Abstract WMP53: Sex Differences n Long-term Mortality and Disability After Stroke: The International Stroke Outcomes Study

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hoang T Phan ◽  
Mathew J Reeves ◽  
Leigh Blizzard ◽  
Amanda Thrift ◽  
Dominique Cadilhac ◽  
...  
Keyword(s):  
Sex Differences ◽  
Population Based ◽  
Stroke Severity ◽  
Related Factors ◽  
Post Stroke ◽  
Modifiable Factors ◽  
Mortality Rate Ratio ◽  
The Impact

Introduction: It is uncertain why women suffer worse long-term outcomes after stroke than men. We examined sex differences in mortality and disability 1 and 5 years after stroke and identified factors contributing to these differences. Methods: Individual patient data pooling study of incident strokes (ischemic and hemorrhagic) from 1987-2013 obtained from 12 population-based cohorts from Australasia, Europe, South America and the Caribbean. Data on socio-demographics, stroke-related factors and pre-stroke health were obtained for each patient and harmonized between studies. Poisson modelling estimated the mortality rate ratio (MRR) for women compared to men at 1 year (12 studies) and 5 years (7 studies) post-stroke. Log binomial regression estimated the relative risk (RR) of poor outcome (modified Rankin scale>2 or Barthel Index <20) for women compared to men at 1 year (9 studies) and 5 years (6 studies) after stroke. Multivariable models were adjusted for potential confounders including age, pre-stroke dependency, stroke severity and comorbidities. Results: A total of 16557 first-ever-stroke patients with follow-up data to 1 year and 12,839 with follow-up to 5 years were included. The pooled crude mortality was greater in women than men at 1-year (MRR 1.37 95% CI 1.27-1.48) and 5 years (MRR 1.25 95% CI 1.13-1.39). However, these sex differences were reversed after adjustment for confounders at both 1 year (MRR 0.94 95% CI 0.82-1.06) and 5-years post stroke (MRR 0.74 95% CI 0.66-0.84). Similarly, the pooled crude RR for disability after stroke was greater in women than men at 1-year (RR 1.28 95% CI 1.17-1.39 and 5-year (RR 1.32 95% CI 1.18-1.47), but these sex differences disappeared after adjustment at both 1 year (RR 1.08 95%CI 0.98-1.18) and 5-years post stroke (RR 1.08 95% CI 0.97-1.20). The key contributors to worse outcomes in women were greater age, pre-stroke dependency, severe strokes and atrial fibrillation (AF, mortality only) compared with men. Conclusion: Worse outcomes in women were mostly due to age and potentially modifiable factors of stroke severity and AF providing potential targets to reduce the impact of stroke in women.

scholarly journals The Impact of Pre- and Post-Stroke Statin Use on Stroke Severity and Long-Term Outcomes: A Population-Based Cohort Study

2019 ◽  
Vol 47 (5-6) ◽  
pp. 260-267 ◽  
Author(s):  
Clare Flach ◽  
Maria Elstad ◽  
Walter Muruet ◽  
Charles D.A. Wolfe ◽  
Anthony G. Rudd ◽  
...  
Keyword(s):  
Population Based ◽  
Stroke Recurrence ◽  
Stroke Severity ◽  
Stroke Incidence ◽  
Post Stroke ◽  
Improvement Programs ◽  
The Impact ◽  
The Relationship ◽  
Statin Use

