Can Hospital Discharge Databases Be Used to Follow Ischemic Stroke Incidence?

Background: Characterizing International Classification of Disease (ICD-9) code validity is essential given widespread use of hospital discharge and claims databases in research. Estimates for acute stroke vary depending on the codes investigated. We sought to estimate the validity of ICD-9 codes grouped according to the 2013 American Heart Association/ American Stroke Association (AHA/ASA) updated stoke definition and to explore differences by patient characteristics and study site. Methods: Medical records (N=4,260) containing ICD-9 codes 430-438 or stroke keywords in the discharge summary were abstracted for hospitalizations of Atherosclerosis Risk in Communities (ARIC) Study cohort members from 1987-2010. A computer algorithm and physician reviewer identified definite and probable ischemic stroke, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) with differences adjudicated by a second physician. Using ARIC diagnosis as a gold standard, we calculated the positive predictive value (PPV) and sensitivity of groups of ICD-9 codes matched to stroke subtypes by the AHA/ASA (ischemic stroke: 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91; ICH: 431; SAH: 430). We excluded codes for spinal and retinal infarcts (336.1, 362.31, 362.32), which were not validated in ARIC (N=3 events). Results: Thirty-three percent of 4,260 hospitalizations were validated as definite or probable strokes (1,251 ischemic, 120 ICH, 46 SAH), and 30% (1,276 of 4,260) of hospitalizations included ICD-9 codes identified by the AHA/ASA. The AHA/ASA code groups had PPV 76% and 68% sensitivity, compared to PPV 40% and 95% sensitivity for ICD-9 codes 430-438 (not 435) traditionally used to identify stroke. For ischemic stroke, AHA/ASA identified ICD-9 codes were present for 1,043 hospitalizations. Among these, PPV was 76% overall and was slightly higher for blacks (80%, N=400) compared to whites (74%, N=643; p=0.04). However, differences by race diminished conditional undergoing a CT scan or MRI (blacks 81%, N=390; whites 78%, N=601). Among whites, PPV for ischemic stroke ranged from 60-79%, and sensitivity ranged from 60-70% across study sites. ICD-9 codes 430-431 for ICH and SAH were present for 225 hospitalizations and had PPV 61%. PPV was higher among blacks (73%, N=89) compared to whites (53%, N=136; p=0.003), and differences by race were not diminished conditional on undergoing a CT scan or MRI. Among whites, PPV for ICH and SAH ranged from 38-60%, and sensitivity ranged from 78-89% across study sites. Conclusion: New AHA/ASA code groups had higher PPV but lower sensitivity for identifying acute stroke than a traditional code group. PPV was higher among blacks compared to whites and both PPV and sensitivity varied by study site. These data may be useful for calibrating estimates of stroke incidence generated from administrative claims data and in sensitivity analyses.

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Impact of COVID-19 on Future Ischemic Stroke Incidence

eNeurologicalSci ◽

10.1016/j.ensci.2021.100325 ◽

2021 ◽

Vol 22 ◽

pp. 100325

Author(s):

Aisha Elfasi ◽

Franklin D. Echevarria ◽

Robert Rodriguez ◽

Yoram A. Roman Casul ◽

Anna Yuzefovich Khanna ◽

...

Keyword(s):

Ischemic Stroke ◽

Stroke Incidence

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Impact of atrial fibrillation on inpatient cost for ischemic stroke in the USA

International Journal of Stroke ◽

10.1177/1747493018765491 ◽

2018 ◽

Vol 14 (2) ◽

pp. 159-166 ◽

Cited By ~ 2

Author(s):

