Abstract 2722: Anti-hypertensive Treatment Prolongs tPA Door-to-treatment Time: Secondary Analysis Of The Increasing Stroke Treatment Through Interventional Behavior Change Tactics (INSTINCT) Trial.

Background/Purpose: Increased time to tPA treatment is associated with worse outcomes. Thus, identifying modifiable treatment delays may improve stroke outcomes. We hypothesized that pre-thrombolytic anti-hypertensive treatment (AHT) may prolong door to treatment time (DTT). Methods: Secondary data analysis of consecutive tPA-treated patients at 24 randomly selected Michigan community hospitals in the INSTINCT trial. DTT among stroke patients who received pre-thrombolytic AHT were compared to those that did not receive pre-thrombolytic AHT. We then calculated a propensity score for the probability of receiving pre-thrombolytic AHT using a logistic regression model with covariates including demographics, stroke risk factors, antiplatelet or beta blocker as home medication, stroke severity (NIHSS), onset to door time, admission glucose, pretreatment systolic and diastolic blood pressure, EMS usage and location at time of stroke. A paired t-test was then performed to compare the DTT between the propensity matched groups. A separate generalized estimating equations (GEE) approach was also used to estimate the differences between patients receiving pre-thrombolytic AHT and those that did not while accounting for within hospital clustering. Results: A total of 557 patients were included in INSTINCT, however onset, arrival or treatment times were not able to be determined in 23, leaving 534 patients for this analysis. The unmatched cohort consisted of 95 stroke patients who received pre-thrombolytic AHT and 439 stroke patients who did not receive AHT from 2007-2010 ( table ). In the unmatched cohort, patients who received pre-thrombolytic AHT had a longer DTT (mean increase 9 minutes; 95% confidence interval (CI) 2-16 minutes) than patients who did not receive pre-thrombolytic AHT. After propensity matching (table), patients who received pre-thrombolytic AHT had a longer DTT (mean increase 10.4 minutes, 95% CI 1.9 - 18.8) than patients who did not receive pre-thrombolytic AHT. This effect persisted and its magnitude was not altered by accounting for clustering within hospitals. Conclusion: Pre-thrombolytic AHT is associated with modest delays in DTT. This represents a feasible target for physician educational interventions and quality improvement initiatives. Further research evaluating optimum hypertension management pre-thrombolytic treatment is warranted.

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A National Study of the Quantity and Cost of Informal Caregiving for the Elderly with Stroke

Stroke ◽

10.1161/str.32.suppl_1.326-b ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 326-326

Author(s):

Susan L Hickenbottom ◽

Kenneth M Langa ◽

Jeffrey S Kutcher ◽

Mohammed U Kabeto ◽

A. M Fendrick ◽

...

Keyword(s):

Informal Care ◽

Annual Cost ◽

The Elderly ◽

Informal Caregiving ◽

National Study ◽

Stroke Severity ◽

Stroke Patients ◽

Stroke Incidence ◽

Stroke Treatment ◽

The Us

56 Background: As the US population ages, increased stroke incidence will result in higher stroke-associated costs. While estimates of direct costs exist, little information is available regarding informal caregiving costs for stroke patients. Objective: To determine a nationally representative estimate of the quantity and cost of informal caregiving for elderly stroke patients. Methods: We used data from the first wave (1993) of the Asset and Health Dynamics (AHEAD) Study, a longitudinal study of people over 70 living in the community, to determine average weekly hours of informal caregiving. Multivariate and logistic regression analyses were performed to examine association of stroke and other covariates and assess the probability of receiving informal care. Average annual cost for informal caregiving was calculated. Results: Of the 7443 respondents, 656 (6%) reported a history of stroke. Of those, 375 (57%) reported stroke-related health problems (SRHP). After adjusting for cormorbid conditions, social support and sociodemographics, the proportion of patients receiving informal care increased with stroke severity, and there was a significant association of weekly hours of caregiving with stroke category (p<0.01). Using the mean 1998 wage for a home health aide ($8.20/hr.) as the value for family caregiver time, the expected yearly caregiving cost per stroke ranged from $3500 to $7600, which would result in an annual cost of more than $5.7 billion for stroke-related informal caregiving in the US. Conclusions: The economic burden of informal caregiving following stroke has not been studied previously. Informal caregiving occurs frequently; associated costs are substantial and should be considered when estimating the cost of stroke treatment.

