The effects of atrial fibrillation on functional recovery in post-stroke patients

2001 ◽  
Vol 23 (5) ◽  
pp. 204-208 ◽  
Author(s):  
Salvatore Giaquinto, Ida Ferrara, Riccardo Mu
Keyword(s):  
Atrial Fibrillation ◽  
Functional Recovery ◽  
Stroke Patients ◽  
Post Stroke

Benefits of antidepressant treatment after a stroke

2017 ◽  
Vol 41 (S1) ◽  
pp. S315-S315 ◽  
Author(s):  
O. Zerriaa ◽  
O. Moula ◽  
S. Ben Saadi ◽  
I. Jelalia ◽  
R. Ghachem
Keyword(s):  
Functional Recovery ◽  
Cognitive Skills ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Antidepressant Therapy ◽  
Motor Deficit ◽  
Stroke Patients ◽  
Double Blind ◽  
Post Stroke ◽  
Post Stroke Depression

IntroductionStroke is an important cause of morbidity and is responsible for 9% of all deaths worldwide. The most frequent neuropsychiatric consequence of stroke is post-stroke depression (PSD). It has been shown to be associated with both impaired recovery and increased mortality. The aim of our study is to determine the benefits of antidepressant prescription after a stroke.MethodThe databases from Medline and PubMed were reviewed for articles related to post-stroke depression (PSD), antidepressant treatment and stroke, post-stroke depression and functional recovery, stroke related impairment.ResultsAntidepressant drugs have been shown to be effective in treating PSD in six double blind randomized studies. Patients treated with antidepressants had better recovery from disability than patients who did not receive antidepressant therapy: it was proved that antidepressant drugs cause an improvement in cognitive skills and functional recovery in PSD patients. In patients with ischemic stroke and moderate to severe motor deficit, the early prescription of fluoxetine with physiotherapy enhanced motor recovery after 3 months. Some studies showed that PSD can be effectively prevented: nortriptyline, fluoxetine, milnacipran and sertraline appeared to be efficacious in preventing depression after stroke and are to use without significant adverse effects in stroke patients.ConclusionAntidepressant treatment plays an increasing role in the management of patients with acute stroke. Therefore, early initiation of antidepressant therapy, in non-depressed stroke patients, may reduce the odds for development of PSD, and improve cognitive and functional recovery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Abstract WP379: Sex-specific Effects of Comorbid Diabetes and Depression on Post-stroke Mortality in Individuals With Atrial Fibrillation

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jodi Edwards ◽  
Jessica Colby-Milley ◽  
Jiming Fang ◽  
Limei Zhou ◽  
Baiju R Shah ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
Comorbid Depression ◽  
Term Care ◽  
Post Stroke ◽  
Specific Effects ◽  
Long Term Mortality

Background: Comorbid diabetes and depression are highly prevalent in atrial fibrillation (AF) and increase the risk of stroke. Women with AF show higher mortality rates and have worse functional outcomes post-stroke. However, the sex-specific effects of comorbid diabetes and depression on mortality and other adverse outcomes in stroke patients with a history of AF is unclear. Methods: Prospectively collected consecutive patients with ischemic stroke and known AF presenting to designated stroke centres in Ontario (2003-2013). Multinomial regression was used to determine sex-specific associations between diabetes and depression and in-hospital mortality post-stroke in individuals with AF. Cox proportional hazards regression was used to estimate the adjusted hazard of long-term mortality post-stroke and competing risks models to estimate hazards of recurrent stroke/TIA, admission to long-term care, and incident dementia post-discharge. Results: Among 5082 stroke patients with known AF (median age=80, IQR:73-85), female patients were more likely to have comorbid depression than males (63.5% vs. 36.5%) and those with comorbid diabetes and depression were younger (77 yrs) and had more vascular history (HTN, CAD, hyperlipidemia) than those with AF only. For males, comorbid diabetes increased the likelihood of in-hospital mortality post-stroke by 53% (OR=1.53, 95% CI=1.16-2.02), after adjustment for stroke severity, demographic and clinical factors, while comorbid depression did not significantly impact in-hospital mortality and neither diabetes or depression affected in-hospital mortality post-stroke for females. However, diabetes was independently associated with increased hazard of long-term mortality for both female (HR=1.15, 95%CI=1.02-1.29) and male AF stroke patients (HR=1.35, 95%CI=1.19-1.53). No associations with recurrent stroke/TIA, institutionalization or dementia post-stroke were observed for either females or males. Conclusion: In stroke patients with known AF, comorbid diabetes but not depression was independently associated with increased in-hospital mortality for males and increased long-term mortality post-stroke for both females and males.

