Abstract MP26: Medicaid Expansion Did Not Reduce Stroke Readmissions After One Year

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Blake T McGee ◽  
Seiyoun Kim
Keyword(s):  
Ischemic Stroke ◽  
Fixed Effects ◽  
Secondary Analysis ◽  
First Year ◽  
Medicaid Expansion ◽  
Targeted Interventions ◽  
Quasi Experimental ◽  
Treatment Interaction ◽  
One Year ◽  
Primary Payer

Introduction: Up to 21% of stroke survivors are re-hospitalized within 30 days. Health insurance promotes access to follow-up care that can mitigate the risk of readmission, but 12 states do not participate in the Affordable Care Act’s Medicaid expansion. Hypothesis: The probability of 30-day hospital readmission after acute ischemic stroke was lower in Medicaid expansion states than in non-expansion states. Methods: A retrospective, quasi-experimental study using six inpatient databases from AHRQ’s Healthcare Cost and Utilization Project: four from expansion states (AR, MD, NM and WA) and two non-expansion (FL and GA). The sample comprised all patients hospitalized in 2012-14 with a principal diagnosis of ischemic stroke (ICD-9-CM 433.x1, 434.x1 or 436) who were aged 19-64; resided in the state where admitted; had a primary payer of Medicaid, self-pay or no charge; and were discharged alive ( N =18,766). Mixed effects logit models with a time-by-treatment interaction were built to test if the probability of readmission changed differentially between expansion and non-expansion states from 2012-13 (before expansion) to 2014. Any in-state hospitalization within 30 days of discharge (except for rehabilitation, psychiatry, or cancer treatment) was considered a readmission. A secondary analysis of unplanned, potentially preventable readmissions (adapted from the AHRQ Prevention Quality Indicators) was also conducted. Models included race, sex, age, number of diagnoses, median household income quartile of patient ZIP code, and metropolitan residence as fixed effects, with random intercepts for hospital and state. Results: In 2012-13, 8.9% of the expansion state patients were readmitted compared to 9.0% in non-expansion states; in 2014, 11.1% were readmitted in expansion states versus 10.5% in non-expansion states. In multivariable models, the time-by-treatment interaction was not statistically significant: β=0.072, p= .541, for all readmissions, β=0.168, p =.683, for unplanned, potentially preventable readmissions. Conclusions: Medicaid expansion did not reduce 30-day readmissions after stroke in the first year of implementation in four diverse states. Stroke readmissions among non-elderly adults require more targeted interventions.

Abstract WMP113: Serial Cognitive Testing Performance by Baseline Fazekas Category in Stroke Survivors: A Secondary Analysis of the SPS-3 Trial

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Natalia Rost ◽  
Shyam Prabhakaran
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Cognitive Abilities ◽  
Secondary Analysis ◽  
College Education ◽  
Cognitive Testing ◽  
White Matter Hyperintensity ◽  
Absolute Difference ◽  
Stroke Survivors ◽  
One Year

Introduction: Prior research has shown that an increased burden of white matter hyperintensity (WMH) is an independent risk factor for the development of dementia. However, research has not focused specifically on stroke survivors, who are also predisposed to dementia. Methods: This is a secondary analysis of patients in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial, who had a lacunar ischemic stroke within 6 months of enrollment and an MRI at study baseline. The primary outcome is change in the Cognitive Abilities Screening Instrument (CASI) from baseline to a 12 month follow-up. The primary predictor is the Fazekas score on the baseline MRI, with the scores of 0 and 1 collapsed to balance the cohort. We fit regression models to the 12 month CASI and adjusted for baseline CASI, patient age, gender, white race, Barthel Index score at 3 months from enrollment, college education, employment status, diabetes, COPD, and SPS3 randomization arm. Results: We included 2,413 patients with a mean (SD) age of 62.8 (10.6) years and 63.7% were male. There were 946 patients in Fazekas 0-1, 1,009 in Fazekas 2, and 458 in Fazekas 3. The mean (SD) CASI score at baseline and 12 months were 85.3 (12.4) and 86.0 (12.4). In the adjusted linear regression model, compared to a baseline Fazekas of 0-1, a baseline Fazekas of 2 was associated with a worse cognitive score (β coef = -0.55, 95% CI -1.01, -0.08, p=0.020), as was Fazekas of 3 (β coef = -0.76, 95% CI -1.36, -0.16, p=0.013). Conclusion: In patients with recent lacunar stroke, an increased baseline WMH burden is a risk factor for worse performance over a one year period on a validated test of global cognition. Although the absolute difference in score that we found was small (~0.5-0.8 points), this difference is over one year and, over years to decades, could become clinically significant. The implication of this finding is that lacunar ischemic stroke has additive cognitive consequences for patients with an established WMH burden, suggesting that primary stroke prevention in patients with WMH could be an important public health goal to reduce the burden of dementia.

