Abstract WP283: The Multiple-Encounter Multiply-Thrombolysed Telestroke Patient - A Unique Patient Population

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Johanna L Morton ◽  
Diamond K Northington ◽  
B. Tilman Jolly
Keyword(s):  
Patient Population ◽  
Stroke Risk ◽  
Standard Of Care ◽  
Psychiatric Disease ◽  
Outcome Analysis ◽  
Single Patient ◽  
Discharge Data ◽  
Stroke Risk Factors ◽  
Inherent Risk ◽  
Patient Database

Background: Thrombolysis with alteplase is the standard of care for the treatment of eligible patients presenting with acute ischemic stroke (AIS). Many hospitals do not have access to in-person cerebrovascular expertise, and utilize telestroke services for the remote diagnosis and treatment of AIS. Through this practice, an unusual subset of patients with multiple presentations having received thrombolysis several times has emerged. This study describes the largest known sample of this multiple-encounter population within a single teleneurology practice spanning 39 states over 4 years. Methods: A retrospective observational study of the experience of a single teleneurology practice serving over 400 hospitals from July 1, 2015 to June 30, 2019 was performed. The alteplase patient database was queried to identify patients with both multiple telestroke and multiple alteplase encounters. Demographic and clinical data were abstracted. Outcome analysis was restricted to those patients with available complete discharge data. Results: Within the queried period, 71 patients were identified to have had multiple encounters with the teleneurology practice, 46 males and 25 females. Of these, 36 patients were seen twice, 18 were seen three times, 10 were seen four times, and 7 had five or more encounters, with the maximum number of encounters of 26. Seven patients received care in multiple states. The overall alteplase rate was 58.2%. Alteplase was administered on more than one encounter in all 71 patients, with a maximum alteplase administration of 4 times in a single patient. The median NIHSS score in this population was 5. Of the 71 patients, all had stroke risk factors, 36.6% had noncerebrovascular neurological comorbidities, and 36.6% had psychiatric disease history. The symptomatic hemorrhage rate in this population was 0%. Conclusion: The observed phenomena of recurrent teleneurology encounters for patients presenting with suspected AIS symptoms and receiving alteplase at increased rates is not well-described and is poorly understood. Given the inherent risk and resource utilization associated with thrombolysis, further analysis of the characteristics of this patient population is warranted.

Abstract WP298: Feasibility of a Large-Scale Teleneurology Network for Thrombolysis Administration in a Heterogeneous Multihospital Population

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Johanna L Morton ◽  
Diamond K Northington ◽  
B. Tilman Jolly
Keyword(s):  
Medical Records ◽  
Large Scale ◽  
Skilled Nursing Facility ◽  
Standard Of Care ◽  
Stroke Care ◽  
Outcome Analysis ◽  
Acute Stroke Care ◽  
Skilled Nursing ◽  
Discharge Data ◽  
Nihss Score

Background: Administration of alteplase is the standard of care for eligible patients presenting with symptoms of acute ischemic stroke (AIS). Telemedicine is increasingly being used to deliver acute stroke care to patients without in-person access to stroke expertise. This study reviews the thrombolysis experience of the largest known teleneurology network spanning 39 states and distributed across a heterogeneous multihospital population throughout the nation. Methods: Data was abstracted from internal medical records systems and relevant medical records obtained from partner hospitals. A retrospective analysis on the prospectively maintained database of patients who have received alteplase was performed. Data was collected from December 1, 2015 to May 31, 2019. Outcome analysis was restricted to those patients with available complete discharge data. Results: The analysis revealed 8,399 patients as having received alteplase during the study period. Of these, 56.7% had discharge information available. The mean patient age was 68.5 years, with a mean age of 70.5 years for females and 66.5 years for males. The median initial NIHSS score was 7, with 31.2% of patients presenting with an initial NIHSS score ≤4, and 8.7% presenting with an initial NIHSS score ≥21. The transfer rate to another facility was 31.0%. There were 2,417 home discharges (48.2%), 1,057 acute rehabilitation discharges (21.1%), and 478 skilled nursing facility discharges (9.5%). There were 28 patients who left against medical advice (0.6%). The symptomatic hemorrhage rate in this population was 1.1% (92), and there were 234 patient deaths (4.7%). Conclusion: A large-scale teleneurology platform for the emergent treatment of patients presenting with AIS symptoms is both safe and feasible. Due to the heterogeneity of this patient and hospital population, higher level refinement of this analysis to include hyperacute metrics, transfer data, and more comprehensive clinical and functional outcomes is warranted.

