Abstract WP379: Sex-specific Effects of Comorbid Diabetes and Depression on Post-stroke Mortality in Individuals With Atrial Fibrillation

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jodi Edwards ◽  
Jessica Colby-Milley ◽  
Jiming Fang ◽  
Limei Zhou ◽  
Baiju R Shah ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
Comorbid Depression ◽  
Term Care ◽  
Post Stroke ◽  
Specific Effects ◽  
Long Term Mortality

Background: Comorbid diabetes and depression are highly prevalent in atrial fibrillation (AF) and increase the risk of stroke. Women with AF show higher mortality rates and have worse functional outcomes post-stroke. However, the sex-specific effects of comorbid diabetes and depression on mortality and other adverse outcomes in stroke patients with a history of AF is unclear. Methods: Prospectively collected consecutive patients with ischemic stroke and known AF presenting to designated stroke centres in Ontario (2003-2013). Multinomial regression was used to determine sex-specific associations between diabetes and depression and in-hospital mortality post-stroke in individuals with AF. Cox proportional hazards regression was used to estimate the adjusted hazard of long-term mortality post-stroke and competing risks models to estimate hazards of recurrent stroke/TIA, admission to long-term care, and incident dementia post-discharge. Results: Among 5082 stroke patients with known AF (median age=80, IQR:73-85), female patients were more likely to have comorbid depression than males (63.5% vs. 36.5%) and those with comorbid diabetes and depression were younger (77 yrs) and had more vascular history (HTN, CAD, hyperlipidemia) than those with AF only. For males, comorbid diabetes increased the likelihood of in-hospital mortality post-stroke by 53% (OR=1.53, 95% CI=1.16-2.02), after adjustment for stroke severity, demographic and clinical factors, while comorbid depression did not significantly impact in-hospital mortality and neither diabetes or depression affected in-hospital mortality post-stroke for females. However, diabetes was independently associated with increased hazard of long-term mortality for both female (HR=1.15, 95%CI=1.02-1.29) and male AF stroke patients (HR=1.35, 95%CI=1.19-1.53). No associations with recurrent stroke/TIA, institutionalization or dementia post-stroke were observed for either females or males. Conclusion: In stroke patients with known AF, comorbid diabetes but not depression was independently associated with increased in-hospital mortality for males and increased long-term mortality post-stroke for both females and males.

Abstract 176: Long Term Mortality in Acute Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation According to Location and Burden of Cerebral Microbleeds

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tae-Jin Song ◽  
Jinkwon Kim ◽  
Dongbeom Song ◽  
Yong-Jae Kim ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Independent Predictor ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Long Term Mortality

Background: Cerebral microbleeds (CMBs) were predictive of mortality in elderly and considered as a putative marker for risk of intracranial hemorrhage. Stroke patients with non valvular atrial fibrillation (NVAF) require anticoagulation, which increases the risk of hemorrhages. We investigated association of CMBs with the long term mortality in acute ischemic stroke patients with NVAF. Methods: During 6 years , consecutive ischemic stroke patients who had NVAF and who had undergone brain MRI with a gradient-recalled echo sequence were enrolled. Long-term mortality and causes of death were identified using data from Korean National Statistical Office. Survival analysis was performed whether the presence, number and location of CMBs were related with all causes, cardiovascular, and cerebrovascular mortality during follow-up. Results: Total 506 patients were enrolled during the study period and were followed up for median 2.5 years. CMBs were found in 30.8% of patients (156/506). Oral anticoagulation with warfarin was prescribed at discharge in 477 (82.7%) patients. During follow up, 177 (35%) patients died and cerebrovascular death was noted in 93 patients (81 ischemic stroke and 12 hemorrhagic stroke). After adjusting age, sex and significant variables in univariate analysis (p<0.1), multiple CMBs (≥5) were the independent predictor for all-cause, cardiovascular and ischemic stroke mortalities. The strictly lobar CMBs were associated with hemorrhagic stroke mortality in multivariate Cox regression analysis (HR 4.776, p=0.032) (Figure 1). Conclusions: Multiple CMBs were the independent predictor for the long term mortality in stroke patients with NVAF. Among them, patients with strictly lobar CMBs had a high risk of death due to hemorrhagic stroke. Our findings suggest that detection of CMBs in stroke patients with NVAF are of clinical relevance for predicting long term outcome and that particular concern is necessary in those with strictly lobar CMBs for their increased risk of death due to hemorrhagic stroke. Figure 1.

scholarly journals Does prior antithrombotic therapy influence recurrence and bleeding risk in stroke patients with atrial fibrillation or atrial flutter?