Effects of IgG from the serum of ischemic stroke patients on hemostasis

2021 ◽  
Author(s):  
Tetiana Katrii ◽  
Nataliia Raksha ◽  
Tetiana Halenova ◽  
Tetiana Vovk ◽  
Olga Kravchenko ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Healthy Subjects ◽  
Protein A ◽  
Factor Xa ◽  
Modern Medicine ◽  
First Year ◽  
Thrombin Time ◽  
Stroke Patients ◽  
One Year ◽  
Hemostasis Factors

Ischemic stroke is among the top diseases leading to mortality and disability in the world. The detailed investigation of the mechanisms underlying this pathology and especially mediating the tendency to relapse during the first year after stroke incident undoubtedly belongs to important tasks of modern medicine and biology. The current study aims to analyze the influence of IgG derived from the blood serum of ischemic stroke patients on some hemostasis factors. In total, 123 participants with IS, 62 with atherothrombotic ischemic stroke, 61 with cardioembolic ischemic stroke, and 57 subjects as control have been examined. The same patients have participated in the research a year after stroke. IgG from serum was isolated by affinity chromatography on protein A Sepharose column. The activity of key hemostasis factors under the influence of IgG was analyzed. Obtained results revealed that IgG of stroke patients but not healthy subjects caused the inhibition of the amidolytic activity of endogenously generated thrombin, protein C, factor Xa, and led to an increase in the degree of ADP-induced platelet aggregation. The reduction of clotting time in the test "Thrombin time" by IgG of patients at the acute phase of disease was also observed; IgG of healthy subjects mediated the opposite effect. In contrast to acute ischemic stroke IgG, IgG of patients one year after both atherothrombotic and cardioembolic ischemic stroke influenced only the activity of endogenously generated thrombin and factor Xa resulting in inhibition of their activities. It was also established that IgG of ischemic stroke patients, as well as healthy subjects, stimulated the secretion of tissue plasminogen activator by endotheliocytes.

Abstract WMP103: Epilepsy is Associated With Poorer Neurologic Outcome After Pediatric Arterial Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Christine K Fox ◽  
Lori C Jordan ◽  
Mark T Mackay ◽  
Gabrielle deVeber ◽  
Keyword(s):  
Ischemic Stroke ◽  
Neurologic Outcome ◽  
First Year ◽  
Stroke Outcome ◽  
Arterial Ischemic Stroke ◽  
Post Stroke ◽  
One Year ◽  
Active Epilepsy ◽  
Relationship Of ◽  
The Relationship

Introduction: Post-stroke epilepsy is common in children, but the relationship of childhood epilepsy with stroke outcome is poorly understood. Hypothesis: Children with epilepsy after arterial ischemic stroke have worse outcomes than those without epilepsy. Methods: We prospectively enrolled children (birth-18 years) with arterial ischemic stroke and identified remote seizures (occurring ≥ 7 days post-stroke). At one-year, patients with active epilepsy (≥ 1 remote seizure + maintenance anti-convulsant) were identified and Pediatric Stroke Outcome Measure (PSOM) was scored. Total PSOM scores range from 0-10; higher values reflect more severe neurologic deficits. Ordinal logistic regression was used to evaluate the relationship between clinical factors and PSOM scores. PSOM scores were categorized 0-1, 1.5-3, 3.5-6, 6.5-10 to depict stratified distribution. Results: Among 94 children (54% male; 20% Hispanic; 25% neonatal strokes; median age for childhood strokes 6.1 years, IQR 1.3-12), 12 had ≥ 1 remote seizure during the first year post-stroke. At one-year follow-up, 19 children were taking a maintenance anti-convulsant and 10 children had active epilepsy. Median PSOM score at one-year for the overall cohort was 0.5 (IQR 0-1.5). Median PSOM score among children with active epilepsy was 3.3 (IQR 0.5-6). Figure demonstrates distribution of categorized PSOM scores stratified by the presence of active epilepsy. On univariable regression analyses, older age (OR 1.1, 95% CI 1.0-1.1, P=0.02), maintenance anti-convulsant at one-year (OR 2.7, 95% CI 1.0-7.0, P=0.04) and active epilepsy (OR 6.3, 95% CI 1.7-25, P=0.007) were associated with higher total PSOM scores. After multivariable adjustment for age and maintenance anti-convulsant, active epilepsy remained associated with higher total PSOM score (OR 7.8, 95% CI 1.3-46, P=0.02). Conclusions: Active epilepsy one-year after pediatric arterial ischemic stroke is associated with poorer neurologic outcome.

