scholarly journals Sex disparity in long-term stroke recurrence and mortality in a rural population in the United States

2020 ◽  
Vol 13 ◽  
pp. 175628642097189
Author(s):  
Clare Lambert ◽  
Durgesh Chaudhary ◽  
Oluwaseyi Olulana ◽  
Shima Shahjouei ◽  
Venkatesh Avula ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Rural Population ◽  
The United States ◽  
Competing Risk ◽  
Stroke Recurrence ◽  
Composite Outcome ◽  
Stroke Patients ◽  
Central Pennsylvania ◽  
All Cause Mortality

Background: Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019. Kaplan–Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine–Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors. Results: Among 8900 adult ischemic stroke patients [median age of 71.6 (interquartile range: 61.1–81.2) years and 48% women], women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared with a 65.7% survival in men ( p = 0.003) at 5 years; however, the survival difference was not present after controlling for covariates, including age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome. Conclusion: Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.

Abstract P693: Sex Disparity in Long-Term Stroke Recurrence and Mortality in a Rural Population in the United States

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Clare M Lambert ◽  
Oluwaseyi Olulana ◽  
Durgesh Chaudhary ◽  
Shima Shahjouei ◽  
Venkatesh Avula ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Rural Population ◽  
The United States ◽  
Competing Risk ◽  
Stroke Recurrence ◽  
Composite Outcome ◽  
Stroke Patients ◽  
Central Pennsylvania ◽  
All Cause Mortality

Introduction: Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aimed to investigate if women had a higher risk of all-cause mortality and recurrence after an ischemic stroke in a rural population in central Pennsylvania, United States. Methods: We analyzed consecutive ischemic stroke patients captured in our comprehensive research database from 2004 to 2019. Kaplan-Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine-Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors. Results: Among 8,900 adult ischemic stroke patients (median age of 71.6 [IQR:61.1-81.2] years and 48% women), women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared to a 65.7% survival in men (p=0.003) at five years; however, the survival difference was not present after adjustment by the associated factors of age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome. Conclusion: Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.

Abstract P699: Trends in Ischemic Stroke Risk Factors and Outcomes in a Rural Population in the United States

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Durgesh Chaudhary ◽  
Ayesha Khan ◽  
Shima Shahjouei ◽  
Mudit Gupta ◽  
Clare Lambert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Rural Population ◽  
The United States ◽  
Stroke Recurrence ◽  
Stroke Mortality ◽  
One Year ◽  
The One

Introduction: The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the trends in stroke risk factors and outcomes among a rural population in the United States between 2004 and 2018. Methods: We built a comprehensive stroke database called “Geisinger NeuroScience Ischemic Stroke (GNSIS)” for this study. Clinical data were extracted from multiple sources, including electronic health records and quality data. Results: Our cohort comprised of 8,561 consecutive ischemic stroke patients (mean age: 70.1±13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The rate of hypertension, diabetes, dyslipidemia, and history of stroke increased significantly over the fifteen years window. The one-year recurrence and mortality rates were 6.3% and 15.8%, respectively. Although the one-year stroke recurrence increased from 2004 to 2018 (Cochran-Armitage test Z = -3.66, p<0.001), the one-year stroke mortality rate decreased significantly (Cochran-Armitage test Z = 2.39, p=0.008). Age >65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Fine-Gray competing risk model, diabetes mellitus and age <65 years was found to be associated with one-year ischemic stroke recurrence. In the logistic regression, chronic kidney disease (CKD), diabetes, and prior ischemic stroke were predictors of one-year recurrence while age >65 years, atrial fibrillation or flutter, CKD, heart failure, prior hemorrhagic and ischemic stroke, history of neoplasm, myocardial infarction, and rheumatic diseases were predictors of one-year mortality. Conclusion: Although stroke mortality has decreased, stroke recurrence and several vascular risk factors have significantly increased in our rural population between 2004-2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes mellitus and age less than 65 years were predictors of ischemic stroke recurrence.

Abstract 196: Thrombolytic Treatment using Drip and Ship Treatment Paradigm among Acute Ischemic Stroke Patients in the United States: Outcomes and impact on regional thrombolytic utilization and referral patterns

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Wondwossen G Tekle ◽  
Saqib A Chaudhry ◽  
Habib Qaiser ◽  
Ameer E Hassan ◽  
Gustavo J Rodriguez ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Thrombolytic Treatment ◽  
Stroke Patients ◽  
Referral Patterns ◽  
Hospital Outcomes ◽  
Treatment Paradigm

