Abstract DP52: Adherence to Physical Activity Recommendations among Stroke Survivors in the United States

Physical activity is an effective modifiable behavior for preventing recurrent strokes. This study aims to determine the adherence to physical activity recommendations among stroke survivors in the United States. We further compared our findings with the adherence observed among myocardial infarction (MI) survivors and healthy adults, each assessed against distinct physical activity guidelines specific to their respective populations. We utilized data from the 2011 to 2019 Behavioral Risk Factor Surveillance System, a nationally representative survey. To establish benchmarks for stroke survivors, we referenced 3 different physical activity recommendations outlined in 2011, 2014, and 2021 American Heart Association stroke prevention guidelines. Similarly, for MI survivors and healthy adults, we used the 2011 guidelines for secondary prevention of coronary vascular diseases and the 2020 World Health Organization physical activity guidelines, respectively. Adherence to recommendations was determined by the respondents' self-reported intensity, duration, and frequency of physical activity. Multivariate logistic regression compared adherence in stroke survivors, MI survivors, and healthy adults. Among 48 222 stroke survivors in the United States, the overall adherence rates to 2011, 2014, and 2021 physical activity guidelines were 75.4%, 40.2%, and 69.2%. For independently mobile stroke survivors, the adherence rates increased to 78.1%, 42.1%, and 69.9%. Among MI survivors and healthy adults, the adherence rates were 42.7% and 72%. When 2021 recommendations were used as a benchmark, older (aged ≥65 years) stroke survivors were more likely to adhere to recommendations than younger survivors (71.9% versus 62.3%; P<0.0001). After adjusting for sociodemographic factors and comorbidities, non-Hispanic Black survivors were less likely to adhere to recommendations (adjusted odds ratio, 0.81 [95% CI, 0.7-0.94]), whereas older and higher educated stroke survivors were more likely to adhere to recommendations. Geographically, stroke belt and nonrural residents were less likely to adhere to recommendations ([63.5% versus 67.9%; P<0.0001]; [53.8% versus 58.7%; P<0.0001]). Stroke and MI survivors were less likely to adhere to the latest recommendations than healthy adults (adjusted odds ratio, 0.74 [95% CI, 0.69-0.8]; (adjusted odds ratio, 0.24 [95% CI, 0.22-0.26]). A substantial number of stroke survivors do not meet physical activity recommendations. Tailored interventions should be designed for at-risk populations, for example, non-Hispanic Black survivors and lower educated stroke survivors.

Age, sex, and race/ethnic temporal trends in metabolic syndrome prevalence among individuals with myocardial infarction or stroke in the United States

BACKGROUND: Several studies have demonstrated that the adequacy of secondary prevention is better among survivors of myocardial infarction (MI) compared with the survivors of stroke. We investigated the hypothesis that long-term survival among stroke survivors is lower than survivors of myocardial infarction. METHODS: We identified stroke and MI survivors from a nationally representative sample of 11989 US adults aged 17 to 59 years who participated in the Third National Health and Nutrition Examination Survey Mortality Follow-up Study. We compared the long-term survival between survivors of stroke and MI and those without any cardiovascular disease using Cox proportional hazards analyses. Potential confounding factors in the association between stroke and MI with death (cardiovascular and all cause) included age, sex, race/ethnicity, hypertension, hyperlipidemia, diabetes mellitus, cigarette smoking, body mass index, and alcohol use. RESULTS: A total of 485 survivors with stroke and 774 survivors with MI were included in the analysis; 74 stroke related, 128 acute MI related, and 356 ischemic heart disease related deaths and 941 all causes deaths were reported during a mean follow-up period of 8.5+/-5.3 years. After adjusting for differences in age, sex, race/ethnicity, hypertension, diabetes mellitus, cholesterol level, cigarette smoking, body mass index, and alcohol use, there was no difference among stroke survivors in likelihood of all-cause mortality (relative risk [RR], 1.1 ; 95% confidence interval [CI], 0.9 to 1.3) and cardiovascular death (RR, 0.9; 95% CI, 0.7 to 1.2) compared with persons without cardiovascular disease. CONCLUSION: Survivors of stroke face the same reduction in long-term survival as survivors of MI in the community. Therefore, proportionate efforts are required in public education and secondary prevention to improve long-term survival in these patients.

