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.

scholarly journals Concurrent intracranial and extracranial artery stenosis and the prognosis of transient ischaemic symptoms or imaging-negative ischaemic stroke

2020 ◽  
pp. svn-2020-000377
Author(s):  
Yue Suo ◽  
Jing Jing ◽  
Yuesong Pan ◽  
Weiqi Chen ◽  
Hongyu Zhou ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Cox Regression ◽  
Recurrent Stroke ◽  
Time Interval ◽  
Symptom Duration ◽  
Large Artery ◽  
Imaging Data ◽  
Vascular Events ◽  
Acute Infarction ◽  
Atherosclerotic Stenosis

Background and purposeTransient ischaemic attack (TIA), transient symptoms with infarction (TSI) and diffusion-weighted imaging (DWI)-negative acute ischaemic stroke (AIS) share similar aetiologies but are considered to have a rather benign prognosis. We intended to investigate the association between intracranial atherosclerotic stenosis (ICAS), extracranial atherosclerotic stenosis (ECAS) and the prognosis of patients with TIA, TSI and DWI-negative AIS.MethodsClinical and imaging data of eligible participants were derived from the Chinese Intracranial Atherosclerosis study, according to symptom duration, acute infarction on DWI and discharge diagnosis. Based on the severity and location of arterial atherosclerosis, we categorised the study population into four groups: no or <50% ICAS and no ECAS; ≥50% ICAS but no ECAS; no or <50% ICAS with ECAS; and concurrent ≥50% ICAS and ECAS. Using multivariable Cox regression models, we analysed the relationship between the severity and distribution of large artery atherosclerosis and the prognosis of TIA, TSI and DWI-negative AIS.ResultsA total of 806 patients were included, 67.3% of whom were male. The median age of the study participants was 63 years. Patients in the concurrent ≥50% ICAS and ECAS subgroup had both a significantly higher 1-year recurrence rate (adjusted HR 3.4 (95% CI 1.15 to 10.04), p=0.027) and a higher risk of composite vascular events (adjusted HR 3.82 (95% CI 1.50 to 9.72), p=0.005).ConclusionsConcurrent ICAS and ECAS is associated with a higher possibility of 1-year recurrent stroke or composite vascular events. Large artery evaluation is necessary to assess patients with transient ischaemic symptoms or DWI-negative AIS. Progress in shortening the time interval between symptom onset and large vessel evaluation is needed.

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 Serum Anti-NMDA (N-Methyl-D-Aspartate)-Receptor Antibodies and Long-Term Clinical Outcome After Stroke (PROSCIS-B)

Stroke ◽  
2019 ◽  
Vol 50 (11) ◽  
pp. 3213-3219 ◽  
Author(s):  
Pia S. Sperber ◽  
Bob Siegerink ◽  
Shufan Huo ◽  
Jessica L. Rohmann ◽  
Sophie K. Piper ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Odds Ratio ◽  
Vascular Event ◽  
Vascular Events ◽  
Aspartate Receptor ◽  
Hazard Ratios ◽  
Increased Risk ◽  
One Year ◽  
The Impact

Background and Purpose— NMDAR1-abs (anti-N-Methyl-D-Aspartate receptor GluN1 antibodies), predominantly known in the context of autoimmune encephalitis, have been observed in serum of healthy individuals. A previous study found smaller stroke magnetic resonance imaging lesion growth in seropositive patients, suggesting a neuroprotective effect of these antibodies. The impact of NMDAR1-abs seropositivity on long-term functional outcome and recurrent vascular events and death after first-ever stroke remains unclear. Methods— Data from the Prospective Cohort with Incident Stroke—Berlin were used. NMDAR1-abs (ie, IgM, IgA, and IgG) were measured in serum within 7 days after first stroke. Outcomes of interest included modified Rankin Scale at one year and the time-to-event of a combined end point (recurrent stroke, myocardial infarction, and all-cause mortality) within 3 years. We calculated odds ratios from adjusted partial proportional odds models and subsequently compared outcome of patients with low titers (1:10; 1:32; and 1:100), and high titers (1:320; 1:1000) to seronegative patients. Furthermore, we estimated hazard ratios for a secondary vascular event or death in NMDAR1-abs seropositive compared to seronegative patients in models adjusted for confounders. Results— The analyses included 583 patients with antibody measurements (39% female, median National Institutes of Health Stroke Scale:2, IQR:1-4), and NMDAR1-abs were observed in 76 (13%) patients. NMDAR1-abs seroprevalence was not associated with functional outcome (odds ratio=1.27; 95% CI, 0.77–2.09); sub-group analyses, however, showed worse outcome in patients with high titers (odds ratio=3.47; 95% CI, 1.54–7.80). Seropositive patients had an increased risk for a secondary vascular event or death (hazard ratios =1.83, 95% CI, 1.10–3.05). Conclusions— In our study, NMDAR1-abs seropositivity was not associated with functional outcome at one year after stroke, however, high titers (≥1:320) were associated with poor functional outcome. Furthermore, NMDAR1-abs seropositivity was associated with increased cardiovascular risk within 3 years after first stroke, independently from other risk factors. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT01363856.

