History Of Stroke Research Articles

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

BackgroundPersistent post-COVID conditions (PCCs) have become inevitable challenges for individuals who have survived COVID. The National Research Plan on Long COVID-19 underscores the priority of addressing post-COVID conditions (PCCs) within specific subgroups of the United States (US) population. This study aimed to investigate the prevalence and factors associated with PCCs among stroke survivors in the US. MethodIn this retrospective cross-sectional study, we utilized the Behavioral Risk Factor Surveillance System (BRFSS) 2022 dataset. First, we identified respondents with a positive history of both COVID-19 and stroke. Subsequently, we categorized these respondents based on whether they experienced PCCs and conducted a comparative analysis of their characteristics. Additionally, our study included a comparison of our findings with those among individuals who have survived myocardial infarction (MI) and cancer. ResultsA total of 3999 stroke, 5406 MI, and 10551 cancer survivors were included. The estimated prevalence of PCCs among stroke survivors was 30.6 %, compared to 22.4 %, 29.2 %, and 24.6 % among non-stroke (p < 0.001), MI, and cancer survivors, respectively. Fatigue, dyspnea, and taste/smell loss were the most common primary symptoms. In multivariate regression analysis, female sex (adjusted odds ratio (aOR):1.62, 95 %CI:[1.17-2.24]), stroke-belt residence (aOR:1.67, 95 %CI: [1.13-2.46]), pulmonary disease (aOR:2.12, 95 %CI:[1.53-2.92]), and depression (aOR:1.55, 95 %CI: [1.1-2.2]) were independent factors associated with higher odds of PCCs among stroke survivors. Additionally, age above 64 years was associated with lower odds of PCCs (aOR:0.6, 95 %CI: [0.41-0.86]). ConclusionOur study highlights a considerable prevalence of PCCs among stroke survivors, particularly among younger women and individuals with other chronic conditions.

Simple Geographic Distribution of Patients with Stroke According to their Medical Care Financing System in a Private University Hospital

Aims: To reveal the geographical distribution of stroke patients in a private university hospital in Jakarta, Indonesia according to their address and further divide them into three sub group of using universal health coverage (UHC) vs other type of insurance ((OTI) vs private non insurance patient (private) Study Design: simple retrospective cross-sectional study. Place and Duration of Study: Sample: Medical record from patients of the Department of Neurology, Rumah Sakit Universitas Kristen Indonesia, Jakarta Indonesia; a private university hospital located in Jakarta Indonesia, between January 2021 and December 2023. Methodology: We analyzed medical record of 162 patients (90 men, 72 women; age range 15-87 years (mean age 61.12 SE± .82) with history of stroke and at the present routinely underwent routine medical control (outpatient) or with current diagnosis of stroke (inpatient in our hospital). We further divided them based on their medical care financing system (UHC vs OTI vs private) and using the help from GPS service made available by Google Maps™ we simply try to make a geographical distribution of those patients based on their address/residence location Results: Geographical distribution of patients using UHC were closer to the hospital compared to the other 2 non UHC medical care financing users. Conclusion: Our analysis regarding stroke patients in our hospital (2021-2023), we found that 55.6% male patients, 42% were in the range of age between 55-64 years old, most of the patient (94.4%) using BPJS as their medical care financing system, with 27.7% came from sub district Makkasar which is near from our hospital. Further analysis using the help of Google maps™ we can show that the UHC or BPJS health referral system has facilitated patients receiving health services at the health facility closest to their residence.

Myxomatous cause of multiple intracranial aneurysms and cognitive decline: a case report

BackgroundThe occurrence of cerebral aneurysm in a case of cardiac myxoma is rare with less than 60 cases reported worldwide. The course of management is still debatable given its rarity. We present a case of multiple intracranial aneurysms secondary to atrial myxoma in a young lady with a brief review of the literature.Case presentationA young lady in her late 30s with a history of right middle cerebral artery territory stroke eight years ago presented with gradually progressive symptoms in the form of holocranial headache, inattention and forgetfulness for the last few years. On neuroimaging, she was found to have multi-territorial lacunar infarcts and multiple intracranial artery aneurysms which was confirmed with a digital subtraction angiogram. A cardiac evaluation revealed a left atrial myxoma. The aetiology of subcortical cognitive decline and intracranial aneurysms was attributed to the myxoma with secondary myxomatous embolism. Other secondary causes were ruled out. She is being followed up medically after resection of the myxoma.ConclusionIntracranial aneurysms are rare complications of cardiac myxoma which may present before, concurrent or many years after diagnosis of the myxoma. Nonspecific neurological complaints occasionally are the ominous signs of intracranial aneurysms which mandate a low threshold for neuroimaging in a case of cardiac myxoma. Given the absence of definitive risk factors and unclear natural history, clinical and radiological follow-ups are critical.Learning PointsIntracranial aneurysms are rare complications of cardiac myxoma that may present before, concurrent or many years after diagnosis of the myxoma.Special attention must be given to nonspecific neurological complaints with a low threshold for neuroimaging in those with a prior history of cardiac myxoma.Given the absence of definitive risk factors and unclear natural history, clinical and radiological follow-up including conventional angiography and/or magnetic resonance imaging is critical.

