Abstract WP222: Patient Factors Influencing Oral Anticoagulant Prescribing for Atrial Fibrillation After Stroke

Introduction: Several studies have observed suboptimal prescribing of oral anticoagulants (OAC) in patients with atrial fibrillation (AF). This occurs especially in older patients, despite higher risk for first or recurrent stroke. The decision not to recommend anticoagulation may be influenced by a wide range of factors. Aims: To determine the patient factors (age, gender, living circumstances and comorbidities) associated with post-stroke OAC prescribing in a national cohort of stroke survivors with atrial fibrillation. Methods: A retrospective cohort observational study, using a linked dataset of the Scottish Stroke Care Audit (2010-15), Prescribing Information System and the Scottish Morbidity Record. Multivariate logistic regression analysis was done to calculate the odds of OAC prescribing within six months post-stroke, adjusting for the following patient factors: age, gender, deprivation, year of admission, stroke subtype, stroke severity (six simple variables), comorbidity count and concomitant medication use. Results: Overall, 8129 stroke survivors had confirmed AF; 4817 (59.3%) were prescribed OAC within the six months post-stroke. Older patients were less likely to be prescribed an OAC (adjusted Odds Ratio (aOR) 0.97, 95% Confidence Interval (CI) 0.96-0.98). There was no significant difference between male and female OAC prescribing (aOR 0.92, CI 0.79 - 1.07) or whether living alone before stroke (aOR 0.928, CI 0.78 - 1.08). Independent in activities of daily living before stroke (aOR 2.09, CI 1.69 - 2.59) and orientated at baseline assessment (aOR 1.51, CI 1.25 - 1.84) were both associated with more OAC prescriptions. Patients who lived in less deprived areas were more likely to be prescribed an OAC. Number of comorbidities significantly influenced prescribing; patients with 1-3 comorbidities (aOR 0.71, CI 0.60 - 0.84), and ≥ 4 comorbidities (aOR 0.46, CI 0.34 - 0.625) respectively were less likely to be prescribed an OAC compared to patients with no comorbidities. Conclusions: Lower OAC prescribing in older age may also reflect prior dependence, social deprivation and multiple comorbidities. Promoting appropriate stroke prevention in higher risk patients who may still benefit from OAC requires ongoing attention.

Download Full-text

Psychological Complications at 3 Months Following Stroke: Prevalence and Correlates Among Stroke Survivors in Lebanon

Frontiers in Psychology ◽

10.3389/fpsyg.2021.663267 ◽

2021 ◽

Vol 12 ◽

Author(s):

Walaa Khazaal ◽

Maram Taliani ◽

Celina Boutros ◽

Linda Abou-Abbas ◽

Hassan Hosseini ◽

...

Keyword(s):