Abstract P232: Patient and Caregiver Agreement on Stroke Survivor Quality of Life in the Year After Stroke Onset

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Robynne Braun ◽  
Alen Delic ◽  
Ka-ho Wong ◽  
Steven C Cramer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Ischemic Stroke ◽  
Secondary Analysis ◽  
Stroke Survivor ◽  
Stroke Onset ◽  
First Year ◽  
Post Stroke ◽  
The Individual

Background: The burden of post-stroke disability falls on both stroke survivors and their caregivers. To better understand patient and caregiver perspectives on post-stroke quality of life (QoL), we explored their agreement on a QoL testing instrument in the year after an ischemic stroke. Methods: This is a secondary analysis of the IMS-III trial. The primary outcome are scores of the 5 domains of the EQ-5D-3L during the year after stroke onset. We included pairs of EQ-5D-3L scores obtained from both the patient and their proxy to determine the level of agreement and Cohen’s Kappa for the individual domains. Results: There were 1,042 instances of a paired EQ-5D-3L during the first year of follow-up, derived from six study visits described in Table 1. The agreement between patient and proxy was highest for the Mobility and Self-Care domains of the EQ-5D-3L (Table 2), achieving a Kappa of 0.7407 and 0.7567, respectively. The agreement for the Anxiety/Depression domain of the EQ-5D-3L was lowest, with a Kappa of 0.6009 (Table 2). Conclusion: In the year after ischemic stroke, the agreement between patients and their caregivers was highest for the motor domains of QoL and lowest for the mental health domain. Depression and anxiety are known to be under-diagnosed and under-treated after stroke. Further research is warranted to explore the reasons for less agreement between patient and caregiver perception of the stroke survivor’s mental health QoL after ischemic stroke.

scholarly journals Impact of Disability Status on Ischemic Stroke Costs in Canada in the First Year

2012 ◽  
Vol 39 (6) ◽  
pp. 793-800 ◽  
Author(s):  
Nicole Mittmann ◽  
Soo Jin Seung ◽  
Michael D. Hill ◽  
Stephen J. Phillips ◽  
Vladimir Hachinski ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Annual Cost ◽  
Emergency Services ◽  
Fold Increase ◽  
Clinical History ◽  
First Year ◽  
Stroke Patients ◽  
Average Annual Cost ◽  
One Year ◽  
The Impact

Background:Longitudinal, patient-level data on resource use and costs after an ischemic stroke are lacking in Canada. The objectives of this analysis were to calculate costs for the first year post-stroke and determine the impact of disability on costs.Methodology:The Economic Burden of Ischemic Stroke (BURST) Study was a one-year prospective study with a cohort of ischemic stroke patients recruited at 12 Canadian stroke centres. Clinical history, disability, health preference and resource utilization information was collected at discharge, three months, six months and one year. Resources included direct medical costs (2009 CAN$) such as emergency services, hospitalizations, rehabilitation, physician services, diagnostics, medications, allied health professional services, homecare, medical/assistive devices, changes to residence and paid caregivers, as well as indirect costs. Results were stratified by disability measured at discharge using the modified Rankin Score (mRS): non-disabling stroke (mRS 0-2) and disabling stroke (mRS 3-5).Results:We enrolled 232 ischemic stroke patients (age 69.4 ± 15.4 years; 51.3% male) and 113 (48.7%) were disabled at hospital discharge. The average annual cost was $74,353; $107,883 for disabling strokes and $48,339 for non-disabling strokes.Conclusions:An average annual cost for ischemic stroke was calculated in which a disabling stroke was associated with a two-fold increase in costs compared to NDS. Costs during the hospitalization to three months phase were the highest contributor to the annual cost. A “back of the envelope” calculation using 38,000 stroke admissions and the average annual cost yields $2.8 billion as the burden of ischemic stroke.