Symptoms of depression and active smoking among survivors of stroke and myocardial infarction: An NHANES analysis

The effect of green tea and coffee consumption on mortality among cardiovascular diseases survivors is unknown. We examined the association between green tea and coffee consumption and mortality among persons with and without stroke or myocardial infarction (MI). In the Japan Collaborative Cohort Study, 46 213 participants (478 stroke survivors, 1214 MI survivors, and 44 521 persons without a history of stroke or MI), aged 40 to 79 years at baseline (1988-1990), completed a lifestyle, diet, and medical history questionnaire and were followed up regarding mortality until 2009. The Cox proportional hazard model was used to calculate the multivariable hazard ratios with 95% CIs of all-cause mortality after adjusting for potential confounding factors. During the 18.5-year median follow-up period, 9253 cases were documented. Green tea consumption was inversely associated with all-cause mortality among stroke or MI survivors; the multivariable hazard ratios (95% CIs) for stroke survivors were 0.73 (0.42-1.27) for 1 to 6 cups/wk, 0.65 (0.36-1.15) for 1 to 2 cups/d, 0.56 (0.34-0.92) for 3 to 4 cups/d, 0.52 (0.31-0.86) for 5 to 6 cups/d, and 0.38 (0.20-0.71) for ≥7 cups/d, compared with nondrinkers. A similar inverse association was observed for MI survivors, but not evident for those without a history of stroke or MI. Coffee consumption was inversely associated with all-cause mortality in persons without a history of stroke or MI; the multivariable hazard ratios (95% CIs) were 0.86 (0.82-0.91) for 1 to 6 cups/wk, 0.86 (0.80-0.92) for 1 cup/d, and 0.82 (0.77-0.89) for ≥2 cups/d, compared with nondrinkers. The corresponding hazard ratios (95% CIs) for MI survivors were 0.69 (0.53-0.91), 0.78 (0.55-1.10), and 0.61 (0.41-0.90). No such association was observed for stroke survivors. Green tea consumption can be beneficial in improving the prognosis for stroke or MI survivors, whereas coffee consumption can also be so for persons without a history of stroke or MI as well as MI survivors.

This study sought to examine the relationship between rural residence and physical activity levels among US myocardial infarction (MI) survivors. We conducted a cross-sectional study using nationally representative Behavioral Risk Factor Surveillance System surveys from 2017 and 2019. We determined the survey-weighted percentage of rural and urban MI survivors meeting US physical activity guidelines. Logistic regression models were used to examine the relationship between rural/urban residence and meeting physical activity guidelines, accounting for sociodemographic factors. Our study included 22,732 MI survivors (37.3% rural residents). The percentage of rural MI survivors meeting physical activity guidelines (37.4%, 95% CI: 35.1%-39.7%) was significantly less than their urban counterparts (45.6%, 95% CI: 44.0%-47.2%). Rural residence was associated with a 28.8% (95% CI: 20.0%-36.7%) lower odds of meeting physical activity guidelines, with this changing to a 19.3% (95% CI: 9.3%-28.3%) lower odds after adjustment for sociodemographic factors. A significant rural/urban disparity in physical activity levels exists among US MI survivors. Our findings support the need for further efforts to improve physical activity levels among rural MI survivors as part of successful secondary prevention in US high-MI burden rural areas.

We examined the association between television (TV) viewing time and all-cause and cardiovascular disease (CVD) mortality among Japanese adults with and without a history of stroke or myocardial infarction (MI). In the Japan Collaborative Cohort Study, 76,572 participants (851 stroke survivors, 1,883 MI survivors, and 73,838 persons without a history of stroke or MI), aged 40-79 years at baseline (1988-1990), completed a lifestyle, diet, and medical history questionnaire, and were followed up regarding mortality until 2009. The Cox proportional hazard model was used to calculate the multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of all-cause and CVD mortality. During the 19.3-year median follow-up period, 17,387 deaths were documented. TV viewing time was positively associated with all-cause and CVD mortality regardless of stroke or MI history. The multivariable-adjusted HRs of all-cause mortality with 95% CIs for TV viewing time of 3-4.9 h, 5-6.9 h, and ≥ 7 h were 1.18 (0.95-1.48), 1.12 (0.86-1.45), and 1.61 (1.12-2.32) for stroke survivors; 0.97 (0.81-1.17), 1.40 (1.12-1.76), and 1.44 (1.02-2.03) for MI survivors; and 1.00 (0.96-1.03), 1.07 (1.01-1.12), and 1.22 (1.11-1.34) for persons without a history of stroke or MI, respectively, compared with ＜3 h. Prolonged TV viewing time was associated with higher risks of all-cause and CVD mortality in stroke or MI survivors and in persons without a history of them. It may be recommended to reduce sedentary time for stroke or MI survivors, independent of the level of physical activity.