Logistic Regression ◽

Neuropathic Pain ◽

Protective Factor ◽

Multivariate Logistic Regression Analysis ◽

Anxiety And Depression ◽

Second Primary ◽

Stroke Survivors ◽

Multivariate Logistic Regression ◽

Post Stroke ◽

Wide Range

Introduction: Stroke continues to be a common and debilitating medical condition which has a significant effect on public health as the second primary source of mortality and the third major root of disability worldwide. A wide range of complications affecting the survivor's life and interfering with the recovery process usually follows stroke; anxiety and depression are considered one of the major complications post-stroke. This study sought to investigate the short-term psychological consequences of stroke among Lebanese survivors and to identify their correlates.Methods: This study is a prospective observational epidemiological study. 143 stroke patients admitted to hospitals in Mount Lebanon and Beirut between February and May 2018.were included in this study. Assessments of complications were carried out at 3 months post-stroke by completing a 30-min face-to-face interview questionnaire. The survey included the socio-demographic -characteristics of the patients, their lifestyle, health indicators, the severity of stroke, and the post-stroke consequences disturbing their quality of life.Results: Complications were recorded for 117 stroke survivors (mean age, 72.46 years; 60.7% male). The analysis of results 3 months post stroke showed that 29 survivors suffered from neuropathic pain (24.8%), 110 (94%) suffered from fatigue, and 81 (69.2%) from cognitive impairment. High rates of anxiety (51.3%), and depression (76.1%) were recorded as well. Multivariate logistic regression confirmed that there is a significant association between depression and the following variables: anxiety (OR = 4.814, p-value = 0.017), pain (OR = 6.868, p-value = 0.002), and physical activity, which acts as a protective factor against depression (OR = 0.261; p-value = 0.029). However, the results of the multivariate logistic regression analysis for anxiety indicated that immobility-related complications increase the risk of anxiety by 8.457 in sedentary duration longer than 12 h (ORa = 8.457, p-value = 0.01). Furthermore, patients with neuropathic pain (24.8%) are 3.858 times more likely to have anxiety compared to patients without neuropathic pain (ORa = 3.858, p-value = 0.019).Conclusion: Using a patient-centered structure more interventions should take place to evaluate stroke survivors' outcomes, and organize rehabilitation services that deal with stroke consequences, particularly high anxiety and depression levels, which are prevalent and persistent among the Lebanese stroke survivors.

Download Full-text

Abstract TP233: Are Baseline Characteristics of Stroke Patients Included Into an Observational Study Similar to Patients Included Into a Randomised Controlled Trial?

Stroke ◽

10.1161/str.47.suppl_1.tp233 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Anna Schulte ◽

Falko Jürries ◽

Anna Messerschmid ◽

Nico Behnke ◽

Jan Liman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Randomised Controlled Trial ◽

Controlled Trial ◽

Stroke Severity ◽

Stroke Patients ◽

Exclusion Criteria ◽

Observational Trial ◽

Significant Difference ◽

Baseline Characteristics ◽

Randomised Controlled

Introduction: Undiagnosed atrial fibrillation (UAF) is a major burden in ischemic stroke. However, randomised trials have partly shown astonishingly low AF detection rates (e. g. in the CRYSTAL-AF study). This may be due to differences in baseline and stroke characteristics between studies. Hypothesis: We hypothesized that stroke patients in a randomised controlled trial have less severe strokes than patients in an observational trial with similar inclusion and exclusion criteria. Methods: We used data from the Find-AF observational (NCT 01855035) and the Find-AF randomised controlled trial (ISRCTN 46104198). We included only patients at study site Goettingen of the Find-AF randomised controlled trial (n=153) and only included patients from the Find-AF observational trial that fulfilled the inclusion/exclusion criteria of Find-AF randomised (n=90). We compared baseline characteristics of screened versus included patients in Find-AF randomised and baseline characteristics and stroke severity parameters between both studies. Data are shown as mean (Standard Deviation) or Median (25%; 75% percentile) and were compared by chi-square, t-test or Mann-Whitney U test. Results: Table 1 shows as comparison between baseline characteristics of both studies Comparing patients fulfilling the inclusion/exclusion criteria of Find-AF randomised, but unwilling to give informed consent to randomised patients showed a significant difference in age (77 ± 11 vs. 74 ± 8; p< 0.001), but no difference in gender (p=0.581). Conclusions: Both studies included patients similar in age, gender and many comorbidities. Major differences occurred in NIHSS and MRS. As NIHSS is a predictor of atrial fibrillation, randomized controlled trials investigating AF detection should include a minimum NIHSS to avoid a selection bias towards less severe strokes.

Download Full-text

Active Cancer and Elevated D-Dimer Are Risk Factors for In-Hospital Ischemic Stroke

Cerebrovascular Diseases Extra ◽

10.1159/000504163 ◽

2019 ◽

Vol 9 (3) ◽

pp. 129-138 ◽

Cited By ~ 1

Author(s):

Izumi Yamaguchi ◽

Yasuhisa Kanematsu ◽

Kenji Shimada ◽

Masaaki Korai ◽

Takeshi Miyamoto ◽

...