Kumar Mukherjee ◽

Khalid M Kamal

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Length Of Stay ◽

Hospital Discharge ◽

Significant Risk ◽

Primary Diagnosis ◽

Inpatient Cost ◽

Targeted Interventions ◽

Hospital Discharge Records ◽

Hospital Characteristics

Background Atrial fibrillation is a significant risk factor for ischemic stroke and increases cost of treatment. Aims To estimate the incremental inpatient cost and length of stay due to atrial fibrillation among adults hospitalized with a primary diagnosis of ischemic stroke after controlling for sociodemographic, clinical, and hospital characteristics in a nationally representative discharge record of US population. Methods Hospital discharge records with a primary diagnosis of ischemic stroke were identified from the National Inpatient Sample data for the years 2010–2013. Generalized linear model with log link and least-square means were utilized to estimate the incremental inpatient cost and length of stay in ischemic stroke due to atrial fibrillation after controlling for sociodemographic, clinical, and hospital characteristics. Results Among 434,544 hospital discharge records with a primary diagnosis of ischemic stroke, 90,190 (20.76%) discharge records had a secondary diagnosis of atrial fibrillation. The average inpatient cost for all discharge records with a primary diagnosis of ischemic stroke was (mean = $13,072, median = $9270.87) significantly (p < 0.0001) higher compared to all discharge records without ischemic stroke (mean = $12,543.07, median = $7517.13). The mean length of stay for all records was 4.55 days (95% CI = 4.53–4.56). Among those identified with ischemic stroke, adjusted mean inpatient cost was higher by $2829 (95% CI = $2708–$2949) and mean length of stay was greater by 0.85 (95% CI = 0.81–0.89) for those with atrial fibrillation compared to those without. Conclusions The presence of atrial fibrillation was associated with increased inpatient cost and length of stay among patients diagnosed with ischemic stroke. Increased inpatient cost and length of stay call for a more comprehensive patient care approach including targeted interventions among adults diagnosed with ischemic stroke and atrial fibrillation, which could potentially reduce the overall cost in this population.

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Predictors of Nasogastric Tube Removal Before Acute Hospital Discharge in First-Ever Ischemic Stroke Patients

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2016.08.147 ◽

2016 ◽

Vol 97 (10) ◽

pp. e49

Author(s):

Yun-Shan Yen ◽

Willy Chou ◽

Ya-Fang Hsu ◽

Mei-Ju Ko ◽

Daniel Chiung Jui Su ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Discharge ◽

Nasogastric Tube ◽

Acute Hospital ◽

Stroke Patients ◽

Tube Removal

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Abstract TP161: Gastrointestinal Bowel Obstruction in Acute Ischemic Stroke: Incidence, Risk Factors, and Outcomes

Stroke ◽

10.1161/str.47.suppl_1.tp161 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Kavelin Rumalla ◽

Adithi Y Reddy ◽

Vijay Letchuman ◽

Paul A Berger ◽

Manoj K Mittal

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Bowel Obstruction ◽

Kidney Injury ◽

Hospital Death ◽

Stroke Incidence ◽

Black Race ◽

Electrolyte Disorder ◽

Incidence Risk

Introduction: The prognosis of patients suffering acute ischemic stroke (AIS) is worsened by medical complications that occur during subsequent hospitalization. The incidence, risk factors, and outcomes of gastrointestinal bowel obstruction (GIBO) in AIS have not been previously reported. Methods: We employed the Nationwide Inpatient Sample from 2002 to 2011 to identify all patients admitted with a primary diagnosis of AIS and subsets with and without a secondary diagnosis of GIBO without hernia. Multivariate logistic regression was utilized to analyze predictors of GIBO in AIS patients and the association between GIBO, in-hospital complications, and outcomes. Results: We identified 16,987 patients with GIBO (425 per 100,000) among 3,988,667 AIS hospitalizations and 4.2% of patients of these patients underwent repair surgery for intestinal obstruction. Multivariate predictors of GIBO included: age 55-64 (OR: 1.52, 95% CI: 1.40-1.64), age 65-74 (OR: 1.69, 95% CI: 1.56-1.84), age 75+ (OR: 1.97, 95% CI: 1.81-2.13), black race (OR: 1.42, 95% CI: 1.36-1.49), coagulopathy (OR: 1.39, 95% CI: 1.29-1.50), cancer (OR: 1.59, 95% CI: 1.44-1.75), blood loss anemia (OR: 2.51, 95% CI: 2.22-2.84), fluid/electrolyte disorder (OR: 2.91, 95% CI: 2.81-3.02), weight loss (OR: 3.08, 95% CI: 2.93-3.25), and thrombolytic therapy (OR: 1.30, 95% CI: 1.20-1.42) (all p<0.0001). Patients with GIBO had a greater likelihood of suffering intubation (OR: 1.79, 95% CI: 1.70-1.90), deep vein thrombosis (OR: 1.35, 95% CI: 1.25-1.46), pulmonary embolism (OR: 1.84, 95% CI: 1.53-2.21), sepsis (OR: 2.39, 95% CI: 2.22-2.56), acute kidney injury (OR: 1.85, 95% CI: 1.76-1.95), gastrointestinal hemorrhage (OR: 2.82, 95% CI: 2.63-3.03), and blood transfusions (OR: 2.02, 95% CI: 1.90-2.15) (all p<0.0001). In adjusted analyses, AIS patients with GIBO were 284% and 39% more likely to face moderate to severe disability and in-hospital death, respectively (p<0.0001). GIBO occurrence increased length of stay and total costs by an average of 9.7 days and $22,342 (p<0.0001). Conclusion: Advanced age, black race, and several pre-existing comorbidities increase the likelihood of post-AIS GIBO, which is an independent predictor of in-hospital complications, disability, and mortality.

