scholarly journals Evaluation of a Newly Developed Smartphone App for Risk Factor Management in Young Patients With Ischemic Stroke: A Pilot Study

2022 ◽  
Vol 12 ◽  
Author(s):  
Viktoria Fruhwirth ◽  
Lisa Berger ◽  
Thomas Gattringer ◽  
Simon Fandler-Höfler ◽  
Markus Kneihsl ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Intervention Group ◽  
Smoking Behavior ◽  
Smartphone App ◽  
Younger Patients ◽  
Risk Factor Management ◽  
Post Stroke

Background: Efficient treatment of modifiable vascular risk factors decreases reoccurrence of ischemic stroke, which is of uttermost importance in younger patients. In this longitudinal pilot study, we thus assessed the effect of a newly developed smartphone app for risk factor management in such a cohort.Methods: The app conveys key facts about stroke, provides motivational support for a healthy lifestyle, and a reminder function for medication intake and blood pressure measurement. Between January 2019 and February 2020, we consecutively invited patients with ischemic stroke aged between 18 and 55 years to participate. Patients in the intervention group used the app between hospital discharge and 3-month follow-up. The control group received standard clinical care. Modifiable risk factors (physical activity, nutrition, alcohol consumption, smoking behavior, obesity, and hypertension) were assessed during the initial hospital stay and at a dedicated stroke outpatient department three months post-stroke.Results: The study cohort comprised 21 patients in the app intervention group (62% male; age = 41 ± 11 years; education = 12 ± 3 years) and 21 sex-, age- and education-matched control patients with a comparable stroke risk factor profile. Baseline stroke severity was comparable between groups (intervention: median NIHSS = 3; control: median NIHSS = 4; p = 0.604). Three months post-stroke, patients in the intervention group reported to be physically almost twice as active (13 ± 9 h/week) compared to controls (7 ± 5 h/week; p = 0.022). More intense app usage was strongly associated with higher physical activity (r = 0.60, p = 0.005) and lower consumption of unhealthy food (r = −0.51, p = 0.023). Smoking behavior (p = 0.001) and hypertension (p = 0.003) improved in all patients. Patients in the intervention group described better self-reported health-related quality of life three months post-stroke (p = 0.003).Conclusions: Specifically designed app interventions can be an easily to implement and cost-efficient approach to promote a healthier lifestyle in younger patients with a stroke.

ICARUSS: An effective model for risk factor management in stroke survivors

2019 ◽  
Vol 15 (4) ◽  
pp. 438-453 ◽  
Author(s):  
Jacques Joubert ◽  
Stephen M Davis ◽  
Geoffrey A Donnan ◽  
Christopher Levi ◽  
Graeme Gonzales ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Risk Factor ◽  
Primary Care Physicians ◽  
Best Practice ◽  
Intervention Group ◽  
Control Group ◽  
Stroke Survivors ◽  
Risk Factor Management ◽  
Practice Recommendations