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Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

Neurological Sciences ◽

10.1007/s10072-020-04775-x ◽

2020 ◽

Author(s):

Nishita Padmanabhan ◽

Indira Natarajan ◽

Rachel Gunston ◽

Marko Raseta ◽

Christine Roffe

Keyword(s):

National Institutes Of Health ◽

University Hospital ◽

Stroke Severity ◽

Stroke Patients ◽

Stroke Treatment ◽

Patient Demographics ◽

The United Kingdom ◽

Significant Difference ◽

Ischaemic Attack ◽

Provision Of Care

Abstract Introduction The coronavirus disease (COVID-19) pandemic has changed routine clinical practice worldwide with major impacts on the provision of care and treatment for stroke patients. Methods This retrospective observational study included all patients admitted to the Royal Stoke University Hospital in Stoke-on-Trent, UK, with a stroke or transient ischaemic attack between March 15th and April 14th, 2020 (COVID). Patient demographics, characteristics of the stroke, treatment details and logistics were compared with patients admitted in the corresponding weeks in the year before (2019). Results There was a 39.5% (n = 101 vs n = 167) reduction in admissions in the COVID cohort compared with 2019 with more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) 7 vs 4, p = 0.02), and fewer strokes with no visible acute pathology (21.8 vs 37.1%, p = 0.01) on computed tomography. There was no statistically significant difference in the rates of thrombolysis (10.9 vs 13.2%, p = 0.72) and/or thrombectomy (5.9 vs 4.8%, p = 0.90) and no statistically significant difference in time from stroke onset to arrival at hospital (734 vs 576 min, p = 0.34), door-to-needle time for thrombolysis (54 vs 64 min, p = 0.43) and door-to-thrombectomy time (181 vs 445 min, p = 0.72). Thirty-day mortality was not significantly higher in the COVID year (10.9 vs 8.9%, p = 0.77). None of the 7 stroke patients infected with COVID-19 died. Conclusions During the COVID-19 pandemic, the number of stroke admissions fell, and stroke severity increased. There was no statistically significant change in the delivery of thrombolysis and mechanical thrombectomy and no increase in mortality.

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Faktor Faktor Risiko terjadinya Pneumonia pada Stroke Akut di RSUP Dr Hasan Sadikin Bandung

Jurnal Neuroanestesi Indonesia ◽

10.24244/jni.v10i3.269 ◽

2021 ◽

Vol 10 (3) ◽

pp. 151-161

Author(s):

Novi Fatni Muhafidzah ◽

◽

Sobaryati Mansur ◽

Emmy Hermiyanti Pranggono ◽

Yusuf Wibisono ◽

...

Keyword(s):

Risk Factors ◽

Infarct Size ◽

Acute Stroke ◽

Primary Data ◽

Neurogenic Pulmonary Edema ◽

Stroke Severity ◽

Stroke Patients ◽

Anterior Circulation ◽

Stroke Treatment ◽

Large Infarct

Risk Factors of Pneumonia in Acute Stroke at Hasan Sadikin Hospital Bandung Abstract Background and Objective:Pneumonia is the most common non neurological complications in acute stroke (22%) that increase mortality rate, length of stay and hospitalization cost. It is necessary to identified risk factors for pneumonia including neurogenic pulmonary edema (NPE) for better prevention and early intervention. The purpose of this study is to determine risk factors of pneumonia (including NPE) in acute stroke patients at Hasan Sadikin General Hospital Bandung. Subject and Methods: Prospective observational descriptive study, consecutive sampling method, during September – October 2019. Primary data collected from acute stroke patients such as stroke severity, type, location and size of stroke, treatment during hospitalizataion, comorbidities (including NPE). Pneumonia was diagnosed based on Central for Disease Control Prevention (CDC) criteria, NPE based on Davison criteria. Results: 30 patients (28.3%) with pneumonia in acute stroke patients. Pneumonia were commonly found in NGT insertion (90%), dysphagia (64,71%), total anterior circulation infarct (TACI) (61,54%), large infarct size (61,54%), GCS 9-12 (50%) and NIHSS 16-20 (50%). NPE only found in 6,60% acute stroke patients, 57,14% of them developed pneumonia. Conclusions: Pneumonia in acute stroke patients is more often found in NGT insertion, dysphagia, TACI location, large infarct size, lower GCS and more severe stroke degree.