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Abstract P72: The Obesity Paradox: Association Between Body Mass Index (BMI) and Disability After Stroke

Stroke ◽

10.1161/str.52.suppl_1.p72 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Brianna R Helms

Keyword(s):

Body Mass Index ◽

Ischemic Stroke ◽

Functional Status ◽

Hospital Discharge ◽

Body Mass ◽

Obesity Paradox ◽

Normal Weight ◽

Stroke Recurrence ◽

Inverse Association ◽

Stroke Patients

Background: Present rise in the incidence of obesity has led to several opposing reports regarding the association between obesity and stroke outcomes. The objective of this study was to investigate a proposed paradoxical relationship between body mass index (BMI) and functional status in ischemic stroke patients at time of hospital discharge. Methods: Saint Francis Hospital Comprehensive Stroke Center patient databases were utilized in identifying 948 patients eligible for retrospective chart review over a period of 15 months. Subjects were divided into 4 groups according to BMI: underweight (BMI < 18.5 kg/m 2 ), normal weight (BMI 18.5-24.9 kg/m 2 ), overweight (BMI 25.0-29.9 kg/m 2 ), and obese (BMI ≥ 30.0 kg/m 2 ). Covariates, such as age, gender, prior to event modified Rankin scale (mRS), stroke recurrence, and smoking, were considered. Functional status and disability of stroke patients was scored via mRS at hospital discharge. Ordered logistic regression, Pearson’s chi-squared test, and Pearson’s r correlation were used for analysis to assess the association of BMI and functional status in ischemic strokes. Results: Of 948 eligible subjects, 49.9% were female and mean (SD) age was 69.4 (14.5) years. According to BMI, 22 (2.3%) were underweight, 247 (26.1%) normal weight, 319 (33.7%) overweight, and 360 (37.9%) obese. After adjusting for covariates, ischemic stroke patients with an increased BMI (OR, 0.98; 95% CI, 0.96-0.99) were not associated with increased disability risk upon discharge. Obese (16.2%) and overweight (14.1%) patients discharged with a mRS of 0 (back to baseline) or 1 more frequently compared to normal weight (6.1%) and underweight (0.21%) patients ( P <0.001). Furthermore, an inverse association between BMI status and disability was significantly evident ( r = -0.17, P < 0.001). Conclusion: Obese and overweight stroke patients discharge with a lower risk of disability than normal weight and underweight patients, supporting the existence of the “obesity paradox” in stroke. An inverse association between obesity status and functional outcome was identified and remained significant regardless of covariates.

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Abstract MP86: Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Acute Ischemic Stroke Patients by History of Hypertension and Use of Antihypertensive Medications

Circulation ◽

10.1161/circ.131.suppl_1.mp86 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Tan Xu ◽

Yonghong Zhang ◽

Yingxian Sun ◽

Chung-Shiuan Chen ◽

Jing Chen ◽

...

Keyword(s):

