Anticoagulant Therapy in Initially Low‐Risk Patients With Nonvalvular Atrial Fibrillation Who Develop Risk Factors

Background The CHA 2 DS 2 ‐VASc score has been validated for stroke risk prediction in patients with atrial fibrillation (AF). Antithrombotic therapy is not recommended for low‐risk patients with AF (CHA 2 DS 2 ‐VASc 0 [male] or 1 [female]). We studied a cohort of initially low‐risk patients with AF in relation to their development of incident comorbidities and their treatment on oral anticoagulation therapy. Methods and Results We assessed data from 14 441 low‐risk patients with AF (CHA 2 DS 2 ‐VASc score of 0 [male] or 1 [female]) using the Korean National Health Insurance Service database, in relation to their development of incident stroke risk factors and adverse outcomes. The clinical end point was the occurrence of ischemic stroke, major bleeding, all‐cause death, or the composite outcome (ischemic stroke + major bleeding + all‐cause death). In our cohort, 2615 (29.1%) male and 1650 (30.3%) female patients acquired at least 1 new stroke risk factor during a mean follow‐up of 2.0 years. Among the patients with an increasing CHA 2 DS 2 ‐VASc score ≥1, male and female patients treated with oral anticoagulants had a significantly lower risk of ischemic stroke (male: hazard ratio [HR], 0.62 [95% CI, 0.44–0.82; P =0.003]; female: HR, 0.65 [95% CI, 0.47–0.84; P =0.007]), all‐cause death (male: HR, 0.67 [95% CI, 0.49–0.88; P =0.009]; female: HR, 0.82 [95% CI, 0.63–1.02; P =0.185]), and composite outcomes (male: HR, 0.78 [95% CI, 0.61–0.95; P =0.042]; female: HR, 0.79 [95% CI, 0.62–0.96; P =0.045]) than patients not treated with oral anticoagulants. Conclusions Approximately 30% of patients acquired ≥1 stroke risk factor over a 2‐year follow‐up period. Low‐risk patients with AF should be regularly reassessed to adequately identify those with incident stroke risk factors that would merit thromboprophylaxis for the prevention of stroke and the composite outcome.

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Abstract WMP95: A Transition of Care Program to Reduce Stroke Related Hospital Readmissions

Stroke ◽

10.1161/str.48.suppl_1.wmp95 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Heather Khan ◽

Hebah M Hefzy

Keyword(s):

Risk Factors ◽

Readmission Rate ◽

Stroke Risk ◽

Community Hospital ◽

Hospital Readmissions ◽

Care Program ◽

Transition Of Care ◽

Stroke Risk Factors ◽

Risk Patients

Introduction: Readmission to the hospital after discharge following a stroke or TIA remains a nation-wide problem. While the CMS national benchmark was approximately 12% in 2015, our hospital Medicare stroke readmission rate rose from approximately 12% at the end of 2014 to 28.6% in February 2015. Our goal was a reduction in stroke readmission rates to below the national benchmark of 12% by December 2015. Hypothesis: We hypothesized that implementing a transition of care program at our 200 bed community hospital would reduce hospital stroke-related readmissions. Methods: In March 2015, a random sample of forty stroke/TIA patients that were discharged home between December of 2014 and February of 2015 were interviewed. The patients were asked about barriers to discharge, what could have improved the discharge experience, and what problems they encountered that could have resulted in a readmission. Based on their answers, risk factors were identified using an inverse Pareto graph and a transition of care program was implemented which included the following work flow: 1) daily rounding to query patients regarding insight into stroke risk factors, environmental concerns, and social impacts to discharge in the stroke unit by the stroke coordinator (a registered nurse); 2) a discharge telephone call within two business days to high risk patients identified during rounds focusing on review of the discharge summary, re-education regarding stroke risk factors, and ensuring that follow-up appointments were in place; 3) an outpatient follow-up appointment with a board certified vascular neurologist within two weeks of discharge. Results: Our transition of care program resulted in an improvement of 82.5%, with a Medicare stroke re-admission rate of 5% in December 2015. As of May 2016, our year-to-date hospital stroke readmission rate is 8.1%, while the current CMS national average is 12.7%. Conclusions: A transition of care program is implementable in a community hospital setting, and results in reduced stroke-related hospital readmissions. Its success emphasizes the importance of identifying high risk patients and assessing individual drivers of readmission risk.