Keyword(s):

Ischemic Stroke ◽

Plasma Levels ◽

Functional Dependence ◽

Multivariate Logistic Regression Analysis ◽

Stroke Onset ◽

Stroke Severity ◽

Significant Difference ◽

Poor Outcomes ◽

D Dimer ◽

Active Cancer

Background and Purpose: Little attention has been paid to the pathogenesis of in-hospital stroke, despite poor outcomes and a longer time from stroke onset to treatment. We studied the pathophysiology and biomarkers for detecting patients who progress to in-hospital ischemic stroke (IHS). Methods: Seventy-nine patients with IHS were sequentially recruited in the period 2011–2017. Their characteristics, care, and outcomes were compared with 933 patients who had an out-of-hospital ischemic stroke (OHS) using a prospectively collected database of the Tokushima University Stroke Registry. Results: Active cancer and coronary artery disease were more prevalent in patients with IHS than in those with OHS (53.2 and 27.8% vs. 2.0 and 10.9%, respectively; p < 0.001), the median onset-to-evaluation time was longer (300 vs. 240 min; p = 0.015), and the undetermined etiology was significantly higher (36.7 vs. 2.4%; p < 0.001). Although there was no significant difference in stroke severity at onset between the groups, patients with IHS had higher modified Rankin Scale (mRS) scores (3–6) at discharge (67.1 vs. 50.3%; p = 0.004) and rates of death during hospitalization (16.5 vs. 2.9%; p < 0.001). D-dimer (5.8 vs. 0.8 µg/mL; p < 0.001) and fibrinogen (532 vs. 430 mg/dL; p = 0.014) plasma levels at the time of onset were significantly higher in patients with IHS after propensity score matching. Multivariate logistic regression analysis revealed that active cancer (odds ratio [OR] 2.30; 95% confidence interval [CI] 1.26–4.20), prestroke mRS scores 3–5 (OR 6.78; 95% CI 3.96–11.61), female sex (OR 1.57; 95% CI 1.19–2.08), and age ≥75 years (OR 2.36; 95% CI 1.80–3.08) were associated with poor outcomes. Conclusions: Patients with IHS had poorer outcomes than those with OHS because of a higher prevalence of active cancer and functional dependence before stroke onset. Elevated plasma levels of D-dimer and fibrinogen, especially with active cancer, can help identify patients who are at a higher risk of progression to IHS.

Download Full-text

Changes in PHQ-9 depression scores in acute stroke patients shortly after returning home

PLoS ONE ◽

10.1371/journal.pone.0259806 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259806

Author(s):

Brent Strong ◽

Michele C. Fritz ◽

Liming Dong ◽

Lynda D. Lisabeth ◽

Mathew J. Reeves

Keyword(s):

Depressive Symptoms ◽

Acute Stroke ◽

Recovery Period ◽

Stroke Severity ◽

Stroke Survivors ◽

Stroke Patients ◽

Early Recovery ◽

Post Stroke ◽

Early Recovery Period ◽

Over Time

Introduction Post-stroke depression is a disabling condition that occurs in approximately one-third of stroke survivors. There is limited information on changes in depressive symptoms shortly after stroke survivors return home. To identify factors associated with changes in post-stroke depressive symptoms during the early recovery period, we conducted a secondary analysis of patients enrolled in a clinical trial conducted during the transition period shortly after patients returned home (MISTT). Methods The Michigan Stroke Transitions Trial (MISTT) tested the efficacy of social worker case management and access to online information to improve patient-reported outcomes following an acute stroke. Patient Health Questionnaire-9 (PHQ-9) scores were collected via telephone interviews conducted at 7 and 90 days post-discharge; higher scores indicate more depressive symptoms. Generalized estimating equations were used to identify independent predictors of baseline PHQ-9 score at 7 days and of changes over time to 90 days. Results Of 265 patients, 193 and 185 completed the PHQ-9 survey at 7 and 90 days, respectively. The mean PHQ-9 score was 5.9 at 7 days and 5.1 at 90 days. Older age, being unmarried, and having moderate stroke severity (versus mild) were significantly associated with lower 7-day PHQ-9 scores (indicating fewer depressive symptoms). However, at 90 days, both unmarried patients and those with moderate or high stroke severity had significant increases in depressive symptoms over time. Conclusions In stroke patients who recently returned home, both marital status and stroke severity were associated with depressive symptom scores; however, the relationships were complex. Being unmarried and having higher stroke severity was associated with fewer depressive symptoms at baseline, but both factors were associated with worsening depressive symptoms over time. Identifying risk factors for changes in depressive symptoms may help guide effective management strategies during the early recovery period.