Ischemic Stroke ◽

Treatment Group ◽

Acute Ischemic Stroke ◽

Hospital Discharge ◽

Odds Ratio ◽

Recurrent Stroke ◽

Stroke Patients ◽

Antihypertensive Medications ◽

History Of

Introduction: The effects of blood pressure (BP) reduction on clinical outcomes among acute stroke patient remain uncertain. Hypothesis: We tested the effects of immediate BP reduction on death and major disability at 14 days or hospital discharge and 3-month follow-up in acute ischemic stroke patients with and without a previous history of hypertension or use of antihypertensive medications. Methods: The China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) randomly assigned patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP) to receive antihypertensive treatment (N=2,038) or to discontinue all antihypertensive medications (N=2,033) during hospitalization. Randomization was stratified by participating hospitals and use of antihypertensive medications. Study outcomes were assessed at 14 days or hospital discharge and 3-month post-treatment follow-up. The primary outcome was death and major disability (modified Rankin Scale score≥3), and secondary outcomes included recurrent stroke and vascular events. Results: Mean SBP was reduced 12.7% in the treatment group and 7.2% in the control group within 24 hours after randomization (P<0.001). Mean SBP was 137.3 mmHg in the treatment group and 146.5 in the control group at day 7 after randomization (P<0.001). At 14 days or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups by subgroups. At the 3-month follow-up, recurrent stroke was significantly reduced in the antihypertensive treatment group among patients with a history of hypertension (odds ratio 0.43, 95% CI 0.24-0.75, P=0.003) and among patients with a history of use of antihypertensive medications (odds ratio 0.41, 95% CI 0.20-0.84, P=0.01). All-cause mortality (odds ratio 2.84, 95% CI 1.11-7.27, P=0.03) was increased among patients without a history of hypertension. Conclusion: Immediate BP reduction lowers recurrent stroke among acute ischemic stroke patients with a previous history of hypertension or use of antihypertensive medications at 3 months. On the other hand, BP reduction increases all-cause mortality among patients without a history of hypertension.

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P3712The omega-3 fatty acid eicosapentaenoic acid (EPA) is inversely associated with ischemic brain infarcts in elderly patients with atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz745.0566 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M F Reiner ◽

P Baumgartner ◽

A Wiencierz ◽

S Aeschbacher ◽

N Rodondi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Elderly Patients ◽

Eicosapentaenoic Acid ◽

Brain Mri ◽

Omega 3 ◽

Total N ◽

Stroke Incidence ◽

Ischemic Brain ◽

Brain Infarcts

Abstract Background The association of individual omega-3 fatty acids (n-3 FAs) with ischemic stroke remains unclear. Experimental data strongly suggest that n-3 FAs reduce ischemic stroke due to their anti-thrombotic and anti-inflammatory properties. Yet, recent clinical trials yielded mixed results. While marine n-3 FA supplementation (1g/day) did not reduce stroke, icosapent ethyl, a purified eicosapentaenoic acid (EPA) ethyl ester (4g/day), significantly reduced stroke incidence in patients at high cardiovascular risk. In the current study, we examined the association of fish-derived EPA, docosapentaenoic acid (DPA), docosahexaenoic acid (DHA) and the plant-derived alpha-linolenic acid (ALA) with the prevalence of ischemic brain infarcts in elderly patients with atrial fibrillation. Methods In this cross-sectional analysis of the Swiss atrial fibrillation (swissAF) cohort study, we determined baseline whole blood n-3 FAs by gas chromatography according to the HS-Omega-3 Index methodology in 1665 patients aged ≥65 years with atrial fibrillation. Large non-cortical and cortical infarcts (LNCCI) were assessed by brain MRI. Total and individual n-3 FAs were correlated with the prevalence of LNCCI in a logit model with continuous factors. Analyses were adjusted for sex, age, body mass index, smoking, alcohol intake, family history of cardiovascular disease and atrial fibrillation, physical activity, hypertension, diabetes, chronic kidney disease, prior stroke, prior transient ischemic attack, aspirin, anticoagulation and type of atrial fibrillation. Results A total of 373 patients with LNCCI (22.4%) were identified. After adjustment, lower risk of LNCCI was associated with higher EPA (odds ratio [OR] 0.50 per increase of one percentage point EPA, 95% confidence interval [CI] 0.28–0.88) and a higher risk was detected with DPA (OR 2.39, 95% CI 1.43–4.01). No statistically significant association was detected with DHA (OR 1.13, 95% CI 0.94–1.35), ALA (OR 0.83, 95% CI 0.23–2.95) or total n-3 FAs (OR 1.03, 95% CI 0.92–1.16). Conclusions Higher levels of EPA are associated with a lower prevalence of ischemic infarcts in aged patients with atrial fibrillation. Unexpectedly, DPA shows a direct correlation with ischemic infarcts. This study demonstrates that individual n-3 FAs may differentially affect stroke risk and that supplementation of EPA may be an interesting strategy to prevent ischemic stroke in atrial fibrillation patients. Acknowledgement/Funding Swiss National Science Foundation