Background and purpose After an initial stroke, the risk of recurrent stroke is high. Models that implement best-practice recommendations for risk factor management in stroke survivors to prevent stroke recurrence remain elusive. We examined a model which focuses on vascular risk factor management to prevent stroke recurrence in survivors returning to their primary care physicians. This model is coordinated from the stroke unit, integrates specialist stroke services with primary care physicians, and directly involves patients and carers in risk factor management. It is underpinned by the shared care principle in which there is joint participation of specialists as well as primary care physicians in a planned, integrated delivery of care with ongoing involvement of patients and carers, a structure which encourages implementation of best-practice recommendations as well as transferability and sustainability. We hypothesized that an integrated, multimodal intervention based on a shared-care model which supports joint participation of stroke specialists and primary care physicians would improve the implementation of best-practice recommendations for risk factor management in stroke survivors returning to the community. Methods We undertook a double-blind randomized controlled trial, testing the model in three Australian cities using stroke survivors admitted to stroke units and discharged from hospital to return to their primary care physicians. The model was a shared care, multifaceted integrated program which included bidirectional feedback between general practitioner and specialist unit, education, and engagement of patient and carer in self-management with ongoing input from a multidisciplinary team. The primary endpoint was improvement or abolition of risk factors such as raised blood pressure, diabetes, hyperlipidemia, the modification of adverse life-style factors such as lack of exercise, smoking and alcohol abuse and adherence to preventive medication at one year. Intermediate measurement points were scheduled at three monthly intervals. Analysis was by intention to treat, evaluated by covariance or a linear model adjusting for confounding factors or variance of base-line risk factors. The study was registered as ACTRN = 1261100026498. Results The study population was as follows: intervention ( n = 112), control ( n = 137). At baseline, there was no statistical difference between the groups for any variable. At the 12-month evaluation, there was a significant decrease in systolic blood pressure from baseline in the intervention group of 5.2 mmHg ( p < 0.01). This change was not observed in the control group ( p = 0.29). Moreover, at 12 months the mean systolic blood pressure in the intervention group was 129.4 mmHg (SD 14.7), a result which was not obtained in controls. Fasting total cholesterol as well as triglycerides was reduced significantly in the intervention group (both p < 0.01) but this was not the case in the control group ( p = 0.11 and p = 0.27, respectively). At 12 months, there was no change in BMI in the intervention group but there was a significant increase in BMI ( p = 0.02) in the control group. At 12 months in the intervention group, the mean distance walked with ease compared to the baseline measurements was increased by a mean distance of 600 m while in the control group the distance walked with ease was reduced compared to that measured at baseline. At 12 months, the Barthel index in the intervention group demonstrated improved function ( p = 0.01), but no change was observed in controls. At 12 months in the intervention group, there was a significant decrease in number of standard alcoholic drinks consumed per week compared to the baseline ( p = 0.04). This was not observed in the control group ( p = 0.34). Conclusion In stroke survivors, the ICARUSS (Integrated Care for the Reduction of Secondary Stroke) model is superior to usual care with respect to best-practice recommendations for traditional risk factors as well as behavioral and functional outcomes.

Abstract T P165: Women Had Worse Stroke Outcome

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Claudia Alonzo ◽  
Maria C Zurru ◽  
Laura Brescacin ◽  
Santiago Pigretti ◽  
Pedro Colla Machado ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Vascular Risk Factor ◽  
Stroke Outcome ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Stroke Outcomes ◽  
Post Stroke ◽  
Artery Disease

Background: women who have ischemic strokes are on average older than men.Several studies, however, show that stroke outcomes are worse in women even after adjusting for age, and the specific conditions that contribute to this outcome are poorly known. Our objective was to evaluate post-stroke disability and mortality after ischemic stroke in women. Methods: acute ischemic stroke patients were prospectively included in a multidisciplinary secondary stroke prevention program. Pre-stroke vascular risk factor profile and control were obtained from electronic records; disability (modified Rankin scale) were evaluated one month after stroke. Results: fifty seven percent of the 1194 ischemic stroke patients prospectively included between December 2006 and December 2013 were women. They were older, more probably hypertensive, dislipidemic and diabetic, and had higher incidence of atrial fibrillation, while men had higher prevalence of obesity, metabolic syndrome, smoking, and history of coronary heart disease and peripheral artery disease. Pre-stroke vascular risk factor control and management are shown in table 1. Women had worst outcome than men: mRankin >1 (66% women vs 52% men, p 0.0001), 30-day mortality (4% women vs 2% men, p 0.04), composite disability + mortality (52% women vs 36% men, p 0.0001). After adjusting by age women still had higher risk of disability and mortality: m-Rankin >1 (OR 1.40, 95%CI 1.05-1.87; p 0.02); mortality (OR 1.64, 95%CI 0,98-2,74), and composite disability + mortality (OR 1.59, 95%CI 1.22-2.07; p 0.004). Conclusion: in our cohort women have worst post-stroke outcome, even though they have higher burden of vascular risk factors they have lower prevalence of vascular disease in other vascular beds previous to stroke. This difference persists after adjusting by age, raising the possibility of specific gender risk factors influencing on ischemic stroke outcomes.