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The Risk of Stroke Using CHA2 DS2 -VASc Score in Hemodialysis Patients at a Tertiary Hospital in Riyadh, Saudi Arabia

Journal of Clinical Review & Case Reports ◽

10.33140/jcrc.04.07.01 ◽

2019 ◽

Vol 4 (7) ◽

Keyword(s):

Risk Factors ◽

High Risk ◽

Stroke Risk ◽

Hemodialysis Patients ◽

Low Risk ◽

High Risk Patients ◽

Stroke Risk Factors ◽

Increased Risk ◽

Risk Patients ◽

History Of

Introduction: Patients undergoing hemodialysis are at increased risk of stroke. However, less known about the impact of some of the stroke risk factors, and the value of stroke risk scores in determining the risk in those patients. Our main goal. To assess the risk factors for stroke in hemodialysis patients and the use of the new CHA2DS2-VASc score for stroke assessment. Methods: Single center, retrospective cohort study of 336 patients undergoing hemodialysis from June 24, 2018, to September 6, 2018, was recruited. Baseline demographics, clinical, and laboratory data were collected. We calculated the CHA2 DS2 -VASc score for stroke assessment in all patients and categorized them into high, moderate and low risk patients according to CHA2 DS2 - VASc score and subcategorized them to two groups atrial fibrillation (AFib) and Non- Atrial fibrillation (Non AFib) patients. Results: 336 patients were included in our study; the majority of patients were at high risk with a CHA2 DS2 -VASc Score mean of 2.9± 1.5, although history of stroke was observed only in 15 patients (4.46%). According to CHA2 DS2 - VASc score, 280 patients were at high risk, 172 (51.19%) were high-risk patients on treatment (anticoagulant or antiplatelet) and 108(32.14%) patients were high risk patients not on treatment 48 were at moderate risk (14.28%) and 8 were at low risk (2.38 %). Patients were divided into subgroups as non-AFib and AFib. In non-AFib patients 320 (95.23%), high-risk patients 103 (32.18%) were not treated; high-risk patients with treatment are 162 (50.62%), moderate patients were 47 (14.68%), 8(2.5%) was in low risk. AFib patients were 16 with a mean CHA2 DS2 -VASc score of 4.4±1.1. Patients with AFib were all at high risk except 1 was at moderate risk (6.25%). There were 11 (68.75%) patients on treatment and 5 (31.25%) patients not on treatment. The risk factors for stroke that were statistically significant in increasing score risk for all patients were: age > 65 (95% CI, -2.04– -1.29; p = 0.000), being female (95% CI, -1.36– -0.68; p = 0.000) hypertension (95% CI, -2.59– -1.37; p = 0.000), diabetes (95% CI, -2.10– -1.50; p = 0.000), CVD (95% CI, -2.07– -1.24; p=0.000), history of stroke or TIA (95% CI, -3.70– -2.03; p = 0.000), CHF or LVEF (95% CI, -2.28– - 0.91; p = 0.000). Conclusions: The risk of stroke in hemodialysis patients is significant according to the use of CHA2 DS2 -VASc score in Non-AFib hemodialysis patients shows supportive evidence of increased risk of stroke in those patients, which suggest the importance of close monitoring of patients with stroke risk factors by the nephrologist and the stroke team which will lead to the initiation of early prophylaxis in those patients.

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Non-valvular atrial fibrillation patients with none or one additional risk factor of the CHA2DS2-VASc score

Thrombosis and Haemostasis ◽

10.1160/th15-07-0565 ◽

2015 ◽

Vol 114 (10) ◽

pp. 826-834 ◽

Cited By ~ 70

Author(s):