ANALYSIS OF THE STRUCTURE AND DYNAMICS OF VERBAL FUNCTIONS FOR THE FIRST YEAR AFTER ISCHEMIC STROKE

2019 ◽  
pp. 19-23
Keyword(s):  
Ischemic Stroke ◽  
Speech Therapy ◽  
Positive Impact ◽  
Speech Disorders ◽  
First Year ◽  
Structure And Dynamics ◽  
Speech Therapist ◽  
Late Recovery ◽  
Verbal Functions ◽  
Stationary Period

The results of psycho-correction speech therapy are analyzed in dynamics in 78 patients with varying severity and various forms of speech disorders in the early and late recovery periods of ischemic stroke. The effectiveness of conducting classes during the stay of patients in a neurological hospital and the positive impact of these exercises in the inpatient period (outpatient classes, classes at home with a speech therapist and trained relatives) are shown. Patients who did not conduct speech recovery classes during the inter-stationary period showed a decrease in speech activity, in some even a negative dynamic.

Improved Outcomes after Reperfusion Therapies for Ischemic Stroke: A “Real-world” Study in a Developing Country

2020 ◽  
Vol 17 (4) ◽  
pp. 361-375
Author(s):  
Victor C. Schulz ◽  
Pedro S.C. de Magalhaes ◽  
Camila C. Carneiro ◽  
Julia I.T. da Silva ◽  
Vivian N. Silva ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Real World ◽  
Time Window ◽  
Functional Dependence ◽  
Developed Countries ◽  
First Year ◽  
Middle Income ◽  
Probability Of Survival ◽  
Stroke Center ◽  
Cerebral Reperfusion

Background: It is unknown if improvements in ischemic stroke (IS) outcomes reported after cerebral reperfusion therapies (CRT) in developed countries are also applicable to the “real world” scenario of low and middle-income countries. We aimed to measure the long-term outcomes of severe IS treated or not with CRT in Brazil. Methods: Patients from a stroke center of a state-run hospital were included. We compared the survival probability and functional status at 3 and 12 months in patients with severe IS treated or not with CRT. From 2010 to 2011, we performed intravenous reperfusion when patients arrived within 4.5 h time-window (IVT group) and after 2011, mechanical thrombectomy (MT) combined or not with intravenous alteplase (IAT group). Those who arrived >4.5 h in 2010-2011 and >6 h in 2012-2017 did not undergo CRT (NCRT group). Results: From 2010 to 2017, we registered 917 patients: 74% (677/917) in the NCRT group, 19% (178/917) in the IVT group and 7% (62/917) in the IAT group. Compared to the NCRT group, IVT patients had a 28% higher (HR: 0.72; 95% CI 0.53-0.96) 3-month adjusted probability of survival and risk of functional dependence was 19% lower (adjusted RR: 0.81; 95% CI 0.73-0.91). For those who underwent MT, the adjusted probability of survival was 59 % higher (HR: 0.41; 95% CI 0.21-0.77) and the risk of functional dependence was 21% lower (adjusted RR: 0.79; 95% CI 0.66-094). These outcomes remained significantly better throughout the first year. Conclusion: CRT led to better outcomes in patients with severe IS in Brazil.

High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

2019 ◽  
Vol 16 (3) ◽  
pp. 250-257 ◽  
Author(s):  
Jiann-Der Lee ◽  
Ya-Han Hu ◽  
Meng Lee ◽  
Yen-Chu Huang ◽  
Ya-Wen Kuo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Stroke Recurrence ◽  
Prior History ◽  
Multivariate Logistic Regression ◽  
Cart Analysis ◽  
Younger Age ◽  
History Of ◽  
One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

scholarly journals Cardiovascular risk factors associated with acute myocardial infarction and stroke in the MADIABETES cohort

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. A. Salinero-Fort ◽  
F. J. San Andrés-Rebollo ◽  
J. Cárdenas-Valladolid ◽  
M. Méndez-Bailón ◽  
R. M. Chico-Moraleja ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
Hdl Cholesterol ◽  
First Year ◽  
Backward Elimination ◽  
One Year ◽  
Time Varying Covariates