Background: The benefit of statins on stroke incidence is well known. However, data on the relationship between pre- and post-stroke statin use, recurrence, and survival outcomes are limited. We aim to investigate the short- and long-term relationships between statin prescription, stroke recurrence, and survival in patients with first-ever ischemic stroke. Methods: Data were collected from the population-based South London Stroke Register for the years 1995–2015. Patients were assessed at the time of first ever stroke, 3 months, and annually thereafter. Data on vascular risk factors, treatments prescribed, sociodemographic characteristics, stroke subtype, survival, and stroke recurrence were collected. Cox proportional hazard analyses were used to assess the relationship of statin prescriptions pre- and post-stroke on stroke severity, long-term recurrence and survival. Results: Patients prescribed statins both pre- and post-stroke showed a 24% reduction in mortality (adjusted Hazard Ratio [aHR] 0.76, 0.60–0.97), those who were prescribed statins pre-stroke and then stopped post-stroke showed greater risk of mortality (aHR 1.85, 1.10–3.12) and stroke recurrence (aHR 3.25, 1.35–7.84) compared to those that were not prescribed statins at any time. No associations were observed between pre-stroke statin and severity of the initial stroke overall, though a protective effect against moderate/severe stroke (Glasgow Coma Scale ≤12) was observed in those aged 75+ years (aOR 0.70, 0.52–0.95). Conclusions: Statins play a significant role in improving the survival rates after a stroke. Adherence to the National Guidelines that promote statin treatment, primary and secondary prevention of stroke should be monitored and a focus for quality improvement programs.

Abstract TP171: Differences Between Men and Women in Long-term Participation Restriction After Stroke: The International Stroke Outcomes Study (INSTRUCT)

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Hoang T Phan ◽  
Leigh Blizzard ◽  
Mathew J Reeves ◽  
Amanda G Thrift ◽  
Dominique Cadilhac ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Population Based ◽  
Stroke Severity ◽  
Participation Restriction ◽  
Related Factors ◽  
Physical Independence ◽  
Individual Participant ◽  
The Difference ◽  
The Impact

Introduction: As women suffer worse functional outcomes of stroke than men, they may also face more challenges with community reintegration but data are scarce. We examined sex differences in participation after stroke and which factors might account for these disparities. Methods: INSTRUCT is an individual participant data pooling study of incident strokes obtained from 13 population-based cohorts worldwide. Two of the cohorts (Melbourne ’96-‘99 and Auckland ’02-‘03) included assessment of participation at 5 years after stroke using the London Handicap Scale (LHS). The LHS is used to assess the individual’s perspective of their involvement in life situations including orientation (person’s awareness of surroundings), physical independence, mobility, occupation, social interaction and economic self-efficiency. The total score ranges from 0 (worst disadvantage) to 100 (no disadvantage). Linear regression was used to compare LHS total scores and sub-domains for women compared to men. Study-specific multivariable models incorporated adjustment for socio-demographics, stroke-related factors, pre-stroke health and post-stroke factors were combined using random-effects meta-analysis. Results: At 5 years after stroke, there were data on participation for 351/592 (59%) of survivors in Melbourne and 266/881 (30%) of survivors in Auckland. Women suffered greater participation restriction than men (total LHS, pooled mean difference, MD -5.55 [95% CI -8.47, -2.63]). The magnitude of the difference attenuated after adjusting for covariates (pooled MD -2.48 [-4.99, 0.03]). Significant confounders in study-specific models included age, stroke severity, pre-stroke dependency and pre-stroke dementia for Melbourne; and age, stroke severity and pre-stroke dependency for Auckland. In sub-dimensions, women had greater restriction than men in mobility, physical independence and occupation. Additionally, women in Melbourne experienced poorer social integration and orientation than men. Conclusion: Greater restriction in participation after stroke among women than men was mostly attributable to their advanced age and greater pre-stroke dependency. Interventions targeting participation could reduce the impact of stroke in women.

scholarly journals From Three-Months to Five-Years: Sustaining Long-Term Benefits of Endovascular Therapy for Ischemic Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Aravind Ganesh ◽  
Johanna Maria Ospel ◽  
Martha Marko ◽  
Wim H. van Zwam ◽  
Yvo B. W. E. M. Roos ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Healthy Lifestyle ◽  
Standard Of Care ◽  
Stroke Treatment ◽  
Post Stroke ◽  
Treatment Benefits ◽  
Family Social Support ◽  
Modifiable Factors