Stroke Measures Analysis of pRognostic Testing-Mortality nomogram predicts long-term mortality after ischemic stroke.

Predicting long-term mortality is essential for understanding prognosis and guiding treatment decisions in patients with ischemic stroke. Therefore, this study aimed to develop and validate the method for predicting 1- and 5-year mortality after ischemic stroke. We used data from the linked dataset comprising the administrative claims database of the Health Insurance Review and Assessment Service and the Clinical Research Center for Stroke registry data for patients with acute stroke within 7 days of onset. The outcome was all-cause mortality following ischemic stroke. Clinical variables linked to long-term mortality following ischemic stroke were determined. A nomogram was constructed based on the Cox's regression analysis. The performance of the risk prediction model was evaluated using the Harrell's C-index. This study included 42,207 ischemic stroke patients, with a mean age of 66.6 years and 59.2% being male. The patients were randomly divided into training (n = 29,916) and validation (n = 12,291) groups. Variables correlated with long-term mortality in patients with ischemic stroke, including age, sex, body mass index, stroke severity, stroke mechanisms, onset-to-door time, pre-stroke dependency, history of stroke, diabetes mellitus, hypertension, coronary artery disease, chronic kidney disease, cancer, smoking, fasting glucose level, previous statin therapy, thrombolytic therapy, such as intravenous thrombolysis and endovascular recanalization therapy, medications, and discharge modified Rankin Scale were identified as predictors. We developed a predictive system named Stroke Measures Analysis of pRognostic Testing-Mortality (SMART-M) by constructing a nomogram using the identified features. The C-statistics of the nomogram in the developing and validation groups were 0.806 (95% confidence interval (CI), 0.802-0.812) and 0.803 (95% CI, 0.795-0.811), respectively. The SMART-M method demonstrated good performance in predicting long-term mortality in ischemic stroke patients. This method may help physicians and family members understand the long-term outcomes and guide the appropriate decision-making process.

Role of interatrial block in modulating cryptogenic stroke risk in patients with patent foramen ovale: a retrospective study

BackgroundThe patent foramen ovale (PFO) and interatrial block (IAB) are associated with cryptogenic stroke (CS). However, the role of the interaction between PFO and IAB in CS remains unclear.MethodsThis case–control study enrolled 256 patients with CS and 156 individuals without a history of stroke or transient ischemic attack. IAB was defined as P wave duration > 120 ms. PFO was evaluated by contrast transesophageal echocardiography, and classified as no-PFO, low-risk PFO and high-risk PFO. Multiplicative and additive interaction analysis were used to assess the interaction between PFO and IAB in CS.ResultsMultiplicative interaction analysis unveiled a significant interaction between IAB and low-risk PFO in CS (OR for interaction = 3.653, 95% CI, 1.115–12.506; P = 0.037). Additive interaction analysis indicated that 68.4% (95% CI, 0.333–1.050; P < 0.001) of the increased risk of CS related to low-risk PFO was attributed to the interaction with IAB. The results were robust in multivariate analysis. However, but no significant multiplicative or additive interaction was observed between IAB and high-risk PFO. When stratified by IAB, high-risk PFO was associated with CS in both patients with IAB (OR, 4.186; 95% CI, 1.617–10.839; P = 0.003) and without IAB (OR, 3.476; 95% CI, 1.790–6.750; P < 0.001). However, low-risk PFO was only associated with CS in patients with IAB (OR, 2.684; 95% CI, 1.007–7.149; P = 0.048) but not in those without IAB (OR, 0.753; 95% CI, 0.343–1.651; P = 0.479).ConclusionThe interaction between IAB and PFO might play an important role in CS, particularly in cases with low-risk PFO.

Application and diagnostic points of carotid artery ultrasound in the detection of internal carotid artery absence: Analysis of 16 cases and literature review.