Download Full-text

Hemispheric Coherence Analysis of Wide Band EEG Signals for Characterization of Post-Stroke Patients with Dementia

Traitement du signal ◽

10.18280/ts.380408 ◽

2021 ◽

Vol 38 (4) ◽

pp. 985-992

Author(s):

Sugondo Hadiyoso ◽

Hasballah Zakaria ◽

Paulus Anam Ong ◽

Tati Latifah E.R. Mengko

Keyword(s):

Quantitative Analysis ◽

Wide Band ◽

P Value ◽

Coherence Analysis ◽

Stroke Survivors ◽

Eeg Signals ◽

Stroke Patients ◽

Post Stroke ◽

Significant Difference

Post-stroke dementia (PSD) is a type of vascular dementia (VaD) that might be occurred in post-stroke patients. Memory, language and behavior tests can be used for the analysis of cognitive impairment caused by PSD. Often a supporting clinical examination such as an electroencephalogram (EEG) is used to support the diagnosis or analyze the characteristic changes that occur in the brain. Conventional analysis or visual inspection of EEG signals can be very difficult, since the nature of the signal tends to be non-stationer. Therefore, this study proposes a quantitative analysis for the characterization of EEG signals in stroke survivors with dementia. It is thought that it has different characteristics with the normal subject so that this study can be used as a reference in supporting dementia detection in post-stroke survivors. The quantitative analysis used in this study is coherence analysis. Coherence analysis was performed on EEG signals recorded from six poststroke patients with dementia and then compared with ten normal healthy subjects. Analysis of coherence between brain areas includes inter and intra-hemispheric coherence. Validation was carried out by using the independent t-test where the confidence level was 95%, indicating that the p-value <0.05 had a significant difference. The test results show that in general the coherence of the electrode pairs in patients with dementia is lower than in the normal healthy group. It is notably, i) In interhemispheric, the C3-C4, T3-T4, and T5-T6 pairs generate significant differences, ii) the highest decrease in intrahemispheric coherence was found in C3-T5 with p = 0.0005. The coherence study presented in this paper is expected to be used for early detection of PSD in the future.

Download Full-text

Post-stroke fatigue is linked to resting state posterior hypoactivity and prefrontal hyperactivity

10.1101/2021.03.17.21253777 ◽

2021 ◽

Author(s):

Georgia Mary Cotter ◽

Mohamed Salah Khlif ◽

Laura Bird ◽

Mark E Howard ◽

Amy Brodtmann ◽

...

Keyword(s):

