Abstract W MP72: Sleep and Timing of Recurrent Events in a Mild Stroke Population: Results of the SWIFT Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Eric Roberts ◽  
Leigh Quarles ◽  
Veronica Torrico ◽  
Bernadette Boden-Albala
Keyword(s):  
Recurrent Events ◽  
Sleep Problems ◽  
Recurrent Stroke ◽  
Recurrent Event ◽  
P Value ◽  
Shortness Of Breath ◽  
Vascular Events ◽  
Cox Models ◽  
Stroke Population ◽  
Index 2

Sleep is an important contributor to cardiovascular disease; we have previously reported it is a risk factor for incident vascular events. It is thought that sleep apena may be the primary mechanism through which sleep disturbance is associated with vascular events. Little is known, however, about the association between sleep and recurrent events. The aim of this analysis was to determine the association between sleep problems and the risk of recurrent vascular events in an elderly, multiethnic population. This analysis uses data from SWIFT, a randomized clinical trial conducted in northern Manhattan designed to test a stroke preparedness intervention. Sleep was measured with the MOS sleep scale. MOS is a 12 item questionnaire that produces 8 validated scales. We report results using the snoring (1 question), shortness of breath during sleep (1 question), and sleep problem index 2 (9 questions) scales. Outcomes were collected prospectively through active surveillance. We used Cox Models to test whether our measures of sleep were associated with an increased hazard of having a recurrent event. SWIFT randomized 1193 stroke participants: mean age 63 years +- 15.14; 50% female; 17% black, 51% Hispanic, 26% white, 6% other. In models adjusted for treatment assignment, race, age, gender, education, marital status and baseline measures of hypertension, diabetes, smoking and NIH stroke scale the sleep problems index 2 was associated with an increased hazard of a first recurrent stroke or TIA (HR=1.91, p-value=0.02), whereas our measures of snoring (HR=1.20, p-value=0.43) and shortness of breath during sleep (HR=1.39, p-value=0.46) were not. The same pattern of results held for a composite measure of first recurrent stroke, TIA, MI or vascular death: sleep problems index 2 (HR=1.97, p-value=0.003), snoring (HR=1.10, p-value=0.62) and shortness of breath during sleep (HR=1.59, p-value=0.18). Our results highlight the contribution of sleep to the risk of recurrent vascular events in a population of mild and moderate stroke/TIA survivors. Importantly, this result is not driven by snoring or trouble breathing at night and is independent of hypertension, smoking and diabetes.

Abstract 3632: Secondary Vascular Events and Sleep Adequacy: the SWIFT Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
LAURA EVENSEN ◽  
Nan Liu ◽  
Yijun Wang ◽  
Bernadette Boden-Albala
Keyword(s):  
Risk Factors ◽  
Recurrent Events ◽  
Sleep Problems ◽  
Recurrent Event ◽  
Vascular Events ◽  
Respiratory Impairment ◽  
Vascular Death ◽  
Increased Risk ◽  
Falling Asleep ◽  
The Relationship

Objective: To describe the relationship between sleep problems, measured by the Medical Outcomes Sleep scale (MOS) at baseline, in ischemic stroke and TIA (IS/TIA) patients and the likelihood of having a recurrent event, leading to vascular death. Background: Among IS/TIA patients, there is increased risk for recurrent vascular events, including stroke, MI and vascular death. While history of stroke is a major predictor of recurrent events, there may be unidentified factors in play. Sleep quality may predict recurrent vascular events, but little is known about the relationship between sleep and recurrent events in IS/TIA patients. Methods: The Stroke Warning Information and Faster Treatment (SWIFT) Study is an NINDS SPOTRIAS funded randomized trial to study the effect of culturally appropriate, interactive education on stroke knowledge and time to arrival after IS/TIA. Sleep problems and recurrent event information were collected among consentable IS/TIA patients. Cox proportional hazards models were used to describe relationships between sleep and recurrent vascular events in IS/TIA patients. The MOS, a 12 item sleep assessment, measures 6 dimensions of sleep: initiation, maintenance, quantity, adequacy, somnolence and respiratory impairment. Results: Over 5 years, the SWIFT study cohort of 1198 [77% IS; 23% TIA] patients were prospectively enrolled. This cohort was 50% female; 50% Hispanic, 31% White and 18% Black, with a mean NIHSS of 3.2 [SD ±3.8]. 750 subjects completed the MOS scale at baseline. In a multivariate analysis, after adjusting for demographics and vascular risk factors: gender, age, race ethnicity, NIHSS, stroke history, qualifying event type, hypertension, diabetes, smoking and family stroke history, longer sleep initiation is associated with combined outcome of IS/TIA, MI and vascular death [p=0.1, HR=1.09]. Significant predictors of vascular death included: trouble falling asleep (initiation) [p=0.05, HR=1.15]; not ‘getting enough sleep to feel rested’ and not ‘getting the amount of sleep you need’ (adequacy) [p=0.06, HR=1.18 and p=0.03, HR=1.18, respectively]; shortness of breath or headache upon waking (respiratory impairment) [p=0.003, HR=1.33]; restless sleep [p=0.07, HR=1.15] and waking at night with trouble resuming sleep [p=0.004, HR=1.23] (maintenance); daytime drowsiness [p=0.05, HR=1.18] and trouble staying awake [p=0.01, HR=1.25] (somnolence); and taking naps (quantity) [p=0.03, HR=1.22]. Conclusions: Sleep problems represent diverse, modifiable risk factors for secondary vascular events, particularly vascular death. Exploring sleep dimensions may yield crucial information for reduction of secondary vascular events in IS/TIA patients. Further investigation is needed to fully understand the effects of sleep on secondary vascular event incidence.