To summarize the ultrasound diagnostic key points and imaging characteristics of absence of the internal carotid artery (ICA), and to explore the application value of carotid artery ultrasound in the diagnosis of ICA absence. Sixteen patients diagnosed with ICA absence at our hospital were retrospectively analyzed. Clinical data, ultrasound images, and other relevant imaging data were reviewed. The ultrasound diagnostic key points and related imaging characteristics of ICA absence were summarized. Combined with a literature review, the application of carotid artery ultrasound in the diagnosis of ICA absence was discussed. Among the 16 patients, there were 10 males and 6 females ages ranging from 13 to 80 years. Among them, 5 patients had a history of cerebral infarction, 1 patient had a history of subarachnoid hemorrhage, and 10 patients had no history of stroke. Among the 16 patients, there were 10 left-sided lesions, 5 right-sided lesions, and 1 bilateral lesion. Three patients had concomitant aneurysms. Carotid ultrasound examinations in all 16 ICA absent patients revealed that a significantly slender common carotid artery (CCA) diameter compared to the contralateral (3.91 ± 0.73 vs. 6.92 ± 1.42, p < 0.001). On the side of ICA absence, the bifurcation of the carotid artery was not detected, with the CCA directly continuing as a single artery (external carotid artery, ECA). The temporal superficial artery percussion test was positive in all cases, and the blood flow spectrum of the single artery (ECA) on the side of the absent ICA showed a serrated pattern during diastole. On the side where the ICA was absent, the blood flow spectrum morphology of the CCA and ECA was consistent. Based on other relevant imaging examinations, the patients were classified into Lie types: A (10 cases), B (2 cases), C (1 case), D (1 case), and 2 cases were unclassified. Carotid artery ultrasound has the advantages of easy operation, affordability, non-invasiveness, and capable of dynamic and high repeatability. Compared to other imaging examinations, it can provide more evidence for the diagnosis of ICA absence, and is suitable for widespread application and promotion.

A - 3 The Relationship between Memory and Depression In an Elderly Chinese Cohort: a Baseline Analysis

Abstract Objective Explore the relationship between depression and memory aged 60 years and older while controlling for age, gender, and education. Method This study utilized data from the Characterization of Dementia in Asian-Pacific Islanders study by Bruce Miller, M.D., and Howie Rosen, M.D., at the Memory and Aging Center at UCSF. Inclusion criteria included participants age 60+ who completed the Benson Figure Test, GDS-30, and the Chinese Version Verbal Learning Test (CVVLT) in English, Cantonese, or Mandarin. Exclusion criteria included participants under age 60 and or experience history of neurological strokes or injuries, and disabilities related to memory. The final sample yielded 136 participants, including 41 (30.1%) males, 95 (69.9%) females, 120 (88.2%) right-handed, 3 (2.2%) left-handed, and 7 (5.1%) ambidextrous. Average age of participants was 71.46 (SD = 7.26). A memory composite score was computed based on average of performances on the Benson Figure Task delay and the CVVLT 10-minute delay. Raw GDS-30 scores represented depression. Results There was a weak positive correlation between memory composite scores, gender, and education, and a weak negative correlation between memory composite scores, age, and GDS-30 scores. Conclusions Findings indicate some evidence for a relationship between depression and memory in elderly Chinese populations. However, the sample was skewed, and consisted of less depressed and higher memory functioning participants. Despite these limitations, it is pertinent to explore how healthcare providers may outreach to this population to monitor risk factors, improve timeliness of dementia diagnosis, and maximize treatment of reversible causes, adherence to treatment plans, and help families care plan.

Contribution of Stroke to Long-Term All-Cause and Cause-Specific Mortality in Mexico City.