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 Women and Stroke: Different, yet Similar

2021 ◽  
pp. 106-111
Author(s):  
Nandini Mitta ◽  
Sapna Erat Sreedharan ◽  
Sankara P. Sarma ◽  
Padmavathy N. Sylaja
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
South India ◽  
Stroke Severity ◽  
Sree Chitra Tirunal Institute ◽  
Large Artery ◽  
Stroke Subtype ◽  
Excellent Outcome ◽  
The Impact

<b><i>Background:</i></b> The impact of gender on acute ischemic stroke, in terms of presentation, severity, etiology, and outcome, is increasingly getting recognized. Here, we analyzed the gender-related differences in etiology and outcome of ischemic stroke in South India. <b><i>Methods:</i></b> Patients with first ever ischemic stroke within 1 week of onset presenting to the Comprehensive Stroke Care Centre, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India, were included in our study. Clinical and risk factor profile was documented. The stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at onset, and stroke subtype classification was done using Trial of Org 10172 in Acute Ischemic Stroke criteria. The 3-month functional outcome was assessed using the modified Rankin Scale (mRS) with excellent outcome defined as an mRS ≤2. <b><i>Results:</i></b> Of the 742 patients, 250 (33.7%) were females. The age, clinical profile, and rate of reperfusion therapies did not differ between the genders. Women suffered more severe strokes (mean NIHSS 9.5 vs. 8.4, <i>p</i> = 0.03). While large artery atherosclerosis was more common in men (21.3% vs. 14.8%, <i>p</i> = 0.03), cardioembolic strokes secondary to rheumatic heart disease were more common in women (27.2% vs. 19.7%, <i>p</i> = 0.02). Men had a better 3-month functional outcome compared to women (68.6% vs. 61.2%, <i>p</i> = 0.04), but was not statistically significant after adjusting for confounders. <b><i>Conclusion:</i></b> Our data, from a single comprehensive stroke unit from South India, suggest that stroke in women are different, yet similar in many ways to men. Guideline-based treatment can result in comparable short-term outcomes, irrespective of admission stroke severity.

Abstract WP183: Borderzone Infarcts Predict Early Recurrence in Patients With Large Artery Atherosclerotic Subtype Despite Medical Treatment

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Alexandra Kvernland ◽  
Shyam Prabhakaran ◽  
Pooja Khatri ◽  
Adam De Havenon ◽  
Sharon Yeatts ◽  
...  
Keyword(s):  
High Risk ◽  
Medical Treatment ◽  
Cox Regression ◽  
Recurrent Stroke ◽  
Treatment Strategies ◽  
Surrogate Marker ◽  
Early Recurrence ◽  
Large Artery ◽  
Cerebrovascular Events ◽  
Increased Risk

