scholarly journals Diagnostic Accuracy in Teleneurological Stroke Consultations

2021 ◽  
Vol 10 (6) ◽  
pp. 1170
Author(s):  
Jordi Kühne Escolà ◽  
Simon Nagel ◽  
Christina Verez Sola ◽  
Eva Doroszewski ◽  
Hannah Jaschonek ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Cerebrovascular Disease ◽  
False Negative ◽  
Intravenous Thrombolysis ◽  
Final Diagnosis ◽  
Ischemic Heart ◽  
Positive Diagnosis ◽  
Test Characteristics ◽  
False Positive Diagnosis

Background: The accuracy of diagnosing acute cerebrovascular disease via a teleneurology service and the characteristics of misdiagnosed patients are insufficiently known. Methods: A random sample (n = 1500) of all teleneurological consultations conducted between July 2015 and December 2017 was screened. Teleneurological diagnosis and hospital discharge diagnosis were compared. Diagnoses were then grouped into two main categories: cerebrovascular disease (CVD) and noncerebrovascular disease. Test characteristics were calculated. Results: Out of 1078 consultations, 52% (n = 561) had a final diagnosis of CVD. Patients with CVD could be accurately identified via teleneurological consultation (sensitivity 95.2%, 95% CI 93.2–96.8), but we observed a tendency towards false-positive diagnosis (specificity 77.4%, 95% CI 73.6–80.8). Characteristics of patients with a false-negative CVD diagnosis were similar to those of patients with a true-positive diagnosis, but patients with a false-negative CVD diagnosis had ischemic heart disease less frequently. In retrospect, one patient would have been considered a candidate for intravenous thrombolysis (0.2%). Conclusions: Teleneurological consultations are accurate for identifying patients with CVD, and there is a very low rate of missed candidates for thrombolysis. Apart from a lower prevalence of ischemic heart disease, characteristics of “stroke chameleons” were similar to those of correctly identified CVD patients.

Abstract 325: Readmission among Hospitalized Patients with Non-Valvular Atrial Fibrillation

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Karen E Smoyer-Tomic ◽  
Kimberly Siu ◽  
Barbara Johnson ◽  
David R Walker ◽  
Stephen Sander ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Cerebrovascular Disease ◽  
Readmission Rate ◽  
Ischemic Heart ◽  
Index Admission ◽  
Readmission Rates ◽  
Diagnosis Codes

Background: An important goal of healthcare reform is reducing the need for hospital readmissions. This study examined readmission rates, reasons for readmissions, and risk factors associated with readmissions in non-valvular atrial fibrillation (NVAF) patients, which may facilitate identification of potential gaps in care. Methods: Patients with AF hospitalizations in any diagnostic position in 2004-2009 were extracted from a large, national commercial and Medicare supplemental administrative claims database. Patients with valvular or transient causes of AF, under the age of 18 years, pregnant, or dead at discharge were excluded from the study. All patients had at least 30 days follow up from the index hospitalization discharge date. Readmission rate within 30 days of discharge date was calculated. Reasons for readmission were reported by ICD-9 diagnosis codes in the primary position. ICD-9 diagnosis codes were grouped into common acute conditions (e.g., ischemic heart disease, cerebrovascular disease) and reported. Logistic regression analyses were conducted to identify risk factors for readmission, controlling for patients’ demographic and clinical characteristics. Results: A total of 6439 patients met the study criteria. The overall 30-day readmission rate was 18.0%. Readmission rates for patients with AF as primary or secondary diagnosis in index admissions were 11.8% and 20.3%, respectively (p<0.001). Readmissions on average occurred 9.7 (SD 9.0) days from index admission discharge, with a mean readmission length of stay (LOS) of 7.4 (SD 8.0) days. The 4 most common grouped diagnoses for readmissions were AF (ICD-9 code 427.31, 10.2% of all readmissions), ischemic heart disease (IHD; 410.xx - 414.xx, 7.2%), heart failure (HF; 428.xx, 7.1%), and cerebrovascular disease (CVD; 430.xx - 438.xx, 6.0%). Longer LOS in the index admission, higher Charlson comorbidity index, and emergency room admission for the index admission all significantly increased the likelihood of having a readmission (p<0.001 in all cases). Patients discharged to home from index admission, patients with AF as primary diagnosis in index admissions, and patients living in the South region were less likely to be readmitted (p<0.01 in all cases). Conclusions: Almost one fifth of patients with NVAF were readmitted within 30 days of discharge. AF, IHD, HF, and CVD were the most common reasons for readmission. Identification of risk factors for readmission may assist healthcare providers in targeting good clinical practice aimed at improving quality of care and reducing the need for readmissions.