Flemming Skjøth ◽

Peter Nielsen ◽

Torben Bjerregaard Larsen ◽

Gregory Lip

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Additional Risk Factor ◽

Stroke Risk Factor ◽

Stroke Risk Factors ◽

Long Run ◽

One Year ◽

Net Clinical Benefit

SummaryOral anticoagulation (OAC) to prevent stroke has to be balanced against the potential harm of serious bleeding, especially intracranial haemorrhage (ICH). We determined the net clinical benefit (NCB) balancing effectiveness and safety of no antithrombotic therapy, aspirin and warfarin in AF patients with none or one stroke risk factor. Using Danish registries, we determined NCB using various definitions intrinsic to our cohort (Danish weights at 1 and 5 year follow-up), with risk weights which were derived from the hazard ratio (HR) of death following an event, relative to HR of death after ischaemic stroke. When aspirin was compared to no treatment, NCB was neutral or negative for both risk strata. For warfarin vs no treatment, NCB using Danish weights was neutral where no risk factors were present and using five years follow-up. For one stroke risk factor, NCB was positive for warfarin vs no treatment, for one year and five year follow-up. For warfarin vs aspirin use in patients with no risk factors, NCB was positive with one year follow-up, but neutral with five year follow-up. With one risk factor, NCB was generally positive for warfarin vs aspirin. In conclusion, we show a positive overall advantage (i.e. positive NCB) of effective stroke prevention with OAC, compared to no therapy or aspirin with one additional stroke risk factor, using Danish weights. ‘Low risk’ AF patients with no additional stroke risk factors (i.e. CHA2DS2-VASc 0 in males, 1 in females) do not derive any advantage (neutral or negative NCB) with aspirin, nor with warfarin therapy in the long run.Note: The review process for this manuscript was fully handled by Christian Weber, Editor in Chief.

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Incident Co-Morbidities in Patients with Atrial Fibrillation Initially with a CHA2DS2-VASc Score of 0 (Males) or 1 (Females): Implications for Reassessment of Stroke Risk in Initially ‘Low-Risk’ Patients

Thrombosis and Haemostasis ◽

10.1055/s-0039-1683933 ◽

2019 ◽

Vol 119 (07) ◽

pp. 1162-1170 ◽

Cited By ~ 16

Author(s):

Tze-Fan Chao ◽

Jo-Nan Liao ◽

Ta-Chuan Tuan ◽

Yenn-Jiang Lin ◽

Shih-Lin Chang ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Adverse Events ◽

Ischaemic Stroke ◽

Stroke Risk ◽

Temporal Trends ◽

Low Risk ◽

Stroke Risk Factor ◽

Timing Interval ◽

Risk Patients

Background Oral anticoagulants (OACs) are not recommended for ‘low-risk’ patients with atrial fibrillation (AF). We investigated the incidences of new risk factors developing, and the temporal trends in the CHA2DS2-VASc score in initially ‘low-risk’ AF patients. Second, we propose a reasonable timing interval at which stroke risk should be reassessed for such AF patients. Methods We studied 14,606 AF patients who did not receive anti-platelet agents or OACs with a baseline CHA2DS2-VASc score of 0 (males) or 1 (females). The CHA2DS2-VASc scores of patients were followed up and updated until the occurrence of ischaemic stroke or mortality or 31 December 2011. The associations between the prescription of warfarin and risk of adverse events once patients' scores changed were analysed. Decile values of durations to incident co-morbidities and from the acquirement of new co-morbidities to ischaemic stroke were studied. Results During a mean follow-up of 4 years, 7,079 (48.5%) patients acquired at least one new stroke risk factor component(s) with annual risks of 6.35% for hypertension, 3.68% for age ≥ 65 years, 2.77% for heart failure, 1.99% for diabetes mellitus and 0.33% for vascular diseases. The incidence for CHA2DS2-VASc score increments was 12.1%/year. Initiation of warfarin was associated with a lower risk of adverse events (adjusted hazard ratio, 0.530; 95% confidence interval, 0.371–0.755). Among 6,188 patients who acquired new risk factors, 80% would acquire these co-morbidities after 4.2 months of AF diagnosis. The duration from the acquirement of incident co-morbidities to the occurrence of ischaemic stroke was longer than 4.4 months for 90% of the patients. Conclusion The CHA2DS2-VASc score increases in approximately 12% of initially ‘low-risk’ AF patients each year, and the initiation of warfarin once the score changed was associated with a better prognosis. Three to four months may be a reasonable timing interval at which stroke risk should be reassessed so that OACs could be prescribed in a timely manner for stroke prevention.

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Dynamic Changes of CHA2DS2-VASc Score and the Risk of Ischaemic Stroke in Asian Patients with Atrial Fibrillation: A Nationwide Cohort Study

Thrombosis and Haemostasis ◽

10.1055/s-0038-1651482 ◽

2018 ◽

Vol 118 (07) ◽

pp. 1296-1304 ◽

Cited By ~ 44

Author(s):

Minjae Yoon ◽

Pil-Sung Yang ◽

Eunsun Jang ◽

Hee Yu ◽

Tae-Hoon Kim ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Ischaemic Stroke ◽

