scholarly journals Ketahanan Hidup Setahun Pasien Stroke di RS Cipto Mangunkusumo Jakarta

2007 ◽  
Vol 2 (3) ◽  
pp. 120
Author(s):  
Sri Mulyani
Keyword(s):  
Heart Disease ◽  
Ischemic Stroke ◽  
Survival Rate ◽  
Stroke Unit ◽  
Total Population ◽  
Cox Regression ◽  
Stroke Patients ◽  
Probability Of Survival ◽  
One Year ◽  
The One

Di Indonesia, penyebab utama kematian di rumah sakit adalah stroke. Penelitian ini bertujuan untuk mengetahui ketahanan hidup 1 tahun pasien stroke yang dirawat di RS Cipto Mangunkusumo Jakarta tahun 2003 dan faktor yang mempengaruhinya. Rancangan penelitian ini adalah kohort retrospektif. Sampelnya adalah total populasi, yaitu 275 pasien yang didiagnosa mengalami serangan stroke pertama dan dirawat di RS Cipto Mangunkusumo Jakarta, yang masuk tanggal 1 Januari sampai 31 Desember 2003. Hasil penelitian menunjukkan bahwa probabilitas ketahanan hidup pasien stroke berbeda beda, tergantung pada tipe stroke, ruang rawat, dan penyakit jantung. Masing-masing probabilitas ketahanan hidup setahun pasien stroke adalah sebagai berikut: 63,7% pada pasien tipe stroke stroke iskemik vs. 22,9% pada pasien tipe stroke hemoragik, 70,4% pada pasien di ruang rawat Unit Stroke vs. 36,9% pada pasien di Ruang Neurologi, 37,7% pada pasien stroke dengan penyakit jantung vs. 53,2% pada pasien tidak dengan penyakit jantung. Hasil analisis regresi cox ganda menunjukkan bahwa setelah dikontrol oleh umur, pasien Stroke Hemoragik berisiko untuk meninggal 3 kali lebih besar dibandingkan pasien Stroke Iskemik, pasien stroke yang dirawat di Ruang Neurologi berisiko untuk meninggal 3 kali lebih besar dibandingkan di Ruang Unit Stroke, dan Pasien stroke berpenyakit jantung berisiko untuk meninggal 1.4 kali.Kata kunci : Stroke, probabilitas ketahanan hidupAbstractIn Indonesia, the main cause of death at hospital is stroke. The objective of this study is to know the one year probability of survival rate of stroke patient at Cipto Mangunkusumo Hospital Jakarta and factors influencing the rate. The design of this study is retrospective cohort using the medical record database, subjects were total population, i.e., 375 patients diagnosed as the first stroke attack and lodge at Cipto Mangunkusumo Hospital during first January to thirty first December year 2003. The results of this study shows that the probability of one year survival stroke patients depend on type of stroke, place of take care, and existing of heart disease after controlled for age of patients. The probability of one year survival stroke patients are as follows: 63,7% among ischemic stroke vs. 22,9% among haemorhagic stroke; 70,4% among patients who take care at Stroke Unit vs. 36,9% among patients take care of at Neurology Unit; 37,7% among patients with existing heart disease vs. 53,2% among patients without heart disease. The multiple Cox regression shows that after controlled for age, the haemoraghic stroke have risk to die 3 time higher compare than ischemic stroke, the patients at Neurology Unit have risk to die 3 time higher compare than those at Stroke Unit, and the patients stoke with existing heart disease have risk to die 1.4 time higher.Keywords : Stroke, probability of survival rate

Abstract 251: The Association Between Receipt of Healthcare Services and Post-stroke Hypertension Control

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Dhanashri Kohok ◽  
Jason J Sico ◽  
Fitsum Baye ◽  
Laura Myers ◽  
Kamalesh Masoor ◽  
...  
Keyword(s):  
Primary Care ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Hypertension Management ◽  
Stroke Patients ◽  
Post Discharge ◽  
Post Stroke ◽  
Care Services ◽  
One Year ◽  
The One