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Abstract P875: Disparities in Delivery of Endovascular Therapy: Data From the Florida State Registry

Stroke ◽

10.1161/str.52.suppl_1.p875 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Nastajjia Krementz ◽

Kefeng Wang ◽

Carolina M Gutierrez ◽

Antonio Bustillo ◽

Nils H Mueller ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Therapy ◽

Treatment Time ◽

Time Window ◽

Systems Of Care ◽

Multivariable Analysis ◽

South Florida ◽

Stroke Patients ◽

Stroke Treatment ◽

High Volume Hospital

Background: Access to endovascular therapy (EVT) should be equitable to all eligible ischemic stroke patients presenting within the treatment time window. In the Florida Stroke Registry (FSR) we sought to determine sex, race/ethnic, hospital and regional disparities in the delivery of EVT. Methods: From January 2010 to January 2020, a total of 99,088 ischemic stroke cases within 24 hours of symptom onset were enrolled. Multivariable logistic regression with generalized estimating equations evaluated independent predictors of EVT utilization. Results: A total of 7,812 patients received EVT (51.2% female, mean age 71.3 ± SD 14.6 years, 61.4% white, 17.4% black, 21.2% Hispanic). Compared to those not treated, EVT treated patients were more likely Hispanic (21.2% vs. 14.6%), arrived earlier to the hospital (median 120 min (IQR 292) vs. 170 min (IQR 446)), via EMS (94% vs. 66%), with more severe strokes (median NIHSS 15 (IQR11) vs. 5 (IQR 9)), to large hospitals (≥ 680 beds) (73.4% vs. 47.7%), in South Florida (50.8% vs. 38.2%). In multivariable analysis, female sex (OR 1.05, 95% CI 1-1.11), atrial fibrillation (OR 1.57, 95% CI 1.45-1.7), higher NIHSS (> 6) (OR 6.19, 95% CI 5.11-7.51) and presenting to a high-volume hospital (OR 3.47, 95% CI 2.25-5.36) positively predicted EVT utilization, whereas older age (>80 years) (OR 0.88, 95% CI 0.80-0.96), and black race (vs. white OR 0.87, 95% CI 0.76-1), were independently associated with lower use of EVT. Conclusions: In this large state-wide registry study, we found significant race-ethic and geographical disparities in delivery of EVT. Systems of care should address disparities in stroke treatment to improve access to EVT for all eligible stroke patients.

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Endovascular therapy for ischemic stroke

Neurology ◽

10.1212/wnl.0000000000003981 ◽

2017 ◽

Vol 88 (22) ◽

pp. 2123-2127 ◽

Cited By ~ 51

Author(s):

