Healthcare costs of post‐stroke oropharyngeal dysphagia and its complications: malnutrition and respiratory infections

Spontaneous swallowing contributes to airway protection and depends on the activation of brainstem reflex circuits in the central pattern generator (CPG). We studied the effect of age and gender on spontaneous swallowing frequency (SSF) in healthy volunteers and assessed basal SSF and TRPV1 stimulation effect on SSF in patients with post-stroke oropharyngeal dysphagia (OD). The effect of age and gender on SSF was examined on 141 healthy adult volunteers (HV) divided into three groups: GI—18–39 yr, GII—40–59 yr, and GIII—>60 yr. OD was assessed by the Volume–Viscosity Swallowing Test (VVST). The effect of sensory stimulation with capsaicin 10−5 M (TRPV1 agonist) was evaluated in 17 patients with post-stroke OD, using the SSF. SSF was recorded in all participants during 10 min using surface electromyography (sEMG) of the suprahyoid muscles and an omnidirectional accelerometer placed over the cricothyroid cartilage. SSF was significantly reduced in GII (0.73 ± 0.50 swallows/min; p = 0.0385) and GIII (0.50 ± 0.31 swallows/min; p < 0.0001) compared to GI (1.03 ± 0.62 swallows/min), and there was a moderate significant correlation between age and SFF (r = −0.3810; p < 0.0001). No effect of gender on SSF was observed. Capsaicin caused a strong and significant increase in SSF after the TRPV1 stimulation when comparing to basal condition (pre-capsaicin: 0.41 ± 0.32 swallows/min vs post-capsaicin: 0.81 ± 0.51 swallow/min; p = 0.0003). OD in patients with post-stroke OD and acute stimulation with TRPV1 agonists caused a significant increase in SSF, further suggesting the potential role of pharmacological stimulation of sensory pathways as a therapeutic strategy for CPG activation in patients with OD.

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Economic evaluations of health care interventions in Oropharyngeal Dysphagia after Stroke: Protocol for a Systematic Review.

10.21203/rs.3.rs-376486/v1 ◽

2021 ◽

Author(s):

Sergio Marin ◽

Mateu Serra-Prat ◽

Omar Ortega ◽

Pere Clavé

Keyword(s):

Systematic Review ◽

Economic Evaluation ◽

Cost Effectiveness ◽

Oropharyngeal Dysphagia ◽

Cost Savings ◽

Economic Evaluations ◽

Stroke Patients ◽

Post Stroke ◽

Healthcare Interventions ◽

The Cost

Abstract Background and purpose: Oropharyngeal Dysphagia (OD) affects 40-81% of patients after stroke. A recent systematic review on the costs of OD and it’s main complications showed higher acute and long-term costs for those patients who developed OD, malnutrition and pneumonia after stroke. These results suggest that appropriate management of post-stroke OD could lead to reduction of clinical complications and significant cost savings. The purpose of this systematic review is to assess the available literature exploring the efficiency or cost-effectiveness of available healthcare interventions on the appropriate management of OD. Methods: A systematic review on economic evaluations of health care interventions on post-stroke patients with OD following PRISMA recommendations will be performed. MEDLINE, Embase, the National Health Service Economic Evaluation Database and the Cost-Effectiveness Analysis Registry Database will be searched and a subsequent reference check will be done. English and Spanish literature will be included without date restrictions. Studies will be included if they refer to economic evaluations or studies in which cost savings were reported in post-stroke patients suffering OD. Studies will be excluded if they are partial economic evaluation studies, if they refer to esophageal dysphagia, or if OD is caused by causes different from stroke. Evidence will be presented and synthetized with a narrative method and using tables. Quality evaluation will be done using Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement. Discussion: The protocol for this systematic review is the first step to assess the cost-effectiveness of the healthcare interventions that have been described as potential treatments for post-stroke OD. This systematic review will summarize the current evidence on the relation between cost and benefits associated with the appropriate management of OD in post-stroke patients. Systematic review registration: PROSPERO CRD42020136245

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Application of a simple point-of-care test to reduce UK healthcare costs and adverse events in outpatient acute respiratory infections

Journal of Medical Economics ◽

10.1080/13696998.2020.1736872 ◽

2020 ◽

Vol 23 (7) ◽

pp. 673-682 ◽

Cited By ~ 1

Author(s):

John E. Schneider ◽

Catharina Boehme ◽

Bettina Borisch ◽

Sabine Dittrich

Keyword(s):

Adverse Events ◽

Healthcare Costs ◽

Respiratory Infections ◽

Point Of Care ◽

Acute Respiratory Infections ◽

Simple Point ◽

Point Of Care Test

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First year post-stroke healthcare costs and fall-status among those discharged to the community

European Stroke Journal ◽

10.1177/2396987318764954 ◽

2018 ◽

Vol 3 (3) ◽

pp. 254-262 ◽

Cited By ~ 4

Author(s):

Mary E Walsh ◽

Jan Sorensen ◽

Rose Galvin ◽

David JP Williams ◽

Joseph A Harbison ◽

...