Background and Purpose: During the months and years post-stroke, treatment benefits from endovascular therapy (EVT) may be magnified by disability-related differences in morbidity/mortality or may be eroded by recurrent strokes and non-stroke-related disability/mortality. Understanding the extent to which EVT benefits may be sustained at 5 years, and the factors influencing this outcome, may help us better promote the sustenance of EVT benefits until 5 years post-stroke and beyond.Methods: In this review, undertaken 5 years after EVT became the standard of care, we searched PubMed and EMBASE to examine the current state of the literature on 5-year post-stroke outcomes, with particular attention to modifiable factors that influence outcomes between 3 months and 5 years post-EVT.Results: Prospective cohorts and follow-up data from EVT trials indicate that 3-month EVT benefits will likely translate into lower 5-year disability, mortality, institutionalization, and care costs and higher quality of life. However, these group-level data by no means guarantee maintenance of 3-month benefits for individual patients. We identify factors and associated “action items” for stroke teams/systems at three specific levels (medical care, individual psychosocioeconomic, and larger societal/environmental levels) that influence the long-term EVT outcome of a patient. Medical action items include optimizing stroke rehabilitation, clinical follow-up, secondary stroke prevention, infection prevention/control, and post-stroke depression care. Psychosocioeconomic aspects include addressing access to primary care, specialist clinics, and rehabilitation; affordability of healthy lifestyle choices and preventative therapies; and optimization of family/social support and return-to-work options. High-level societal efforts include improving accessibility of public/private spaces and transportation, empowering/engaging persons with disability in society, and investing in treatments/technologies to mitigate consequences of post-stroke disability.Conclusions: In the longtime horizon from 3 months to 5 years, several factors in the medical and societal spheres could negate EVT benefits. However, many factors can be leveraged to preserve or magnify treatment benefits, with opportunities to share responsibility with widening circles of care around the patient.

Care-Related Distress: A Nationwide Study of Parents Who Lost Their Child to Cancer

2005 ◽  
Vol 23 (36) ◽  
pp. 9162-9171 ◽  
Author(s):  
Ulrika Kreicbergs ◽  
Unnur Valdimarsdóttir ◽  
Erik Onelöv ◽  
Olle Björk ◽  
Gunnar Steineck ◽  
...  
Keyword(s):  
Population Based ◽  
Postal Questionnaire ◽  
Physical Pain ◽  
Related Factors ◽  
Nationwide Study ◽  
Pediatric Hematology ◽  
The Moment ◽  
Oncology Center

Purpose Palliative care is an important part of cancer treatment. However, little is known about how care-related factors affect bereaved intimates in a long-term perspective. We conducted a population-based, nationwide study addressing this issue, focusing on potential care-related stressors in parents losing a child to cancer. Methods In 2001, we attempted to contact all parents in Sweden who had lost a child to cancer in 1992 to 1997. The parents were asked, through an anonymous postal questionnaire, about their experience of the care given and to what extent these experiences still affect them today. Results Information was supplied by 449 (80%) of 561 eligible parents. Among 196 parents of children whose pain could not be relieved, 111 (57%) were still affected by it 4 to 9 years after bereavement. Among 138 parents reporting that the child had a difficult moment of death, 78 (57%) were still affected by it at follow-up. The probability of parents reporting that their child had a difficult moment of death was increased (relative risk = 1.4; 95% CI, 1.0 to 1.8) if staff were not present at the moment of death. Ten percent of the parents (25 of 251 parents) were not satisfied with the care given during the last month at a pediatric hematology/oncology center; the corresponding figure for care at other hospitals was 20% (33 of 168 parents; P = .0163). Conclusion Physical pain and the moment of death are two important issues to address in end-of-life care of children with cancer in trying to reduce long-term distress in bereaved parents.