Abstract 3239: Risk of Stroke after New-Onset Atrial Fibrillation versus Chronic AF in Patients Undergoing Coronary Artery Bypass Surgery

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Khung Keong Yeo ◽  
Zhongmin Li ◽  
Scott Katz ◽  
James Douketis ◽  
Beate Danielsen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Hospital Discharge ◽  
Stroke Risk ◽  
Artery Bypass ◽  
Discharge Data ◽  
Stroke Risk Factors ◽  
Time Of Admission ◽  
New Onset

Background: Among patients undergoing isolated coronary artery bypass graft surgery (CABG), the risk of post-operative stroke has not been compared between patients with chronic atrial fibrillation (AF) versus patients with hospital-acquired new-onset AF (new-AF). Methods: Using linked hospital discharge data together with comprehensive clinical data from the California CABG outcomes reporting program, we conducted a retrospective cohort study of all patients undergoing isolated CABG in California between years 2003–2006. Using hospital discharge data, chronic AF was defined as ICD-9-CM =427.31 present at time of admission and during a previous hospitalization. New-AF was defined as a first-ever code for AF that was not present at the time of admission. The risk of stroke < 30 days after surgery, defined using specific ICD-9-CM codes, was analyzed using logistic regression, with adjustment for 15 clinically important stroke risk factors. As a sensitivity analysis, we developed a propensity model for new-AF, and analyzed the risk of stroke after hospital discharge but within 30 days of surgery. Results: Among 61,031 cases, 2081 (3.4%) had chronic AF; 9858 (17%) had new-AF; the 30-day incidence of stroke was 1222 (2.0%). Compared to patients with no-AF, the adjusted risk of stroke in patients with chronic AF was odds ratio (OR) = 1.2 (CI: 0.9 –1.5), whereas for new-AF, it was OR= 1.7 (CI: 1.5–1.9), c-statistic = 0.73. Using the propensity analysis, the risk of stroke after hospital discharge associated with new-AF versus no-AF was similar across quintiles of the risk score (OR range=1.7–1.8). Conclusion: After adjusting for stroke risk factors, patients who developed AF during hospitalization for CABG had an approximately 70% higher risk of stroke within 30 days compared to patients without AF, whereas the risk of stroke in patients with chronic AF was not significantly increased. Interventions that reduce the incidence of new-AF after CABG surgery may reduce the incidence of subsequent stroke.

scholarly journals 947. Stroke demographics and risk factor profile in HIV infected individuals in Florida

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S506-S506
Author(s):  
Folusakin Ayoade ◽  
Dushyantha Jayaweera
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Clinical Research ◽  
Stroke Risk ◽  
Research Network ◽  
Categorical Variables ◽  
People Living With Hiv ◽  
Risk Factor Profile ◽  
Stroke Risk Factors ◽  
Living With Hiv

Abstract Background The risk of ischemic stroke (IS) is known to be higher in people living with HIV (PLWH) than uninfected controls. However, information about the demographics and risk factors for hemorrhagic stroke (HS) in PLWH is scant. Specifically, very little is known about the differences in the stroke risk factors between HS and IS in PLWH. The goal of this study was to determine the demographics and risk factor differences between HS and IS in PLWH. Methods We retrospectively analyzed the demographic and clinical data of PLWH in OneFlorida (1FL) Clinical Research Consortium from October 2015 to December 2018. 1FL is a large statewide clinical research network and database which contains health information of over 15 million patients, 1240 clinical practices, and 22 hospitals. We compared HS and IS based on documented ICD 9 and 10 diagnostic codes and extracted information about sociodemographic data, traditional stroke risk factors, Charlson comorbidity scores, habits, HIV factors, diagnostic modalities and medications. Statistical significance was determined using 2-sample T-test for continuous variables and adjusted Pearson chi square for categorical variables. Odds ratio (OR) and 95% confidence intervals (CI) between groups were compared. Results Overall, from 1FL sample of 13986 people living with HIV, 574 subjects had strokes during the study period. The rate of any stroke was 18.2/1000 person-years (PYRS). The rate of IS was 10.8/1000 PYRS while the rate of HS was 3.7/1000 PYRS, corresponding to 25.4% HS of all strokes in the study. Table 1 summarizes the pertinent demographic and risk factors for HS and IS in PLWH in the study. Table 1: Summary of pertinent demographic and risk factors for hemorrhagic and ischemic strokes in people living with HIV from One Florida database Conclusion In this large Floridian health database, demographics and risk factor profile differs between HS and IS in PLWH. Younger age group is associated with HS than IS. However, hypertension, hyperlipidemia and coronary artery disease are more likely to contribute to IS than HS in PLWH. Further research is needed to better understand the interplay between known and yet unidentified risk factors that may be contributing to HS and IS in PLWH. Disclosures All Authors: No reported disclosures

The Burden of Stroke in Pakistan

2008 ◽  
Vol 3 (4) ◽  
pp. 293-296 ◽  
Author(s):  
Bhojo A. Khealani ◽  
Mohammad Wasay
Keyword(s):  
Risk Factors ◽  
Stroke Risk ◽  
Case Series ◽  
Stroke Care ◽  
Poor Control ◽  
Stroke Incidence ◽  
Treatment Practices ◽  
Stroke Risk Factors ◽  
The Subject ◽  
Artery Disease