Hypertension is a known risk factor for primary as well as recurrent stroke. Improving blood pressure (BP) control has been associated with decreased risk of recurrent stroke. Several factors have been associated with poor BP control among stroke patients such as non-compliance and clinical inertia. We examined the receipt of health care services by patients in the one-year period following discharge for ischemic stroke. This was a retrospective cohort study of patients who were admitted for acute ischemic stroke at a Veterans Affairs hospital during year 2011 and who were discharged with a BP >140/90 mmHg. The following were reviewed: primary care visits; sub-specialty clinic visits; emergency department (ED) visits; hospitalizations; utilization of ancillary care (i.e., telehealth, pharmacy, nutrition services); medications upon discharge; adherence to medications and occurrence of recurrent stroke during the one-year post-discharge period. The cohort included 124 patients with an average age of 66.4 years (± standard deviation of10.3); 123 were male; 62.9% were white; diabetes mellitus was present in 32.5%; and 13.0% had history of coronary artery disease. The average BP at the time of discharge from the index stroke hospitalization was 149.5/82.6 (±11.3/9.8) mmHg. Only 38.7% of patients had an average BP over the one year period of <140/90 mmHg. The average number of primary care visits during this period was 2.8 (±1.6). The overwhelming majority of patients had at least one primary care visit (N=119, 95.9%) however the median time from discharge to the first primary clinic visit was 32 days (IQR 59). Forty four percent of patients were seen as outpatient by neurology, 19.4% by cardiology, 9.7% by nephrology, 5.7% by nutrition, 23.4% by clinical pharmacy, and 9.7% by the telehealth service. BP monitors were issued to or being used by 39.5% patients. Non-adherence was documented in the medical record as an interfering issue in 25.8% of patients. More than two antihypertensive agents were prescribed at discharge in 50.8% patients. During the one-year post-discharge period 29.0% of patients were hospitalized at least once and 24.2% had at least one ED visit. Recurrent stroke occurred in 3.2% of patients. The stroke rate was 4.23% among patients with uncontrolled BP compared with 2.08% among patients with well-controlled BP (p=0.40). This indicates that patients with elevated BP at the time of discharge from an ischemic stroke hospitalization remain with poorly controlled BP in the year post-discharge. Although patients appear to be receiving primary care services, these visits are not successfully achieving BP control. Relative underuse of certain resources for hypertension management such as ancillary services and home BP monitoring is observed.Future intervention studies seeking to improve the hypertension management of post-stroke patients should address these observed gaps in care.

scholarly journals Y-shaped Ventriculo-peritoneal Shunt for Adult Complicated Hydrocephalus: Report of 28 Illustrative Cases

2020 ◽  
Author(s):  
Xiaohui Ren ◽  
Chuanwei Yang ◽  
Xiangrong Li ◽  
Yonggang Wang ◽  
Song Lin
Keyword(s):  
Survival Rate ◽  
Cox Regression ◽  
Tumor Resection ◽  
Long Term Outcome ◽  
Frontal Horn ◽  
First Choice ◽  
Multiloculated Hydrocephalus ◽  
One Year ◽  
The One ◽  
Ventriculo Peritoneal Shunt

Abstract ObjectiveTo investigate the effectiveness of Y-shaped ventriculo-peritoneal shunt (VPS) (one abdominal tip connected with double or triple ventricular tips by one or two Y-shaped connectors) in the treatment of adult complicated hydrocephalus, we analyzed the long-term outcome and reported some illustrative cases.MethodsAmong 1,100 VPS surgeries between 2012 and 2017 in neurosurgery of Beijing Tiantan Hospital, twenty-eight (2.5%) adult patients with multiloculated hydrocephalus treated with Y-shaped shunt were analyzed.ResultsNineteen patients underwent Y-shaped VPS (bilateral frontal horn shunt) before or without tumor resection/stereotactic biopsy, 7 patients underwent Y-shaped VPS after tumor resection (5 bilateral and 2 triple shunts), and the other 2 patients underwent sequential bilateral VPS (unilateral VPS with additional contralateral ventricular tip by Y-shaped connector 6 months later). The one-year and two-year hydrocephalus-free survival rate for was both 88.7%. The one-year and two-year overall survival rate was both 66.7%. Cox regression confirmed that the OS is correlated with tumor grades. ConclusionsY-shaped VPS strategy is an easy and reliable option for multiloculated hydrocephalus, which can be used as the first choice for some indications.