Abstract TMP45: Predicting Long-term Body Function, Activity & Participation After Stroke: The Prevailing Role of Cognition in Determining Functional Outcome

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Arunima Kapoor ◽  
Krista Lanctot ◽  
Mark Bayley ◽  
Alex Kiss ◽  
Richard Swartz
Keyword(s):  
Cognitive Impairment ◽  
Functional Outcome ◽  
Stroke Severity ◽  
Post Stroke ◽  
Body Function ◽  
Multiple Levels ◽  
Multiple Domains ◽  
Levels Of Functioning ◽  
The Impact

Background: Stroke can impact multiple levels of function and result in complex disability. Few studies have examined limitations across the range of functions from body function to social participation, or explored the impact of post-stroke comorbidities, such as depression, obstructive sleep apnea (OSA) and cognition, on function, especially in the long-term. We aimed to determine post-stroke predictors of multiple levels of functioning approximately 2 years after a stroke, and to specifically evaluate the impact of depressive symptoms, OSA and cognitive impairment on outcome. Hypothesis: We hypothesized that in addition to traditional predictors of outcome–age and stroke severity–depression, OSA and cognitive impairment will predict functional outcome in multiple domains. Methods: Baseline assessment of depression, apnea and cognitive impairment with 2-year follow-up assessment of functional outcome to evaluate each of the three levels of functioning as stated in the WHO International Classification of Functioning: Body Function (Montreal Cognitive Assessment), Activity (modified Rankin) and Participation (Reintegration to Normal Living Index). Results: A total of 162 patients were enrolled at approximately 2 years and 5 months post-stroke. Forty one percent had activity limitations, 58% were cognitively impaired and 68% had restrictions in participation. Long-term activity limitation was predicted by greater age (OR = 0.95), stroke severity (OR = 1.69) and cognitive impairment (OR = 1.28) at baseline. Body function impairment was predicted by greater age (OR = 0.96), and cognitive impairment (OR = 1.49). Participation restriction was predicted by cognitive impairment (OR = 1.26). Conclusion: Baseline cognition predicts long-term function in multiple domains and is a better predictor of long-term participation than age or baseline stroke severity. In view of the widespread impact of post-stroke cognitive impairment on every level of functioning, routine post-stroke cognitive screening and target interventions are warranted. Greater attention to functional domains beyond activity could further optimize recovery and enhance outcome after stroke.

Abstract 172: Medical and Demographic Predictors of Long-term Cognitive Outcomes of Pediatric Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alice A Holland ◽  
Kimberly D Goodspeed ◽  
Patricia Plumb ◽  
Peter L Stavinoha ◽  
Michael Dowling
Keyword(s):  
Neurological Impairment ◽  
Cognitive Outcomes ◽  
Stroke Severity ◽  
Pediatric Stroke ◽  
Post Stroke ◽  
Age Related ◽  
Long Term Follow Up ◽  
The Relationship

Introduction: Studies examining cognitive outcomes for pediatric stroke are sparse, and few account for stroke severity. The Pediatric Stroke Outcome Measure (PSOM) provides an objective, comprehensive rating of neurological impairment. This study investigated the relationship between initial PSOM score and long-term cognitive outcomes. It was hypothesized that greater severity of stroke (worse initial PSOM score) would predict lower IQ at long-term follow-up. Other factors considered were age at stroke and months post stroke. Age-related studies in broad cognitive outcomes for pediatric stroke are sparse and somewhat inconsistent in findings. It was hypothesized that severity of stroke would be more relevant than age of stroke for long-term cognitive outcomes. Methods: PSOM scores at initial visit and IQ scores at long-term follow-up (M=3.77 years) were obtained for 84 survivors of pediatric stroke ages 4:0-25:6 (M=11:5 years; 37 females). A one-sample t-test was conducted to compare mean IQ to the normative sample. To examine the hypotheses, all variables of interest (PSOM, age at stroke, and months s/p) were entered into a stepwise regression equation. Results: Mean IQ for the sample was 84.77 (SD=17.26), significantly below average relative to healthy norms ( t =-8.088, p =.000). PSOM scores ranged 0-5.5 (median/mode=1.0). The regression was significant ( F =8.798; p =.000), with both PSOM score ( b =-.350; t [80]=-3.483; p =.001) and months post stroke ( b =-.355; t [80]=-3.005; p =.004) significantly contributing to the model, but not age at stroke. Conclusions: PSOM was more relevant than age at stroke in predicting long-term cognitive outcomes, and greater stroke severity was associated with lower IQ at follow-up. Finding suggest that initial PSOM score and greater time since stroke may be more relevant to long-term cognitive outcomes than age at stroke. The present study lends validity to using the PSOM both as a marker of functional severity of stroke and a potential indicator of relative risk for poorer long-term cognitive outcomes. Better predictors of cognitive outcomes for pediatric stroke are greatly needed in order to facilitate earlier intervention/rehabilitation and improve the efficacy of such efforts.