scholarly journals A hospital-based study of post-stroke aphasia: frequency, risk factors, and topographic representation

2019 ◽  
Vol 56 (1) ◽  
Author(s):  
Eman M. Khedr ◽  
Mohamed A. Abbass ◽  
Radwa K. Soliman ◽  
Ahmed F. Zaki ◽  
Aymen Gamea ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Parietal Lobe ◽  
Inferior Parietal Lobe ◽  
Post Stroke ◽  
Motor Aphasia ◽  
Sensory Aphasia ◽  
High Risk Factor

Abstract Background and objective The crude prevalence rate of stroke in Qena, Egypt, is high (922/100,000). For the first time, we estimate the frequency of aphasia following the first-ever ischemic stroke and its relationship to the site of lesion in Arabic-speaking countries. Methods The study was conducted on 180 acute or subacute ischemic stroke patients. Aphasia was diagnosed with the short form of the Boston Diagnostic Aphasia Examination after establishment of the cases (at least 10 days of stroke onset). Computed tomography and/or magnetic resonance imaging were performed for topographic localization of stroke, and routine laboratory investigations were done to evaluate the possible stroke risk factors. Results The frequency of post-stroke aphasia was recorded in 20%, and atrial fibrillation (AF) represents a high-risk factor for ischemic stroke with aphasia. The following categories were observed: global aphasia in 50%, motor aphasia in 27.7%, sensory aphasia in 11.1%, nominal aphasia in 2.8%, and conductive aphasia in 8.3%. Global aphasia was mainly associated with complete middle cerebral artery (MCA) territories infarction. Motor aphasia was associated mainly with frontal or frontoparietal operculum lesions as well as basal ganglionic lesions. Sensory aphasia was associated with temporal lobe lesions, inferior parietal lobe, and basal ganglia. Conductive aphasia showed lesions in the deep white matter of the frontal and parietal lobes. Anomic aphasia was associated with inferior parietal lobe lesion. Conclusion Our data are consistent with other reports as regards the frequency and risk factors of post-stroke aphasia. Atrial fibrillation represents a high-risk factor for ischemic strokes with aphasia. Global and motor aphasia are the major subtypes. The lesion locations are predictive of aphasia subtypes.

General practice capacity for behavioural risk factor management: A SNAP-shot of a needs assessment in Australia

2005 ◽  
Vol 11 (2) ◽  
pp. 120 ◽  
Author(s):  
Cheryl Amoroso ◽  
Coletta Hobbs ◽  
Mark F Harris
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
General Practice ◽  
Risk Factor ◽  
Nutritional Risk ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Activity Increase ◽  
Risk Factor Management ◽  
Rural And Urban

The objective of this study is to examine current activities, barriers, and capacity needs for the assessment and management of smoking, nutrition, alcohol and physical activity behavioural risk factors in rural and urban general practices. A cross-sectional survey of 287 general practitioners (GPs) was conducted in a rural and urban Division of General Practice in NSW. A total of 146 GPs responded yielding Divisional response rates of 51% rural and 61% urban. For each of the SNAP risk factors, between 37% and 46% of GPs report using guidelines. Verbal advice is given "very often" for smoking by 68% of GPs, for nutrition and alcohol by 48%, and physical activity by 60%. Guideline use is associated with increased frequency of advising patients. Patient compliance is the most frequently reported barrier to giving advice, especially for smoking and alcohol. GPs report that they "often" or "very often" refer patients due to nutritional risk factors (48%), with lower referral rates reported for physical activity and alcohol risk factors (28% and 27% respectively). Only 10% refer patients "often" or "very often" for smoking management, and referral for smoking management and physical activity increase as a result of training in these areas. There is considerable variability in smoking, nutrition, alcohol and physical activity risk factor intervention and management in the general practice setting. A range of strategies is required to improve the systematic management of risk factors including training, use of guidelines, referral networks, and patient education.