Recurrent Stroke Risk in Pilots with Atrial Fibrillation

2020 ◽  
Vol 91 (4) ◽  
pp. 352-357
Author(s):  
Jessica Tedford ◽  
Valerie Skaggs ◽  
Ann Norris ◽  
Farhad Sahiar ◽  
Charles Mathers
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Recurrent Events ◽  
Stroke Risk ◽  
Event Rate ◽  
Recurrent Stroke ◽  
Previous History ◽  
Recurrent Event ◽  
Recurrence Rates ◽  
Medical Certification

INTRODUCTION: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias in the general population and is considered disqualifying aeromedically. This study is a unique examination of significant outcomes in aviators with previous history of both AF and stroke.METHODS: Pilots examined by the FAA between 2002 and 2012 who had had AF at some point during his or her medical history were reviewed, and those with an initial stroke or transient ischemic attack (TIA) during that time period were included in this study. All records were individually reviewed to determine stroke and AF history, medical certification history, and recurrent events. Variables collected included medical and behavior history, stroke type, gender, BMI, medication use, and any cardiovascular or neurological outcomes of interest. Major recurrent events included stroke, TIA, cerebrovascular accident, death, or other major events. These factors were used to calculate CHA2DS2-VASc scores.RESULTS: Of the 141 pilots selected for the study, 17.7% experienced a recurrent event. At 6 mo, the recurrent event rate was 5.0%; at 1 yr, 5.8%; at 3 yr 6.9%; and at 5 yr the recurrent event rate was 17.3%. No statistical difference between CHA2DS2-VASc scores was found as it pertained to number of recurrent events.DISCUSSION: We found no significant factors predicting risk of recurrent event and lower recurrence rates in pilots than the general population. This suggests CHA2DS2-VASc scores are not appropriate risk stratification tools in an aviation population and more research is necessary to determine risk of recurrent events in aviators with atrial fibrillation.Tedford J, Skaggs V, Norris A, Sahiar F, Mathers C. Recurrent stroke risk in pilots with atrial fibrillation. Aerosp Med Hum Perform. 2020; 91(4):352–357.

Abstract P288: Multiple Versus Single Lesions in Lower-Extremity Peripheral Arterial Disease: 2.5-Year Risk of Recurrent Cardiovascular Events

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Moniek van Zitteren ◽  
Johan Denollet ◽  
Phil G Jones ◽  
John A Spertus ◽  
Jan M Heyligers ◽  
...  
Keyword(s):  
Cardiovascular Event ◽  
Cardiovascular Events ◽  
Recurrent Events ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards Model ◽  
Recurrent Event ◽  
P Value ◽  
Multiple Lesions ◽  
Increased Risk ◽  
Event Model