Abstract WP349: Sex-Based Claims Models for the Prediction of 1-Year Mortality After Ischemic and Hemorrhagic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Judith H Lichtman ◽  
Erica C Leifheit ◽  
Yun Wang ◽  
Larry B Goldstein
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Cox Regression ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Discharged Patients ◽  
One Year

Background: Claims-based models have been developed to predict 30-day mortality after ischemic and hemorrhagic stroke, yet few models are available for predicting 1-year post-stroke mortality among discharged patients. Moreover, there are limited data on whether factors associated with 1-year mortality differ for women and men. We developed claims-based models to predict 1-year mortality after hospital discharge for ischemic and hemorrhagic stroke stratified by sex. Methods: We identified fee-for-service Medicare beneficiaries aged ≥65y who were discharged alive with a principal diagnosis of ischemic (ICD-9 433, 434, 436) or hemorrhagic (ICD-9 430, 431) stroke in 2014. We fit Cox regression models with Markov-chain Monte Carlo simulation to identify risk factors for 1-year all-cause mortality; variables with a posterior probability ≥0.95 of being associated with 1-year mortality were considered significant and included in the models for the overall samples and for each sex. Results: The study included 235,737 ischemic (53% women; mean age 80.3y [women] and 77.2y [men]) and 43,084 hemorrhagic (52% women; mean age 80.0y [women] and 77.8y [men]) stroke patients. One-year mortality was 27.9% (95% CI 27.7%-28.2%) for women and 22.0% (21.8%-22.3%) for men who had an ischemic stroke and was 50.8% (50.2%-51.5%) for women and 46.4% (45.7%-47.1%) for men who had a hemorrhagic stroke. The c statistics for the models in the overall samples were 0.79 for ischemic stroke and 0.76 for hemorrhagic stroke (Figure). Although there were small differences in the variables included in the models by sex, the c statistics were comparable. Conclusions: One-year claims-based models can be used by hospitals to predict the risk of death for patients discharged after stroke. The models identified many risk factors common to women and men that can inform strategies to improve the clinical management of stroke patients during the first year of recovery.

scholarly journals Impacts of treatments on recurrence and 28-year survival of ischemic stroke patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ting-Ann Wang ◽  
Tzy-Haw Wu ◽  
Shin-Liang Pan ◽  
Hsiu-Hsi Chen ◽  
Sherry Yueh-Hsia Chiu
Keyword(s):  
Ischemic Stroke ◽  
Cerebrovascular Disease ◽  
Cox Regression ◽  
Controlled Trial ◽  
Stroke Recurrence ◽  
Long Term Effects ◽  
Stroke Patients ◽  
Double Blind ◽  
Term Survival

AbstractAspirin and nicametate are well-established therapies for preventing recurrence and mortality from stroke in patients diagnosed as ischemic stroke. However, their respective effects on the recurrence, making allowance for the duration of recurrence and death without the occurrence of recurrence, and long-term survival have not been well elucidated. We aimed to evaluate long-term effect of two kinds of treatment on cerebrovascular death among ischemic stroke patients with or without the recurrence of stroke. Data used in this study were derived from the cohort based on a multicenter randomized double-blind controlled trial during 1992 to 1995 with the enrollment of a total of 466 patients with first-time non-cardioembolic ischemic stroke who were randomly allocated to receive aspirin (n = 222) or nicametate (n = 244). The trial cohort was followed up over time to ascertain the date of recurrence within trial period and death until Sep of 2019. The time-dependent Cox regression model was used to estimate the long-term effects of two treatments on death from cerebrovascular disease with and without recurrence. A total of 49 patients experienced stroke recurrence and 89 cerebrovascular deaths was confirmed. Patients treated with nicametate were more likely, but non statistically significantly, to have recurrence (aHR: 1.73, 95% CI 0.96–3.13) as compared with those treated by aspirin. Nicametate reduced the risk of cerebrovascular death about 37% (aHR: 0.63, 95% CI 0.41–0.97) compared with aspirin. The aspirin group had a lower recurrence rate than the nicametate group even with recurrence after 1–2 years of follow-up of first stroke but the latter had significantly reduced death from cerebrovascular disease for nicametate group, which requires more research to verify.

scholarly journals Actigraphic Measurement of the Upper Limbs for the Prediction of Ischemic Stroke Prognosis: An Observational Study

Sensors ◽  
2021 ◽  
Vol 21 (7) ◽  
pp. 2479
Author(s):  
Giuseppe Reale ◽  
Silvia Giovannini ◽  
Chiara Iacovelli ◽  
Stefano Filippo Castiglia ◽  
Pietro Picerno ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Observational Study ◽  
Acute Ischemic Stroke ◽  
Acute Phase ◽  
Stroke Unit ◽  
Prognostic Model ◽  
Recovery Process ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Movement Asymmetry

