Post-stroke Pathway: Analysis and Link With One Year Sequelae in a French Cohort of Stroke Patients

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.

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Driving after a Stroke

Journal of the Royal Society of Medicine ◽

10.1177/014107688607900404 ◽

1986 ◽

Vol 79 (4) ◽

pp. 200-203 ◽

Cited By ~ 91

Author(s):

J Legh-Smith ◽

D T Wade ◽

R Langton Hewer

Keyword(s):

Functional Ability ◽

Easy Access ◽

Social Activities ◽

Stroke Patients ◽

Post Stroke ◽

Arm Function ◽

One Year ◽

At Home

Four hundred and thirty-eight stroke patients from a community register covering a period of 28 months were interviewed at one year post-stroke. Of 144 (34%) living at home who had been driving prior to their stroke, 82 (58%) did not resume post-stroke. Assessments of arm function, walking, functional ability and IQ showed ex-drivers to be significantly more disabled than drivers. Stopping driving was associated with a loss of social activities and with a higher frequency of depression amongst ex-drivers when compared with drivers. This was despite 79% of ex-drivers having easy access to alternative car transport. Extending mobility allowance to the 49 (60%) ex-drivers over 65 years old at the time of their stroke might ease their situation. More appropriate assessments would be needed to establish whether ex-drivers would benefit from retraining or car adaptations to enable them to return to driving.

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Fatigue Impact Scale Demonstrates Greater Fatigue in Younger Stroke Survivors

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100015353 ◽

2012 ◽

Vol 39 (5) ◽

pp. 619-625 ◽

Cited By ~ 23

Author(s):

Natalie E. Parks ◽

Gail A. Eskes ◽

Gordon J. Gubitz ◽

Yvette Reidy ◽

Christine Christian ◽

...

Keyword(s):

Quality Of Life ◽

Ischemic Stroke ◽

Stroke Severity ◽

Stroke Patients ◽

Younger Patients ◽

Post Stroke ◽

Impact Scale ◽

Fatigue Impact Scale ◽

One Year

Background:Fatigue affects 33-77% of stroke survivors. There is no consensus concerning risk factors for fatigue post-stroke, perhaps reflecting the multifaceted nature of fatigue. We characterized post-stroke fatigue using the Fatigue Impact Scale (FIS), a validated questionnaire capturing physical, cognitive, and psychosocial aspects of fatigue.Methods:The Stroke Outcomes Study (SOS) prospectively enrolled ischemic stroke patients from 2001-2002. Measures collected included basic demographics, pre-morbid function (Oxford Handicap Scale, OHS), stroke severity (Stroke Severity Scale, SSS), stroke subtype (Oxfordshire Community Stroke Project Classification, OCSP), and discharge function (OHS; Barthel Index, BI). An interview was performed at 12 months evaluating function (BI; Modified Rankin Score, mRS), quality of life (Reintegration into Normal living Scale, RNL), depression (Geriatric Depression Scale, GDS), and fatigue (FIS).Results:We enrolled 522 ischemic stroke patients and 228 (57.6%) survivors completed one-year follow-up. In total, 36.8% endorsed fatigue (59.5% rated one of worst post-stroke symptoms). Linear regression demonstrated younger age was associated with increased fatigue frequency (β=-0.20;p=0.01), duration (β=-0.22;p<0.01), and disability (β=-0.24;p<0.01). Younger patients were more likely to describe fatigue as one of the worst symptoms post-stroke (β=-0.24;p=0.001). Younger patients experienced greater impact on cognitive (β=-0.27;p<0.05) and psychosocial (β=-0.27;p<0.05) function due to fatigue. Fatigue was correlated with depressive symptoms and diminished quality of life. Fatigue occurred without depression as 49.0% of respondents with fatigue as one of their worst symptoms did not have an elevated GDS.Conclusions:Age was the only consistent predictor of fatigue severity at one year. Younger participants experienced increased cognitive and psychosocial fatigue.