Introduction: Large artery atherosclerosis subtype carries a high risk of early recurrent stroke despite medical management. Predictors of recurrence remain poorly understood. We hypothesized that borderzone infarcts are associated with a higher risk of recurrence. Objectives: We aim to investigate infarct patterns and 90-day recurrence in patients with symptomatic intracranial and/or extracranial atherosclerotic disease. Methods: We included consecutive patients admitted to NYU Langone Health (Manhattan and Brooklyn campuses) over 32-months with a diagnosis of acute ischemic stroke secondary to symptomatic intracranial or extracranial atherosclerosis. The primary predictor was infarct pattern (borderzone vs. non-borderzone infarction), defined in accordance to previous studies. Borderzone infarcts were divided into internal borderzone and cortical borderzone. We used univariate and multivariable cox-regression models to determine associations between infarct pattern and recurrent cerebrovascular events (RCVE) at 90-days. Results: Fifty-five patients met the inclusion criteria; 38 were intracranial, 3 tandem, 14 extracranial. Nearly 71% of patients were treated with dual antiplatelet therapy and 96% were treated with high intensity statin. The RCVE rate was 23.6%. In multivariable models, borderzone infarcts were associated with increased risk of RCVE (adjusted HR 9.8 95% CI 2.1-44.8, p=0.003). The risk of RCVE was highest among internal borderzone infarcts (47.3%) as opposed to cortical borderzone infarcts (33.3%) or non borderzone infarcts (18.8%). Conclusions: Borderzone (and particularly internal borderzone) infarcts are a surrogate marker of impaired distal blood flow and are associated with RCVE despite medical treatment. This highlights the need to develop alternate treatment strategies for this high-risk cohort.

scholarly journals Association between insulin resistance and post-ischaemic stroke outcome in patients without diabetes: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044771
Author(s):  
Jeremiah Hadwen ◽  
Woojin Kim ◽  
Brian Dewar ◽  
Tim Ramsay ◽  
Alexandra Davis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Insulin Resistance ◽  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Stroke Outcome ◽  
Post Stroke ◽  
Meta Analyses

IntroductionInsulin resistance is an independent risk factor for atherosclerosis, coronary artery disease and ischaemic stroke. Currently, insulin resistance is not usually included in post-stroke risk stratification. This systematic review and meta-analysis intends to determine if available scientific knowledge supports an association between insulin resistance and post-stroke outcomes in patients without diabetes.Methods and analysisThe authors will conduct a literature search in Medline, Embase, Web of Science and Cochrane Central. The review will include studies that assess the association between elevated insulin homeostasis model of insulin resistance (HOMA-IR) and post-stroke outcome (functional outcome and recurrent stroke). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines will be used. The primary outcome will be post-stroke functional outcome (Modified Rankin Scale), and the secondary outcome will be recurrent ischaemic stroke. Comparison of outcome will be made between highest and lowest HOMA-IR range (as defined in each article included in this systematic review). Risk of bias will be assessed qualitatively. Meta-analysis will be performed if sufficient homogeneity exists between studies. Heterogeneity of outcomes will be assessed by I².Ethics and disseminationNo human or animal subjects or samples were/will be used. The results will be published in a peer-reviewed journal, and will be disseminated at local and international neurology conferences.PROSPERO registration numberCRD42020173608.

Abstract NS6: To Rest or Mobilize... When to Start Early Mobilization in Acute Stroke: a Systematic Review

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Michelle Whaley ◽  
Wendy Dusenbury ◽  
Andrei V Alexandrov ◽  
Georgios Tsivgoulis ◽  
Anne W Alexandrov
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Early Mobilization ◽  
Future Research ◽  
Cochrane Central Register ◽  
Large Artery ◽  
Stroke Subtype ◽  
Vascular Insufficiency ◽  
The Impact

Background: Recent nursing initiatives encourage early mobilization of neurocritical care patients, but whether this intervention can be safely generalized to acute stroke is debatable. We performed a systematic review of findings from recent studies to provide direction for patient management and future research. Methods: An exhaustive literature search was performed in Medline, SCOPUS and the Cochrane Central Register of Controlled Trials to identify published clinical trial research using a very early mobility intervention (within 24 hours) in acute ischemic stroke patients. The primary efficacy outcome supporting the search was neurologic disability reduction or improved functional outcomes, and the primary safety outcome was neurologic deterioration. Studies were critically reviewed for inclusion by 3 separate investigators, findings were synthesized, and an overall recommendation for very early mobilization use in acute stroke was assigned according to GRADE criteria. Results: We initially identified 12 papers focused on early mobilization in acute stroke; of these, 6 observational studies were excluded, 1 study was excluded due to an ambiguous population, and 3 studies were excluded due to first initial mobilization out of bed occurring greater than 24 hours after admission. Two prospective randomized outcome blinded evaluation (PROBE) studies were retained, consisting of a total 2160 patients; ischemic stroke subtype was not disclosed in either study, limiting an understanding of the impact of very early mobilization on small versus large artery occlusion. Slower mobilization occurring beyond the first 24 hours was associated with higher rates of favorable outcome (mRS 0-2) at 90 days, whereas very early mobilization within the first 24 hours was associated with a number needed to harm of 25. Conclusions: In acute stroke, evidence supports a rested approach to care within the first 24 hours of hospitalization (GRADE: Strong recommendation, high quality of evidence). Similar to acute myocardial infarction, vascular insufficiency experienced in stroke likely warrants a more guarded approach to mobility. Additional studies exploring timing beyond 24 hours and dose of mobility interventions are warranted in discreet populations.