Stroke mortality is more common in low-income and middle-income nations such as Mexico. Prognosis data typically rely on short-term hospital follow-ups, revealing high mortality rates due to systemic complications and early recurrence. We aim to explore stroke's long-term impact by examining all-cause and cause-specific mortality. We analyzed data from the Mexico City Prospective Study (1998-2004) with known mortality outcomes until December 2022. Baseline variables were compared between participants who had stroke and nonstroke participants. Cox proportional hazard regression assessed each variable's contribution to overall mortality. Subsequent analysis within the stroke subgroup aimed to identify unique risk factors of mortality, using Cox regression models adjusted for age, sex, and time since stroke. Among 145,537 eligible participants, 1,492 (1.0%) had a history of stroke. Participants who had stroke were older (57.58 vs 50.16, p < 0.001); had lower mean weekly income ($108.24 vs $176.14, p < 0.001); had higher alcohol intake and smoking frequency; and had more frequent comorbidities such as hypertension (48.9 vs 19.3%, p < 0.001), diabetes (23.4 vs 12.9%, p < 0.001), and ischemic heart disease (5.4 vs 1.0%, p < 0.001). They had a significantly increased risk of death from any cause (hazard ratio [HR] 2.59, 95% CI 2.37-2.83, p < 0.001). Deceased participants with stroke were more likely to be male, with a higher prevalence of diabetes, hypertension, and abnormal waist-hip index. Stroke increased the risk of death from cardiac (HR 3.56, 95% CI 3.02-4.19, p < 0.001), renal (HR 2.05, 95% CI 1.58-2.66, p < 0.001), and pulmonary (HR 2.29, 95% CI 1.79-2.92, p < 0.001) causes. This study confirms stroke's association with higher mortality rates, especially from cardiac, renal, and pulmonary causes in Mexico. It underscores the elevated prevalence of cardiovascular comorbidities and adverse socioeconomic profiles among participants who had stroke and those who died with a history of stroke.

The Association Between Sickle Cell Anemia and Cognitive Dysfunction: A Systematic Review.

A kind of hemoglobinopathy known as sickle cell anemia (SCA) is characterized by aberrant hemoglobin molecules. The most frequent neurological side effects linked to SCA include neurocognitive dysfunction, asymptomatic cerebral infarction, and ischemic stroke.This study aims to investigate the relationship between SCA and cognitive dysfunction.We systematically searched electronic databases like PubMed, MEDLINE, Science Direct, and Scopus. Two independent reviewers screened and extracted data from eligible studies.Eighteen studies, including 2,457 participants in total and nearly half of them 1,151 (46.8%) were males, were included in our data. The prevalence of cognitive dysfunction in the adult population ranged from 11.5% to 70%. Cognitive dysfunction among adults was significantly associated with poorer educational status, reduced family income, decreased kidney function, older age, stroke history, and vasculopathy. The prevalence of cognitive dysfunction in children ranged from 10.2% to 68.2%. The decline in cognitive function among adults was significantly associated with children over the age of four, abnormal transcranial Doppler and previous stroke, school absence, age beyond 13, and increased BMI.Cognitive function deficiencies are a defining feature of SCA that affects people of all ages. These findings suggest that if cognitive decline is not slowed down, or better still, stopped, medical interventions targeting a variety of sequelae in this population will be ineffective. Future analyses of this population's cognition should evaluate the environmental and other biological variables.

Impact of Cardio-Ankle Vascular Index on Future Cancer in Patients With Coronary Artery Disease.

Cardiovascular risk factors are associated with increased risk of future cancer. However, the relationship between quantitative parameters of atherosclerosis and future cancer risk is unclear. A total of 1,057 consecutive patients with coronary artery disease was divided into 2 groups according to the cutoff value of the cardio-ankle vascular index (CAVI) derived by receiver operating characteristic curve analysis: low CAVI group (CAVI <8.82; n=487), and high CAVI group (CAVI ≥8.82; n=570). Patients in the high CAVI group were older and had a higher prevalence of diabetes, chronic kidney disease, anemia and history of stroke compared with patients in the low CAVI group. There were 141 new cancers during the follow-up period. The cumulative incidence of new cancer was significantly higher in the high CAVI group than in the low CAVI group (P=0.001). In a multivariate Cox proportional hazard analysis, high CAVI was found to be an independent predictor of new cancer diagnosis (hazard ratio 1.62; 95% confidence interval 1.11-2.36; P=0.012). In the analysis of individual cancer types, high CAVI was associated with lung cancer (hazard ratio 2.85; 95% confidence interval 1.01-8.07; P=0.049). High CAVI was associated with the risk of future cancer in patients with coronary artery disease.

Telomere Length Is Associated with Increased Risk of Cardiovascular Events in Patients with End-Stage Kidney Disease on Hemodialysis