Stroke Risk ◽

Low Risk ◽

Dynamic Changes ◽

Risk Patients ◽

Changes Over Time ◽

Over Time

Background Stroke risk in atrial fibrillation (AF) is often assessed at initial presentation, and risk stratification performed as a ‘one off’. In validation studies of risk prediction, baseline values are often used to ‘predict’ events that occur many years later. Many clinical variables have ‘dynamic’ changes over time, as the patient is followed up. These dynamic changes in risk factors may increase the CHA2DS2-VASc score, stroke risk category and absolute ischaemic stroke rate. Objective This article evaluates the ‘dynamic’ changes of CHA2DS2-VASc variables and its effect on prediction of stroke risk. Patients and Methods From the Korea National Health Insurance Service database, a total of 167,262 oral anticoagulant-naive non-valvular AF patients aged ≥ 18 years old were enrolled between January 1, 2002, and December 31, 2005. These patients were followed up until December 31, 2015. Results At baseline, the proportions of subjects categorized as ‘low’, ‘intermediate’ or ‘high risk’ by CHA2DS2-VASc score were 15.4, 10.6 and 74.0%, respectively. Mean CHA2DS2-VASc score increased annually by 0.14, particularly due to age and hypertension. During follow-up of 10 years, 46.6% of ‘low-risk’ patients and 72.0% of ‘intermediate risk’ patients were re-classified to higher stroke risk categories. Among the original ‘low-risk’ patients, annual ischaemic stroke rates were significantly higher in the re-classified ‘intermediate’ (1.17 per 100 person-years, p < 0.001) or re-classified ‘high-risk’ groups (1.44 per 100 person-years, p = 0.048) than consistently ‘low-risk’ group (0.29 per 100 person-years). The most recent CHA2DS2-VASc score and the score change with the longest follow-up had the best prediction for ischaemic stroke. Conclusion In AF patients, stroke risk as assessed by the CHA2DS2-VASc score is dynamic and changes over time. Rates of ischaemic stroke increased when patients accumulated risk factors, and were re-classified into higher CHA2DS2-VASc score categories. Stroke risk assessment is needed at every patient contact, as accumulation of risk factors with increasing CHA2DS2-VASc score translates to greater stroke risks over time.

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Abstract WP182: Trends in Acute Ischemic Stroke Hospitalizations and Risk Factors Among Young Adults: 12 Years of Nationally Representative Data

Stroke ◽

10.1161/str.48.suppl_1.wp182 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Urvish K Patel ◽

Priti Poojary ◽

Vishal Jani ◽

Mandip S Dhamoon

Keyword(s):

Risk Factors ◽

Older Adults ◽

Young Adults ◽

Ischemic Stroke ◽

Length Of Stay ◽

Acute Ischemic Stroke ◽

Stroke Risk ◽

Behavioral Risk Factors ◽

Behavioral Risk ◽

Stroke Risk Factors

Background: There is limited recent population-based data of trends in acute ischemic stroke (AIS) hospitalization rates among young adults (YA). Rising prevalence of stroke risk factors may increase stroke rates in YA. We hypothesized that 1) stroke hospitalizations and mortality among YA are increasing over time (2000-2011), 2) besides traditional stroke risk factors, non-traditional factors are associated with stroke in YA, 3) stroke hospitalization among YA is associated with higher mortality, length of stay (LOS), and cost. Methods: In the Nationwide Inpatient Sample database (years 2000-2011), adult hospitalizations for AIS and concurrent diagnoses were identified by ICD-9-CM codes; the analytic cohort constituted all AIS hospitalizations. We performed weighted analysis using chi-square, t-test, and Jonckheere trend test. Multivariable survey regression models evaluated interactions between age group (18-45 vs. >45 years) and traditional and non-traditional risk factors, with outcomes including mortality, LOS, and cost. Models were adjusted for race, sex, Charlson’s Comorbidity Index, primary payer, location and teaching status of hospital, and admission day. Results: Among 5220960 AIS hospitalizations, 231858 (4.4%) were YA. On trend analysis, proportion of YA amongst AIS increased from 3.6% in 2000 to 4.7% in 2011 (p<0.0001) but mortality in YA decreased from 3.7% in 2000 to 2.6% in 2011, compared to 7.1% in 2000 to 4.6% in 2011 (p<0.0001) among older adults. Non-traditional, especially behavioral, risk factors were more common among YA, and LOS and cost were higher (Table). Conclusion: There was a trend for higher proportion of YA among AIS hospitalizations, though there was a decreasing mortality trend over 10 years. Behavioral risk factors were more common among YA, and there was an increased length of stay and cost. AIS in YA may require different preventive approaches compared to AIS among older adults.