Background: It is often challenging to formulate a reliable prognosis for patients with acute ischemic stroke. The most accepted prognostic factors may not be sufficient to predict the recovery process. In this view, describing the evolution of motor deficits over time via sensors might be useful for strengthening the prognostic model. Our aim was to assess whether an actigraphic-based parameter (Asymmetry Rate Index for the 24 h period (AR2_24 h)) obtained in the acute stroke phase could be a predictor of a 90 d prognosis. Methods: In this observational study, we recorded and analyzed the 24 h upper limb movement asymmetry of 20 consecutive patients with acute ischemic stroke during their stay in a stroke unit. We recorded the motor activity of both arms using two programmable actigraphic systems positioned on patients’ wrists. We clinically evaluated the stroke patients by NIHSS in the acute phase and then assessed them across 90 days using the modified Rankin Scale (mRS). Results: We found that the AR2_24 h parameter positively correlates with the 90 d mRS (r = 0.69, p < 0.001). Moreover, we found that an AR2_24 h > 32% predicts a poorer outcome (90 d mRS > 2), with sensitivity = 100% and specificity = 89%. Conclusions: Sensor-based parameters might provide useful information for predicting ischemic stroke prognosis in the acute phase.

Abstract P670: Obesity and Mortality After the First Ischemic Stroke: Is Obesity Paradox Real?

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Durgesh Chaudhary ◽  
Ayesha Khan ◽  
Mudit Gupta ◽  
Yirui Hu ◽  
Jiang Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Proportional Hazards Model ◽  
Obesity Paradox ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Obese Patients ◽  
Stroke Patients ◽  
Stroke Event ◽  
One Year ◽  
First Time

Introduction: Obesity is an established risk factor for ischemic stroke but the association of increased body mass index (BMI) with survival after ischemic stroke remains controversial. Many studies have shown that increased BMI has a “protective” effect on survival after stroke while other studies have debunked the obesity paradox. This study aimed at examining the relationship between BMI and all-cause mortality at one year in first-time ischemic stroke patients using data extracted from different resources including electronic health records. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke (GNSIS) database. Survival in first-time ischemic stroke patients was analyzed using Kaplan-Meier estimator, stratified by different BMI categories. The predictors of mortality at one-year were assessed using a multivariate Cox proportional hazards model. Results: Among 6,703 first-time adult ischemic stroke patients, mean age was 70.2 ±13.5 years and 52% were men. Of these patients, 24% patients were non-overweight (BMI < 25), 34% were overweight (BMI 25-29.9) and 41% were obese (BMI ≥ 30). One-year survival probability was significantly higher in overweight patients (87%, 95% CI: [85.6 - 88.4], p<0.001) and obese patients (89.5%, 95% CI: [88.4 - 90.7], p<0.001) compared to non-overweight patients (78.1%, 95% CI: [76.0 - 80.1]). In multivariate analysis, one-year mortality was significantly lower in overweight and obese patients (overweight patients- HR = 0.61 [95% CI, 0.52 - 0.72]; obese patients- HR = 0.56 [95% CI, 0.48 - 0.67]). Other significant predictors of one-year mortality were age at the ischemic stroke event (HR = 1.04 [95% CI, 1.03 - 1.04]), history of neoplasm (HR = 1.59 [95% CI, 1.38 - 1.85]), atrial fibrillation or flutter (HR = 1.26 [95% CI, 1.09 - 1.46]), heart failure (HR = 1.68 [95% CI, 1.42 - 1.98]), diabetes mellitus (HR = 1.27 [95% CI, 1.1 - 1.47]), rheumatic disease (HR = 1.37 [95% CI, 1.05 - 1.78]) and myocardial infarction ((HR = 1.23 [95% CI, 1.02 - 1.48]). Conclusion: Our results support the obesity paradox in ischemic stroke patients as shown by a significantly decreased hazard ratio for one-year mortality among overweight and obese patients in comparison to non-overweight patients.

scholarly journals Incident Cancer in a Cohort of 3,247 Cancer Diagnosis Free Ischemic Stroke Patients