Introduction: Patients with chronic kidney disease, especially those with end-stage kidney disease (ESKD) on hemodialysis (HD), are at increased risk for cardiovascular disease (CVD), including myocardial infarction and ischemic stroke. A shortening in telomere length, as a parameter for accelerated vascular aging, is an established biomarker for CVD in the general population. We aimed to elucidate the role of telomere length in ESKD patient on HD and its association with cardiovascular outcomes. Methods: Telomere length was measured in a prospective population-based cohort study of prevalent HD patients. DNA was isolated from whole blood, sampled at baseline, and analyzed for telomere length via a qPCR-based approach. The risk for the occurrence of the independently adjudicated three-point major adverse cardiovascular event outcome (myocardial infarction, ischemic stroke, and cardiovascular death) was statistically analyzed considering the competing risk of non-cardiovascular death. Results: In the cohort of 308 patients with ESKD (115 [37.3%] women, median [25th–75th percentile] age: 67.0 [56.8–76.0]), the median telomere length was 1.51 kb (25th–75th percentile 0.6–3.2 kb). The 3P-MACE outcome occurred with an incidence rate of 9.4 per 100 patient-years. Patients with longer telomere length more frequently had vascular nephropathy compared to patients with shorter telomere length. Interestingly, patients in the highest quartile of telomere length had a 1.8-fold increased risk for 3P-MACE (95% CI: 1.051–3.201, p = 0.033), after multivariable adjustment for age, history of stroke, myocardial infarction, venous thromboembolism, presence of heart valve replacement, atrial fibrillation, smoking, anticoagulation, or immunosuppressive use. Conclusion: Surprisingly, in this high-risk cohort of patients with ESKD on HD, longer telomere lengths were associated with increased risk of cardiovascular events.

Stroke after heart valve surgery: a single center institution report

IntroductionStroke is a potentially debilitating complication of heart valve replacement surgery, with rates ranging from 1 to 10%. Despite advancements in surgical techniques, the incidence of postoperative stroke remains a significant concern, impacting patient outcomes and healthcare resources. This study aims to investigate the incidence, risk factors, and outcomes of in-hospital adverse neurologic events, particularly stroke, following valve replacement. The analysis focuses on identifying patient characteristics and procedural factors associated with increased stroke risk.MethodsThis retrospective study involves a review of 417 consecutive patients who underwent SVR between January 2004 and December 2022. The study cohort was extracted from a prospectively recorded cardiac intensive care unit database. Preoperative and perioperative data were collected, and subjects with specific exclusion criteria were omitted from the analysis. The analysis includes demographic information, preoperative risk factors, and perioperative variables.ResultsThe study identified a 4.3% incidence of postoperative stroke among SVR patients. Risk factors associated with increased stroke susceptibility included prolonged cardiopulmonary bypass time, aortic cross-clamp duration exceeding 90 min, prior stroke history, diabetes mellitus, and mitral valve annulus calcification. Patients undergoing combined procedures, such as aortic valve replacement with mitral valve replacement or coronary artery bypass grafting with AVR and MVR, (OR = 10.74, CI:2.65–43.44, p-value = < 0.001) and (OR = 11.66, CI:1.02–132.70, p-value = 0.048) respectively, exhibited elevated risks. Internal carotid artery stenosis (< 75%) and requiring prolonged inotropic support were also associated with increased stroke risk(OR = 3.04, CI:1.13–8.12, P-value = 0.026). The occurrence of stroke correlated with extended intensive care unit stay (OR = 1.12, CI: 1.04–1.20, P-value = 0.002) and heightened in-hospital mortality.ConclusionIn conclusion, our study identifies key risk factors and underscores the importance of proactive measures to reduce postoperative stroke incidence in surgical valve replacement patients.

A study on possible risk factors for progressive supranuclear palsy in southern part of India.

Background: The etiological factors leading to progressive supranuclear palsy (PSP) are poorly understood. This study aims to evaluate the role of various risk factors in patients with PSP. Methods: A case-control study was conducted over a period of two years from March 2016 to March 2018. The cases were recruited independently by two senior neurologists and a consensus was then reached after discussion for their inclusion. The controls were free of parkinsonian features or dementia and matched by age (± 3 years), sex, and race with the cases. The study population was then interviewed using a standard questionnaire for various possible risk factors. Variables with a significance (P ≤ 0.05) in univariate analysis were considered for bivariate analysis, multivariate analysis, and logistic-regression analysis. Results: A total of 51 cases with an equal number of controls were included in this study. Ten separate variables that included poor educational status, well water, smoking, tapioca, bakery/fast food, tea ≥ 5 cups/day, personality, exposure to pets, exposure to cattle, and family history of stroke were found to show statistical significance after univariate analysis. Among these, tapioca consumption, fast food and bakery items consumption, type A personality, and family history of stroke were found significant after adjusting for the confounding factors. Conclusion: The possible etiological factors that have a relevance in the causation of PSP as borne out in our study include dietary habits such as tapioca, fast food, and bakery items consumption, family history of stroke, and type A personality trait.