2019 ◽  
Vol 27 (7) ◽  
pp. 729-737
Author(s):  
David T Gamble ◽  
Romain Buono ◽  
Mamas A Mamas ◽  
Stephen Leslie ◽  
Joao H Bettencourt-Silva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Ischaemic Stroke ◽  
Antithrombotic Therapy ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Stroke Patients ◽  
Antithrombotic Treatment ◽  
Long Term Mortality

Background Whilst antithrombotic therapy is recommended in people with atrial fibrillation, little is known about the survival benefits of antithrombotic treatment in those with both high ischaemic and bleeding risk scores. We aim to describe the distribution of these risk scores in those with a prior diagnosis of atrial fibrillation who have suffered stroke and to determine the net clinical benefit of antithrombotic treatment. Methods We used regional stroke register data in the UK. Patients with a prior diagnosis of atrial fibrillation and ischaemic or haemorrhagic stroke patients were selected and their ischaemic stroke risk score (CHA2DS2-VASc) and bleeding risk score (HEMORR2HAGES) scores retrospectively calculated. Logistic regression and Cox proportional hazards models were constructed to determine the association between antithrombotic therapy prior to stroke and in-hospital and long-term mortality. Results A total of 1928 stroke patients (mean age 81.3 years (standard deviation 8.5), 56.8% women) with prior atrial fibrillation were included. Of these, 1761 (91.3%) suffered ischaemic stroke. The most common phenotype (64%) was of those with both high CHA2DS2-VASc (≥2) and high HEMORR2HAGES score (≥4). In our fully adjusted model, patients on antithrombotic treatment with both high ischaemic and bleeding risk had a significant reduction in odds of 31% for in-hospital mortality (odds ratio 0.69 (95% confidence interval 0.48–1.00: p = 0.049)) and 17% relative risk reduction for long-term mortality (hazard ratio 0.83 (95% confidence interval 0.71–0.97: p = 0.02)). Conclusions Our study suggests that antithrombotic treatment has a prognostic benefit following incident stroke in those with both high ischaemic risk and high bleeding risk. This should be considered when choosing treatment options in this group of patients.

scholarly journals Individual and Combined Impact of Heart Failure and Atrial Fibrillation on Ischemic Stroke Outcomes

Stroke ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1838-1845 ◽  
Author(s):  
Tiberiu A. Pana ◽  
David J. McLernon ◽  
Mamas A. Mamas ◽  
Joao H. Bettencourt-Silva ◽  
Anthony K. Metcalf ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Stroke Recurrence ◽  
Stroke Outcomes ◽  
Long Term Mortality

Background and Purpose— We aimed to determine individual and combined effects of atrial fibrillation (AF) and heart failure (HF) on acute ischemic stroke outcomes: in-hospital mortality, length-of-stay, and poststroke disability; long-term mortality and stroke recurrence. Methods— Prospective cohort study of patients with acute ischemic stroke admitted to a UK center with a catchment population of ≈900 000 between 2004 and 2016. Exposure groups were patients with neither AF nor HF (reference group), those with AF but without HF, those with HF but without AF, and those with AF+HF. Logistic and Cox regressions were used to model in-hospital and long-term outcomes, respectively. Results— A total of 10 816 patients with a mean age±SD =77.9±12.1 years, 48% male were included. Only 30 (4.9%) of the patients with HF but not AF were anticoagulated at discharge. Both AF (odds ratio, 1.24 [95% CI, 1.07–1.43]), HF (odds ratio, 1.40 [1.10–1.79]), and their combination (odds ratio, 2.23 [1.83–2.72]) were associated with increased odds of in-hospital mortality. All 3 exposure groups were associated with increased length-of-stay, while only AF predicted increased disability (1.36 [1.12–1.64]). Patients were followed for a median of 5.5 and 3.7 years for mortality and recurrence, respectively. Long-term mortality was associated with AF (hazard ratio, 1.45 [95% CI, 1.33–1.59]), HF (2.07 [1.83–2.36]), and their combination (2.20 [1.96–2.46]). Recurrent stroke was associated with AF 1.50 (1.26–1.78), HF (1.33 [1.01–1.75]), and AF with HF (1.62 [1.28–2.07]). Conclusions— The AF-associated excess risk of stroke recurrence was independent of comorbid HF. HF without AF was also associated with a significant risk of recurrence. Anticoagulation for secondary stroke prevention in patients with HF without AF may require further evaluation in a clinical trial setting.