scholarly journals Secondary Prevention Post Stroke in Primary Care in an Asian Setting: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Vivek Bansal ◽  
Eng Sing Lee ◽  
Helen Smith
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Primary Care ◽  
Secondary Prevention ◽  
Retrospective Cohort ◽  
Care Setting ◽  
Primary Care Setting ◽  
Stroke Patients ◽  
Factors Associated ◽  
Post Stroke

Abstract Background: Stroke is one of the top contributors to burden of disability-adjusted life-years worldwide. Family physicians have key role in optimal secondary prevention post-stroke helping patients make appropriate lifestyle changes and take medication in accordance with the recommended clinical practice guidelines.Methods: Our aim was to characterize the profile of patients who were being managed in primary care setting for secondary prevention of stroke. Our specific objectives were: (i) to examine the level of overall and individual risk factors control after an index-stroke event in patients visiting the primary care setting and (ii) to describe the factors associated with the achievement of overall risk factors control in post-stroke patients.Study Design: Retrospective cohort study.We conducted a study looking retrospectively at records from our electronic chronic disease database. Our study included post-stroke patients who visited public primary care setting in Singapore between 1st January 2012 to 31st December 2016. Based on AHA Stroke guidelines, we operationalized our outcome of secondary prevention post-stroke as overall control, which comprised of patients having blood pressure, lipids, and glucose reading (for those who had diabetes) all well-controlled. We conducted descriptive analysis and performed multivariable logistic analysis to determine factors associated with overall control.Results: There were 24,240 patients in our study. Overall control was better in post-stroke patients without diabetes (49.2%) as compared to those with diabetes (28.1%).Among post-stroke patients without diabetes, factors significantly associated with overall control were sex [OR: 1.23, 95% CI: 1.10, 1.39], ethnicity [OR: 0.72, 95% CI: 0.58, 0.90], BMI [OR: 0.72, 95% CI: 0.62, 0.84) and atrial fibrillation [OR: 1.47, 95% CI: 1.21, 1.78].Among post-stroke patients with diabetes, factors significantly associated with overall control were sex [OR: 1.28, 95% CI: 1.12, 1.46], ethnicity, BMI, atrial fibrillation[OR: 1.24; 95% CI: 1.02, 1.51], chronic kidney disease and smoking status.Conclusion: We reported a sub-optimal level of overall control. Among post-stroke patients, those with diabetes had a higher proportion of sub-optimal control as compared to those without diabetes. Irrespective of diabetic status, being female, having high BMI, and of Malay ethnicity were associated with poor overall control compared to Chinese.

Abstract TP323: Does Serum Level Of Sex Hormones Before Rehabilitation Predict Functional Recovery In Elderly Post-stroke Patients?

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Ryo Momosaki ◽  
Masahiro Abo ◽  
Wataru Kakuda
Keyword(s):  
Serum Level ◽  
Sex Hormones ◽  
Functional Recovery ◽  
Testosterone Level ◽  
Free Testosterone ◽  
Serum Levels ◽  
Stroke Patients ◽  
Post Stroke ◽  
Male Patients ◽  
Free Testosterone Level

Background: Sex hormone is recognized as a critical factor affecting physical function in the elderly. However, the influence of these hormones on functional recovery after stroke has not been studied in elderly patients. The objective of the study was to examine whether serum level of sex hormones before rehabilitation can predict clinical outcome in elderly post-stroke patients. Subjects and Methods: Seventy-on post-stroke hemiparetic patients who were hospitalized to our rehabilitation ward in their subacute-chronic phase, were subjected (age: 78 ± 6 years, period between onset and admission: 47 ± 31 days). On their admission, serum levels of dehydroepiandrosterone sulfate (DHEA-S) and free testosterone (only in male patients) were measured after an overnight fast. As functional measures, NIHSS and functional Independence Measure (FIM) were evaluated at their admission and discharge. We assessed the correlation between changes in serum levels of measured hormones and functional changes during hospitalization. Results: Neither DHEA-S nor free testosterone levels at admission correlated with the severity of stroke at admission. In male patients, significant positive correlation was found between free testosterone level at admission and FIM at discharge (r=0.31, p<0.05), although there was not significant correlation between DHEA-S level at admission and FIM change. Furthermore, the results of multivariate analysis showed that free testosterone level at admission significantly predicted the rate of FIM change during hospitalization in male patients. Conclusions: Serum level of free testosterone at the admission to rehabilitation ward can be a predictor of functional recovery in elderly male patients after stroke.