A retrospective evaluation of the potential of ChatGPT in the accurate diagnosis of acute stroke.

Stroke is a neurological emergency requiring rapid, accurate diagnosis to prevent severe consequences. Early diagnosis is crucial for reducing morbidity and mortality. Artificial intelligence (AI) diagnosis support tools, such as Chat Generative Pre-trained Transformer (ChatGPT), offer rapid diagnostic advantages. This study assesses ChatGPT's accuracy in interpreting diffusion-weighted imaging (DWI) for acute stroke diagnosis. A retrospective analysis was conducted to identify the presence of stroke using DWI and apparent diffusion coefficient (ADC) map images. Patients aged >18 years who exhibited diffusion restriction and had a clinically explainable condition were included in the study. Patients with artifacts that affected image homogeneity, accuracy, and clarity, as well as those who had undergone previous surgery or had a history of stroke, were excluded from the study. ChatGPT was asked four consecutive questions regarding the identification of the magnetic resonance imaging (MRI) sequence, the demonstration of diffusion restriction on the ADC map after sequence recognition, and the identification of hemispheres and specific lobes. Each question was repeated 10 times to ensure consistency. Senior radiologists subsequently verified the accuracy of ChatGPT's responses, classifying them as either correct or incorrect. We assumed a response to be incorrect if it was partially correct or suggested multiple answers. These responses were systematically recorded. We also recorded non-responses from ChatGPT-4V when it failed to provide an answer to a query. We assessed ChatGPT-4V's performance by calculating the number and percentage of correct responses, incorrect responses, and non-responses across all images and questions, a metric known as "accuracy." ChatGPT-4V was considered successful if it answered ≥80% of the examples correctly. A total of 530 diffusion MRI, of which 266 were stroke images and 264 were normal, were evaluated in the study. For the initial query identifying MRI sequence type, ChatGPT-4V's accuracy was 88.3% for stroke and 90.1% for normal images. For detecting diffusion restriction, ChatGPT-4V had an accuracy of 79.5% for stroke images, with a 15% false positive rate for normal images. Regarding identifying the brain or cerebellar hemisphere involved, ChatGPT-4V correctly identified the hemisphere in 26.2% of stroke images. For identifying the specific brain lobe or cerebellar area affected, ChatGPT-4V had a 20.4% accuracy for stroke images. The diagnostic sensitivity of ChatGPT-4V in acute stroke was found to be 79.57%, with a specificity of 84.87%, a positive predictive value of 83.86%, a negative predictive value of 80.80%, and a diagnostic odds ratio of 21.86. Despite limitations, ChatGPT shows potential as a supportive tool for healthcare professionals in interpreting diffusion examinations in stroke cases, where timely diagnosis is critical. ChatGPT can play an important role in various aspects of stroke cases, such as risk assessment, early diagnosis, and treatment planning.

Application of Range of Motion Exercises to Increase Muscle Strength in Non-Hemorrhagic Stroke Patients

Stroke is a disruption of blood flow in the brain, patients who suffer from weakness in the limbs can cause a decrease in muscle strength, so they cannot move their body. Solutions to prevent and reduce disability, complications and death after having a stroke. Rehabilitation in stroke patients one of them is by doing Range of Motion exercises. Objective: This study was to analyze the application of ROM exercise to increase muscle strength in ischemic stroke patients. Design: This study used quasi-experimental with Pre-Test and Post-Test approaches with a sample of 15 people using Purposive Sampling techniques. Data analysis using the Wilcoxon Match Pairs test. The data collected consisted of respondents' characteristics in the form of age, gender, history of stroke and muscle strength. The instrument used is an observation sheet and muscle strength measurement, MMT (Manual Muscle Testing). Results: Showed that there was an increase in muscle strength after (post-test) intervening with an average value of 4,13, while muscle strength up to condition 5 (normal) after implementing as many as 7 people (40,67%).