Atte Meretoja ◽

Mahsa Keshtkaran ◽

Turgut Tatlisumak ◽

Geoffrey A. Donnan ◽

Leonid Churilov

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Treatment Time ◽

Prediction Interval ◽

Stroke Severity ◽

Vessel Occlusion ◽

Treatment Delays ◽

Mr Clean

Objective:To quantify the patient lifetime benefits gained from reduced delays in endovascular therapy for acute ischemic stroke.Methods:We used observational prospective data of consecutive stroke patients treated with IV thrombolysis in Helsinki (1998–2014; n = 2,474) to describe distributions of age, sex, stroke severity, onset-to-treatment times, and 3-month modified Rankin Scale (mRS) in routine clinical practice. We used treatment effects by time of endovascular therapy in large vessel occlusion over and above thrombolysis as reported by the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) study to model the shift in 3-month mRS distributions with reducing treatment delays. From the 3-month outcomes we derived patient-expected lifetimes and cumulative long-term disability with incremental treatment delay reductions.Results:Each minute saved in onset-to-treatment time granted on average 4.2 days of extra healthy life, with a 95% prediction interval 2.3–5.4. Women gained slightly more than men due to their longer life expectancies. Patients younger than 55 years with severe strokes of NIH Stroke Scale score above 10 gained more than a week per each minute saved. In the whole cohort, every 20 minutes decrease in treatment delays led to a gain of average equivalent of 3 months of disability-free life.Conclusions:Small reductions in endovascular delays lead to marked health benefits over patients' lifetimes. Services need to be optimized to reduce delays to endovascular therapy.

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Estonian young stroke registry: High burden of risk factors and high prevalence of cardiomebolic and large-artery stroke

European Stroke Journal ◽

10.1177/23969873211040990 ◽

2021 ◽

pp. 239698732110409

Author(s):

Riina Vibo ◽

Siim Schneider ◽

Liisa Kõrv ◽

Sandra Mallene ◽

Liisi-Anette Torop ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Young Patients ◽

Stroke Severity ◽

Large Artery ◽

Stroke Patients ◽

Stroke Registry ◽

Young Stroke ◽

Stroke Risk Factors ◽

High Prevalence

Background and aims The aim of the present study was to assess the risk factor burden and stroke etiology of young stroke patients in Estonia and to compare the results with similar cohorts from other countries. Methods This study includes ischemic stroke patients aged 18–54 years from the prospective Estonian Young Stroke Registry between 2013 and 2020. All patients were managed in a stroke unit following a prespecified detailed protocol. Data on stroke risk factors, etiology, and stroke severity were analyzed. Results A total of 437 patients (mean age 44.7 ± 8.3 years; 62% males) were included in the registry during the 8-year study period. A total of 50.2% of patients had ≥ 3 well-documented risk factors (higher for men: odds ratio (OR) 3.8; 95% cardiac index confidence interval (CI) 1.8–8.3; p < .001) and 6.2% of patients had ≥ 3 less well-documented risk factors. While 42% of patients had undetermined cause of stroke (34% of them cryptogenic), the second most frequent etiologies were large-artery atherosclerosis and cardioembolism (both 19%). 60 percent of cardioembolic strokes were due to high-risk causes. Large-artery atherosclerosis was more prevalent in men (OR 1.8; 95% CI 1–3.3; p = .05) and among older patients (OR 6.2; 95% CI 1.8–21.4; p = .008). The median National Institutes of Health Stroke Scale score on admission was 3 (interquartile ranges 2–6), stroke was more severe in men ( p = .05). Conclusions Our study revealed that young patients with stroke in Estonia have higher burden of well-documented risk factors, higher prevalence of high-risk cardioembolic causes and higher prevalence of large-artery stroke compared to other young stroke cohorts.

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Effects of Glycemic Gap on Post-Stroke Cognitive Impairment in Acute Ischemic Stroke Patients

Brain Sciences ◽

10.3390/brainsci11050612 ◽

2021 ◽

Vol 11 (5) ◽

pp. 612

Author(s):

Minwoo Lee ◽

Jae-Sung Lim ◽

Yerim Kim ◽

Ju Hun Lee ◽

Chul-Ho Kim ◽

...

Keyword(s):