An absolute risk-guided approach to cardiovascular risk management within a chest pain clinic: the ARCPAC randomized trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.A Black ◽  
J Campbell ◽  
J Sharman ◽  
M Nelson ◽  
S Parker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Chest Pain ◽  
Smoking Status ◽  
Absolute Risk ◽  
Pain Clinic ◽  
Risk Scores ◽  
Cardiovascular Risk Management ◽  
Risk Factor Management

Abstract Background The majority of patients attending chest pain clinics are found not to have a cardiac cause of their symptoms, but have a high burden of cardiovascular risk factors that may be opportunistically addressed. Absolute risk calculators are recommended to guide risk factor management, although it is uncertain to what extent these calculations may assist with patient engagement in risk factor modification. Purpose We sought to determine the usefulness of a proactive, absolute risk-based approach, to guide opportunistic cardiovascular risk factor management within a chest pain clinic. Methods This was a prospective, open-label, blinded-endpoint study in 192 enhanced risk (estimated 5-year risk ≥8%, based on Australian Absolute Risk Calculator) patients presenting to a tertiary hospital chest pain clinic. Patients were randomized to best practice usual care, or intervention with development of a proactive cardiovascular risk management strategy framed around a discussion of the individual's absolute risk. Patients found to have a cardiac cause of symptoms were excluded as they constitute a secondary prevention population. Primary outcome was 5-year absolute cardiovascular risk score at minimum 12 months follow up. Secondary outcomes were individual modifiable risk factors (lipid profile, blood pressure, smoking status). Results 192 people entered the study; 100 in the intervention arm and 92 in usual care. There was no statistical difference between the two groups' baseline sociodemographic and clinical variables. The intervention group showed greater reduction in 5-year absolute risk scores (difference −2.77; p&lt;0.001), and more favourable individual risk factors, although only smoking status and LDL cholesterol reached statistical significance (table). Conclusion An absolute risk-guided proactive risk factor management strategy employed opportunistically in a chest pain clinic significantly improves 5-year cardiovascular risk scores. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Tasmanian Community Fund

scholarly journals Modifiable and Non-Modifiable Risk Factors for Atherothrombotic Ischemic Stroke among Subjects in the Malmö Diet and Cancer Study

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1952
Author(s):  
Anna Johansson ◽  
Isabel Drake ◽  
Gunnar Engström ◽  
Stefan Acosta
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Body Mass Index ◽  
Ischemic Stroke ◽  
Family History ◽  
Diet Quality ◽  
Alcohol Intake ◽  
Modifiable Risk Factors ◽  
History Of ◽  
Diet And Cancer

Risk factors for ischemic stroke is suggested to differ by etiologic subtypes. The purpose of this study was to examine the associations between modifiable and non-modifiable risk factors and atherothrombotic stroke (i.e., excluding cardioembolic stroke), and to examine if the potential benefit of modifiable lifestyle factors differs among subjects with and without predisposing comorbidities. After a median follow-up of 21.2 years, 2339 individuals were diagnosed with atherothrombotic stroke out of 26,547 study participants from the Malmö Diet and Cancer study. Using multivariable Cox regression, we examined non-modifiable (demographics and family history of stroke), semi-modifiable comorbidities (hypertension, dyslipidemia, diabetes mellitus and atherosclerotic disease), and modifiable (smoking, body mass index, diet quality, physical activity, and alcohol intake) risk factors in relation to atherothrombotic stroke. Higher age, male gender, family history of stroke, and low educational level increased the risk of atherothrombotic stroke as did predisposing comorbidities. Non-smoking (hazard ratio (HR) = 0.62, 95% confidence interval (CI) 0.56–0.68), high diet quality (HR = 0.83, 95% CI 0.72–0.97) and high leisure-time physical activity (HR = 0.89, 95% CI 0.80–0.98) decreased the risk of atherothrombotic ischemic stroke independent of established risk factors, with non-significant associations with body mass index and alcohol intake. The effect of the lifestyle factors was independent of predisposing comorbidities at baseline. The adverse effects of several cardiovascular risk factors were confirmed in this study of atherothrombotic stroke. Smoking cessation, improving diet quality and increasing physical activity level is likely to lower risk of atherothrombotic stroke in the general population as well as in patient groups at high risk.