Background: Lower-extremity peripheral arterial disease (PAD) is associated with an increased risk of mortality and high resource utilization. Therefore, there is a real need to assess PAD patients' risk for an initial cardiovascular event as well as their risk for multiple, serial cardiovascular events over time. Although it is expected, but unexplored, that those with a greater burden of disease (e.g. multiple vs. single lesions) would have an increased risk for events, common modeling strategies only emphasize time to first event. We tested a novel recurrent event model to examine whether more advanced disease is associated with a persistent, increased risk for subsequent cardiovascular events. Methods: A prospective cohort of 717 patients with newly diagnosed PAD - enrolled from 2 vascular clinics in The Netherlands - underwent duplex ultrasound testing at enrollment to determine the presence of multiple vs. single lesions. A traditional time-to-first event Cox regression model examined the association between multiple vs. single (reference) lesions and 2.5-year cardiovascular events, adjusting for site, demographics and risk factors (see Table). We then replicated these analyses using an advanced Cox-based model for recurrent events. Results: A total of 324 out of 717 (44.5%) patients had multiple lesions. After 2.5 year follow-up, patients with multiple lesions not only had an increased time-to-first cardiovascular event risk (35.2% vs. 32.8%; adjusted HR=1.32; 95%CI 1.07-1.62), but also had an increased risk of recurrent cardiovascular events (60.2% vs.47.7%; adjusted HR=1.24; 95%CI 1.00-1.53) (Table). Conclusions: Using a recurrent event model, we were able to demonstrate that patients with PAD who present with multiple lesions are not only at increased risk of having a first cardiovascular event, but also remain at increased risk for subsequent events over 2.5 years of observation; even after their first event and subsequent management of their PAD. Table-The Association Between Having Multiple vs. Single Lesions and 2.5-Year Cardiovascular Events * Model Unadjusted Adjusted HR (95% CI) P-value HR (95% CI) P-value (1) Time-to-First Event Model Cox Proportional Hazards Model 1.36 (1.12-1.67) 0.003 1.32 (1.07-1.62) 0.008 (2) Cox-Based Model for Recurrent Events Conditional-Gap Time † 1.36 (1.17-1.66) 0.002 1.24 (1.00-1.53) 0.047 The unadjusted and adjusted effects (Hazard Ratio [HR], 95% Confidence Interval [CI]) for (1) a traditional time-to-first event Cox Proportional Hazards model and (2) an advanced Cox-based model for recurrent events are depicted. Covariates in the adjusted model included: site, age, sex, history of cerebrovascular disease, history of cardiac disease, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, kidney disease, current smoking, and hyperlipidemia. * Cardiovascular events constituted of admissions for peripheral, coronary, and carotid revascularizations, bleeding events, abnormal cardiac rhythm, heart failure, non-fatal stroke/transient ischemic attack, non-fatal myocardial infarction, angina, other ischemic events, and fatal myocardial infarction/stroke, and other cardiovascular death; † Risk interval is the time elapsed since each prior event.

Abstract TMP54: A VA Observational Study Examining the Benefit of Various Post-Ischemic Stroke/Tia Hypertension Goals in Preventing Recurrent Vascular Events

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jason J Sico ◽  
Xin Hu ◽  
Laura Myers ◽  
Greg Arling ◽  
Dawn Bravata
Keyword(s):  
Ischemic Stroke ◽  
Recurrent Events ◽  
Medical Center ◽  
Clinical Care ◽  
Recurrent Event ◽  
National Committee ◽  
Quadratic Term ◽  
Cerebrovascular Event ◽  
Protective Effects ◽  
Vascular Events

Introduction: Joint National Committee (JNC)-8 goal blood pressure (BP) recommendation of < 140/90 mmHg has been supplanted by 2017 ACC/AHA goal of < 130/80 mmHg for patients with ischemic stroke/TIA. Understanding the potential benefit in preventing recurrent vascular events for patients reaching ACC/AHA BP goals is necessary to inform clinical care. Methods: This is a retrospective cohort of Veterans with stroke/TIA (N=39,053) who received their longitudinal outpatient primary care within a Veterans Administration Medical Center between 10/2014 and 9/2018. Patients were excluded (n=25,381) if they had missing or physiologically improbable BP values, died, or had less than 1 year of follow-up. Vascular events were defined as cerebrovascular-only, cardiovascular-only, and the composite of each. We calculated average SBP during 90 days after discharge and assessed it in categorical form (≤115 mmHg, 106-115 mmHg, 116-130, mmHg, 131-140 mmHg, and >140 mmHg) and continuous form. Multivariate COX proportional hazard regression was used to examine the relationship between average SBP groups and time to recurrent event 90 days after discharge up to 1 year. In multivariate logistic regression, we used continuous SBP along with its quadratic term to predict 1-year recurrent vascular event rates. Results: A total of 12,337 eligible patients were included in the final analysis. Compared to those with SBP > 140 mmHg, patients reaching ACC/AHA BP goal had significant lower risk of cerebrovascular recurrent events (HR=0.77, 95% CI=0.60-0.99) but not cardiovascular recurrence or both combined. Conclusions: In considering BP reached by 90-days, ACC/AHA BP guidelines showed protective effects on cerebrovascular event recurrence only.

