Trends in Hospital Admission for Stroke in Calgary

Background:Stroke incidence has fallen since 1950. Recent trends suggest that stroke incidence may be stabilizing or increasing. We investigated time trends in stroke occurrence and in-hospital morbidity and mortality in the Calgary Health Region.Methods:All patients admitted to hospitals in the Calgary Health Region between 1994 and 2002 with a primary discharge diagnosis code (ICD-9 or ICD-10) of stroke were included. In-hospital strokes were also included. Stroke type, date of admission, age, gender, discharge disposition (died, discharged) and in-hospital complications (pneumonia, pulmonary embolism, deep venous thrombosis) were recorded. Poisson and simple linear regression was used to model time trends of occurrence by stroke type and age-group and to extrapolate future time trends.Results:From 1994 to 2002, 11642 stroke events were observed. Of these, 9879 patients (84.8%) were discharged from hospital, 1763 (15.1%) died in hospital, and 591 (5.1%) developed in-hospital complications from pneumonia, pulmonary embolism or deep venous thrombosis. Both in-hospital mortality and complication rates were highest for hemorrhages. Over the period of study, the rate of stroke admission has remained stable. However, total numbers of stroke admission to hospital have faced a significant increase (p=0.012) due to the combination of increases in intracerebral hemorrhage (p=0.021) and ischemic stroke admissions (p=0.011). Sub-arachnoid hemorrhage rates have declined. In-hospital stroke mortality has experienced an overall decline due to a decrease in deaths from ischemic stroke, intracerebral hemorrhage and sub-arachnoid hemorrhage.Conclusion:Although age-adjusted stroke occurrence rates were stable from 1994 to 2002, this is associated with both a sharp increase in the absolute number of stroke admissions and decline in proportional in-hospital mortality. Further research is needed into changes in stroke severity over time to understand the causes of declining in-hospital stroke mortality rates.

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Mortality of major cardiovascular emergencies among patients admitted to hospitals on weekends as compared with weekdays in Taiwan

BMC Health Services Research ◽

10.1186/s12913-021-06553-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chao-Lun Lai ◽

Raymond Nien-Chen Kuo ◽

Ting-Chuan Wang ◽

K. Arnold Chan

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Pulmonary Embolism ◽

Ischemic Stroke ◽

Aortic Aneurysm ◽

Hospital Mortality ◽

Weekend Effect ◽

Claims Database ◽

Ruptured Aortic Aneurysm ◽

Incident Cases

Abstract Background Several studies have found a so-called weekend effect that patients admitted at the weekends had worse clinical outcomes than patients admitted at the weekdays. We performed this retrospective cohort study to explore the weekend effect in four major cardiovascular emergencies in Taiwan. Methods The Taiwan National Health Insurance (NHI) claims database between 2005 and 2015 was used. We extracted 3811 incident cases of ruptured aortic aneurysm, 184,769 incident cases of acute myocardial infarction, 492,127 incident cases of ischemic stroke, and 15,033 incident cases of pulmonary embolism from 9,529,049 patients having at least one record of hospitalization in the NHI claims database within 2006 ~ 2014. Patients were classified as weekends or weekdays admission groups. Dates of in-hospital mortality and one-year mortality were obtained from the Taiwan National Death Registry. Results We found no difference in in-hospital mortality between weekend group and weekday group in patients with ruptured aortic aneurysm (45.4% vs 45.3%, adjusted odds ratio [OR] 1.01, 95% confidence interval [CI] 0.87–1.17, p = 0.93), patients with acute myocardial infarction (15.8% vs 16.2%, adjusted OR 0.98, 95% CI 0.95–1.00, p = 0.10), patients with ischemic stroke (4.1% vs 4.2%, adjusted OR 0.99, 95% CI 0.96–1.03, p = 0.71), and patients with pulmonary embolism (14.6% vs 14.6%, adjusted OR 1.02, 95% CI 0.92–1.15, p = 0.66). The results remained for 1 year in all the four major cardiovascular emergencies. Conclusions We found no difference in either short-term or long-term mortality between patients admitted on weekends and patients admitted on weekdays in four major cardiovascular emergencies in Taiwan.