PCV63 IMPACT OF DEPRESSION ON HEALTH-RELATED QUALITY OF LIFE AMONG OLDER ADULTS WITH MYOCARDIAL INFARCTION IN THE UNITED STATES

BackgroundLittle is known regarding the health-related quality of life among myocardial infarction (MI) survivors in the United States. The purpose of this population-based study was to identify differences in health-related quality of life domains between MI survivors and propensity score matched controls.MethodsThis retrospective, cross-sectional matched case-control study examined differences in health-related quality of life (HRQoL) among MI survivors of myocardial infarction compared to propensity score matched controls using data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey. Propensity scores were generated via logistic regression for MI survivors and controls based on gender, race/ethnicity, age, body mass index (BMI), smoking status, and comorbidities. Chi-square tests were used to compare differences between MI survivors to controls for demographic variables. A multivariate analysis of HRQoL domains estimated odds ratios. Life satisfaction, sleep quality, and activity limitations were estimated using binary logistic regression. Social support, perceived general health, perceived physical health, and perceived mental health were estimated using multinomial logistic regression. Significance was set at p < 0.05.ResultsThe final sample consisted of 16,729 MI survivors matched to 50,187 controls (n = 66,916). Survivors were approximately 2.7 times more likely to report fair/poor general health compared to control (AOR = 2.72, 95% CI: 2.43–3.05) and 1.5 times more likely to report limitations to daily activities (AOR = 1.46, 95% CI: 1.34–1.59). Survivors were more likely to report poor physical health >15 days in the month (AOR = 1.63, 95% CI: 1.46–1.83) and poor mental health >15 days in the month (AOR = 1.25, 95% CI: 1.07–1.46) compared to matched controls. There was no difference in survivors compared to controls in level of emotional support (rarely/never: AOR = 0.75, 95% CI: 0.48–1.18; sometimes: AOR = 0.73, 95% CI: 0.41–1.28), hours of recommended sleep (AOR = 1.14, 95% CI: 0.94–1.38), or life satisfaction (AOR = 1.62, 95% CI: 0.99–2.63).ConclusionMI survivors experienced lower HRQoL on domains of general health, physical health, daily activity, and mental health compared to the general population.

IntroductionThe purpose of this study was to evaluate the effect of depression on health behavior among myocardial infarction (MI) survivors.MethodsThis retrospective, cross-sectional study used publicly available 2015 Behavioral Risk Factor Surveillance System (BRFSS) data. Our study sample includes adults aged 50 years or older who completed the 2015 BRFSS survey and reported having MI. The BRFSS participants with a yes response to the question, Has a doctor, nurse, or other health care professional ever told you that you had a heart attack, also called a myocardial infarction? were identified as MI survivors. The presence or absence of depression among MI survivors was identified using a similar question. Health behaviors, the dependent variable of this study, included physical activity, smoking status, alcohol use, body mass index, last flu immunization, last physical checkup, last blood cholesterol check, heavy drinking, and vegetable and fruit consumption. Univariate (χ2 tests) and multivariable (binomial logistic regression) analyses were used to assess the differences in health behaviors between MI survivors with or without depression.ResultsOur final study sample consists of 20 483 older adults with MI among whom 5343 (26.19%) reported having depression. Multivariable analyses reveal MI survivors with depression are more overweight, have less physical activity, and have higher likelihood of smoking but less odds of consuming alcohol compared to MI survivors without depression.DiscussionIn this nationally representative sample of adults aged over 50 years in the United States, MI survivors with depression exhibited poorer health behaviors compared to those without depression.

