Number Of Ischemic Stroke Patients Research Articles

Establishing an MSU service in a medium-sized German urban area-clinical and economic considerations.

Mobile stroke units (MSU) have been demonstrated to improve prehospital stroke care in metropolitan and rural regions. Due to geographical, social and structural idiosyncrasies of the German city of Mannheim, concepts of established MSU services are not directly applicable to the Mannheim initiative. The aim of the present analysis was to identify major determinants that need to be considered when initially setting up a local MSU service. Local stroke statistics from 2015 to 2021 were analyzed and circadian distribution of strokes and local incidence rates were calculated. MSU patient numbers and total program costs were estimated for varying operating modes, daytime coverage models, staffing configurations which included several resource sharing models with the hospital. Additional case-number simulations for expanded catchment areas were performed. Median time of symptom onset of ischemic stroke patients was 1:00 p.m. 54.3% of all stroke patients were admitted during a 10-h time window on weekdays. Assuming that MSU is able to reach 53% of stroke patients, the average expected number of ischemic stroke patients admitted to MSU would be 0.64 in a 10-h shift each day, which could potentially be increased by expanding the MSU catchment area. Total estimated MSU costs amounted to € 815,087 per annum. Teleneurological assessment reduced overall costs by 11.7%. This analysis provides a framework of determinants and considerations to be addressed during the design process of a novel MSU program in order to balance stroke care improvements with the sustainable use of scarce resources.

Potential candidacy for thrombolysis among ischemic stroke patients presenting to Khyber Teaching Hospital, Peshawar.

To determine the number of ischemic stroke patients presenting to a tertiary care hospital that are potential candidates for thrombolysis. This need analysis study was conducted on one hundred consecutive ischemic stroke patients during the last quarter of 2022 at the Department of Medicine, Khyber Teaching Hospital, Peshawar. The Arrival National Institute of Health Stroke Scale (NIH Stroke Scale) was calculated for all suspected stroke patients after a detailed history and clinical examination. An urgent non-contrast-enhanced CT scan brain was carried out. Patients were included in the study group after intra-cranial bleed was excluded on imaging. The majority (43%) of the patients (male and female) fell in the age group 51-60 years. Fifty-nine (59%) patients had hypertension as a co-morbid condition; 49% had diabetes mellitus while the remaining percentages were constituted by other risk factors. Fifty-seven (57%) patients presented with NIH Stroke Scale between 5-15; 25% had NIH Stroke Scale greater than or equal to 21. Forty-one (41%) patients having daytime (8 am to 8 pm) strokes presented within 4.5 hours of stroke onset to the hospital while 31% of patients having nighttime strokes (8 pm to 8 am) presented within 4.5 hours of stroke onset to the hospital. The majority (72%) of ischemic stroke patients reached the hospital facility within 4.5 hours of stroke onset. These patients can be benefited from thrombolysis leading to improved outcomes if available in that particular health facility.

The Incidence of Ischemic Stroke in Cancer Patients in Thailand

Objective: Cancer and stroke are leading causes of morbidity and mortality in Thailand. The objectives of the present study were 1) to determine the incidence of ischemic stroke in cancer patients in Thailand, 2) to identify the cancer subtypes most associated with ischemic stroke, and 3) to compare the etiology of stroke in two groups of patients, those who had conventional risk factors for stroke and those without conventional risk factors or cryptogenic stroke. Materials and Methods: The present study was a retrospective descriptive study. The authors collected data on cancer patients hospitalized between 2008 and 2020 according to International Classification of Disease and Related Health Problem Tenth Revision (ICD-10) and identified the number of ischemic stroke patients and the cancer subtype for each patient. Risk factors for stroke were identified as conventional risk factors (hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, smoking, and imaging evidence of atherosclerosis) and cryptogenic risk factors (none of the conventional risk factors). Results: Sixteen thousand six hundred forty-seven cancer patients were included in the present study and 85 of these patients were diagnosed with ischemic stroke. Therefore, the incidence of ischemic stroke in cancer patients was 0.51%. The cancer subtypes most often associated with ischemic stroke were thoracic as predominantly lung, lower gastrointestinal tract, and hepatobiliary cancer. Most patients (88.24%) had at least one conventional risk factor. Hypertension was the most common conventional risk factor. Cryptogenic stroke was found in 5.88% of the patients and 5.88% of the patients had insufficient data on risk factors. Conclusion: The incidence of ischemic stroke in Thai cancer patients is low. Lung cancer is the cancer type most associated with ischemic stroke. Most cancer patients with ischemic stroke had multiple vascular risk factors. Keywords: Stroke; Cancer; Incidence