scholarly journals Prognostic Significance of Prolonged Corrected QT Interval in Acute Ischemic Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Sung-Ho Ahn ◽  
Ji-Sung Lee ◽  
Young-Hak Kim ◽  
Mi-Sook Yun ◽  
Jung-Hee Han ◽  
...  
Keyword(s):  
Heart Rate ◽  
Sex Differences ◽  
Ischemic Stroke ◽  
Cardiovascular Risk ◽  
Acute Ischemic Stroke ◽  
Stroke Severity ◽  
Qtc Interval ◽  
The Impact ◽  
Long Term Mortality

Background and Purpose: The aim of this study was to determine the relationship between the heart rate-corrected QT (QTc) interval and the risk of incident long-term mortality in patients with acute ischemic stroke (AIS), considering the impact of sex differences on clinical characteristics, outcomes, and QTc intervals.Methods: We analyzed prospectively registered data included patients with AIS who visited the emergency room within 24 h of stroke onset and underwent routine cardiac testing, such as measurements of cardiac enzymes and 12-lead ECG. QTc interval was corrected for heart rate using Fridericia's formula and was stratified by sex-specific quartiles. Cox proportional hazards models were used to examine the association between baseline QTc interval and incident all-cause death.Results: A total of 1,668 patients with 1,018 (61.0%) men and mean age 66.0 ± 12.4 years were deemed eligible. Based on the categorized quartiles of the QTc interval, cardiovascular risk profile, and stroke severity increased with prolonged QTc interval, and the risk of long-term mortality increased over a median follow-up of 33 months. Cox proportional hazard model analysis showed that the highest quartile of QTc interval (≥479 msec in men and ≥498 msec in women; hazard ratio [HR]: 1.49, 95% confidence interval [CI]: 1.07–2.08) was associated with all-cause death. Furthermore, dichotomized QTc interval prolongation, defined by the highest septile of the QTc interval (≥501 ms in men and ≥517 m in women: HR: 1.33, 95% CI: 1.00–1.80) was significantly associated with all-cause mortality after adjusting for all clinically relevant variables, such as stroke severity.Conclusions: Prolonged QTc interval was associated with increased risk of long-term mortality, in parallel with the increasing trend of prevalence of cardiovascular risk profiles and stroke severity, across sex differences in AIS patients.

Effort–reward imbalance and long-term benzodiazepine use: longitudinal findings from the CONSTANCES cohort

2019 ◽  
Vol 73 (11) ◽  
pp. 993-1001 ◽  
Author(s):  
Guillaume Airagnes ◽  
Cédric Lemogne ◽  
Sofiane Kab ◽  
Nicolas Hoertel ◽  
Marcel Goldberg ◽  
...  
Keyword(s):  
Tobacco Smoking ◽  
Population Based ◽  
Administrative Databases ◽  
Related Factors ◽  
The Third ◽  
Effort Reward Imbalance ◽  
Benzodiazepine Use ◽  
Reward Imbalance