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The influence of sex on ischemic stroke incidence, therapeutic procedures and in‐hospital mortality: Results of the Spanish National Hospital Discharge

International Journal of Clinical Practice ◽

10.1111/ijcp.14984 ◽

2021 ◽

Author(s):

José M. Miguel‐Yanes ◽

Rodrigo Jiménez‐García ◽

Ana López‐de‐Andrés ◽

Valentín Hernández‐Barrera ◽

Javier Miguel‐Díez ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Hospital Discharge ◽

National Hospital ◽

Stroke Incidence ◽

Therapeutic Procedures

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Abstract P673: The Obesity Paradox in Patients Hospitalized for Ischemic Stroke

Stroke ◽

10.1161/str.52.suppl_1.p673 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Genaro Velazquez ◽

Hafeez Shaka ◽

Hernan G. Marcos-Abdala ◽

Emmanuel Akuna

Keyword(s):

Pulmonary Embolism ◽

Risk Factor ◽

Ischemic Stroke ◽

Respiratory Failure ◽

Hospital Mortality ◽

Odds Ratio ◽

Mechanical Thrombectomy ◽

Length Of Hospital Stay ◽

Obesity Paradox ◽

Secondary Outcomes

Introduction: Even though Obesity, as measured by BMI > 30.00 kg/m 2 , is a established risk factor for ASCVD, it hasn’t been proven as a risk factor for adverse outcomes in patients with diagnosis of ischemic stroke. Our study sought to compare outcomes for ischemic stroke hospitalizations in patients with and without Obesity. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 71,473,874who had ischemic stroke as primary diagnosis were enrolled and further stratified based on the presence or absence of Obesity as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, treatment with mechanical thrombectomy, treatment with tPA, and complications like respiratory failure requiring intubation, pulmonary embolism (PE), DVT, NSTEMI and sepsis. Multivariate regression analysis was done to adjust for confounders. Results: The in-hospital mortality for patients with ischemic stroke was 42 145 overall. Compared with patients without obesity, patients with Obesity had a lower odds of in- hospital mortality (aOR 0.85, 95% CI 0.79-0.93, p<0.001) when adjusted for patient and hospital characteristics. We found that patients with ischemic stroke and obesity had decreased length of hospital stay and higher odds ratio of treatment with mechanical thrombectomy, treatment with tPA, and higher odds ratio of complications like respiratory failure requiring intubation and pulmonary embolism (PE). No significant difference in other secondary outcomes (DVT, NSTEMI and sepsis). Conclusion: There is convincing evidence supporting the existence of the “obesity paradox” in patients with ischemic stroke. Several stroke-associated mechanisms, like autonomous nervous activation and pro-inflammatory cytokine release in addition to other factors like impaired feeding and inactivity cause accelerated tissue degradation and overall weight loss. It is thought that obese patients with better metabolic reserve may be less affected from this unfavorable metabolic dysregulation as compared to underweight patients. Nevertheless, further studies are needed in order to identify factors responsible for this paradox.

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Clinical and economic burden of heparin-induced thrombocytopenia in hospitalized patients undergoing percutaneous peripheral arterial interventions

Vascular ◽

10.1177/1708538119868615 ◽

2019 ◽

Vol 28 (1) ◽

pp. 81-86 ◽

Cited By ~ 1

Author(s):

Ahmed Subahi ◽

Mohammed Osman ◽

Oluwole Adegbala ◽

Hossam Abubakar ◽

Babikir Kheiri ◽

...

Keyword(s):