Wybrane czynniki ryzyka chorób układu sercowo-naczyniowego związane z miażdżycą tętnic jako problem zdrowotny wśród młodzieży ponadgimnazjalnej

2018 ◽  
Vol 21 (1A) ◽  
Author(s):  
Zdzisława Chmiel ◽  
Grażyna Hejda ◽  
Monika Binkowska-Bury
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Risk Factor ◽  
Cardiovascular Diseases ◽  
World Health ◽  
Study Group ◽  
Atherosclerosis Risk ◽  
Atherosclerosis Risk Factors ◽  
Atherosclerosis Risk Factor ◽  
Recommended Physical Activity

Introduction. A World Health Organization (WHO) conference on a “second wave” epidemic of cardiovascular diseases, directly linked to arterial sclerosis (AS), predicts that in 2020 cardiovascular diseases will most likely be the leading cause of death in the world. The development of AS begins in youth and progresses with age. It’s intensity depends on the risk factors involved, such as: smoking, hypertension, obesity and fat and sugar disorders in the body. Aim. The aim of this study was to establish the risk factors of cardiovascular diseases and their existence, among the youth of the upper gymnasium school. Material and methods. The research was conducted using 511 volunteer students from upper and lower gymnasium schools, between 16-19 years of age. Our research methods included: a diagnostic questionnaire, the measurement of blood pressure (BP) and anthropometric measurements. In the statistical study, we used chi-square independence testing, the V-Kramer test and the tau-b Kendall test; the level of changes α = 0.05 – was used. Results. Over a half of the study group (52.5%) was characterised with the lack of recommended physical activity, much more common in girls than boys (p = 0.000), just like smoking (p = 0.009) which was declared by 39.7% of the interviewed youth. In turn, a heightened value of systolic and diastolic pressure occurred more often in boys (19.6%) than in girls (12.1%); (p = 0.000 vs. p = 0.003). Excessive body mass was noted in 15.7% of the respondents, also more often in boys than in girls (p = 0.02), and abdominal obesity occurred in 10.2% of the respondents, with no significant differences between the sexes. 42.3% of the respondents showed one, 29.9% showed two and 18.8% showed three atherosclerosis risk factors. 9.0% of the study group showed 4 and more such risk factors. Accumulation of atherosclerosis risk factors occurred significantly more often in girls than in boys (p = 0.002). Conclusions. In all the respondents at least one atherosclerosis risk factor was found, and in over half of the study group, more frequently in girls than in boys, an accumulation of two or more risk factors was observed. Lack of recommended physical activity was the most frequent atherosclerosis risk factor occurring in the youth.

Abstract TP208: Sleep Disordered Breathing (SDB) - An Overlooked Modifiable Risk Factor in Acute Stroke Care

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Vishal Shah ◽  
Ashrai Gudlavalleti ◽  
Julius G Latorre
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Sleep Disordered Breathing ◽  
Modifiable Risk Factor ◽  
Inclusion Criteria ◽  
Risk Of Death ◽  
Disordered Breathing