scholarly journals B-PO02-045 UTILITY OF A SMARTPHONE CONNECTED ELECTROCARDIOGRAM RECORDER FOR DETECTING ATRIAL FIBRILLATION IN POST-STROKE PATIENTS

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S114
Author(s):  
Ayan Abdrakhmanov ◽  
Idalya Rakhimova ◽  
Zhanasyl Suleymen ◽  
Zhanar Abdrakhmanova
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Patients ◽  
Post Stroke

scholarly journals Functional recovery of post stroke patients with hemiparesis after stroke of different aetiology

2012 ◽  
Vol 65 (3-4) ◽  
pp. 158-162 ◽  
Author(s):  
Milan Mandic
Keyword(s):  
Functional Recovery ◽  
Total Sample ◽  
Medical Rehabilitation ◽  
Left Hemiparesis ◽  
Physical Medicine ◽  
Stroke Patients ◽  
Barthel Index Score ◽  
Post Stroke ◽  
Physical Medicine And Rehabilitation ◽  
The City

Introduction. Medical rehabilitation focuses on improvement of functional recovery in post stroke patients. The aim of the work was to analyze functional recovery in a cohort of post stroke patients with hemiparesis three months after stroke. Material and Methods. A prospective, cohort study included 30 patients from the city of Nis aged 40 to 69. The study was conducted at the Department of Physical Medicine and Rehabilitation in Nis from March 1 to June 30, 2009. The aetiology of stroke was determined by the nuclear magnetic resonance. The average values, standard deviation, and t-test were calculated. Results. Of the total sample of 30 patients, 23 (77%, 16 men and 7 women) had left hemiparesis and 7 (23%, 4 men and 3 women) had right hemiparesis. The average age of the patients was 58.93? 6.86. Fourteen (47%) patients were not able to move, 10 (33%) patients could move when they were assisted by someone and only 6 (20%) patients could move independently. Twenty-six (88%) patients were not able to take care of themselves without assistance and 4 (13%) patients could take care of themselves. The average Barthel Index score on admission to the Department of Physical Medicine and Rehabilitation was 57 and 3 months after discharge it was 79; the determined difference was statistically significant (p<0.01). At the end of the study, 57% of all the patients could walk without assistance. Conclusion. These results suggest that disabled post stroke patients may attain significant functional improvements in response to early rehabilitation as well as to prolonged rehabilitation therapy.

scholarly journals Non-invasive markers of liver fibrosis and outcome in large vessel occlusion stroke

2021 ◽  
Vol 14 ◽  
pp. 175628642110372
Author(s):  
Simon Fandler-Höfler ◽  
Rudolf E. Stauber ◽  
Markus Kneihsl ◽  
Gerit Wünsch ◽  
Melanie Haidegger ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Liver Fibrosis ◽  
Intracranial Hemorrhage ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Post Stroke ◽  
Non Invasive

Background: Liver fibrosis has been identified as an outcome predictor in cardiovascular disease and has been associated with hematoma expansion and mortality in patients with primary intracerebral hemorrhage. We aimed to explore whether clinically inapparent liver fibrosis is related to neurological outcome, mortality, and intracranial hemorrhage risk in ischemic stroke patients after mechanical thrombectomy. Methods: We included consecutive patients with anterior circulation large vessel occlusion stroke treated at our center with mechanical thrombectomy between January 2011 and April 2019. Clinical data had been collected prospectively; laboratory data were extracted from our electronic hospital information system. We calculated the Fibrosis-4 index (FIB-4), an established non-invasive liver fibrosis test. The main outcomes were postinterventional intracranial hemorrhage, unfavorable functional status (modified Rankin scale scores of 3–6), and mortality three months post-stroke. Results: In the 460 patients (mean age 69 years, 49.3% female) analyzed, FIB-4 indicated advanced liver fibrosis in 22.6%. Positive FIB-4 was associated with unfavorable neurological outcomes and mortality three months post-stroke, even after correction for co-factors [Odds Ratio (OR) 2.15 for unfavorable outcome in patients with positive FIB-4, 95% confidence interval (CI) 1.21–3.83, p = 0.009, and 2.16 for mortality, 95% CI 1.16–4.03, p = 0.01]. However, FIB-4 was neither related to hemorrhagic transformation nor symptomatic intracranial hemorrhage. Moreover, atrial fibrillation was more frequent in patients with liver fibrosis ( p < 0.001). Two further commonly-used liver fibrosis indices (Forns index and the Easy Liver Fibrosis Test) yielded comparable results regarding outcome and atrial fibrillation. Conclusions: Clinically inapparent liver fibrosis (based on simple clinical and laboratory parameters) represents an independent risk factor for unfavorable outcomes, including mortality, at three months after stroke thrombectomy. Elevated liver fibrosis indices warrant further hepatological work-up and thorough screening for atrial fibrillation in stroke patients.