Keyword(s):

Healthcare Costs ◽

Linear Regression Analysis ◽

Tertiary Care ◽

Future Research ◽

First Year ◽

Stroke Severity ◽

Living Situation ◽

Post Stroke ◽

Recurrent Falls ◽

Utilisation Data

Introduction Falls are common post-stroke events but their relationship with healthcare costs is unclear. The aim of this study was to examine the relationship between healthcare costs in the first year after stroke and falls among survivors discharged to the community. Patients and methods Survivors of acute stroke with planned home discharges from five large hospitals in Ireland were recruited. Falls and healthcare utilisation data were recorded using inpatient records, monthly calendars and post-discharge interviews. Cost of stroke was estimated for each participant from hospital admission for one year. The association of fall-status with overall cost was tested with multivariable linear regression analysis adjusting for pre-stroke function, stroke severity, age and living situation. Results A total of 109 stroke survivors with complete follow-up data (mean age = 68.5 years (SD = 13.5 years)) were included. Fifty-three participants (49%) fell following stroke, of whom 28 (26%) had recurrent falls. Estimated mean total healthcare cost was €20,244 (SD=€23,456). The experience of one fall and recurrent falls was independently associated with higher costs of care (p = 0.02 and p < 0.01, respectively). Discussion The observed relationship between falls and cost is likely to be underestimated as aids and adaptions, productivity losses, and nursing home care were not included. Conclusion This study points at differences across fall-status in several healthcare costs categories, namely the index admission, secondary/tertiary care (including inpatient re-admissions) and allied healthcare. Future research could compare the cost-effectiveness of inpatient versus community-based fall-prevention after stroke. Further studies are also required to inform post-stroke bone-health management and fracture-risk reduction.

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Oropharyngeal Dysphagia in Older Patients

10.1007/978-3-030-63892-4_18 ◽

2021 ◽

pp. 225-235

Author(s):

Lina Spirgienė ◽

Rebecca Lindhe ◽

Gytė Damulevičienė

Keyword(s):

Older Adults ◽

Healthcare Costs ◽

Older Patients ◽

Oropharyngeal Dysphagia ◽

Hydration Status ◽

Speech Language Pathologist ◽

Nutrition And Hydration ◽

Adverse Influence ◽

Management Of Dysphagia

AbstractDysphagia in older adults can have a profound adverse influence nutrition and hydration status, quality of life, morbidity, mortality and healthcare costs in adults. Identification and management of dysphagia in older adults are most effective when implemented by a team, including a nurse, physician, speech-language pathologist, dietitian and occupational therapist. However, each professional’s role may vary according to the standards, responsibilities and resources available in local settings.

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Sensory Neuromodulation Protocol for the Treatment of Post-stroke Oropharyngeal Dysphagia.

Case Medical Research ◽

10.31525/ct1-nct04052178 ◽

2019 ◽

Author(s):

Keyword(s):

Oropharyngeal Dysphagia ◽

Post Stroke

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Prevalence, Risk Factors, and Complications of Oropharyngeal Dysphagia in Older Patients with Dementia

Nutrients ◽

10.3390/nu12030863 ◽

2020 ◽

Vol 12 (3) ◽

pp. 863 ◽

Cited By ~ 5

Author(s):

Mᵃ Carmen Espinosa-Val ◽

Alberto Martín-Martínez ◽

Mercè Graupera ◽

Olivia Arias ◽

Amparo Elvira ◽

...

Keyword(s):

Risk Factors ◽

Older Patients ◽

Respiratory Infections ◽

Oropharyngeal Dysphagia ◽

Therapeutic Effects ◽

Fluid Viscosity ◽

Volume Viscosity ◽

Texture Modification ◽

Prospective Longitudinal

The prevalence of older patients with dementia and oropharyngeal dysphagia (OD) is rising and management is poor. Our aim was to assess the prevalence, risk factors, and long-term nutritional and respiratory complications during follow-up of OD in older demented patients. We designed a prospective longitudinal quasi-experimental study with 255 patients with dementia. OD was assessed with the Volume-Viscosity Swallowing Test and a geriatric evaluation was performed. OD patients received compensatory treatments based on fluid viscosity and texture modified foods and oral hygiene, and were followed up for 18 months after discharge. Mean age was 83.5 ± 8.0 years and Alzheimer’s disease was the main cause of dementia (52.9%). The prevalence of OD was 85.9%. Up to 82.7% patients with OD required fluid thickening and 93.6% texture modification, with poor compliance. OD patients were older (p < 0.007), had worse functionality (p < 0.0001), poorer nutritional status (p = 0.014), and higher severity of dementia (p < 0.001) than those without OD and showed higher rates of respiratory infections (p = 0.011) and mortality (p = 0.0002) after 18 months follow-up. These results show that OD is very prevalent among patients with dementia and is associated with impaired functionality, malnutrition, respiratory infections, and increased mortality. New nutritional strategies should be developed to increase the compliance and therapeutic effects for this growing population of dysphagic patients.