Prevalence and determinant of long-term Post-COVID conditions among stroke survivors in the United States

Background Young stroke survivors are likely to be discharged home from acute hospital care without rehabilitation more quickly than older survivors, but it is not clear why. File-audit studies capturing real-world clinical practice are lacking for this cohort. We aimed to compare characteristics and care pathways of young and older survivors and describe stroke presentations and predictors of pathways of care in young survivors (≤45 years), including a focus on care received for ‘invisible’ (cognitive, psychological) difficulties. Methods A retrospective audit of 847 medical records (67 young stroke survivors, mean age = 36 years; 780 older patients, mean age = 70 years) was completed for stroke survivors admitted to an Australian tertiary hospital. Stroke characteristics and presence of cognitive difficulties (identified through clinician opinion or cognitive screening) were used to predict length of stay and discharge destination in young stroke survivors. Results There were no differences in length of stay between young and older survivors, however, young stroke survivors were more likely to be discharged home without rehabilitation (though this may be due to milder strokes observed in young stroke survivors). For young stroke survivors, stroke severity and age predicted discharge destination, while cognitive difficulties predicted longer length of stay. While almost all young survivors were offered occupational therapy and physiotherapy, none received psychological input (clinical, health or neuropsychology). Conclusions Cognitive and psychological needs of young stroke survivors may remain largely unmet by a service model designed for older people. Findings can inform service development or models of care, such as the new Australian Young Stroke Service designed to better meet the needs of young survivors.

Continued smoking after stroke is associated with a high risk of stroke recurrence and other cardiovascular disease. We sought to comprehensively understand the epidemiology of smoking cessation in stroke survivors in the United States. Furthermore, we compared smoking cessation in stroke and cancer survivors because cancer is another smoking-related condition in which smoking cessation is prioritized. We performed a cross-sectional analysis of data from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, an annual, nationally representative health survey. Using pooled data from 2013 to 2019, we identified stroke and cancer survivors with a history of smoking. We used survey procedures to estimate frequencies and summarize quit ratios with attention to demographic and geographic (state-wise and rural-urban) factors for stroke survivors. The quit ratio is conventionally defined as the proportion of ever smokers who have quit. Then, we used multivariable logistic regression to compare quit ratios in stroke and cancer survivors while adjusting for demographics and smoking-related comorbidities. Among 4 434 604 Americans with a history of stroke and smoking, the median age was 68 years (interquartile range, 59-76), and 45.4% were women. The overall quit ratio was 60.8% (95% CI, 60.1%-61.6%). Quit ratios varied by age group, sex, race and ethnicity, and several geographic factors. There was marked geographic variation in quit ratios, ranging from 48.3% in Kentucky to 71.5% in California. Furthermore, compared with cancer survivors, stroke survivors were less likely to have quit smoking (odds ratio, 0.72 [95% CI, 0.67-0.79]) after accounting for differences in demographics and smoking-related comorbidities. There were considerable demographic and geographic disparities in smoking quit ratios in stroke survivors, who were less likely to have quit smoking than cancer survivors. A targeted initiative is needed to improve smoking cessation for stroke survivors.

Health-related risk behaviors among myocardial infarction survivors in the United States: A propensity score matched study.

Background: Despite increasing stroke incidence in US adults younger than 44 years, little is known about their illness perceptions, which have been shown to impact stroke recovery and possibly secondary prevention. This study’s objective is to identify facilitators and barriers to positive illness perception of stroke survivors and their caregivers during acute hospitalization. Methods: Stroke survivors and caregivers participated in virtual focus group sessions with structured interview guides assessing perceptions of hospitalization and general wellbeing. Sessions were recorded and transcribed using NVivo software. Framework method was used for analysis; three independent coders developed a comprehensive codebook from transcripts. Framework matrices were used to identify recurrent themes, which were then determined to be facilitators or barriers to positive illness perception during acute hospitalization. Results: Stroke survivors and caregivers (n=12) participated in seven focus group sessions. Younger survivors (n=4; 3 male, 1 female survivors) were aged 25 to 44, compared with older survivors (n=8; 3 female survivors, 5 female caregivers) aged 45 to 84. Across each phase of acute hospitalization, five themes related to illness perceptions emerged: (1) symptom recognition and health system navigation; (2) communication of diagnosis and management; (3) presence of a champion; (4) clinician bias; (5) psychological distress. Figure 1 shows how stroke survivors, based on their age, experienced the acute hospitalization and how illness perception was shaped by these themes. Clinician bias, psychological distress, and the inability to recognize stroke symptoms emerged as unique barriers for younger stroke survivors. Conclusion: Despite a similar diagnosis, illness perceptions of younger stroke survivors were distinct compared to older counterparts. Younger survivors experienced bias and psychological distress, exposing differential treatment in care. A facilitator to positive illness perception among both populations was the presence of a champion; in younger survivors, advocacy of a partner was crucial for diagnosis, suggesting the importance of symptom recognition in younger populations. Future studies are required to explore the transferability of our findings and to investigate clinician recognition of stroke in younger populations.