Ischaemic Stroke ◽

Resting State ◽

Large Scale ◽

Brain Activity ◽

Low Frequency ◽

Resting State Fmri ◽

Stroke Severity ◽

Stroke Survivors ◽

Whole Brain ◽

Post Stroke

Background and Purpose. Fatigue is associated with poor functional outcomes and increased mortality following stroke. Survivors identify fatigue as one of their key unmet needs. Despite the growing body of research into post-stroke fatigue, the specific neural mechanisms remain largely unknown. Methods. This observational study included 63 stroke survivors (22 women; age 30-89 years; mean 67.5 years) from the Cognition And Neocortical Volume After Stroke (CANVAS) study, a cohort study examining cognition, mood, and brain volume in stroke survivors following ischaemic stroke. Participants underwent brain imaging 3 months post-stroke, including a 7-minute resting state fMRI echoplanar sequence. We calculated the fractional amplitude of low-frequency fluctuations, a measure of resting state brain activity at the whole-brain level. Results. Forty-five participants reported experiencing post-stroke fatigue as measured by an item on the Patient Health Questionnaire-9. A generalised linear regression model analysis with age, sex, and stroke severity covariates was conducted to compare resting state brain activity in the 0.01-0.08 Hz range, as well as its subcomponents - slow-5 (0.01-0.027 Hz), and slow-4 (0.027-0.073 Hz) frequency bands between fatigued and non-fatigued participants. We found no significant associations between post-stroke fatigue and ischaemic stroke lesion location or stroke volume. However, in the overall 0.01-0.08 Hz band, participants with post-stroke fatigue demonstrated significantly lower resting-state activity in the calcarine cortex (p<0.001, cluster-corrected pFDR=0.009, k=63) and lingual gyrus (p<0.001, cluster-corrected pFDR=0.025, k=42) and significantly higher activity in the medial prefrontal cortex (p<0.001, cluster-corrected pFDR=0.03, k=45), attributed to slow-4 and slow-5 oscillations, respectively. Conclusions. Post-stroke fatigue is associated with posterior hypoactivity and prefrontal hyperactivity, reflecting dysfunction within large-scale brain systems such as fronto-striatal-thalamic and frontal-occipital networks. These systems in turn might reflect a relationship between post-stroke fatigue and abnormalities in executive and visual functioning. This first whole-brain resting-state study provides new targets for further investigation of post-stroke fatigue beyond the lesion approach.

Download Full-text

Comparative Efficacy of Open-chain Kinematics and Closed-chain Kinematics on Walking Proficiency and Societal Integration in Post-stroke Individuals: a Pretest- Post-test Experimental Study

10.21203/rs.3.rs-990536/v1 ◽

2021 ◽

Author(s):

Obianuju Nwaedozie ◽

Caleb Gbiri ◽

Olajide Olawale ◽

Ukamaka Mgbeojedo ◽

Caleb Adeagbo

Keyword(s):

Experimental Study ◽

Bicycle Ergometer ◽

Stroke Survivors ◽

Walking Ability ◽

Open Chain ◽

Post Stroke ◽

Gait Parameters ◽

Closed Chain ◽

Significant Difference ◽

Spatio Temporal

Abstract Background Post-stroke hemiplegic gait is a mixture of deviations and compensatory motion dictated by residual function. To improve stroke survivors' walking ability, it is necessary to evaluate different rehabilitation approaches and identify those that have a greater effect on locomotor recovery of stroke patients. Objectives This study was designed to compare the effect of open-chain kinematics (bicycle ergometry) and closed-chain kinematics (treadmill) on walking proficiency in post-stroke individuals and their societal integration. Methods This was a pretest- posttest- experimental study involving 35 ambulatory hemiplegic stroke survivors (18males and 17 females) with a mean age of 53.77±10.95 undergoing rehabilitation at the two Teaching Hospitals in Lagos. Patients went through a 10-week rehabilitation and were randomly assigned to two intervention groups. Spatio-temporal gait parameters were measured by the six-metre walkway and community integrated questionnaire was used to examine home integration, social integration and productive activities. Data were subjected to inferential and descriptive statistics. The level of significance was set at p<0.05. Results Results showed significant difference between baseline and post intervention scores for all the gait parameters in the bicycle ergometer group except for stride length (p = 0.078). There was also a significant difference in the mean change in cadence between the treadmill and bicycle ergometer group (p = 0.04). Conclusions Both open-chain and closed-chain kinematics are effective, but closed- chain is most effective in re-educating ambulation and re-gaining spatio-temporal gait parameters after stroke and should be structured into the patients’ treatment regimen to effectively improve functional capability in post-stroke individuals.