Acute Kidney Injury ◽

Pulmonary Embolism ◽

Ischemic Stroke ◽

Venous Thrombosis ◽

Arterial Intervention ◽

Kidney Injury ◽

Heparin Induced Thrombocytopenia ◽

Baseline Characteristics ◽

Peripheral Arterial ◽

Prolonged Hospital

Background Percutaneous peripheral arterial intervention (PPAI) patients are at a high risk of developing heparin-induced thrombocytopenia due to the need for repeated and prolonged heparin exposure. We sought to investigate the incidence, outcomes, and economic impact of heparin-induced thrombocytopenia post-PPAI utilizing the National Inpatient Sample. Methods All patients who underwent PPAI (age ≥18 years) from 2007 to 2014 were identified by using ICD-9-CM codes. Patients were then classified into two groups based on the presence or absence of heparin-induced thrombocytopenia during hospitalization. In-hospital outcomes were compared between the two groups after propensity-score matching to account for differences in baseline characteristics. Results Heparin-induced thrombocytopenia was reported in 527 patients (0.23%). After adjusting for patient-level and hospital-level characteristics, in-hospital mortality differences were not significantly different between patients with heparin-induced thrombocytopenia vs. those without heparin-induced thrombocytopenia (odds ratio (OR) 1.02, 95% confidence interval (CI) 0.67 to 1.57, p = 0.951). However, PPAI patients with heparin-induced thrombocytopenia were more likely to develop ischemic stroke (OR 3.84, 95%CI 1.26 to 11.75, p = 0.018), deep venous thrombosis/pulmonary embolism (OR 1.32, 95%CI 0.79 to 1.79, p = 0.078), and acute kidney injury requiring dialysis (OR 4.04, 95%CI 1.72 to 9.50, p = 0.001). Furthermore, post-PPAI patients who developed heparin-induced thrombocytopenia had longer hospitalizations (13.8 vs. 9.8 days, p < 0.0001), higher cost of stay ($62,022 vs. $44,904, p < 0.0001), and higher rates of non-routine home discharges (50.15% vs. 42.19%, p = 0.013). Conclusion Among patients who underwent PPAI, heparin-induced thrombocytopenia was associated with a higher risk of venous thrombosis/pulmonary embolism, ischemic stroke, acute kidney injury requiring dialysis, prolonged hospital stay, and increased cost.

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Time trends in hospital mortality and diagnosis of pulmonary embolism

American Heart Journal ◽

10.1016/0002-8703(82)90207-1 ◽

1982 ◽

Vol 104 (2) ◽

pp. 305-306 ◽

Cited By ~ 34

Author(s):

Samuel Z. Goldhaber ◽

Charles H. Hennekens

Keyword(s):

Pulmonary Embolism ◽

Hospital Mortality ◽

Time Trends

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Prevention of Deep Venous Thrombosis and Pulmonary Embolism in Patients With Acute Intracerebral Hemorrhage

The Neurologist ◽

10.1097/nrl.0b013e3181a93bac ◽

2009 ◽

Vol 15 (6) ◽

pp. 329-331 ◽

Cited By ~ 57

Author(s):

Dilek Necioglu Orken ◽

Gulay Kenangil ◽

Huseyin Ozkurt ◽

Cetin Guner ◽

Lale Gundogdu ◽

...

Keyword(s):

Pulmonary Embolism ◽

Intracerebral Hemorrhage ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Acute Intracerebral Hemorrhage

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Abstract WMP60: Association Between Liver Cirrhosis and Stroke in a Nationally Representative Cohort

Stroke ◽

10.1161/str.48.suppl_1.wmp60 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Neal S Parikh ◽

Babak B Navi ◽

Yecheskel Schneider ◽

Hooman Kamel

Keyword(s):