2015 ◽  
Vol 39 (5-6) ◽  
pp. 262-268 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Ahmed A. Malik ◽  
Omar Saeed ◽  
Malik M. Adil ◽  
Gustavo J. Rodriguez ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
General Population ◽  
Annual Rate ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Incident Cancer ◽  
Race Ethnicity ◽  
Age Adjusted Rates

Background: Subclinical cancer can manifest as a thromboembolic event and may be detected at a later interval in ischemic stroke survivors. We determined the rate of incident cancer and effect on cardiovascular endpoints in a large cohort of ischemic stroke survivors. Methods: An analysis of 3,680 adults with nondisabling cerebral infarction who were followed for two years within the randomized, double-blinded VISP trial was performed. The primary intervention was best medical/surgical management plus a daily supplementation of vitamin B6, vitamin B12, and folic acid. We calculated age-adjusted rates of incidence of cancer among ischemic stroke survivors and standardized incidence ratios (SIR) with 95% confidence intervals (CI) based on comparison with age-adjusted rates in the general population. The significant variables from univariate analysis were entered in a Cox Proportional Hazards analysis to identify the association between various baseline factors and incident cancer after adjusting age, gender, and race/ethnicity. A logistic regression analysis evaluated the association between incident cancer and various endpoints including stroke, coronary heart disease, myocardial infarction, and death after adjusting age, gender, and race/ethnicity. Results: A total of 3,247 patients (mean age ± SD of 66 ± 11; 2,013 were men) were cancer free at the time of enrollment. The incidence of new cancer was 0.15, 0.80, 1.2, and 2.0 per 100 patients at 1 month, 6 months, 1 year, and 2 years, respectively. The age-adjusted annual rate of cancer in patients with ischemic stroke was higher than in persons in the general population at 1 year (581.8/100,000 persons vs. 486.5/100,000 persons, SIR 1.2, 95% CI 1.16-1.24) and 2 years (1,301.7/100,000 vs. 911.5/100,000, SIR 1.4, 95% CI 1.2-1.6) after recruitment. There was a higher risk for death (odds ratio (OR) 3.1, 95% CI 1.8-5.4), and composite endpoint of stroke, coronary heart disease, and/or death (OR 1.4, 95% CI 1.0-2.2) among participants who developed incident cancer compared with those who were cancer free after adjusting for potential confounders. Conclusions: The annual rate of age-adjusted cancer incidence was higher among ischemic stroke patients compared with those in the general population. The odds of mortality were three folds higher among stroke survivors who developed incident cancer.

scholarly journals Gaya Hidup yang Berpengaruh terhadap Kejadian Stroke Iskemik pada Usia Kurang dari 45 Tahun (Studi Pada BLUD RSUD Cut Nyak Dhien Meulaboh Kabupaten Aceh Barat Provinsi Aceh)

2018 ◽  
Vol 3 (2) ◽  
pp. 55
Author(s):  
Arif Iskandar ◽  
Suharyo Hadisaputro ◽  
Dwi Pudjonarko ◽  
Suhartono Suhartono ◽  
Dodik Tugasworo Pramukarso
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Life Style ◽  
Smoking Habit ◽  
Modern Society ◽  
Observational Method ◽  
High Fat ◽  
Stroke Patients

Background: Ischemic stroke that occurs at the age of less than 45 years accounts for about 5 until 10 percent of the total stroke. This is influenced by changes in the life-style of modern society, such as changes in the pattern of food consumption, lazy to move, and smoking habits. This study aims to examine the effect of life-style on ischemic stroke at less than 45 years old people.Method: This study uses observational method with design of cases and controls. The samples are 86 observations consisting of 43 cases and 43 controls. Cases are patients with ischemic stroke less than 45 years of age and controls are non-stroke patients of neurology who are less than 45 years old.Results: The results show that the habit of consuming food containing high fat (p=0,032, OR=3,744, 95% CI=1,124-12,468) and smoking habit (p=0,019, OR=3.859, 95% CI=1,250-11,911) affect the occurrence of ischemic stroke at age less than 45 years. However, the habit of consuming red meat, consuming foods containing high salt, consuming drugs, and lack of physical activity do not affect the occurrence of ischemic stroke at age less than 45 years.Conclusion: The habits of consuming food containing high fat and smoking affect theoccurrence of ischemic stroke at age less than 45 years after hypertension, heart disease, and diabetes mellitus are controlled.

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