Frequency of Iron Deficiency Anemia in Ischemic Stroke

Objective: To determine the frequency of iron deficiency anemia in ischemic stroke. Methods: Total 200 patients with ischemic stroke were included. Investigations including Hemoglobin, Mean Corpuscular Volume (MCV), MeanCorpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC) serum iron level, and serum ferritin level, Total Iron Binding Capacity (TIBC), White Blood Cell (WBC) count andplatelets count (PC) were done. CT scan of brain was also done.Mean±SD were evaluated for quantitative variables which were distributed normally. However, median with inter-quartile range were evaluated for quantitative variables which were non-normally distributed. Data was compiled using SPSS version 25. To check normality of data, Shapiro-Wilk test was applied. To compare the association of qualitative variables, Chi-square test was used. Pvalue ?0.05 was considered as statistically significant. Results: In our study, out of 200 patients having ischemic stroke, 156 (78%) patients were found with iron deficiency and 44 (22%) did not have iron deficiency. Total 164 (82%) patients were anemic and 36 (18%) did not have anemia. The results showed significant mean ranks for Ferritin (p<0.001), Iron (p<0.001), Hemoglobin(p<0.001), Mean Corpuscular Volume(p<0.001), Mean Cell Hemoglobin(p<0.001), Mean Corpuscular Hemoglobin Concentration(p<0.001), and Total Iron Binding Capacity(p=0.005) with respect to iron deficiency, however White Blood Count (p=0.417) and platelet counts (p=0.511) did not have significant mean rank with respect to iron deficiency. As far as anemia is concerned, significant mean ranks was observed for Ferritin (p=0.002), Iron (p<0.001), Hemoglobin (p<0.001), Mean Corpuscular Volume (p<0.001), Mean Cell Hemoglobin (p<0.001), and Mean Corpuscular Hemoglobin Concentration (p<0.001). However, white blood count (p=0.270), platelet counts (p=0.320), and Total Iron Binding Capacity (p=0.535) did not have significant mean rank. .A significant association of iron deficiency with anemia (p<0.001) was also observed Conclusion: Study results show thatsignificant number ofischemic stroke patients have iron deficiency anemia.

Trends of ischemic stroke admission during two years of COVID-19 pandemic: A retrospective cross-sectional study at a tertiary hospital in Indonesia

Introduction: There is no much information on how admission rates of non-coronavirus disease 2019 (COVID-19) diseases altered after two years of COVID-19 pandemic. The aim of this study was to determine the pattern of ischemic stroke admission rates within the two years of the COVID-19 pandemic in Indonesia. Method: A cross-sectional retrospective study investigated the admissions data of ischemic stroke was conducted at a tertiary hospital in Indonesia between January 2019 and December 2021. Ischemic stroke patients aged over 18 years old were identified using the ICD-10 I63 code. The data was accumulated every month and analyzed descriptively. We also analyzed the admissions data of ischemic stroke patients with COVID-19 and in-hospital mortality was calculated. Results: There were 2,710 ischemic stroke patients treated between 2019 and 2021 of which the number decreased from 1535 patients in 2019 to 730 in 2020 and only 445 cases in 2021. During 2019-2021, a total of 777 patients (28.67%) died during hospitalization; the most was in 2021 (33.3%). There is a consistent downward trend in ischemic stroke admissions during the COVID-19 pandemic with the monthly average admissions decreased 52.4% in 2020 compared to 2019 and 38.9% in 2021. Despite that, the mortality rate of ischemic stroke patients in the hospital increased from 26.5% in 2019 to 30.4% in 2020, and 33.3% in 2021. The number of ischemic stroke patients coinfected with COVID-19 was 3.5% (26/730) in 2020 and 8.1% (36/445) in 2021. Of all 62 ischemic stroke cases with COVID-19 in 2020-2021, 36 died yielded 58.1% in-hospital mortality rate. Conclusion: The decreased admissions and the increased mortality rate of ischemic stroke patients in particular those coinfected with COVID-19 during the first two years of pandemic should draw government attention to the necessity of improving stroke managements in Indonesia.