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Abstract T P153: Women and Men with Ischemic Stroke in SiGN Have Different Subtype Distributions and Risk Factors

Stroke ◽

10.1161/str.45.suppl_1.tp153 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Kathryn M Rexrode ◽

Braxton D Mitchell ◽

Kathleen A Ryan ◽

Steven J Kittner ◽

Hakan Ay ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Stroke Risk ◽

Cardioembolic Stroke ◽

Relative Distribution ◽

Large Artery ◽

Stroke Risk Factors ◽

Stroke Subtypes ◽

Small Artery Occlusion ◽

Ischemic Stroke Risk

Introduction: The relative distribution of stroke risk factors, as well as ischemic stroke subtypes, in women compared with men is not well described. Hypothesis: We hypothesized that the distribution of ischemic stroke risk factors and subtypes would differ by sex, with a later onset in women and greater proportion of comorbidities. Methods: The NINDS Stroke Genetics Network (SiGN) consortium was established to evaluate genetic risk factors for ischemic stroke. A total of 23 separate studies performed Causative Classification of Stroke (CCS) typing using standardized criteria on ischemic stroke cases and contributed data on risk factors. We compared the distribution of ischemic stroke risk factors and CCS phenotypes between men and women with ischemic stroke. Results: Of the 16,228 ischemic strokes in SiGN, 8005 (49.3%) occurred in women. Median age at stroke was older in female than male stroke cases (73 vs. 66 years) (p=<0.0001). Among stroke cases, women were more likely than men cases to have hypertension or atrial fibrillation and less likely to have diabetes or coronary artery disease, or to smoke (p <0.003 for all). The distribution of stroke subtypes also differed by sex, with women less likely than men to have large artery infarction and small artery occlusion, and more likely to have cardioembolic stroke and undetermined stroke due to incomplete work-up (p values all <0.0001; see Table). Results were similar when the distribution of stroke subtypes was examined for those <70 years and ≥70 years, except for cardioembolic stroke remaining more common only among women ≥70. Conclusions: In this large group of carefully phenotyped ischemic strokes, the distribution of ischemic stroke subtypes and risk factor profiles differ significantly by sex. Evaluation of the causes of these differences may highlight areas for improved prevention and risk reduction in both genders.

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Abstract WP328: A Nurse-Led Initiative Improves Adherence Rates for Stroke Follow-up and Blood Pressure Management

Stroke ◽

10.1161/str.44.suppl_1.awp328 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Darren T Larsen ◽

Helmi L Lutsep

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Stroke Prevention ◽

Stroke Risk ◽

Retention Rates ◽

Matched Cohort ◽

Stroke Patients ◽

Stroke Risk Factor ◽

Chi Square Analysis

Background and Issues Aggressive management of vascular risk factors reduces stroke rates. It is unknown whether structured nurse-led follow up increases adherence rates for stroke patients after hospital discharge. Purpose The purpose of this program is to improve secondary stroke risk factor management by instituting a nurse-led initiative called Stroke Therapy, Education, Prevention (STEP). Methods The pilot STEP program was based on protocols used for other stroke prevention trials. This nurse-led program includes inpatient initiation and outpatient maintenance of pharmacologic and lifestyle goals for stroke patients. Eligible patients have a non-disabling ischemic stroke or TIA and are without insurance restrictions and live within a distance allowing return to clinic for follow up. Prior to discharge, the STEP nurse completes patient education, and reviews outpatient goals. The STEP nurse makes phone contact with the patient 7-10 days after discharge to review medication compliance and reinforce education. At 30 days post discharge patients are seen in clinic by the STEP nurse where a resting blood pressure (BP) is measured. If the patient does not meet targets (<140 SBP or <130 SBP for DM) medications are adjusted by a stroke neurologist. We undertook a retrospective chart review of a consecutive cohort of patients matched to STEP eligibility criteria to determine whether the program improved retention rates and BP management. Chi-Square analysis was used to compare visit adherence and percentage achieving goal BPs at 30 days. Results In the STEP group 25/32(78%) patients completed the 30 day follow up compared to 14/32 (44%) patients in the historical matched cohort (p=0.0048). Target BP was achieved in 13/25(52%) STEP patients and 5/14 (36%) matched cohort patients (p=0.32) returning to clinic. Overall, target BP was achieved in 13/32 (41%) and 5/32 (16%) respectively (p=0.026). Conclusions In conclusion, follow up adherence and BP management in the group as a whole was better in the nurse-led model and is recommended for secondary stroke prevention. Long term follow up with this model may further increase in-target rates of BP control and other stroke risk factors.