AbstractWe aimed to develop two models to estimate first AMI and stroke/TIA, respectively, in type 2 diabetes mellitus patients, by applying backward elimination to the following variables: age, sex, duration of diabetes, smoking, BMI, and use of antihyperglycemic drugs, statins, and aspirin. As time-varying covariates, we analyzed blood pressure, albuminuria, lipid profile, HbA1c, retinopathy, neuropathy, and atrial fibrillation (only in stroke/TIA model). Both models were stratified by antihypertensive drugs. We evaluated 2980 patients (52.8% women; 67.3 ± 11.2 years) with 24,159 person-years of follow-up. We recorded 114 cases of AMI and 185 cases of stroke/TIA. The factors that were independently associated with first AMI were age (≥ 75 years vs. < 75 years) (p = 0.019), higher HbA1c (> 64 mmol/mol vs. < 53 mmol/mol) (p = 0.003), HDL-cholesterol (0.90–1.81 mmol/L vs. < 0.90 mmol/L) (p = 0.002), and diastolic blood pressure (65–85 mmHg vs. < 65 mmHg) (p < 0.001). The factors that were independently associated with first stroke/TIA were age (≥ 75 years vs. < 60 years) (p < 0.001), atrial fibrillation (first year after the diagnosis vs. more than one year) (p = 0.001), glomerular filtration rate (per each 15 mL/min/1.73 m2 decrease) (p < 0.001), total cholesterol (3.88–6.46 mmol/L vs. < 3.88 mmol/L) (p < 0.001), triglycerides (per each increment of 1.13 mmol/L) (p = 0.031), albuminuria (p < 0.001), neuropathy (p = 0.01), and retinopathy (p = 0.023).

scholarly journals Mortality in older adults following a fragility fracture: real-world retrospective matched-cohort study in Ontario

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jacques P. Brown ◽  
Jonathan D. Adachi ◽  
Emil Schemitsch ◽  
Jean-Eric Tarride ◽  
Vivien Brown ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Fragility Fracture ◽  
Mortality Risk ◽  
Real World ◽  
First Year ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Fracture Cohort ◽  
One Year

Abstract Background Recent studies are lacking reports on mortality after non-hip fractures in adults aged > 65. Methods This retrospective, matched-cohort study used de-identified health services data from the publicly funded healthcare system in Ontario, Canada, contained in the ICES Data Repository. Patients aged 66 years and older with an index fragility fracture occurring at any osteoporotic site between 2011 and 2015 were identified from acute hospital admissions, emergency and ambulatory care using International Classification of Diseases (ICD)-10 codes and data were analyzed until 2017. Thus, follow-up ranged from 2 years to 6 years. Patients were excluded if they presented with an index fracture occurring at a non-osteoporotic fracture site, their index fracture was associated with a trauma code, or they experienced a previous fracture within 5 years prior to their index fracture. This fracture cohort was matched 1:1 to controls within a non-fracture cohort by date, sex, age, geography and comorbidities. All-cause mortality risk was assessed. Results The survival probability for up to 6 years post-fracture was significantly reduced for the fracture cohort vs matched non-fracture controls (p < 0.0001; n = 101,773 per cohort), with the sharpest decline occurring within the first-year post-fracture. Crude relative risk of mortality (95% confidence interval) within 1-year post-fracture was 2.47 (2.38–2.56) in women and 3.22 (3.06–3.40) in men. In the fracture vs non-fracture cohort, the absolute mortality risk within one year after a fragility fracture occurring at any site was 12.5% vs 5.1% in women and 19.5% vs 6.0% in men. The absolute mortality risk within one year after a fragility fracture occurring at a non-hip vs hip site was 9.4% vs 21.5% in women and 14.4% vs 32.3% in men. Conclusions In this real-world cohort aged > 65 years, a fragility fracture occurring at any site was associated with reduced survival for up to 6 years post-fracture. The greatest reduction in survival occurred within the first-year post-fracture, where mortality risk more than doubled and deaths were observed in 1 in 11 women and 1 in 7 men following a non-hip fracture and in 1 in 5 women and 1 in 3 men following a hip fracture.

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