Risk Factors ◽

Liver Cirrhosis ◽

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Intracerebral Hemorrhage ◽

Cox Proportional Hazards ◽

Medicare Beneficiaries ◽

Stroke Incidence ◽

Increased Risk ◽

Thrombotic Complications

Introduction: Liver cirrhosis is characterized by a coagulopathy associated with both hemorrhagic and thrombotic complications. However, the risk of stroke - hemorrhagic and ischemic - in patients with cirrhosis has not been rigorously assessed. Methods: We performed a retrospective cohort study of Medicare beneficiaries ≥66 years of age using a 5% sample of inpatient and outpatient claims from 2008-2014. Our predictor was liver cirrhosis, defined by presence of at least two ICD-9-CM inpatient or outpatient claims for liver cirrhosis or its complications, a validated algorithm previously used to study cirrhosis in Medicare beneficiaries. The primary outcome was stroke, and the secondary outcomes were ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Outcomes were defined by validated ICD-9-CM algorithms. Patients were censored at the time of an outcome, death, or on December 31, 2014. We used survival analysis to compare stroke incidence in patients with and without liver cirrhosis. Cox proportional hazards analysis was used to evaluate the association between cirrhosis and stroke while adjusting for demographics and established stroke risk factors. Results: Among the 1,564,277 beneficiaries in our sample, we identified 10,512 (0.7%) patients with liver cirrhosis. The mean age of patients with cirrhosis was 74.1 (±6.5) years. Over a median follow-up of 5 years, 76,195 patients were hospitalized with a stroke. The incidence of stroke was 1.9% (95% confidence interval [CI], 1.7-2.1%) per year in patients with cirrhosis and 1.1% (95% CI, 1.1-1.1%) per year in patients without cirrhosis. After adjusting for demographics and vascular risk factors, patients with cirrhosis experienced a higher risk of stroke (hazard ratio [HR], 1.4; 95% CI, 1.2-1.5); however, associations appeared more robust for intracerebral hemorrhage (HR, 2.2; 95% CI, 1.7-2.8) and subarachnoid hemorrhage (HR, 2.0; 95% CI, 1.2-3.1) than for ischemic stroke (HR, 1.3; 95% CI, 1.1-1.4). Conclusions: We found that liver cirrhosis was associated with an increased risk of stroke, particularly hemorrhagic stroke. Our results build on recent work investigating the hemorrhagic and thrombotic complications of liver cirrhosis outside of the portal circulation.

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Abstract WP312: The Association of Chronic Kidney Disease (CKD) With 30-day and 1-year Post Ischemic Stroke Mortality and Rehospitalization: Get With the Guidelines (GWTG) Stroke

Stroke ◽

10.1161/str.47.suppl_1.wp312 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Nada El Husseini ◽

Gregg C Fonarow ◽

Eric E Smith ◽

Christine Ju ◽

Lee H Schwamm ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Proportional Hazards ◽

Reference Group ◽

Cox Proportional Hazards ◽

Fee For Service ◽

Stroke Mortality ◽

Medicare Beneficiaries ◽

Cox Proportional Hazards Models ◽

Ckd Stage

Background: The extent to which CKD is associated with 30-day and 1-year post ischemic stroke mortality and rehospitalization rates has not been well studied. Methods: Data from 232,236 fee for service Medicare patients admitted with ischemic stroke to 1581 AHA GWTG-Stroke participating hospitals between January 2009 and December 2012 were analyzed. Estimated GFR in mL/min/1.73 m2 was determined based on the MDRD study equation categorized as: no CKD (GFR ≥60); stage 3a CKD (GFR 45-59); stage 3b CKD (GFR 30-44); stage 4 CKD, (GFR 15-29); stage 5 CKD (GFR <15 excluding those on dialysis). Dialysis was identified by ICD-9 codes. Multivariable Cox proportional hazards models adjusted for demographics, medical history, NIHSS, arrival hour, and hospital characteristics were used to determine the independent associations of CKD (reference group those without CKD) with mortality and readmission at 30 days and 1 year. Results: After adjustment, 30-days poststroke mortality was highest among those with CKD stage 5 (HR 1.94, 95%CI 1.72-2.18), even after excluding in-hospital mortality and patients discharged to hospice (HR 2.09, 95%CI 1.66-2.63). Unadjusted 1-year mortality and readmission rates were highest among patients on dialysis (Figure). After adjustment, 1-year post-stroke mortality remained highest among patients on dialysis (HR 2.19, 95%CI 2.08-2.31), even after excluding in-hospital mortality and discharge to hospice (HR 2.65, 95%CI 2.49-2.81). For those discharged alive, 30-day and 1-year rehospitalization rates were also highest among patients on dialysis (HR 2.10, 95%CI 1.95-2.26; HR 2.55, 95%CI 2.44-2.66, respectively) as was the 30-day and 1-year composite of mortality and rehospitalization (HR 2.04, 95%CI 1.90-2.18; HR 2.46, 95% CI 2.36-2.56, respectively). Conclusion: Among Medicare beneficiaries with acute ischemic stroke, poststroke mortality and rehospitalization varied by CKD stage and were highest among those with advanced CKD.