Potential of creatine or phosphocreatine supplementation in cerebrovascular disease and in ischemic heart disease

Amino Acids ◽  
2016 ◽  
Vol 48 (8) ◽  
pp. 1955-1967 ◽  
Author(s):  
Maurizio Balestrino ◽  
Matteo Sarocchi ◽  
Enrico Adriano ◽  
Paolo Spallarossa
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Cerebrovascular Disease ◽  
Ischemic Heart

Longevity and Diet in Okinawa, Japan: The Past, Present and Future

2003 ◽  
Vol 15 (1_suppl) ◽  
pp. S3-S9 ◽  
Author(s):  
S Miyagi ◽  
N Iwama ◽  
T Kawabata ◽  
K Hasegawa
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Cerebrovascular Disease ◽  
Daily Intake ◽  
National Average ◽  
Ischemic Heart ◽  
Meat Intake ◽  
The Past ◽  
Life Expectancy At Birth ◽  
Okinawa Prefecture

Japan has the longest life expectancy at birth (LEB) in the world. Okinawa, Japan's poorest prefecture, previously had the highest longevity indices in the country. However, the latest LEB for men in Okinawa is no higher than the national average. The purpose of this study is to examine why the longevity indices in Okinawa were once the highest in Japan, and to examine the reasons for their recent decline. In 1990, in Okinawa, the age-adjusted death rates (ADR) of the three leading causes of death were lower than their national averages. By 2000, the standard mortality ratios (SMR, Japan=100) of heart disease and cerebrovascular disease for both sexes in Okinawa had increased, compared to their 1990 levels. Both of the ADR of ischemic heart disease and the ADR of cerebrovascular disease for men increased to 45.5 and 63.5 in 2000, up from 42.9 and 59.1 in 1990, respectively, and the SMR of ischemic heart disease for men in Okinawa reached 101 in 2000. Consequently, the national ranking of Okinawa prefecture for LEB of men has dropped. As of 1988, in Okinawa, daily intake of meat and daily intake of pulses were both approximately 90 grams, which is about 20% and 30% higher than the national average, respectively. Also, as of 1988, daily intake of green and yellow vegetables in Okinawa was about 50% higher than the national average. However, by 1998, daily meat intake and fat energy ratio had surpassed 100 grams and 30%, respectively, and daily intake of pulses and green and yellow vegetables had declined to the level of the national average. Recently, young Japanese, particularly young men in Okinawa, have shown a tendency to avoid the traditional dishes of stewed meat and champuru.

scholarly journals Mortality in a Cohort of Men Expressing the Glucose-6-Phosphate Dehydrogenase Deficiency

Blood ◽  
1998 ◽  
Vol 91 (2) ◽  
pp. 706-709
Author(s):  
Pierluigi Cocco ◽  
Pierfelice Todde ◽  
Susanna Fornera ◽  
Maria Bonaria Manca ◽  
Pierina Manca ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Heart Disease ◽  
Cardiovascular Diseases ◽  
Ischemic Heart Disease ◽  
Cerebrovascular Disease ◽  
Hodgkin’S Lymphoma ◽  
Ischemic Heart ◽  
Hodgkin's Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Glucose 6 Phosphate Dehydrogenase