scholarly journals Stroke Recurrence Based on Stroke Prognosis Instrument II (SPI-II) and the Attackumber of Stroke

2019 ◽  
Author(s):  
Tri Antika Rizki Kusuma Putri ◽  
Listian Prisilia Rahayu ◽  
Elis Nurhayati Agustina
Keyword(s):  
Risk Factors ◽  
Recurrent Events ◽  
Recurrent Stroke ◽  
Community Setting ◽  
Self Control ◽  
Stroke Recurrence ◽  
P Value ◽  
Cross Sectional ◽  
Positive Correlation ◽  
Significant Difference

Background: Stroke is increasing every year so the risk of recurrent stroke is also increasing, the more risk factors they have, the higher the likelihood of recurring strokes. if a recurring attack occurs, the condition can be more severe than the first attack, generally occurs in patients who lack self-control and low level of awareness. Objectives: This study aimed to identify the risk factors of stroke recurrence base on SPI-II. Methods: This study was a cross-sectional descriptive study with 274 strokes patients as samples. The samples were recruited from one of general hospital specialize in neurology disorders in Jakarta, Indonesia. Results:The result of this study indicated a significant difference in risk factor score between primary attack group and recurrence stroke (p-value<0.05). Simple linear regression showed that incidence of stroke attack has a positive correlation to the risk of stroke recurrent events (B= 3.484). Conclusion: The attacks number of strokes has a positive correlation with risk of recurrence stroke. Nurses must be aware when doing the discharge planning for recurrent stroke patient. Monitoring and controlling the risk factors on community setting is an important thing to have known by nurses.

scholarly journals Stroke Recurrence Based on Stroke Prognosis Instrument II (SPI-II) and The Attack Number of Stroke

2019 ◽  
Author(s):  
Tri Antika Rizki Kusuma Putri1 ◽  
Listian Prisilia Rahayu ◽  
Elis Nurhayati Agustina
Keyword(s):  
Risk Factors ◽  
Recurrent Events ◽  
Recurrent Stroke ◽  
Community Setting ◽  
Self Control ◽  
Stroke Recurrence ◽  
P Value ◽  
Cross Sectional ◽  
Positive Correlation ◽  
Significant Difference

Background: Stroke is increasing every year so the risk of recurrent stroke is also increasing, the more risk factors they have, the higher the likelihood of recurring strokes. if a recurring attack occurs, the condition can be more severe than the first attack, generally occurs in patients who lack self-control and low level of awareness. Objectives: This study aimed to identify the risk factors of stroke recurrence base on SPI-II. Methods: This study was a cross-sectional descriptive study with 274 strokes patients as samples. The samples were recruited from one of general hospital specializeinneurologydisordersinJakarta,Indonesia. Results:The result of this study indicated a significant difference in risk factor score between primary attack group and recurrence stroke (p-value<0.05). Simple linear regression showed that incidence of stroke attack has a positive correlation to the risk of stroke recurrent events (B= 3.484). Conclusion: The attacks number of strokes has a positive correlation with risk of recurrence stroke. Nurses must be aware when doing the discharge planning for recurrent stroke patient. Monitoring and controlling the risk factors on community setting is an important thing to have known by nurses.

Association between self-care and prognosis in 1123 patients with chronic heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Calero ◽  
E Hidalgo ◽  
R Marin ◽  
L Rosenfeld ◽  
I Fernandez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Acute Heart Failure ◽  
Nyha Class ◽  
Self Care ◽  
P Value ◽  
Funding Source ◽  
Class Iii ◽  
Cox Models ◽  
Lower Tertile