scholarly journals Systematic Review and Meta-Analysis on the Impact of Thrombolytic Therapy in Liver Transplantation Following Donation after Circulatory Death

2018 ◽  
Vol 7 (11) ◽  
pp. 425 ◽  
Author(s):  
Kumar Jayant ◽  
Isabella Reccia ◽  
Francesco Virdis ◽  
A. Shapiro
Keyword(s):  
Liver Transplantation ◽  
Blood Transfusion ◽  
Graft Survival ◽  
Meta Analysis ◽  
Donation After Cardiac Death ◽  
Clinical Trial Registry ◽  
Increased Risk ◽  
Increasing Demand ◽  
One Year ◽  
The Impact

Aim: The livers from DCD (donation after cardiac death) donations are often envisaged as a possible option to bridge the gap between the availability and increasing demand of organs for liver transplantation. However, DCD livers possess a heightened risk for complications and represent a formidable management challenge. The aim of this study was to evaluate the effects of thrombolytic flush in DCD liver transplantation. Methods: An extensive search of the literature database was made on MEDLINE, EMBASE, Cochrane, Crossref, Scopus databases, and clinical trial registry on 20 September 2018 to assess the role of thrombolytic tissue plasminogen activator (tPA) flush in DCD liver transplantation. Results: A total of four studies with 249 patients in the tPA group and 178 patients in the non-tPA group were included. The pooled data revealed a significant decrease in ischemic-type biliary lesions (ITBLs) (P = 0.04), re-transplantation rate (P = 0.0001), and no increased requirement of blood transfusion (P = 0.16) with a better one year graft survival (P = 0.02). Conclusions: To recapitulate, tPA in DCD liver transplantation decreased the incidence of ITBLs, re-transplantation and markedly improved 1-year graft survival, without any increased risk for blood transfusion, hence it has potential to expand the boundaries of DCD liver transplantation.

scholarly journals COPD, Depression and COVID-19 Pandemic: A Harrowing, Demoralizing and Deleterious Triad

2021 ◽  
Vol 3 (8) ◽  
pp. 01-06
Author(s):  
Iqbal Akhtar Khan ◽  
Hamza Iltaf Malik
Keyword(s):  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Public Health Problem ◽  
Well Being ◽  
Care Utilization ◽  
Global Public Health ◽  
Increased Risk ◽  
Co Morbidity ◽  
Pulmonary Manifestations ◽  
The Impact

COPD is a highly incapacitating global public health problem, with pulmonary and extra-pulmonary manifestations and usually associated with significant concomitant chronic diseases. With enhanced understanding, it has extensively been reported as a complex, heterogeneous and dynamic disease affecting patients’ health beyond pulmones. Depression, with prevalence of 322 million people, is a major contributor to the overall global burden of disease. In various epidemiological and clinical studies, its prevalence among patients with COPD varies from 18% to 80%. This deadly duo leads to excessive health care utilization rates and costs including increased rates of exacerbation, sub-optimal adherence to prescribed medications, increased hospital admissions, longer hospital stays and increased hospital readmissions. Moreover, there is increased risk of suicidal ideation, suicidal attempts, and suicidal drug overdose. It is a pity that, in significant cases, the co-morbidity remains under-recognized and under-treated. The impact of prevailing COVID 19 pandemic, on the dual burden of COPD and depression, and possible remedial measures including “The 6 ways to boost one’s well-being-by Mental Heath UK, “The Living with the Times” toolkit--by WHO” and innovative add-ons like Dance Movement Therapy and Musical Engagement Therapy have been discussed.

Sign in / Sign up

Export Citation Format

Share Document