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The Sensitivity and Specificity of the Center for Epidemiologic Studies Depression Scale in Screening for Post-Stroke Depression

The International Journal of Psychiatry in Medicine ◽

10.2190/bh75-euya-4fm1-j7qa ◽

1989 ◽

Vol 18 (2) ◽

pp. 169-181 ◽

Cited By ~ 95

Author(s):

Rajesh M. Parikh ◽

Dianne T. Eden ◽

Thomas R. Price ◽

Robert G. Robinson

Keyword(s):

Sensitivity And Specificity ◽

Depression Scale ◽

Screening Instrument ◽

Epidemiologic Studies ◽

Stroke Patients ◽

Post Stroke ◽

Standardized Interview ◽

Post Stroke Depression ◽

One Year

The present study examines the sensitivity and specificity of the Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for post-stroke depression. Eighty stroke patients were evaluated by a research nurse over a two-year period using the CES-D and also by a trained psychiatrist using a standardized interview for affective, cognitive, physical and social functioning. CES-D scores correlated significantly with DSM-III diagnoses of depression in-hospital and at three months, six months, and one year follow-up but not at two years follow-up, reflecting the natural course of these depressions, as well as the predictive validity of the CES-D. Furthermore, at a cut-off point of 16, the CES-D was found to have a specificity of 90 percent, a sensitivity of 86 percent and a positive predictive value of 80 percent and thus may be a potentially useful screening instrument for post-stroke depression.

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Caregiver burden and emotional problems in partners of stroke patients at two months and one year post-stroke: Determinants and prediction

Patient Education and Counseling ◽

10.1016/j.pec.2016.04.007 ◽

2016 ◽

Vol 99 (10) ◽

pp. 1632-1640 ◽

Cited By ~ 43

Author(s):

Willeke J. Kruithof ◽

Marcel W.M. Post ◽

Maria L. van Mierlo ◽

Geertrudis A.M. van den Bos ◽

Janneke M. de Man-van Ginkel ◽

...

Keyword(s):

Caregiver Burden ◽

Emotional Problems ◽

Stroke Patients ◽

Post Stroke ◽

One Year

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Deep vein thrombosis inhibitor may play a therapeutic role in post-stroke patients

BMC Medical Genetics ◽

10.1186/s12881-020-01108-9 ◽

2020 ◽

Vol 21 (S1) ◽

Author(s):

Xixi Xiang ◽

Di Yuan ◽

Peiyan Kong ◽

Ting Chen ◽

Han Yao ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Pathway Analysis ◽

Influential Factors ◽

Influential Factor ◽

Stroke Patients ◽

Therapeutic Role ◽

Expression Levels ◽

Post Stroke ◽

Vein Thrombosis ◽

Deep Vein

Abstract Background Deep vein thrombosis (DVT) is associated with stroke. Here, we hypothesize that genes associated with DVT may also play roles in the development of stroke. Methods we firstly conducted large-scale literature based disease-gene relationship data analysis to explore the genes implicated with DVT and stroke. Further, a mega-analysis was conducted for each of these genes that were linked to DVT but not stroke, using 11 independent stroke RNA expression datasets (176 stroke cases and 102 healthy controls). Then, a multiple linear regression (MLR) model was employed to study possible influential factors on the gene expression levels in stroke. After that, a functional pathway analysis was performed to identify the potential biological linkage between stroke and the target genes suggested by mega-analysis. Results Over 81.10% genes implicated with DVT also suggested an association with stroke. Among the 24 DVT-specific genes, one DVT-inhibiting gene, SP1, presented significantly increased expression in stroke (LFC = 1.34, p-value = 0.0045). Pathway analysis showed that SP1 may play a therapeutic role in post-stroke patients by promoting multiple of stroke-inhibitors. Moreover, geographical region was indicated as an influential factor on the expression levels of SP1 in stroke samples (p-value = 0.037). Conclusion Our results suggested that DVT inhibitor SP1 could be a novel therapeutic target gene for post-stroke treatment. Further study of the potential relations between SP1 and stroke was guaranteed.

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