Exploring potential serum levels of Homocysteine, interleukin-1 beta, and apolipoprotein B 48 as new biomarkers for patients with ischemic stroke.

BackgroundStroke is the second leading cause of death worldwide with heterogeneous characteristics. The subtypes of stroke are due to different pathophysiological regulations and causes. This study aimed to investigate the correlation of serum levels of apolipoprotein B 48, interleukin‐1β and Homocysteine with BMI in patients with ischemic stroke (IS).MethodsOver one hundred controls (120) and an equal number of IS patients, including 31 women and 89 men, were recruited to participate in the case‐control study conducted at Imam Reza Hospital (Tabriz, Iran) from February 2019 to March 2020. We measured serum levels of apolipoprotein B 48, interleukin‐1β, and Homocysteine. Receiver operating characteristic analysis (ROC) was performed to evaluate the diagnostic value of these indices in patients and control groups.ResultsThe mean serum levels of apolipoprotein B 48, interleukin‐1β, and Homocysteine, were significantly increased in the experimental group compared to the control group with a p‐value of 0.001. The ROC curve analysis showed that the area under the curve for apo B48, IL −1β, hs‐CRP, and Homocysteine serum levels were 0.94, 0.98, 0.99, and 1, respectively.ConclusionsThe results of our current study show that the determination of serum levels of apolipoprotein B 48, interleukin‐1β, and Homocysteine can potentially be used to monitor and diagnose IS patients. However, there was no statistically significant correlation between serum levels of apolipoprotein B 48, interleukin 1β and Homocysteine and BMI in the patient group. However, there was a statistically significant inverse correlation between serum levels of high‐sensitivity C‐reactive protein (hs‐CRP) and BMI in the patient group.

A Case for the Non-Neurologist Telestroke Provider.

Introduction: Telestroke networks have effectively increased the number of ischemic stroke patients who have access to acute stroke therapy. However, the availability of a dedicated group of stroke subspecialists is not always feasible. We hypothesize that rates of tPA recommendation, sensitivity of final diagnosis, and post-tPA hemorrhagic complications do not differ significantly between neurologists and an emergency-medicine physician during telestroke consultations.Methods: Retrospective review of all telestroke consults performed at a comprehensive stroke center over 1 year. Statistical analysis: Chi squared test.Results: Three hundred and three consults were performed among 6 spoke sites. 16% (48/303) were completed by the emergency medicine physician; 25% (76/303) were performed by non-stroke-trained neurologists, and 59% (179/303) were completed by a board-certified Vascular Neurologist. Overall rate of tPA recommendation was 40% (104/255), 38% (18/48), 41% (73/179), and 41% (31/76) among the all neurology-trained, emergency medicine-trained, stroke neurology-trained and other neurology- trained provider groups, respectively (p = 0.427). Sensitivity of final stroke diagnosis was 77% (14/18) and 72% (75/104) in the emergency-medicine trained and neurology-trained provider groups (p = 0.777) No symptomatic hemorrhagic complications following the administration of tPA via telestroke consultation occurred in any group over this time period. One asymptomatic intracerebral hemorrhage was observed (0.96% or 1/104) in the neurology-trained provider group.Discussion/Conclusion: Our results did not illustrate any statistically significant difference between care provided by an emergency medicine-trained physician and neurologists during telestroke consultation. While our study is limited by its relatively low numbers, it suggests that identifying a non-neurologist provider who has requisite clinical experience with acute stroke patients can safely and appropriately provide telestroke consultation. The lack of formerly trained neurologists, therefore, may not need to serve as an impediment to building an effective telestroke network. Future efforts should be focused on illuminating all strategies that facilitate sustainable telestroke implementation.