scholarly journals 87 Evolution of Atrial Fibrillation

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Marykate Meagher ◽  
Imelda Noone ◽  
Naomi Davey ◽  
Tim Cassidy
Keyword(s):  
Atrial Fibrillation ◽  
Long Term Care ◽  
Vitamin K Antagonist ◽  
Stroke Patients ◽  
Term Care ◽  
Mortality And Morbidity ◽  
Established Risk Factor ◽  
History Of ◽  
New Diagnosis

Abstract Background Atrial Fibrillation (AF) is a common cardiac arrhythmia and a well-established risk factor for stroke with its prevalence increasing with age. AF related strokes are associated with increased mortality and morbidity however the risk of stroke is reduced by almost 70% by oral anticoagulation (OAC). Methods Analysis of data using SPSS allowed us to identify all acute stroke patients admitted in 2018 with AF. We compared data on patients who were admitted with known AF and those who were newly identified with AF and looked at their outcomes. Results 373 stroke patients admitted,of which 108(29%) patients had AF, mean age 79. 68(63%) had known AF and 40(37%) had a new diagnosis of AF. 52(76.5%) of the known AF were on an OAC (11 on warfarin) and 40(78%) on a Non- Vitamin K antagonist oral anticoagulant (NOAC). 16 patients (23.5%) with known AF were not anticoagulated on admission. (Reasons for no OAC-3 had a history of previous intracerebral haemorrhage (ICH). 2 a history of bleeding and 1 a history excess alcohol). 10 patients were on antiplatelet therapy and were subsequently anticoagulated on discharge. 33(48.5%) of the known AF were discharged home versus 15(37.5%) in the new AF cohort and while mortality was higher in the known AF, there were more patients in the new AF cohort 14(35%) that required long term care compared with 3(4%) in the known AF cohort which not only indicates the severity of their stroke but also suggests that if AF had been detected and treated sooner their outcome may have been very different. Conclusion There has been a significant increase in primary prevention practices for AF and this is reflected in the number of stroke patients presenting with known AF on a NOAC, however more needs to be done as there are still patients who have AF that are not being anticoagulated in the community.

scholarly journals 99 New onset atrial fibrillation in STEMI patients: main prognostic factors and clinical outcome

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Beatrice Dal Zotto ◽  
Lucia Barbieri ◽  
Gabriele Tumminello ◽  
Massimo Saviano ◽  
Domitilla Gentile ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Short And Long Term ◽  
Long Term Mortality ◽  
New Onset

Abstract The treatment of patients with known atrial fibrillation (AF) undergoing percutaneous coronary intervention has clear indications in the actual guidelines. Remarkable lack of evidence regarding new-onset AF (NOAF) in particular during STEMI is the reason for this study. We retrospectively analysed 1455 consecutive STEMI patients. The primary outcomes are in-hospital, 1-year and long-term follow-up mortality. Cerebral ischaemic events and major bleedings were considered clinical endpoints at 1 year. NOAF was detected in 102 subjects, 62.7% males, mean age 74.8 ± 10.6 years. Mean left ventricular ejection fraction (LVEF) was 43.5 ± 12.1% and left atrial enlargement (58 ± 20.9 ml) was observed. Anterior STEMI accounted for the majority (46%). NOAF has been predominantly recorded in the acute phase (mean duration of 8.1 ± 12.5 h). CHA2DS2-VASc score &gt;2 was recorded in 83% of cases, while HAS-BLED score of 2 or 3 was the most represented. All patients acutely received enoxaparin, but only 21.6% were discharged on oral anticoagulation (OAC). In-hospital mortality was 14.2%, while 1-year and long-term mortality were 17.2% and 32.1%, respectively. We identified age as an independent predictor of short- and long-term mortality, while LVEF was the only other independent predictor for in-hospital mortality and arrhythmia duration for 1-year mortality. After 1-year of follow-up we recorded three ischaemic events and no major bleeding. In conclusion, STEMI patients who present NOAF are a very high-risk population with increased short- and long-term mortality. Our data suggest that the indication for OAC should be always driven by CHA2DS2-VASC and HAS-BLEED score, even in patients with a single episode indeed. 99 Figure 1Kaplan-Meier curve representing the long-term survival of the entire population from hospital admission up to the maximum follow-up time was performed

scholarly journals Postural Control Disturbances Induced by Virtual Reality in Stroke Patients