ObjectivesTo examine the association between effort–reward imbalance and incident long-term benzodiazepine use (LTBU).MethodsWe included 31 077 employed participants enrolled in the French population-based CONSTANCES cohort between 2012 and 2014 who had not undergone LTBU in the 2 years before enrolment. LTBU was examined using drug reimbursement administrative databases. The effort–reward imbalance was calculated in quartiles. We computed ORs (95% CIs) for LTBU according to effort–reward imbalance over a 2-year follow-up period. We adjusted for age, gender, education, occupational grade, income, marital status, tobacco smoking, risk of alcohol use disorder, depressive symptoms and self-rated health.ResultsOver the 2-year follow-up, 294 (0.9%) participants experienced incident LTBU. In the univariable analysis, effort–reward imbalance was associated with subsequent LTBU with ORs of 1.79 (95% CI 1.23 to 2.62) and 2.73 (95% CI 1.89 to 3.95) for the third and fourth quartiles, respectively, compared with the first quartile. There was no interaction between effort–reward imbalance and any of the considered variables other than tobacco smoking (p=0.033). The association remained significant in both smokers and non-smokers, with higher odds for smokers (p=0.031). In the fully adjusted model, the association remained significant for the third and fourth quartiles, with ORs of 1.74 (95% CI 1.17 to 2.57) and 2.18 (95% CI 1.50 to 3.16), respectively. These associations were dose dependent (p for trend <0.001).ConclusionsEffort–reward imbalance was linked with incident LTBU over a 2-year follow-up period after adjustment for sociodemographic and health-related factors. Thus, screening and prevention of the risk of LTBU should be systematised among individuals experiencing effort–reward imbalance, with special attention paid to smokers.

scholarly journals Under-recognition of heart failure in patients with atrial fibrillation and the impact of gender: a UK population-based cohort study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Rosita Zakeri ◽  
Ann D. Morgan ◽  
Varun Sundaram ◽  
Chloe Bloom ◽  
John G. F. Cleland ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Surrogate Marker ◽  
Population Based ◽  
Loop Diuretics ◽  
The Impact

Abstract Background Patients with atrial fibrillation (AF) complicated by heart failure (HF) have a poor prognosis. We investigated whether long term loop-diuretic therapy in patients with AF and no known diagnosis of HF, as a potential surrogate marker of undiagnosed HF, is also associated with worse outcomes. Methods Adults with incident AF were identified from UK primary and secondary care records between 2004 and 2016. Repeat prescriptions for loop diuretics, without a diagnosis of HF or documented non-cardiac indication, were classified as ‘isolated’ loop diuretic use. Results Amongst 124,256 people with incident AF (median 76 years, 47% women), 22,001 (17.7%) had a diagnosis of HF, and 22,325 (18.0%) had isolated loop diuretic use. During 2.9 (LQ-UQ 1–6) years’ follow-up, 12,182 patients were diagnosed with HF (incidence rate 3.2 [95% CI 3.1–3.3]/100 person-years). Of these, 3999 (32.8%) had prior isolated loop diuretic use, including 31% of patients diagnosed with HF following an emergency hospitalisation. The median time from AF to HF diagnosis was 3.6 (1.2–7.7) years in men versus 5.1 (1.8–9.9) years in women (p = 0.0001). In adjusted models, patients with isolated loop diuretic use had higher mortality (HR 1.42 [95% CI 1.37–1.47], p < 0.0005) and risk of HF hospitalisation (HR 1.60 [95% CI 1.42–1.80], p < 0.0005) than patients with no HF or loop diuretic use, and comparably poor survival to patients with diagnosed HF. Conclusions Loop diuretics are commonly prescribed to patients with AF and may indicate increased cardiovascular risk. Targeted evaluation of these patients may allow earlier HF diagnosis, timely intervention, and better outcomes, particularly amongst women with AF, in whom HF appears to be under-recognised and diagnosed later than in men.

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