Background: While single center and regional estimates of thrombolytic administration using drip and ship treatment paradigm are available, patient outcomes, thrombolytic utilization, cost, and referral patterns has not been assessed in United States. Objective: To provide national estimates of patients treated with thrombolytics using drip and ship paradigm and determine the impact of drip and ship treatment on regional thrombolytic utilization, treatment cost, and referral patterns of acute stroke patients in a large cohort. Methods: We determined the proportion of patients treated with drip and ship paradigm among all acute ischemic stroke patients treated with thrombolytic treatment and obtained comparative in-hospital outcomes from the Nationwide Inpatient Survey (NIS) data files from October 2008 to December 2009. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis. Thrombolytic utilization, hospitalization cost, and patterns of referral related to drip and ship treatment of acute stroke were estimated. Results: Of the 26,814 ischemic stroke patients who received thrombolytic treatment, 5144 (19%) were treated using drip and ship paradigm. Seventy nine percent of all the drip and ship treated patients were referred to urban teaching hospitals for further care, and 7% of them received follow up endovascular treatment at the referral facility. States with higher proportion of patients treated using the drip and ship paradigm had higher rates of thrombolytic utilization (3.1% vs. 2.4%, p<0.001). After adjusting for age, gender, presence of hypertension, diabetes mellitus, renal failure, and hospital teaching status, outcomes of patients treated with drip and ship paradigm was similar to those who received thrombolytic and stayed in the same facility: self care (odds ratio [OR], 1.055, 95% confidence interval [CI], 0.910-1.224, p=0.4779); death(OR , 0.821 95% CI, 0.619- 1.088, p=0.1688); and nursing home discharge (OR, 1.023, 95% CI, 0.880- 1.189, p=0.7659) at discharge. Drip and ship paradigm was associated with shorter hospital stay (mean [days, SE] 5.9± 0.18 vs. 7.4 ± 0.15, p<0.001), and lower cost of hospitalization (mean total charges [$, SE) 57,000 ± 3,324 vs. 83,000 ± 3,367, p<0.001). Conclusions: One out of every five patients who received thromboytic treatment in United States is currently treated using drip and ship paradigm with comparable adjusted rates of favorable outcomes. There was a higher rates of thrombolytic utilization in States where drip and ship was more commonly implemented.

scholarly journals Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States

2021 ◽  
Vol 30 (2) ◽  
pp. 105535
Author(s):  
Adam de Havenon ◽  
John P. Ney ◽  
Brian Callaghan ◽  
Alen Delic ◽  
Samuel Hohmann ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
The United States ◽  
Stroke Patients

scholarly journals Low Toe–Brachial Index Is Associated With Stroke Outcome Despite Normal Ankle–Brachial Index

2021 ◽  
Vol 12 ◽  
Author(s):  
Minho Han ◽  
Young Dae Kim ◽  
Ilhyung Lee ◽  
Hyungwoo Lee ◽  
Joonnyung Heo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Cox Regression ◽  
Ankle Brachial Index ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
All Cause Mortality ◽  
Toe Brachial Index

Introduction: We investigated whether the toe–brachial index (TBI) is associated with stroke prognosis and evaluated this association in patients with normal ankle–brachial index (ABI).Methods: Acute ischemic stroke patients who underwent TBI measurements were enrolled. Poor functional outcome was defined as modified Rankin Scale score ≥3. Major adverse cardiovascular event (MACE) was defined as stroke recurrence, myocardial infarction, or death. Normal ABI was defined as 0.9 ≤ ABI ≤ 1.4.Results: A total of 1,697 patients were enrolled and followed up for a median 39.7 (interquartile range, 25.7–54.6) months. During the period, 305 patients suffered MACE (18.0%), including 171 (10.1%) stroke recurrences. TBI was associated with hypertension, diabetes, atrial fibrillation, aortic plaque score, ABI, and brachial–ankle pulse wave velocity (all p &lt; 0.05). In multivariable logistic regression, TBI was inversely associated with poor functional outcome in all patients [odds ratio (OR) 0.294, 95% confidence interval (CI) 0.114–0.759], even in patients with normal ABI (OR 0.293, 95% CI 0.095–0.906). In multivariable Cox regression, TBI &lt; 0.6 was associated with stroke recurrence [hazard ratio (HR) 1.651, 95% CI 1.135–2.400], all-cause mortality (HR 2.105, 95% CI 1.343–3.298), and MACE (HR 1.838, 95% CI 1.396–2.419) in all patients. TBI &lt; 0.6 was also associated with stroke recurrence (HR 1.681, 95% CI 1.080–2.618), all-cause mortality (HR 2.075, 95% CI 1.180–3.651), and MACE (HR 1.619, 95% CI 1.149–2.281) in patients with normal ABI.Conclusions: Low TBI is independently associated with poor short- and long-term outcomes in acute ischemic stroke patients despite normal ABI.

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