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Abstract WP345: Stroke Risk Factors Screening and Education: A Regional Strategy to Address Stroke Prevalence and Mortality in Eastern North Carolina

Stroke ◽

10.1161/str.44.suppl_1.awp345 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Terry M Congleton ◽

Cristine W Small ◽

Susan D Freeman

Keyword(s):

Risk Factors ◽

North Carolina ◽

Stroke Risk ◽

Stroke Mortality ◽

Transient Ischemia ◽

Stroke Risk Factor ◽

Stroke Risk Factors ◽

Regional Collaboration ◽

Stroke Prevalence ◽

Eastern North Carolina

Background: Eastern North Carolina (ENC) stroke mortality is 12 percent higher than the rest of the state. Often, geographical and sociological barriers prevent people residing in our rural communities from seeking routine health care. Stroke risk factors are known. The purpose of this initiative is to reduce the stroke prevalence and mortality in ENC through community risk factors screening and education. Methods: Medical center volunteers’ staff the screening and volunteer hours are recorded in a community benefit database. Each participant completes a standardized evidenced based assessment. Information collected at each screening includes demographic data, cardiovascular history, knowledge of stroke/transient ischemia signs and symptoms. Clinical metrics obtained are finger stick for random lipid panel and blood glucose, body mass index, hip to waist ratio and carotid bruit screen. Based on the screening results, education, recommendations and referrals are reviewed with every participant. Results: From 2007-2010 the screening volume doubled. In 2011, there was a reduction in screening volume as our system hospitals expanded their community stroke outreach efforts. Approximately 4900 community screenings have been conducted from 2007-2011. Elevated blood pressure and cholesterol respectively are most frequently occurring stroke risks factor found, which is consistent with national trends. Stroke mortality has decreased in the region while transient ischemia attack admissions volume has increased at our certified primary stroke center and regional referral center. Conclusions: In conclusion, primary and secondary prevention through community outreach education, risk factors screening and regional collaboration has made a difference. The region has seen a decrease in stroke prevalence and mortality in ENC. Further reduction is necessary to continue to make an even greater impact. Future directions for the stroke risk factor identification screening is to further integrate community efforts and seeks grant opportunities to establish stroke prevention and management clinics throughout the region.

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Abstract WP236: The Urban-Rural Divide: Risk Factor Prevalence in Ischemic Stroke Patients Across Two Decades

Stroke ◽

10.1161/str.51.suppl_1.wp236 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Dinesh V Jillella ◽

Sara Crawford ◽

Anne S Tang ◽

Rocio Lopez ◽

Ken Uchino

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Regression Models ◽

Stroke Risk ◽

Stroke Patients ◽

Stroke Risk Factor ◽

Risk Factor Prevalence ◽

Urban Rural ◽

Artery Disease

Introduction: Regional disparities exist in stroke incidence and stroke related mortality in the United States. We aimed to elucidate the stroke risk factor prevalence trends based on urban versus rural location. Methods: From the National Inpatient Sample database the comorbid stroke risk factors were collected among hospitalized ischemic stroke patients during 2000-2016. Crude and age-and sex-standardized prevalence estimates were calculated for each risk factor during the time periods 2000-2008 and 2009-2016. We compared risk factor prevalence over the defined time periods using regression models, and differences in risk factor trends based on patient location categorized as urban (metropolitan with population of ≥ 1 million) and rural (neither micropolitan or metropolitan) using interaction terms in the regression models. Results: Stroke risk factor prevalence significantly increased from 2000-2008 to 2009-2016. When stratified based on patient location, most risk factors increased in both urban and rural groups. In the crude model, the urban to rural trend difference across 2000-08 and 2009-16 was significant in hypertension (p<0.0001), hyperlipidemia (p=0.0008), diabetes mellitus (p<0.0001), coronary artery disease (p<0.0001), smoking (p<0.0001) and alcohol (p=0.02). With age and sex standardization, the urban to rural trend difference was significant in hypertension (p<0.0001), hyperlipidemia (p=0.0007), coronary artery disease (p=0.01) and smoking (p<0.0001). Conclusion: The prevalence of vascular risk factors among ischemic stroke patients has increased over the last two decades. There exists an urban-rural divide, with rural patients showing larger increases in prevalence of several risk factors compared to urban patients.

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