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Nationwide Trends in Incidence and Mortality of Stroke Among Younger and Older Adults in Denmark

Neurology ◽

10.1212/wnl.0000000000011636 ◽

2021 ◽

Vol 96 (13) ◽

pp. e1711-e1723

Author(s):

Nils Skajaa ◽

Kasper Adelborg ◽

Erzsébet Horváth-Puhó ◽

Kenneth J. Rothman ◽

Victor W. Henderson ◽

...

Keyword(s):

Older Adults ◽

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Intracerebral Hemorrhage ◽

Temporal Trends ◽

Age Groups ◽

Stroke Mortality ◽

Younger Adults ◽

Incidence And Mortality ◽

First Time

ObjectiveTo investigate the extent to which the incidence and mortality of a first-time stroke among younger and older adults changed from 2005 to 2018 in Denmark using nationwide registries.MethodsWe used the Danish Stroke Registry and the Danish National Patient Registry to identify patients 18 to 49 years of age (younger adults) and those ≥50 years of age (older adults) with a first-time ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. We computed age-standardized incidence rates and 30-day and 1-year mortality risks separately for younger and older adults and according to smaller age groups, stroke subtype, sex, and severity (Scandinavian Stroke Scale score). Average annual percentage changes (AAPCs) were computed to assess temporal trends.ResultsWe identified 8,680 younger adults and 105,240 older adults with an ischemic stroke or intracerebral hemorrhage. The incidence rate per 100,000 person-years of ischemic stroke (20.8 in 2005 and 21.9 in 2018, AAPC −0.6 [95% confidence interval (CI) −1.5 to 0.3]) and intracerebral hemorrhage (2.2 in 2005 and 2.5 in 2018, AAPC 0.6 [95% CI −1.0 to 2.3]) remained steady in younger adults. In older adults, rates of ischemic stroke and intracerebral hemorrhage declined, particularly in those ≥70 years of age. Rates of subarachnoid hemorrhage declined, but more so in younger than older adults. Stroke mortality declined over time in both age groups, attributable largely to declines in the mortality after severe strokes. Most trends were similar for men and women.ConclusionThe incidence of ischemic stroke and intracerebral hemorrhage was steady in younger adults from 2005 to 2018, while it dropped in adults >70 years of age. Stroke mortality declined during this time.

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Abstract P219: Constant Numbers but Change in Stroke Subtype of Patients with First-Ever Minor Stroke/TIA from 2002 to 2012 in London, Canada

Circulation ◽

10.1161/circ.129.suppl_1.p219 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Chrysi Bogiatzi ◽

Daniel G Hackam ◽

Ian A McLeod ◽

David J Spence

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Minor Stroke ◽

Stroke Mortality ◽

Stroke Subtype ◽

Stroke Incidence ◽

Stroke Subtypes ◽

Reliable Classification ◽

Over Time ◽

Major Stroke

Introduction: In Canada, major stroke hospital admission decreased by 27.6% and stroke mortality decreased by 28.2% between 1994 and 2004. However, there are no regional data on rates of incident minor stroke/TIA. We hypothesized that there has been a decrease in minor stroke/TIA over time due to better management of cerebrovascular risk factors. Methods: We included patients who diagnosed with a minor stroke/TIA in the regional Urgent TIA Clinic in London, Ontario, Canada from 2002 to 2012. We used a valid and reliable classification system for subtypes of ischemic stroke (SPARKLE) to categorize patients into five etiological stroke subtypes. Secular trends of minor stroke/TIA and the five ischemic stroke subtypes, represented with Lattice Plots, were analyzed using Poisson regression analysis with spline trend function. Results: Between 2002 and 2012, we identified 3,445 eligible patients. There was no decrease in minor stroke/TIA during the study period (348 patients in 2002 versus 261 patients in 2012, p=0.65 for trend). However, there was a significant increase in cardioembolic stroke/TIA, with a corresponding decrease in all other ischemic stroke subtypes. Patients in 2012 were one year younger compared to patients in 2002 (p=0.04). Discussion: Stroke mortality and major stroke incidence have decreased over time, but numbers of patients who experience a first-ever minor stroke/TIA have remained constant. With more intensive medical therapy there may have been a shift from major to minor stroke occurrence, given that more recent patients are younger than patients presenting in previous years. Further investigation is required to identify prevailing stroke risk factors in this population to decrease the burden and incidence of stroke/TIA.

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