The epidemiological characteristics and adherence to hypoglycemic agents of ischemic stroke patients with diabetes

Objective: To investigate the epidemiological characteristics and adherence to hypoglycemic agents of the ischemic stroke patients combined with diabetes. Methods: The study recruited 23 044 ischemic stroke cases from 2013-2015 screening period of China National Stroke Screening Survey. Standardized questionnaires were used to obtain information on demographic data, stroke history, the presence of influence factors, as well as the type of stroke, diagnosis date, frequency, chronic diseases history and hypoglycemic therapy. We used logistics model to investigate the possible risk factors of ischemic stroke combined with diabetes, and calculated the population attributable risk proportion (PARP). We also investigate the adherence to hypoglycemic agents. Results: The mean age of 23 044 ischemic stroke patients was (64.99±9.42) years old, 50.91% were males (11 731). In ischemic stroke patients, 21.52% had diabetes. According to the results of logistics model, ischemic stroke patients with hypertension, dyslipidemia, atrial fibrillation or family history of stroke had higher risk to combine with diabetes, their Odds Ratios (OR) were 2.18 (1.87-2.55), 1.99 (1.78-2.23), 1.64 (1.39-1.92) and 1.19 (1.06-1.33). Considering the prevalence of each influence factor in ischemic stroke patients, atrial fibrillation had the highest PARP (95%CI) of 62.65% (61.27%-63.76%). In ischemic stroke patients combined with diabetes, 70.73% (3 463/4 896) had taken hypoglycemic agents. Conclusion: There still were a large number of ischemic stroke patients combined with diabetes and a low rate of adherence to hypoglycemic agents.

Analyzing Cost-Effectiveness of Allocating Neurointerventionist for Drive and Retrieve System for Patients with Acute Ischemic Stroke

ObjectivesThere are regional disparities in implementation rates of endovascular thrombectomy due to time and resource constraints such as endovascular thrombectomy specialists. In Hokkaido, Japan, Drive and Retrieve System (DRS), where endovascular thrombectomy specialists perform early endovascular thrombectomies by traveling from the facilities where they normally work to facilities closer to the patient. This study analyzed the cost-effectiveness of allocating a endovascular thrombectomy specialist for DRS to treat stroke patients. Materials and methodshe number of ischemic stroke patients expected to receive endovascular thrombectomy in Hokkaido in 2015 was estimated. It was assumed that an additional neutointerventionist was allocated for DRS. The analysis was performed from the government's perspective, which includes medical and nursing-care costs, and the personnel cost for endovascular thrombectomy specialist. The analysis was conducted comparing the current scenario, where patients received endovascular thrombectomy in facilities where endovascular thrombectomy specialists normally work, with the scenario with DRS within 60 min drive distance. Patient transport time was analyzed using geographic information system, and patient severity was estimated from the transport time. The primary outcome was incremental cost-effectiveness ratio (ICER) in each medical area which was calculated from the incremental costs and the incremental quality-adjusted life years (QALYs), estimated from patient severity using published literature. The entire process was repeated 100 times. ResultsDRS was most cost-effective in Kamikawachubu area, where the ICER was $14,173±16,802/QALY, significantly lower than the threshold that the Japanese guideline suggested. ConclusionsSince DRS was cost-effective in Kamikawachubu area, the area should be prioritized when a endovascular thrombectomy specialist for DRS is allocated as a policy.

Comparison of Tryglicerides Levels and Total Cholesterol in Ischemic Stroke and Haemorrhagic Stroke Patients

Background: Stroke is the second largest cause of death in the world. Stroke is classified based on its etiology as ischemic stroke and hemorrhagic stroke. Most large-scale studies on the risk of total cholesterol and triglyceride levels in stroke are not distinguished between ischemic and hemorrhagic strokes. Purposes: The purpose of this study was to determine the comparison of triglyceride and total cholesterol levels in ischemic stroke patients with hemorrhagic stroke. Method: Descriptive analytic study using medical records of patients at Medan Haji General Hospital in 2018-2019. The number of ischemic stroke patients is 28 patients and hemorrhagic stroke 28 patients with a total sample of 56 patients. Results: In ischemic stroke patients, the average value of triglyceride levels was 144.75 mg/dL and the average value of total cholesterol was 250.93 mg/dL. In hemorrhagic stroke patients, the average value of triglyceride levels is 126.93 mg/dL and the average total cholesterol level is 174.25 mg/dL. Conclusion: From this study we found a significant difference in total cholesterol between ischemic and hemorrhagic strokes. No significant difference was found in triglycerides between ischemic and hemorrhagic strokes.

