adjusted hazard ratios for stroke in patients with TIA increased with moderate-risk group (Hazard ratio [HR]: 3.47, 95% CI: 1.03-21.66, P<0.05) and high-risk group (HR: 4.46, 95% CI: 1.31-27.85, P<0.05), compared to low-risk group. Conclusions— The ABCD 2 score is able to predict the long-term risk of stroke after TIA.

Prediction and prevention of stroke after transient ischemic attack in the short and long term

2006 ◽  
Vol 6 (3) ◽  
pp. 381-395 ◽  
Author(s):  
Matthew F Giles ◽  
Peter M Rothwell
Keyword(s):  
Transient Ischemic Attack ◽  
Prediction And Prevention ◽  
Short And Long Term ◽  
Ischemic Attack

scholarly journals Antiplatelet Therapy After Noncardioembolic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1812-1818 ◽  
Author(s):  
Jacoba P. Greving ◽  
Hans-Christoph Diener ◽  
Johannes B. Reitsma ◽  
Philip M. Bath ◽  
László Csiba ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Major Bleeding ◽  
Transient Ischemic Attack ◽  
Clinical Benefit ◽  
Antiplatelet Agents ◽  
Vascular Events ◽  
Subgroup Analyses ◽  
Ischemic Attack ◽  
Net Clinical Benefit

Background and Purpose— We assessed the efficacy and safety of antiplatelet agents after noncardioembolic stroke or transient ischemic attack and examined how these vary according to patients’ demographic and clinical characteristics. Methods— We did a network meta-analysis (NMA) of data from 6 randomized trials of the effects of commonly prescribed antiplatelet agents in the long-term (≥3 months) secondary prevention of noncardioembolic stroke or transient ischemic attack. Individual patient data from 43 112 patients were pooled and reanalyzed. Main outcomes were serious vascular events (nonfatal stroke, nonfatal myocardial infarction, or vascular death), major bleeding, and net clinical benefit (serious vascular event or major bleeding). Subgroup analyses were done according to age, sex, ethnicity, hypertension, qualifying diagnosis, type of vessel involved (large versus small vessel disease), and time from qualifying event to randomization. Results— Aspirin/dipyridamole combination (RR NMA-adj , 0.83; 95% CI, 0.74–0.94) significantly reduced the risk of vascular events compared with aspirin, as did clopidogrel (RR NMA-adj , 0.88; 95% CI, 0.78–0.98), and aspirin/clopidogrel combination (RR NMA-adj , 0.83; 95% CI, 0.71–0.96). Clopidogrel caused significantly less major bleeding and intracranial hemorrhage than aspirin, aspirin/dipyridamole combination, and aspirin/clopidogrel combination. Aspirin/clopidogrel combination caused significantly more major bleeding than aspirin, aspirin/dipyridamole combination, and clopidogrel. Net clinical benefit was similar for clopidogrel and aspirin/dipyridamole combination (RR NMA-adj , 0.99; 95% CI, 0.93–1.05). Subgroup analyses showed no heterogeneity of treatment effectiveness across prespecified subgroups. The excess risk of major bleeding associated with aspirin/clopidogrel combination compared with clopidogrel alone was higher in patients aged <65 years than it was in patients ≥65 years (RR NMA-adj , 3.9 versus 1.7). Conclusions— Results favor clopidogrel and aspirin/dipyridamole combination for long-term secondary prevention after noncardioembolic stroke or transient ischemic attack, regardless of patient characteristics. Aspirin/clopidogrel combination was associated with a significantly higher risk of major bleeding compared with other antiplatelet regimens.

scholarly journals Acute and long-term impairments regarding emotional symptoms and quality of life in patients suffering from transient ischemic attack and stroke

2021 ◽  
pp. 1-11
Author(s):  
Alexander Prost ◽  
Katharina Kubitz ◽  
Johann Pelz ◽  
Carsten Hobohm ◽  
Andreas Hinz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Transient Ischemic Attack ◽  
Emotional Symptoms ◽  
Ischemic Attack
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