The objective of this study was to test the hypothesis of a lower mortality from cancer and cardiovascular diseases among men expressing glucose-6-phosphate dehydrogenase (G6PD) deficiency. We designed a mortality study based on death certificates from January 1, 1982 through December 31, 1992 in a cohort of G6PD-deficient men. Cohort members were 1,756 men, identified as expressing the G6PD-deficient phenotype during a 1981 population screening of the G6PD polymorphism. The setting was the island of Sardinia, Italy. Outcome measures were cause-specific standardized mortality ratios (SMRs), which were computed as 100 times the observed/expected ratio, with the general Sardinian male population as the reference. Deaths from all causes were significantly less than expected due to decreased SMRs for ischemic heart disease (SMR, 28; 95% confidence interval [CI], 10 to 62), cerebrovascular disease (SMR, 22; 95% CI, 6 to 55), and liver cirrhosis (SMR, 12; 95% CI, 0 to 66), which explained 95.6% of the deficit in total mortality. All cancer mortality was close to the expectation, with a significant increase in the SMR for non-Hodgkin's lymphoma (SMR, 545; 95% CI, 147 to 1,395). A decrease in mortality from cardiovascular diseases was one of the study hypotheses, based on an earlier human report and experimental evidence. However, selection bias is also a likely explanation. Further analytic studies are warranted to confirm whether subjects expressing the G6PD-deficient phenotype are protected against ischemic heart disease and cerebrovascular disease. This cohort study is consistent with more recent case-control studies in rejecting the hypothesis of a decreased cancer risk among G6PD-deficient subjects. The observed increase in mortality from non-Hodgkin's lymphoma and decrease in mortality from liver cirrhosis were not previously reported.

scholarly journals Lipoprotein (a) in Ischemic Heart Disease and Cerebrovascular Disease

1995 ◽  
Vol 2 (Supplement1) ◽  
pp. S13-S16
Author(s):  
Taku Yamamura ◽  
Shuichi Nomura ◽  
Xia Yang ◽  
Yasushi Toyota ◽  
Miyahiko Sonobe ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Cerebrovascular Disease ◽  
Ischemic Heart ◽  
Lipoprotein A

scholarly journals Increased risk of ischemic heart disease after kidney donation

2021 ◽  
Author(s):  
Anders J Haugen ◽  
Stein Hallan ◽  
Nina E Langberg ◽  
Dag Olav Dahle ◽  
Hege Pihlstrøm ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Cerebrovascular Disease ◽  
Ischemic Heart ◽  
Kidney Donation ◽  
Baseline Body Mass Index ◽  
Healthy Controls ◽  
Kidney Donors ◽  
Increased Risk

Abstract Background Previous reports suggest increased risk of hypertension and cardiovascular mortality after kidney donation. In this study we investigate occurrence of ischemic heart disease and cerebrovascular disease, diabetes and cancer in live kidney donors compared with healthy controls eligible for donation. Methods Different diagnoses were assessed in 1029 kidney donors and 16084 controls. The diagnoses at follow-up were self-reported for the controls and registered by a physician for the donors. Stratified logistic regression was used to estimate associations with various disease outcomes, adjusted for gender, age at follow up, smoking at baseline, body mass index at baseline, systolic blood pressure at baseline and time since donation. Results The mean (standard deviation) observation time was 11.3 (8.1) years for donors versus 16.4 (5.7) years for controls. Age at follow-up was 56.1 (12.4) years in donors vs 53.5 (11.1) years in controls and 44% of donors were males vs 39.3% in the controls. At follow up 35 (3.5%) of the donors had been diagnosed with ischemic heart disease versus 267 (1.7%) of the controls. Adjusted odds ratio for ischemic heart disease was 1.64 (confidence interval 1.10-2.43, P = 0.01) in donors compared with controls. There were no significant differences for the risks of cerebrovascular disease, diabetes or cancer. Conclusions During long-term follow-up of kidney donors we find an increased risk of ischemic heart disease compared to healthy controls. This information may be important in the follow-up and selection process of living kidney donors.

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