Comparison of Tryglicerides Levels and Total Cholesterol in Ischemic Stroke and Haemorrhagic Stroke Patients

Background: Stroke is the second largest cause of death in the world. Stroke is classified based on its etiology as ischemic stroke and hemorrhagic stroke. Most large-scale studies on the risk of total cholesterol and triglyceride levels in stroke are not distinguished between ischemic and hemorrhagic strokes. Purposes: The purpose of this study was to determine the comparison of triglyceride and total cholesterol levels in ischemic stroke patients with hemorrhagic stroke. Method: Descriptive analytic study using medical records of patients at Medan Haji General Hospital in 2018-2019. The number of ischemic stroke patients is 28 patients and hemorrhagic stroke 28 patients with a total sample of 56 patients. Results: In ischemic stroke patients, the average value of triglyceride levels was 144.75 mg/dL and the average value of total cholesterol was 250.93 mg/dL. In hemorrhagic stroke patients, the average value of triglyceride levels is 126.93 mg/dL and the average total cholesterol level is 174.25 mg/dL. Conclusion: From this study we found a significant difference in total cholesterol between ischemic and hemorrhagic strokes. No significant difference was found in triglycerides between ischemic and hemorrhagic strokes.

Epidemiology and outcomes of ischemic stroke treatment in two public hospitals of Campos dos Goytacazes, RJ.

Background: The main origin of functional dependence in Brazil and the world is the ischemic stroke. The early thrombolytic treatment reduces this morbidity. However, the extended in-hospital delay is the main risk factor for the suboptimal number of ischemic stroke patients who receive this treatment. Objective: To describe the management of patients admitted with ischemic stroke in two Brazilian public hospitals. Methods: This cross-sectional study was carried out in two emergency units in 2016 in Campos dos Goytacazes: Hospital Ferreira Machado (HFM) and Hospital Geral de Guarus (HGG). We analyzed the prevalence of sex, age, risk factors, time of first symptoms, prescription of thrombolytic therapy and contraindications to its use. Results: None of the 130 patients with ischemic stroke received a prescription of rt-PA, even though HFM had rt-PA available throughout the period of the study. HGG does not keep this data documented. Of all, 41 patients died (31,54%). Advancing age (p < 0.0005) and atrial fibrillation 3.458 (CI = 95%, 1.239 to 10.16, p = 0.0238) were risks factors for the mortality in this population. Conclusions: The lack of information in medical records reveals that low staff training may be the main reason why thrombolytic therapy was not prescribed. The elevated mortality rate shows that medical care for patients admitted with ischemic stroke in our region is far from ideal.

Abstract TP241: Neurologists' Role in Telestroke; How Essential Are We?

Background: Telestroke networks have effectively increased the number of ischemic stroke patients who have access to acute stroke therapy. However, the availability of a dedicated group of stroke subspecialists is not always feasible. Hypothesis: Rates of tPA recommendation, accuracy of final diagnosis and post-tPA hemorrhagic complications do not differ significantly between neurologists and an emergency-medicine physician during telestroke consultations. Methods: Retrospective review of all telestroke consults performed at a comprehensive stroke center during one year. Statistical analysis: Chi squared test. Results: 303 consults were performed among 6 spoke sites. 16% (48/303) were completed by the emergency medicine physician; 25% (76/303) were performed by non stroke-trained neurologists, and 60% (179/303) were completed by a board-certified Vascular Neurologist. Overall rate of tPA recommendation was 40% (104/255), 38% (18/48), 41% (73/179), and 41% (31/76) among the all neurology-trained, emergency medicine- trained, stroke neurology-trained and other neurology- trained provider groups respectively (p = .427). Accuracy of final stroke diagnosis was 77% (14/18) and 72% (75/104) in the emergency-medicine trained and neurology-trained provider groups (p = 0.777) No symptomatic hemorrhagic complications following the administration of tPA via telestroke consultation occurred in any group over this time period. One asymptomatic intracerebral hemorrhage was observed (0.96% or 1/104) in the neurology-trained provider group. Conclusion: Our results did not illustrate any statistically significant difference between care provided by an Emergency Medicine-trained physician and neurologists during telestroke consultation. While our study is limited by its relatively low numbers, it suggests that identifying a non-neurologist provider who has requisite clinical experience with acute stroke patients can safely and appropriately provide telestroke consultation. The lack of formerly trained neurologists, therefore may not need to serve as an impediment to building an effective telestroke network. Future efforts should be focused on illuminating all strategies that facilitate sustainable telestroke implementation.