Ischemic Stroke ◽

Cognitive Impairment ◽

Acute Ischemic Stroke ◽

Sex Education ◽

Cognitive Domain ◽

P Value ◽

Stroke Severity ◽

Stroke Patients ◽

Stroke Treatment ◽

Post Stroke

Background: Post-stroke hyperglycemia is a frequent finding in acute ischemic stroke patients and is associated with poor functional and cognitive outcomes. However, it is unclear as to whether the glycemic gap between the admission glucose and HbA1c-derived estimated average glucose (eAG) is associated with post-stroke cognitive impairment (PSCI). Methods: We enrolled acute ischemic stroke patients whose cognitive functions were evaluated three months after a stroke using the Korean version of the vascular cognitive impairment harmonization standards neuropsychological protocol (K-VCIHS-NP). The development of PSCI was defined as having z-scores of less than −2 standard deviations in at least one cognitive domain. The participants were categorized into three groups according to the glycemic gap status: non-elevated (initial glucose − eAG ≤ 0 mg/dL), mildly elevated (0 mg/dL < initial glucose − eAG < 50 mg/dL), and severely elevated (50 mg/dL ≤ initial glucose − eAG). Results: A total of 301 patients were enrolled. The mean age was 63.1 years, and the median National Institute of Health Stroke Scale (NIHSS) score was two (IQR: 1–4). In total, 65 patients (21.6%) developed PSCI. In multiple logistic regression analyses, the severely elevated glycemic gap was a significant predictor for PSCI after adjusting for age, sex, education level, initial stroke severity, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and left hemispheric lesion (aOR: 3.65, p-value = 0.001). Patients in the severely elevated glycemic gap group showed significantly worse performance in the frontal and memory domains. Conclusions: In conclusion, our study demonstrated that an elevated glycemic gap was significantly associated with PSCI three months after a stroke, with preferential involvement of frontal and memory domain dysfunctions.

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Influence of Renal Function on Treatment Results after Stroke Thrombectomy

Cerebrovascular Diseases ◽

10.1159/000481147 ◽

2017 ◽

Vol 44 (5-6) ◽

pp. 351-358 ◽

Cited By ~ 8

Author(s):

Mona Laible ◽

Markus Alfred Möhlenbruch ◽

Johannes Pfaff ◽

Ekkehart Jenetzky ◽

Peter Arthur Ringleb ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Multivariate Regression ◽

Stroke Severity ◽

Stroke Patients ◽

Anterior Circulation ◽

Stroke Treatment ◽

Poor Outcome ◽

Increased Risk

Background: Renal dysfunction (RD) may be associated with poor outcome in ischemic stroke patients treated with mechanical thrombectomy (MT), but data concerning this important and emerging comorbidity do not exist so far. Here, we investigated the influence of RD on postprocedural intracerebral hemorrhage (ICH), clinical outcome, and mortality in a large prospectively collected cohort of acute ischemic stroke patients treated with MT. Methods: Consecutive patients with anterior-circulation stroke treated with MT between October 2010 and January 2016 were included. RD was defined as glomerular filtration rate (GFR) <60 mL/min/1.73 m2. In a prospective database, clinical characteristics were recorded and brain images were analyzed for the presence of ICH after treatment in all patients. Clinical outcome was assessed by the modified Rankin Scale (mRS) after 3 months. To evaluate associations between clinical factors and outcomes uni- and multivariate regression analyses were conducted. Results: In total, 505 patients fulfilled all inclusion criteria (female: 49.7%, mean age: 71.0 years). RD at admission was present in 20.2%. RD patients were older and had cardiovascular risk factors more often. Multivariate regression analysis after adjustment for age, stroke severity, diabetes, hypertension, GFR, previous stroke, MT alone, or additional thrombolysis and recanalization results revealed that lower GFR was not independently associated with poor outcome (mRS 3-6; OR 1.13, 95% CI 0.99-1.28; p = 0.072) or ICH. However, lower GFR at admission was associated with a higher risk of mortality (OR 1.15, 95% CI 1.01-1.31; p = 0.038). Compared to admission, GFR values were higher at discharge (mean: 77.9 vs. 80.8 mL/min/1.73 m2; p = 0.046). Conclusions: We did not find evidence for an association of lower GFR with an increased risk of poor outcome and ICH, but lower GFR was a determinant of 90-day mortality after endovascular stroke treatment. Our findings encourage also performing MT in this relevant subgroup of acute ischemic stroke patients.