2021 ◽  
Vol 11 (4) ◽  
pp. 1510
Author(s):  
Charles Morizio ◽  
Maxime Billot ◽  
Jean-Christophe Daviet ◽  
Stéphane Baudry ◽  
Christophe Barbanchon ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Postural Control ◽  
Virtual Environments ◽  
Center Of Pressure ◽  
Dynamic Condition ◽  
Static Condition ◽  
Stroke Patients ◽  
Post Stroke ◽  
Subacute Stroke

People who survive a stroke are often left with long-term neurologic deficits that induce, among other impairments, balance disorders. While virtual reality (VR) is growing in popularity for postural control rehabilitation in post-stroke patients, studies on the effect of challenging virtual environments, simulating common daily situations on postural control in post-stroke patients, are scarce. This study is a first step to document the postural response of stroke patients to different challenging virtual environments. Five subacute stroke patients and fifteen age-matched healthy adults were included. All participants underwent posturographic tests in control conditions (open and closed eyes) and virtual environment without (one static condition) and with avatars (four dynamic conditions) using a head-mounted device for VR. In dynamic environments, we modulated the density of the virtual crowd (dense and light crowd) and the avoidance space with the avatars (near or far). Center of pressure velocity was collected by trial throughout randomized 30-s periods. Results showed that more challenging conditions (dynamic condition) induced greater postural disturbances in stroke patients than in healthy counterparts. Our study suggests that virtual reality environments should be adjusted in light of obtaining more or less challenging conditions.

scholarly journals Resting Heart Rate and In-Hospital Mortality in Acute Ischemic Stroke Patients With and Without Atrial Fibrillation

2020 ◽  
Vol 84 (4) ◽  
pp. 656-661
Author(s):  
Qiao Han ◽  
Chunyuan Zhang ◽  
Shoujiang You ◽  
Danni Zheng ◽  
Chongke Zhong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Resting Heart Rate ◽  
Stroke Patients

scholarly journals Identifying unmet needs in long-term stroke care using in-depth assessment and the Post-Stroke Checklist – The Managing Aftercare for Stroke (MAS-I) study

2018 ◽  
Vol 3 (3) ◽  
pp. 237-245 ◽  
Author(s):  
Benjamin Hotter ◽  
Inken Padberg ◽  
Andrea Liebenau ◽  
Petra Knispel ◽  
Sabine Heel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Caregiver Burden ◽  
Unmet Needs ◽  
Community Dwelling ◽  
Social Needs ◽  
Interquartile Range ◽  
Stroke Patients ◽  
Post Stroke

Introduction Detailed data on the long-term consequences and treatment of stroke are scarce. We aimed to assess the needs and disease burden of community-dwelling stroke patients and their carers and to compare their treatment to evidence-based guidelines by a stroke neurologist. Methods We invited long-term stroke patients from two previous acute clinical studies ( n = 516) in Berlin, Germany to participate in an observational, cross-sectional study. Participants underwent a comprehensive interview and examination using the Post-Stroke Checklist and validated standard measures of: self-reported needs, quality of life, overall outcome, spasticity, pain, aphasia, cognition, depression, secondary prevention, social needs and caregiver burden. Results Fifty-seven participants (median initial National Institutes of Health Stroke Scale score 10 interquartile range 4–12.75) consented to assessment (median 41 months (interquartile range 36–50) after stroke. Modified Rankin Scale was 2 (median; interquartile range 1–3), EuroQoL index value was 0.81 (median; interquartile range 0.70–1.00). The frequencies for disabilities in the major domains were: spasticity 35%; cognition 61%; depression 20%; medication non-compliance 14%. Spasticity ( p = 0.008) and social needs ( p < 0.001) had the strongest impact on quality of life. The corresponding items in the Post-Stroke Checklist were predictive for low mood ( p < 0.001), impaired cognition ( p = 0.015), social needs ( p = 0.005) and caregiver burden ( p = 0.031). In the comprehensive interview, we identified the following needs: medical review (30%), optimization of pharmacotherapy (18%), outpatient therapy (47%) and social work input (33%). Conclusion These results suggest significant unmet needs and gaps in health and social care in long-term stroke patients. Further research to develop a comprehensive model for managing stroke aftercare is warranted. Clinical Trial Registration: clinicaltrials.gov NCT02320994.

Sign in / Sign up

Export Citation Format

Share Document