scholarly journals Functional recovery in post-stroke patients on hemodialysis during the convalescent phase: a comparison with those not undergoing hemodialysis

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Takeki Ishida ◽  
Kenichi Kono ◽  
Yuusuke Nishida ◽  
Masahiro Yoshida
Keyword(s):  
Functional Recovery ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Hemodialysis Patients ◽  
Stroke Patients ◽  
Post Stroke ◽  
Rehabilitation Hospital ◽  
Convalescent Phase ◽  
The Difference ◽  
Impaired Motor Function

Abstract Background Low physical fitness is often found in patients undergoing hemodialysis. It may be possible that the recovery of impaired motor function with rehabilitative training might be affected when the patient is on hemodialysis. So far, however, no researcher has clinically investigated this issue in post-stroke patients. The purpose of this study is to clarify the difference of functional recovery during the convalescent phase between post-stroke patients with and without hemodialysis. Methods A cohort of 82 post-stroke hemiparetic patients who were admitted to our rehabilitation hospital, were subjected. On the day of admission and discharge, some clinical parameters including Functional Independence Measure (FIM) and Functional Ambulation Category (FAC) were evaluated for each patient. The changes during the hospitalization and the values at the discharge in these parameters were statistically compared between the patients with and without hemodialysis. Results The FIM motor score at the discharge was significantly lower in hemodialysis patients than non-hemodialysis patients (64.7 ± 21.2 points in hemodialysis patients and 81.8 ± 28.0 points in non-hemodialysis patients, p < 0.05). In addition, the frequency of FAC at the discharge of ≥ 3 was significantly lower in hemodialysis patients than non-hemodialysis patients (40.0% in hemodialysis patients and 72.2% in non-hemodialysis patients, p < 0.05). Conclusion In patients undergoing hemodialysis seem to experience a worse functional recovery during the convalescent phase compared to those not undergoing hemodialysis. We might have to modify the rehabilitative program during the convalescent phase after stroke if the patient was on hemodialysis.

scholarly journals 86 Haemorrhagic Stroke: What's in a Bleed?

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Imelda Noone ◽  
Mary Kate Meagher ◽  
Naomi Davey ◽  
Diarmuid O'Shea ◽  
Tim Cassidy
Keyword(s):  
Atrial Fibrillation ◽  
Intracerebral Haemorrhage ◽  
Haemorrhagic Stroke ◽  
Amyloid Angiopathy ◽  
Stroke Patients ◽  
Post Stroke ◽  
Significant Difference ◽  
History Of ◽  
Cerebral Amyloid

Abstract Background Intracerebral haemorrhage (ICH) accounts for approximately 20% of all strokes and is a leading cause of disability and mortality. The distribution of the ICH(Lobar v Deep) may be explained by the two major aetiologies of ICH, Cerebral Amyloid Angiopathy (CAA) versus hypertensive (HBP) respectively. The aim of our study was to look at outcomes of lobar versus deep ICH stroke patients. Methods We analyzed data of all ICH’s admitted in 2018 using SPSS. Demography, classification of haemorrhage, hypertension, atrial fibrillation (AF) and anticoagulation history, pre and post stroke Rankin and subsequent outcome were analyzed. Results 373 acute strokes were admitted of which 66(18%) were ICH. Mean age was 73yrs (52-93) and 50% were male. On neuroradiology imaging, 40(60%) were lobar and 26(39%) were deep. Lobar haemorrhages were significantly more likely to be older (p = 0.0001) however, there was no significant difference in pre-stroke Rankin. Post stroke the lobar haemorrhages had both a worse outcome from disability (p = 0.005) and mortality (p = 0.0001). 17(26%) patients with a ICH also had AF with 94% were on an oral anticoagulant(OAC).17.5% of the lobar bleeds were on an OAC versus 36% of the deep ICH. Of the lobar bleeds on OAC none died versus 4 of the deep ICH (p = .001). In total, 48(72%) of patients had a history of hypertension, but only 34(51%) were on HBP medication on admission. Conclusion There were a greater proportion of patients with lobar versus deep bleeds in our cohort which may be due to the older population in our area. Mortality and disability was far greater in the lobar cohort. None of the lobar bleeds with AF who were on OAC died in contrast to the deep ICH patients. This may suggest that more aggressive hypertensive treatment is required in this subpopulation.

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