O06 HYPERTENSION CONTROL AND COMORBIDITIES: INSIGHTS FROM THE MAY MEASUREMENT MONTH CAMPAIGN, 2017-2019

Background and Objective: Hypertension frequently coexists with other chronic conditions and cardiometabolic risk factors. The identification of comorbidities is key in the management of hypertensive patients. May Measurement Month (MMM) is a global initiative aimed at enhancing the detection and awareness of hypertension. This study analyzes data from MMM collected between 2017 and 2019 to evaluate hypertension control among adults aged 18 years and the frequency of comorbidities. Methods: Three sitting blood pressure (BP) readings, anthropometric measurements, and self-reported history of diabetes, myocardial infarction and stroke were collected. Missing BP readings were inputted using multiple imputation based on available BP measurements and sociodemographic variables. Hypertension was defined as an average systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or taking antihypertensive medication. Hypertension treatment was defined as current medication use; control was defined as BP &lt;140/90 mmHg. Results: Among 2,907,848 participants from 95 countries, 34.2% had hypertension, and 12.1% had a history of at least one other chronic condition. Specifically, 8.3% self-reported type 2 diabetes, 4.5% had experienced myocardial infarction, and 2.9% had a history of stroke. Some individuals had multiple comorbidities at the time of the screening: 6% had both myocardial infarction and type 2 diabetes, 8% had myocardial infarction and stroke, 2% had stroke and type 2 diabetes, and 8% had all three comorbidities. Among those with hypertension, 58.9% were on medication and 24.0% had at least one additional comorbidity, specifically, 15.8% reported type 2 diabetes, 8.8% had experienced myocardial infarction, and 5.5% had a history of stroke. Of those with hypertension on medication, 43.1% were controlled. Among treated individuals, hypertension control rates were higher in individuals with comorbidities (50% vs 30%). Conversely, individuals without comorbidities had poorer hypertension control. Conclusions: The data suggest a high prevalence of comorbidities within the screened population and among individuals diagnosed with hypertension. Additionally, individuals without comorbidities exhibited suboptimal hypertension management.

P218 MAY MEASUREMENT MONTH 2019: BLOOD PRESSURE VARIABILITY AND ITS RELATIONSHIP WITH HYPERTENSION AND COMORBIDITIES

Background and Objective: Within-visit blood pressure variability (BPV) is a predictor of cardiovascular events, independent of mean blood pressure (BP) levels. This study explored the associations of BPV with hypertension status and comorbidities in May Measurement Month (MMM) 2019 global survey participants. Methods: Adults (≥18 years) were surveyed via convenience sampling from 92 countries in May 2019. Each participant had up to three standardized seated BP readings. Participants with incomplete data on age or sex, or any missing BP readings were excluded. Hypertension was defined as having a BP ≥140 and/or 90 mmHg or being treated with BP-lowering medication. Participants were stratified into three groups: normotensive, untreated hypertensives, treated hypertensives, and normotensives. BPV was calculated as the variation independent of the mean (VIM) of the three BP readings. Associations between BPV and each of three conditions (previous stroke, previous myocardial infarction, or diabetes) were modelled using linear regression. Each model was adjusted for mean BP, age, sex, and an interaction term between age and sex. Results: Data from 1,128,889 participants were included. The mean age was 45.2 (SD 16.6) years and 51.4% were female. A third (33.6%) of participants were hypertensive, of whom 200,370 (53.2%) were treated. Of non-hypertensive and untreated hypertensive participants, those with a history of stroke, myocardial infarction, or diabetes had lower BPV relative to those without a history of these conditions (Figure). A stronger association was observed for diabetes within untreated hypertensive than non-hypertensive participants. However, amongst treated hypertensive participants, differences in BPV between those with comorbid conditions and those without were smaller than in the other two groups. Conclusions: Contrary to expectation, BPV was significantly lower in those with diabetes, or a history of stroke or myocardial infarction, amongst both untreated hypertensives and normotensives. However, among treated hypertensives, BPV was similar between those with or without each comorbidity, suggesting a modifying effect of BP-lowering medication.

Early thoracic surgery consultation and location of therapy impact time to esophagectomy.

Neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy is the standard treatment for resectable, locally advanced esophageal cancer. The ideal timing between neoadjuvant therapy and esophagectomy is unclear. Delayed esophagectomy is associated with worse outcomes. We investigated which factors impacted time to esophagectomy in our patients. We conducted a retrospective analysis of prospectively collected data of patients with pT0-3N0-2 esophageal cancers who underwent CROSS trimodality therapy from May 2016 to January 2020. Sociodemographic factors, comorbidities, and neoadjuvant factors (location of CRT, treatment toxicity, discontinuation of treatment) were compared between patients who underwent surgery within 60 days and those after 60 days. In total, 197 patients were analyzed of whom 137 underwent esophagectomy within 60 days (early surgery, ES) and 60 were outside that window (delayed surgery, DS). More DS patients had a history of myocardial infarction (MI) or stroke (both 11.67% vs. 3.65%, P=0.05) and required CRT dose reduction (16.67% vs. 6.57%, P=0.04). Fewer DS patients received CRT at Dana-Farber Cancer Institute (DFCI) or a DFCI satellite site (33.33% vs. 58.4%, P=0.01) and saw our surgeons before CRT completion (68.33% vs. 89.78%, P=0.001). CRT at DFCI [odds ratio (OR) 2.63, P=0.01] or a satellite site (OR 3.07, P=0.01) and evaluation by a thoracic surgeon (OR 4.07, P=0.001) shortened time to esophagectomy. History of MI (OR 0.29, P=0.04), stroke (OR 0.29, P=0.04), and CRT dose reduction (OR 0.35, P=0.03) delayed time to esophagectomy. Improving access to multispecialty cancer centers and increasing satellite sites may improve time to esophagectomy.