Therapeutic Modulation of the Complement Cascade in Stroke.

Stroke is a leading cause of death and disability worldwide and an increasing number of ischemic stroke patients are undergoing pharmacological and mechanical reperfusion. Both human and experimental models of reperfused ischemic stroke have implicated the complement cascade in secondary tissue injury. Most data point to the lectin and alternative pathways as key to activation, and C3a and C5a binding of their receptors as critical effectors of injury. During periods of thrombolysis use to treat stroke, acute experimental complement cascade blockade has been found to rescue tissue and improves functional outcome. Blockade of the complement cascade during the period of tissue reorganization, repair, and recovery is by contrast not helpful and in fact is likely to be deleterious with emerging data suggesting downstream upregulation of the cascade might even facilitate recovery. Successful clinical translation will require the right clinical setting and pharmacologic strategies that are capable of targeting the key effectors early while not inhibiting delayed repair. Early reports in a variety of disease states suggest that such pharmacologic strategies appear to have a favorable risk profile and offer substantial hope for patients.

The Underlying Stroke Etiology: A Comparison of Two Classifications in a Rural Setup.

IntroductionThis study compares the Trial of Org 10172 in Acute Stroke Treatment (TOAST) and the atherothrombosis, small vessel disease, cardiac pathology, other causes, and dissection (ASCOD) classification performed in a rural hospital setup. Stroke is the second leading cause of death after ischemic heart disease with over 9.5 million new cases of ischemic stroke in 2016. Stroke is a complex disease with numerous contributing factors. India needs a standardized stroke classification system, as without one it becomes difficult to collect data on stroke patients, perform follow-ups, and provide appropriate secondary prevention. A standardized stroke classification system would also help in building a nationwide database in order to note epidemiological trends of ischemic stroke. This would also create greater awareness regarding stroke in rural parts of India where healthcare is difficult to access. Aims and objectivesOur aim was to review all admitted stroke patients’ data and classify their etiology and mechanism based on the TOAST and ASCOD classification systems. The ASCOD classification has yet to be utilized in the Indian population. The two classifications are then compared in order to gain a better insight into which classification is a better fit for the Indian population. Both are based on the etiology of ischemic stroke but the ASCOD classification differs because it gives suitable secondary prevention measures based on the diseases linked to stroke. ASCOD also gives a proper indication of the patient’s present causative factor (similar to TOAST) and other factors that can possibly lead to further recurrences. This is different from TOAST, which denotes only a single cause for stroke and eliminates the possibility of other involved contributing factors.Materials and methodsAll patients involved in the study were admitted to a rural Indian hospital from January 2014 to July 2016. All the relevant clinical details of each patient were then retrieved from the hospital’s electronic medical record system for the study. We then classified all the patients based on the TOAST and ASCOD classification criteria.ResultsUsing the ASCOD classification, we found that 179 (86%) patients out of 209 had either atherothrombosis or small vessel disease. The ASCOD classification also showed substantial evidence that the determined stroke mechanism/etiology is interconnected to multiple causal factors in over 50% of patients. In contrast, the TOAST classification had identified a larger number of ischemic stroke patients as having an etiology of other and undetermined causes as compared to the ASCOD classification.ConclusionThe ASCOD classification is better to use in patients and helps decide the secondary prevention appropriately.

Modifiable and non-modifiable risk factors in ischemic stroke: a meta-analysis.