Abstract Background Self-care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease. However, little is published about its major clinical implications as admission or mortality in patients with HF. Aims and methods The aim of the study was to analyze time to admission due to acute heart failure and mortality associated with poor self-care in patients with chronic HF. We prospectively recruited consecutive patients with stable chronic HF referred to a nurse-led HF programme. Selfcare was evaluated at baseline with the 9 item European Heart Failure Self-Care Behavior Scale. Scores were standardized and reversed from 0 (worst selfcare) to 100 (better self care). For the purpose of this study we analyzed the associations of worse self-care (defined as scores below the lower tertile of the scale) with demographic, disease-related (clinical) and psychosocial factors in all patients at baseline. Results We included 1123 patients, mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40,4%) were in NYHA class III or IV. Mean score of the 9-item ESCBE was 69±28. Score below 55 (lower tertile) defined impaired selfcare behaviour. Those patients with worse self-care had more ischaemic heart disease, more COPD, and they achieved less distance in the 6 minute walking test. Regarding psychosocial items patients in lower tertile of self-care needed a caregiver more frequently, they present more cognitive impairment, depressive symptoms and worse score in terms of health self-perception. Multivariate Cox Models showed that a score below 55 points in 9-item ESCBE was independently associated with higher readmission due to acute heart failure [HR 1.26 (1.02–1.57), p value=0.034] and with mortality [HR 1.24 CI95% (1.02–1.50), p value=0.028] Conclusion Poor self-care measured with the modified 9-item ESCBE was associated with higher risk of admission due to acute decompensation and higher risk of mortality in patients with chronic heart failure. These results highlight the importance of assessing self-care and provide measures to improve them. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Hospital Univesitario de Bellvitge

scholarly journals Risks of recurrent stroke and all serious vascular events after spontaneous intracerebral haemorrhage: pooled analyses of two population-based studies

2021 ◽  
Vol 20 (6) ◽  
pp. 437-447 ◽  
Author(s):  
Linxin Li ◽  
Michael T C Poon ◽  
Neshika E Samarasekera ◽  
Luke A Perry ◽  
Tom J Moullaali ◽  
...  
Keyword(s):  
Intracerebral Haemorrhage ◽  
Recurrent Stroke ◽  
Population Based ◽  
Vascular Events ◽  
Spontaneous Intracerebral Haemorrhage

scholarly journals Interleukin-6, C-reactive protein, fibrinogen, and risk of recurrence after ischaemic stroke: Systematic review and meta-analysis

2021 ◽  
pp. 239698732098400
Author(s):  
JJ McCabe ◽  
E O’Reilly ◽  
S Coveney ◽  
R Collins ◽  
L Healy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Interleukin 6 ◽  
Inflammatory Markers ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Randomised Trials ◽  
C Reactive Protein ◽  
Vascular Events ◽  
Reactive Protein

Background Recent randomised trials showed benefit for anti-inflammatory therapies in coronary disease but excluded stroke. The prognostic value of blood inflammatory markers after stroke is uncertain and guidelines do not recommend their routine measurement for risk stratification. Methods We performed a systematic review and meta-analysis of studies investigating the association of C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen and risk of recurrent stroke or major vascular events (MVEs). We searched EMBASE and Ovid Medline until 10/1/19. Random-effects meta-analysis was performed for studies reporting comparable effect measures. Results Of 2,515 reports identified, 39 met eligibility criteria (IL-6, n = 10; CRP, n = 33; fibrinogen, n = 16). An association with recurrent stroke was reported in 12/26 studies (CRP), 2/11 (fibrinogen) and 3/6 (IL-6). On random-effects meta-analysis of comparable studies, CRP was associated with an increased risk of recurrent stroke [pooled hazard ratio (HR) per 1 standard-deviation (SD) increase in loge-CRP (1.14, 95% CI 1.06–1.22, p < 0.01)] and MVEs (pooled HR 1.21, CI 1.10–1.34, p < 0.01). Fibrinogen was also associated with recurrent stroke (HR 1.26, CI 1.07–1.47, p < 0.01) and MVEs (HR 1.31, 95% CI 1.15–1.49, p < 0.01). Trends were identified for IL-6 for recurrent stroke (HR per 1-SD increase 1.17, CI 0.97–1.41, p = 0.10) and MVEs (HR 1.22, CI 0.96–1.55, p = 0.10). Conclusion Despite evidence suggesting an association between inflammatory markers and post-stroke vascular recurrence, substantial methodological heterogeneity was apparent between studies. Individual-patient pooled analysis and standardisation of methods are needed to determine the prognostic role of blood inflammatory markers and to improve patient selection for randomised trials of inflammatory therapies.

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