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The impact of post-stroke complications on in-hospital mortality depends on stroke severity

European Stroke Journal ◽

10.1177/2396987316681872 ◽

2016 ◽

Vol 2 (1) ◽

pp. 54-63 ◽

Cited By ~ 7

Author(s):

Alejandro Bustamante ◽

Dolors Giralt ◽

Teresa García-Berrocoso ◽

Marta Rubiera ◽

José Álvarez-Sabín ◽

...

Keyword(s):

Ischemic Stroke ◽

Random Forest ◽

Hospital Mortality ◽

Brain Edema ◽

Respiratory Infections ◽

National Institutes Of Health ◽

Stroke Severity ◽

Stroke Patients ◽

Post Stroke ◽

The Impact

Introduction Controversies remain on whether post-stroke complications represent an independent predictor of poor outcome or just a reflection of stroke severity. We aimed to identify which post-stroke complications have the highest impact on in-hospital mortality by using machine learning techniques. Secondary aim was identification of patient’s subgroups in which complications have the highest impact. Patients and methods Registro Nacional de Ictus de la Sociedad Española de Neurología is a stroke registry from 42 centers from the Spanish Neurological Society. Data from ischemic stroke patients were used to build a random forest by combining 500 classification and regression trees, to weight up the impact of baseline characteristics and post-stroke complications on in-hospital mortality. With the selected variables, a logistic regression analysis was performed to test for interactions. Results 12,227 ischemic stroke patients were included. In-hospital mortality was 5.9% and median hospital stay was 7(4–10) days. Stroke severity [National Institutes of Health Stroke Scale > 10, OR = 5.54(4.55–6.99)], brain edema [OR = 18.93(14.65–24.46)], respiratory infections [OR = 3.67(3.02–4.45)] and age [OR = 2.50(2.07–3.03) for >77 years] had the highest impact on in-hospital mortality in random forest, being independently associated with in-hospital mortality. Complications have higher odds ratios in patients with baseline National Institutes of Health Stroke Scale <10. Discussion Our study identified brain edema and respiratory infections as independent predictors of in-hospital mortality, rather than just markers of more severe strokes. Moreover, its impact was higher in less severe strokes, despite lower frequency. Conclusion Brain edema and respiratory infections were the complications with a greater impact on in-hospital mortality, with the highest impact in patients with mild strokes. Further efforts on the prediction of these complications could improve stroke outcome.

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Efeitos da Terapia da Fala em Pacientes Internados com Disfagia Pós-Acidente Cerebrovascular: Revisão Sistemática de Estudos Observacionais

Acta Médica Portuguesa ◽

10.20344/amp.9183 ◽

2017 ◽

Vol 30 (12) ◽

pp. 870 ◽

Cited By ~ 1

Author(s):

Joice Santos Andrade ◽

Wagner Walter Oliveira de Jesus Souza ◽

Luiz Renato Paranhos ◽

Danielle Ramos Domenis ◽

Carla Patrícia Hernandez Alves Ribeiro César

Keyword(s):

Early Intervention ◽

Recovery Time ◽

Speech Therapy ◽

Oropharyngeal Dysphagia ◽

Control Group ◽

Loss To Follow Up ◽

Post Stroke ◽

Swallowing Rehabilitation ◽

Hospital Bed

Introduction: Since dysphagia may be one of the brain post-stroke consequences, the objective of this study was to analyze the average recovery time of patients with cerebrovascular accident and dysphagia subjected to speech therapy in a hospital bed.Material and Methods: Systematic review performed following the ‘Preferred Reporting Items is Systematic Reviews and MetaAnalyses’ instructions. The search was performed in different electronic databases, without restriction of time and language. The studies were evaluated regarding their methodological quality.Results: Of 5671 titles, five studies were included. 176 patients with stroke and dysphagia were obtained (aged between 22 and 91 years old – average: 68.95), with no preference regarding gender. Improvement occurred in 84.26% of the subjects and the recovery time was between one and ninety days (average: 22 days). Randomization, blinding, loss to follow-up and withdrawal were not performed with control group in any study.Discussion: The success of rehabilitation of oropharyngeal dysphagia as a post-stroke sequela will depend on the extent, location of the neurological lesion and early intervention in the hospital bed. Despite the recognition of health professionals about the importance of swallowing rehabilitation for these patients, there is a lack of studies that support an evidence-based practice, although the results point to improvements in this regard.Conclusion: Speech therapy in hospital bed in post-stroke hospitalized patients with dysphagia seems to bring satisfactory results in the short-term, revealing the importance of diagnosis and early intervention in these cases.

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