Stroke is a heterogeneous, multifactorial disease regulated by modifiable and non-modifiable risk factors like total cholesterol, triglycerides, high density lipid-cholesterol (HDL-C), low density lipid-cholesterol (LDL-C) and glucose and non-modifiable factors like age. Evaluation of these risk factors for ischemic stroke may contribute to more effective prevention. This meta-analysis investigated the data up to 2018 with respect to age, total cholesterol, triglycerides, high density lipid-cholesterol (HDL-C), low density lipid-cholesterol (LDL-C) and glucose levels in the Ischemic stroke patients and controls. Data from each eligible study was extracted such as year of publication, first author name, ethnicity/country, number of ischemic stroke patients and healthy controls and studies were subjected to heterogeneity analysis. Meta-analysis of the modifiable and non-modifiable risk factors like total cholesterol, HDL-C and LDL-C glucose, triglycerides levels and age were not having significantly associated with ischemic stroke (p>0.05). However meta-analysis of triglyceride yielded significant association ischemic stroke with overall 95% CI (-0.62- (-0.09) and P= 0.007 and glucose also showed significant association with ischemic stroke with 95% CI (-1.08- (-0.14), P=0.01. Studies were subjected to heterogeneity which revealed significant heterogeneity with (P<0.00) and I2>96%. Meta-analysis revealed that levels of triglyceride and glucose are the predisposing factors for ischemic stroke in the Asian population.

Abstract 118: Predictors of Post-Stroke Depression in Ischemic Stroke Patients using the Patient Health Questionnaire-9

Introduction: Post-stroke depression (PSD), which affects one-third of stroke patients, is an important psychosocial consequence after stroke linked with higher stroke morbidity, mortality, and recurrence. Current guidelines do not direct when to screen for PSD. Using hospital and clinic PSD screening, we sought to identify predictors of PSD symptoms, factors associated with worsening PSD symptoms, and use of antidepressants in PSD. Methods: In a retrospective review of patients hospitalized with ischemic stroke from 01/2014-11/2016, patients completed a Patient Health Questionnaire-9 (PHQ-9) inpatient and again in clinic follow-up within 180 days (median 45 days). PHQ-9 score was categorized as no symptoms (0-4), mild (5-9), moderate (10-14) and severe (15-27). Baseline and follow-up data were analyzed by t-test and Fisher’s exact test for univariate analyses and logistic regression model for multivariable analyses. Results: Among 201 patients, depressive symptoms (PHQ-9 &gt; 4) were seen in 30% of patients during hospitalization and 46% in clinic (54% of which had no symptoms inpatient). At follow-up, 64% of patients had stable/improved symptoms and 36% were worse by PHQ-9 category. In univariate analysis, clinic modified Rankin Scale (mRS) ≥2 (p=0.027) and clinic antidepressant prescription (p=0.0004) were associated with worsening PHQ-9 category. In logistic regression analysis, mRS ≥2 (p=0.022), posterior circulation stroke (p=0.029), and clinic antidepressant prescription (p=0.002) were associated with worsening. Conclusions: A substantial number of ischemic stroke patients develop or have worsening depression from hospitalization to follow-up. Post-stroke disability (mRs ≥2) and posterior circulation stroke were associated with worsening depression at follow-up. Worsening symptoms prompted a change in management in our clinic. Screening for PSD inpatient should be followed-up in clinic as both may impact treatment and outcomes.

Underuse of Oral Anticoagulants in Patients With Ischemic Stroke and Atrial Fibrillation in China

Anticoagulant therapy is an effective stroke prevention measurement for subjects with atrial fibrillation (AF) who are at high risk of ischemic stroke. However, it is reported that oral anticoagulants (OACs) are generally underused in clinical practice. A better awareness of current usage of anticoagulant therapy would enable prevention of stroke secondary to AF. Therefore, we determined the nationwide prevalence of AF and the frequency of OACs use among patients with ischemic stroke in China. Based on the China National Stroke Screening Survey, a representative nationwide sample of 1,252,703 adults over 40 years old during 2013 and 2014 was involved. Information on demographic data, diagnosis of stroke, behavioral risk factors, family history of stroke, related diseases, and medications was collected. The community-based survey data showed that 5,588 patients (12.0%) with ischemic stroke had previous, or newly diagnosed, AF. Therefore, more than 2.15 million ischemic stroke patients had AF in China. Among ischemic stroke patients with AF, the strongest risk factor was coronary heart disease (odds ratio = 2.53), whereas dyslipidemia accounted for the largest contribution (population-attributable risk proportion = 17.33%). Of ischemic stroke patients with AF, only 2.2% had taken OACs; of them, 98.2% had taken warfarin. In conclusion, a large number of ischemic stroke patients with AF are significantly undertreated with OACs in China. This highlights the need for improvement of prevention of ischemic stroke secondary to AF.