Introduction: In patients with acute stroke, part of the acute management entails identifying the risk factors; modifiable or non modifiable. Early recognition of these factors is essential for optimizing therapeutic procedures, especially those with a known effective treatment. In this sense, Sleep Disordered Breathing (SDB) has also been suggested as a modifiable and independent risk factor for stroke as defined by international guidelines and some studies have demonstrated that patients with stroke and particularly Obstructive Sleep Apnea (OSA) have an increased risk of death or new vascular events. Pathogenesis of ischemic stroke in SDB is probably related to worsening of existing cardiovascular risk factors such as hypertension and hypoxia driven cardiac arrhythmia leading to higher prevalence of ischemic stroke in patients with sleep disordered breathing disease. Despite strong evidence linking SDB to ischemic stroke, evaluation for SDB is rarely performed in patients presenting with an acute ischemic stroke. Hypothesis: Evaluation of SDB is rarely performed in patients presenting with acute ischemic stroke. Methods: We performed a retrospective review of all patients above the age of 18 who were admitted to the acute stroke service at University Hospital July 2014 to December 2014. Demographic data, etiology of stroke as identified per TOAST criteria, modifiable risk factors, presenting NIHSS and frequency of testing for SDB and their results were collected. The data was consolidated and tabulated by using STATA version 14. Results: Total of 240 patients satisfied our inclusion criteria. Only 24 patients ie 10% of those who satisfied our inclusion criteria received evaluation for SDB. Out of those evaluated, 62.5% ie 15 patients out of 24 patients had findings concerning for significant desaturation. Only 2 providers out of 8 stroke physicians ie 25% tested for SDB in more than 5 patients. Conclusions: Our observations highlight the paucity in evaluation for SDB in acute ischemic stroke in a tertiary care setting. Being a modifiable risk factor, greater emphasis must be placed on evaluation for SDB in patients in patients with acute stroke. Education must be provided to all patients and providers regarding identification of these factors.

Characteristics, outcomes, and risk factors of ICANS after axicabtagene ciloleucel: Does age matter?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19556-e19556
Author(s):  
Kitsada Wudhikarn ◽  
Radhika Bansal ◽  
Arushi Khurana ◽  
Matthew Hathcock ◽  
Michael Ruff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Older Patients ◽  
Clinical Course ◽  
International Prognostic Index ◽  
Age Groups ◽  
Central Nervous System Involvement ◽  
Microvascular Disease ◽  
B Cell Lymphoma ◽  
Younger Patients

e19556 Background: CD19 chimeric antigen receptor T cell therapy possesses unique side effects including cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS). Age is a major risk factor for ICANS. However, whether ICANS in older patients is different compared to younger patients is unknown. Herein, we report clinical course, outcomes and risk factors for ICANS in older patients with large B cell lymphoma (LBCL) treated with axicabtagene ciloleucel (axi-cel). Methods: We comprehensively reviewed detailed clinical courses of ICANS in 78 adult patients with LBCL treated with axi-cel between June 2016 and October 2020. Incidence, manifestation, risk factors, treatment, and outcomes of ICANS were compared between patients age ≥60 (n=32) and <60 (n=46) years old. Results: Baseline characteristics were comparable between older and younger patients except higher proportion of high international prognostic index and underlying cerebral microvascular disease in older patients. ICANS was observed in 16 patients in the older and 24 patients in the younger age group, with a 30-day incidence of 52% and 50%, respectively. Median time to CRS and ICANS were similar between 2 age groups. The most common initial neurological findings included aphasia, dysgraphia and encephalopathy in both age groups. Table summarizes the characteristics, clinical course and interventions of ICANS in older and younger patients. In Cox regression model, the presence of CRS was the only factor associated with ICANS in both age groups. Age, history of central nervous system involvement and cerebral microvascular disease were not associated with ICANS. Importantly, all patients had complete resolution of ICANS. No elderly patients in our cohort experienced seizure as a manifestation of ICANS. Conclusions: In our study, older age was not a risk factor for ICANS. CRS was the only factor associated with ICANS in both younger and older patients. Incidence, clinical course and neurological outcomes of ICANS in older patients treated with axi-cel were comparable to younger patients. [Table: see text]

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