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FAKTOR-FAKTOR RISIKO STROKE PADA PENYAKIT GINJAL KRONIK STADIUM V YANG MENJALANI HEMODIALISIS

Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia ◽

10.52386/neurona.v35i2.105 ◽

2018 ◽

Vol 35 (2) ◽

Author(s):

Susanti Dwi Ariani ◽

Dodik Tugasworo ◽

Maria Imakulata Widiastuti Samekto

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Chronic Kidney Disease ◽

Multivariate Analysis ◽

Ischemic Stroke ◽

Kidney Disease ◽

Case Group ◽

Chi Square ◽

Stroke Incidence ◽

Incidence And Mortality

RISK FACTORS OF STROKE IN STAGE V CHRONIC KIDNEY DISEASE WHO UNDERWENT HEMODIALYSISABSTRACTIntroduction: Chronic kidney disease (CKD) and end-stage renal disease are associated with a significantly in- creased risk of stroke. Incidence and mortality of stroke in CKD patients is higher rather than among the general popula- tion. Stroke in hemodialysis patients is also associated with high mortality.Aims: To analyze risk factors that have a relationship with the occurrence of stroke in patients with stage V CKD who underwent hemodialysis in Dr. Kariadi Hospital, Semarang.Method: A case control with retrospective cohort study of patients diagnosed with stage V CKD undergoing hemo- dialysis in Dr. Kariadi Hospital, Semarang, from March 2016 to August 2017. Subject was divided into case group, who experienced stroke, and control group, who did not experience stroke. Bivariate analysis was performed with Chi-square test, multivariate analysis with logistic regression test and rasio Odds.Results: There were 140 subjects with stage V CKD, 70 subjects in each groups. In case group, 85.7% experienced ischemic stroke while the rest hemorrhagic stroke. The duration of hemodialysis was related to the incidence of stroke. In multivariate analysis, patients with diabetes mellitus were more likely to have a stroke by 0.14 times compared to patients who did not have diabetes mellitus, and patients who underwent hemodialysis >12 months, were more likely to have a stroke 4.05 times greater than patients who underwent hemodialysis <12 months.Discussion: There is a relationship between diabetes mellitus and duration of hemodialysis with the occurrence of ischemic stroke, in stage V CKD patients who underwent hemodialysis.Keywords: Chronic kidney disease, hemodialysis, strokeABSTRAKPendahuluan: Penyakit ginjal kronik (PGK) dan penyakit ginjal stadium akhir terkait dengan peningkatan risiko yang signifikan dari stroke. Insiden dan mortalitas stroke pada pasien PGK lebih tinggi dibandingkan populasi umum. Stroke pada pasien dialisis juga dihubungkan dengan mortalitas yang tinggi.Tujuan: Untuk menganalisis faktor-faktor risiko yang memengaruhi terjadinya stroke pada pasien dengan PGK stadium V yang menjalani hemodialisis (HD) di RSUP Dr. Kariadi, Semarang.Metode: Penelitian kasus kontrol dengan pendekatan kohort retrospektif terhadap pasien penyakit ginjal kronik stadium V yang menjalani HD di RSUP Dr. Kariadi, Semarang dari bulan Maret 2016 hingga Agustus 2017. Subjek dibagi ke dalam kelompok kasus, yaitu yang mengalami stroke dan kelompok kontrol yang tidak mengalami stroke. Dilakukan analisis bivariat dengan uji Chi-square dan analisis multivariat dengan uji regresi logistik serta rasio Odds.Hasil: Didapatkan 140 subjek dengan PGK stadium V yang masing-masing kelompok terdiri dari 70 orang. Pada kelompok kasus, sebanyak 85,7% adalah stroke iskemik dan sisanya stroke hemoragik. Lama HD berhubungan dengan kejadian stroke. Pada uji multivariat, subjek yang menderita diabetes melitus (DM) berisiko mengalami stroke sebesar 0,14 kali dibandingkan yang tidak DM dan subjek yang menjalani HD >12 bulan berisiko mengalami stroke 4,05 kali lebih besar dibandingkan yang menjalani HD <12 bulan.Diskusi: Terdapat pengaruh faktor risiko DM dan lama hemodialisis terhadap kejadian stroke iskemik pada pasien PGK stadium V yang menjalani HD.Kata kunci: Hemodialisis, penyakit ginjal kronik, stroke

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