Abstract WP266: Associations Between Temporal Improvement of Stroke Care Capabilities and Functional Outcome in Acute Ischemic Stroke: J-aspect Study

Introduction: Certification system of the primary and comprehensive stroke center (PSC and CSC) is still under discussion in Japan. This study attempts to examine associations between the variation of stroke center capabilities and the improvement of outcomes for acute ischemic stroke on a national scale. Hypothesis: Improvements in hospital stroke center capabilities leads to better outcome of acute ischemic stroke patients. Methods: Using a validated score for evaluating CSC capabilities, which consists of 5 categories (personnel, diagnostic techniques, specific expertise, infrastructure, and education) on a 25 point scale, we assessed CSC capabilities for 137 certified training hospitals in 2011 and 2015 (Kada et al. BMC Neurol 2017). A consecutive health insurance claims data known as the Japanese Diagnosis Procedure Combination/Per Diem Payment Systems of 2011 and 2015 was obtained from the hospitals. The proportion of favorable outcome—score 0 to 1 on the modified Rankin Scale (mRS)—at discharge was quantified as the primary outcome. The change in CSC score with more than two points over time was quantified as an independent variable. We regressed the change of CSC score on morbidity with adjustment of average age and sex in the hospitals. Results: In total, 18,658 in 2011 and 29,999 in 2015 ischemic stroke patients were admitted to 137 hospitals. Median annual number of ischemic stroke patients per hospital increased from 115 to 183 over time. Mean age (74.5 year vs 74.2 years) and proportions of men (56.8% vs 58.2%) were almost the same. The mean CSC scores increased from 15.9±4.0/25 to 17.2±4.2/25 point. The mean hospital mortality decreased from 6.1% to 4.3%. The mean proportion of patients with the favorable outcome at discharge increased from 39.2% to 45.5%. We selected random-effect model based on Housman test. In regression analyses, the increase of CSC score over time was significantly associated with the increasing proportion of the favorable outcome at discharge (coefficient, 2.76; 95% CI, 0.04-5.47; p-value, 0.047). Conclusions: Improvements in CSC capabilities overtime was significantly related to the improvement of functional outcome at discharge in ischemic stroke patients.

Improving Access to Thrombolysis and Inhospital Management Times in Ischemic Stroke: A Stepped-Wedge Randomized Trial.

A suboptimal number of ischemic stroke patients eligible for thrombolysis actually receive it, partly because of extended inhospital delays. We developed a comprehensive program designed for emergency unit staff and evaluated its effectiveness for reducing intrahospital times and improving access to thrombolysis. We conducted a randomized stepped-wedge controlled trial in 18 emergency unit. The sequentially implemented training intervention, targeting emergency physicians and nurses, was based on specifically designed videos and interactive simulation workshops on intrahospital management optimization. The effectiveness was assessed on intrahospital times and thrombolysis proportion. During the study period, all consecutive patients with confirmed ischemic stroke and no contraindications to thrombolysis were included. A total of 328 patients were enrolled in the control group and 363 in the intervention group. Mean age was 73.6 years. Overall thrombolysis proportion was 34.2% in the intervention group versus 25.6% in the control group (adjusted odds ratio, 1.42; 95% confidence interval, 1.01-2.01), thrombolysis proportion within 4 hours 30 minutes almost doubled (adjusted odds ratio, 1.9; 95% confidence interval, 1.32-2.73). Although imaging-to-stroke unit time was significantly decreased in the intervention group (39 versus 53 minutes; P=0.03), median door-to-imaging and door-to-needle times were not different between groups (P=0.70 and P=0.40, respectively). An interactive and multifaceted training program targeting emergency professionals was significantly associated with an increased access to thrombolysis, especially within 4 hours and 30 minutes. URL: https://www.clinicaltrials.gov. Unique identifier: NCT02814760.