Epidemiologic literature on stroke burden, patterns of stroke is almost non existent from Pakistan. However, several hospital-based case series on the subject are available, mainly published in local medical journals. Despite the fact that true stroke incidence and prevalence of stroke in Pakistan is not known, the burden is assumed to be high because of highly prevalent stroke risk factors (hypertension, diabetes mellitus, coronary artery disease, dyslipidemia and smoking) in the community. High burden of these conventional stroke risk factors is further compounded by lack of awareness, poor compliance hence poor control, and inappropriate management/treatment practices. In addition certain risk factors like rheumatic valvular heart disease may be more prevalent in Pakistan. We reviewed the existing literature on stroke risk factors in community, the risk factor prevalence among stroke patients, patterns of stroke, out come of stroke, availability of diagnostic services/facilities related to stroke and resources for stroke care in Pakistan.

scholarly journals Knowledge of Stroke Risk Factors among Stroke Survivors in Nigeria

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Grace Vincent-Onabajo ◽  
Taritei Moses
Keyword(s):  
Risk Factors ◽  
Stroke Risk ◽  
Tertiary Education ◽  
Effective Means ◽  
Descriptive Statistics ◽  
Stroke Survivors ◽  
Questionnaire Data ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Stroke Risk Factors

Background. Knowledge of stroke risk factors is expected to reduce the incidence of stroke—whether first-ever or recurrent. This study examined knowledge of stroke risk factors and its determinants among stroke survivors.Methods. A cross-sectional survey of consenting stroke survivors at two physiotherapy facilities in Nigeria was carried out. Sociodemographic and clinical data were obtained and knowledge of stroke risk factors (defined as the ability to mention at least one correct risk factor) was assessed using open-ended questionnaire. Data were treated with descriptive statistics and logistic regression analysis.Results. Sixty-nine stroke survivors (male = 72.5%; mean ± SD age =49.7±10.6years) participated in the study. Thirty-four (49.4%) participants had knowledge of stroke risk factors. Only educational level was significantly associated with knowledge and participants with tertiary educational qualification were about 48 times (odds ratio = 48.5; CI = 7.6–309.8;P<0.0001) more likely to be knowledgeable than those with no education.Conclusion. Less than half of the participants had knowledge of stroke risk factors. Participants with tertiary education were significantly more knowledgeable than those with lower educational qualifications. Effective means of educating stroke survivors on stroke risk factors should be identified and adopted.

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

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Urvish K Patel ◽  
Priti Poojary ◽  
Vishal Jani ◽  
Mandip S Dhamoon
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Stroke Risk ◽  
Behavioral Risk Factors ◽  
Behavioral Risk ◽  
Stroke Risk Factors

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

Abstract T P136: Potential Contributors to the Declining Impact of Stroke Risk Factors with Age: Implications for Stroke Epidemiology in the Elderly

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
George Howard ◽  
Mary Cushman ◽  
Maciej Banach ◽  
Brett M Kissela ◽  
David C Goff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Stroke Risk ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Stroke Risk Factors ◽  
Age Related ◽  
Increased Risk ◽  
The Impact ◽  
Age Related Changes

Purpose: The importance of stroke research in the elderly is increasing as America is “graying.” For most risk factors for most diseases (including stroke), the magnitude of association with incident events decreases at older ages. Potential changes in the impact of risk factors could be a “true” effect, or could be due to methodological issues such as age-related changes in residual confounding. Methods: REGARDS followed 27,748 stroke-free participants age 45 and over for an average of 5.3 years, during which 715 incident strokes occurred. The association of the “Framingham” risk factors (hypertension [HTN], diabetes, smoking, AFib, LVH and heart disease) with incident stroke risk was assessed in age strata of 45-64 (Young), 65-74 (Middle), and 75+ (Old). For those with and without an “index” risk factor (e.g., HTN), the average number of “other” risk factors was calculated. Results: With the exception of AFib, there was a monotonic decrease in the magnitude of the impact across the age strata, with HTN, diabetes, smoking and LVH even becoming non-significant in the elderly (Figure 1). However, for most factors, the increasing prevalence of other risk factors with age impacts primarily those with the index risk factor absent (Figure 2, example HTN as the “index” risk factor). Discussion: The impact of stroke risk factors substantially declined at older ages. However, this decrease is partially attributable to increases in the prevalence of other risk factors among those without the index risk factor, as there was little change in the prevalence of other risk factors in those with the index risk factor. Hence, the impact of the index risk factor is attenuated by increased risk in the comparison group. If this phenomenon is active with latent risk factors, estimates from multivariable analysis will also decrease with age. A deeper understanding of age-related changes in the impact of risk factors is needed.

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