Download Full-text

Abstract WP233: Unraveling the Profile and Risk Factors of Post-Stroke Cognitive Impairment Among West African Stroke Survivors: Data From the SIREN Study

Stroke ◽

10.1161/str.51.suppl_1.wp233 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Rufus Akinyemi ◽

Bruce Ovbiagele ◽

Onoja Akpa ◽

Fred Sarfo ◽

Joshua Akinyemi ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Conditional Logistic Regression ◽

Leafy Vegetables ◽

Stroke Severity ◽

Stroke Survivors ◽

Community Screening ◽

Post Stroke ◽

Green Leafy Vegetables ◽

Education Network

Background: There is paucity of data on the epidemiology of post-stroke cognitive impairment among African stroke survivors. The aim of this study is to report the profile and risk factors of post- stroke cognitive impairment among stroke survivors participating in the Stroke Investigative Research and Education Network (SIREN) Study. Methods: 1566 were evaluated with the Montreal Cognitive Assessment (MoCA) tool, the Community Screening Instrument for Dementia (CSID) and the Stick Design Test three months after the index stroke. Domain scores were derived for executive function, language memory and visuo-constructive/visuospatial domains. Cut off scores were derived from normative cognitive data obtained from comparable healthy stroke-free control subjects. We used conditional logistic regression to estimate odds ratios (OR) with 95% CIs. Results: Of 1566 stroke survivors [mean age 57.7 (13.4) years] who were assessed 3 months after stroke, 37% were impaired in global cognition and 18-43% were impaired in different domains of cognition (executive, memory, language and visuo-constructive). Stroke severity measured by modified NIHSS score had a strong significant negative association with cognitive function in all domains OR 1.96(1.32-2.91). Older age 1.04 (1.02-2.05), male gender 0.69 (0.50 -0.96), low intake of green leafy vegetables 2.83 (2.03 -3.95) and cardiac disease 1.86 (1.31 -2.75) were associated with poorer cognitive performance in different cognitive domains. Conclusion: The frequency of post-stroke cognitive impairment was high among African stroke survivors three months after the ictus. Diet low in green leafy vegetables is a potentially modifiable risk factor for post-stroke cognitive impairment among West Africans.

Download Full-text

STROKE PATIENTS AND THEIR PARTNER’S PERCEPTIONS OF SURVIVOR FUNCTIONING

Acta Neuropsychologica ◽

10.5604/01.3001.0010.2407 ◽

2017 ◽

Vol 15 (2) ◽

pp. 0-0 ◽

Cited By ~ 1

Author(s):

Chloe Witty ◽

Thomas Heffernan ◽

Leigh Riby

Keyword(s):

Verbal Memory ◽

Digit Span ◽

Qualitative Interviews ◽

Stroke Survivor ◽

Self Report ◽

Stroke Recovery ◽

Step Test ◽

Stroke Survivors ◽

Post Stroke ◽

Significant Difference

[b]Background: [/b]Research into stroke survivors and their partners have shown that the partner frequently rates the stroke survivor as less capable than the survivors rate themselves through self-report questionnaires or qualitative interviews; however, no research to date has used cognitive tasks as a method for in vestigation. This paper aims to investigate if the stroke survivor or the partner rate the stroke survivor as worse across all cognitive domains. [b]Material/ Methods:[/b]This research aimed to observe the incongruence of stroke survivors and their spouse’s perception of survivor functioning by rating their confidence on Picture Memory, Verbal Memory, Digit Span, Luria’s Three Step Test, NART and Raven’s Matrices. Participants, and to compare these score to see if either could predict the actual score. [b]Results: [/b]Showed that neither the stroke survivor nor the partner consistently rated functioning as worse, but there was a significant difference between the dyad. Further, the stroke survivor and the partner’s confidence had no relationship with raw scores. A thematic analysis was also conducted and themes emerged from the data. These were “Confidence,” “Insight into Ability,” and “Post-Stroke Changes.”[b]Conclusions:[/b]These themes were shown to interlink with the scores provided in the qualitative analysis, and implied that low self-efficacy may be crucial in post stroke recovery. Limitations and implications are discussed in full.

Download Full-text