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The Effect of Self-Efficacy Based Education on the Daily Care of Stroke Patients and its Implications with Counseling

KONSELI Jurnal Bimbingan dan Konseling (E-Journal) ◽

10.24042/kons.v8i2.9221 ◽

2021 ◽

Vol 8 (2) ◽

pp. 241-250

Author(s):

Rizaldi Nanda Wiguna ◽

Kiking Ritarwan ◽

Nur Asnah Sitohang ◽

M. Harwansyah Putra Sinaga

Keyword(s):

Motor Skills ◽

Self Efficacy ◽

Self Care ◽

Secondary Data ◽

Skills Training ◽

Educational Interventions ◽

Control Group ◽

P Value ◽

Stroke Patients ◽

Daily Care

Stroke patients generally experience daily self-care disorders due to old age (elderly), so that motor skills are low. One factor affecting the ability to take care of oneself every day and be motivated to be independent is self-efficacy. The purpose of this study was to analyze the effect of self-efficacy-based education on the daily self-care of stroke patients at the Haji Adam Malik General Hospital and its implications with counselling guidance. The type of research used is a quasi-experimental design using the nonequivalent control group pre- post-test only design method. The population in this study were all ischemic stroke patients at Haji Adam Malik Hospital Medan and a sample of 36 people. Researchers provided educational interventions based on self-efficacy using visual media, discussions, motor skills training, and occupational exercises for three meetings per week with a duration of 30 minutes each session for six weeks. Data collection with primary and secondary data and analyzed by statistical test Paired Sample t-Test. The results showed an effect of self-efficacy-based education on the daily care of stroke patients at Haji Adam Malik Hospital Medan (p-value = 0.000 0.05) such as motor function and improving their daily activities.

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Abstract 157: No Need To Exclude Diabetics From Thrombolysis: Diabetic And Non-diabetic Stroke Patients Profit Equally Well. Report From The Austrian National Stroke Unit Registry

Stroke ◽

10.1161/str.43.suppl_1.a157 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Michael Brainin ◽

Karl Matz ◽

Yvonne Teuschl ◽

Beate Reindl ◽

Leonhard Seyfang ◽

...

Keyword(s):

Stroke Unit ◽

Recurrent Stroke ◽

Outcome Data ◽

National Database ◽

Stroke Severity ◽

Thrombolytic Treatment ◽

Stroke Patients ◽

Stroke Risk Factors ◽

The Difference ◽

Nation Wide Survey

Background: Diabetes has been known to be a predictor for poor outcome after thrombolysis in stroke patients, and early poststroke glycaemia is known to be associated with higher rates of postthrombolytic symptomatic intracerebral haemorrhages. Therefore, diabetic stroke patients are often excluded from thrombolytic treatment. Up to now comparisons exist only from clinical trials (e.g. VISTA collaboration) and registry data of thrombolysed paients (e.g. SITS registry). No nation-wide data have been investigated for the outcomes of thrombolysis in diabetics and non-diabetics. Methods: National database of the Austrian Stroke Unit Registry, 2003-2010 , comprising 34 acute stroke units, comparison of outcome data of thrombolysed and non-thrombolysed diabetic and non-diabetic stroke. Stratification according to sex, age, stroke severity, functional impairment before stroke and recurrent stroke to non-thrombolysed diabetic strokes and to non-diabetic thrombolysed and non-thrombolysed controls. Improvement was defined as the difference between stroke severity at admission and at discharge. Results: A modelled cohort of 1,988 r-tPA thrombolysed diabetic stroke patients from 13,246 ischaemic stroke patients were compared according to sex, age, stroke severity, and prestroke disability. A regression model with improvement as depending variable and age, sex, stroke severity, aetiology of stroke, risk factors (including diabetes) and treatment (including thrombolysis) found no effect of diabetes (p=0.854) or the interaction diabetes x thrombolysis (p=0.277), whereas the effect of thrombolysis itself was highly significant (p=0.0001). No differences were found in the number of symptomatic intracerebral haemorrhages after thrombolytic treatment between diabetic strokes (5.2%) and non-diabetic strokes (4.0%). Both groups had a higher risk of intracerebral haemorrhages compared to the non-thrombolysed groups (diabetic 2.9%, non-diabetic 2.6%). Conclusion: Data from this nation-wide survey show that diabetic stroke patients have a substantial benefit from thrombolysis and therefore diabetic strokes should not be excluded from thrombolysis treatment.

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