Long daytime napping: A silent danger for hypertensive individuals.

Hypertension significantly contributes to stroke. Previous research has indicated a connection between daytime napping and stroke. Research on the connection between daytime napping duration and first stroke in hypertensive individuals is lacking nevertheless. This research, which ran from 24 August 2013 to 31 December 2022, recruited 11,252 individuals with hypertension and without a history of stroke from the China Stroke Primary Prevention Trial. To determine the relationship between daytime napping duration and stroke onset in hypertensive individuals, we conducted analyses for threshold effects, multivariate-adjusted Cox proportional hazard regression models, and Kaplan-Meier survival curves. The duration of daytime napping (<75 min) was positively correlated with stroke risk; beyond 75 min, the risk did not increase further. When compared to hypertensive individuals who napped for 1-30 min, daytime napping 31-60 min (hazard ratio [HR] = 1.27, 95% confidence interval [CI] = 1.06-1.53) and >60 min (HR = 1.37, 95% CI = 1.14-1.65) were substantially related with a greater risk of first stroke. Additionally, this correlation was absent in cases of hemorrhagic stroke, but present in cases of ischemic stroke, specifically for hypertensive individuals who napped for 31-60 min or >60 min (p < 0.05). Kaplan-Meier survival curves displayed that hypertensive individuals who extended daytime napping had an elevated incidence of stroke. Hypertensive individuals who take longer daytime naps (>30 min) are at an elevated risk of stroke onset, particularly ischemic stroke, irrespective of other factors.

P142 ADHERENCE TO PHYSICAL ACTIVITY GUIDELINES IN MAY MEASUREMENT MONTH 2021 AND 2022 PARTICIPANTS

Background and Objective: Physical activity (PA) lowers blood pressure (BP) and improves other cardiovascular risk factors, but many adults fail to achieve recommended PA levels. We aimed to evaluate adherence to the World Health Organisation's (WHO) PA guidelines and associations with BP treatment and control rates amongst adults screened in May Measurement Month (MMM) 2021 and 2022. Methods: Adults (≥18 years) were surveyed opportunistically from 74 countries. Each participant had three seated BP readings, using multiple imputation for any missing values. Participants who self-reported (yes/no) adherence to the WHO PA guidelines (75 minutes of vigorous exercise or 150 minutes of moderate exercise per week) were included. Hypertension was defined as a BP ≥140/90mmHg and/or taking BP-lowering medication. Results: Of 1,357,575 participants screened, 1,098,038 (80.9%) provided information on PA adherence. The mean (standard deviation) age was 46.8 (16.8) years and 52.9% were female. 333,214 (30.3%) participants adhered to PA guidelines. Of 394,444 (35.9%) participants with hypertension, PA adherence was higher in the 211,900 (53.7%) treated with BP-lowering medication (33.2% vs 27.4%, p&lt;0.0001) than those untreated. Amongst treated hypertensives, adherence was higher in those with controlled BP (Table) and increased with age (p&lt;0.0001). Of participants not taking BP-lowering medication, higher adherence was reported by the 703,594 (79.4%) normotensive participants (p&lt;0.0001) and adherence was highest in the 18–29 age group. The absolute rates of PA adherence were 40.3%, 37.3% and 36.2% in those with a history of diabetes, stroke and myocardial infarction, respectively, compared to 29.7, 30.3, 30.2% in those without these respective conditions (all p&lt;0.0001). Conclusions: Only 30% of MMM 2021 and 2022 participants worldwide adhered to WHO PA guidelines. Compared with untreated hypertensive participants, adherence was higher amongst those taking BP-lowering medication. PA adherence was significantly higher in those with diabetes. Those adhering to PA guidelines were more likely to have BP &lt;140/90 mmHg, regardless of taking BP-lowering medication, emphasising the importance of PA for BP control.