Number Of Ischemic Strokes Research Articles

Ischemic Stroke During the Pandemic in a Secondary Care Hospital: COVID-19 and Its Collateral Effects

Aim: Ischemic stroke is among the leading causes of death and disability. Although recent studies have
 shown a possible relationship between COVID-19 and ischemic stroke, the effect of the pandemic period,
 which may be another factor in the increase of ischemic stroke risk factors, has not been investigated.
 Therefore, in current study, we assessed how the COVID-19 pandemic affected ischemic strokes.
 Material and Methods: Patients were divided as two years before and after the first COVID-19 case
 in Turkey, and their COVID-19 history, demographic characteristics and clinical features (comorbid
 diseases, etc.) were obtained.
 Results: There were 588 ischemic stroke patients pre-pandemic and 694 ischemic stroke patients
 post-pandemic. In post-pandemic periods, 322 patients were vaccinated, and 288 patients were not.
 No significant difference in ischemic stroke was found between vaccinated and unvaccinated groups
 (p = 0.168) and between different vaccine-type groups (p = 0.873). Partial anterior circulation infarct
 (PACI) was the most common ischemic stroke subtype in both groups; there was no difference between
 them (p=0.719). The number of ischemic stroke were significantly increased in the post-pandemic
 period (p

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.

Global Burden, Risk Factor Analysis, and Prediction Study of Ischemic Stroke, 1990-2030.

Ischemic stroke (IS), 1 of the 2 main subtypes of stroke, occurs because of brain ischemia caused by thrombosis of a cerebral blood vessel. IS is one of the most important neurovascular causes of death and disability. It is affected by many risk factors, such as smoking and a high body mass index (BMI), which are also critical in the preventive control of other cardiovascular and cerebrovascular diseases. However, there are still few systematic analyses of the current and predicted disease burden and the attributable risk factors of IS. Based on the Global Burden of Disease 2019 database, we used age-standardized mortality rate and disability-adjusted life year to systematically present the geographical distribution and trends of IS disease burden worldwide from 1990 to 2019 by calculating the estimated annual percentage change and to analyze and predict the death number of IS accounted by 7 major risk factors for 2020-2030. Between 1990 and 2019, the global number of IS deaths increased from 2.04 million to 3.29 million and is expected to increase further to 4.90 million by 2030. The downward trend was more pronounced in women, young people, and high sociodemographic index (SDI) regions. At the same time, a study of attributable risk factors of IS found that 2 behavioral factors, smoking and diet in high sodium, and 5 metabolic factors, including high systolic blood pressure, high low-density lipoprotein cholesterol, kidney dysfunction, high fasting plasma glucose, and a high BMI, are major contributors to the increased disease burden of IS now and in the future. Our study provides the first comprehensive summary for the past 30 years and the prediction of the global burden of IS and its attributable risk factors until 2030, providing detailed statistics for decision-making on the prevention and control of IS globally. An inadequate control of the 7 risk factors would lead to an increased disease burden of IS in young people, especially in low SDI regions. Our study identifies high-risk populations and helps public health professionals develop targeted preventive strategies to reduce the global disease burden of IS.

Ischemic stroke in patients with congenital heart disease and atrial fibrillation

Abstract Background Atrial fibrillation (AF) is one of the most common arrhythmias in patients with congenital heart disease (CHD). The risk of developing AF is more than 20 times higher in patients with CHD compared with non-CHD controls. However, while it is known that young non-CHD patients with AF have a low risk for ischemic stroke (IS), little is known about the risk for IS young CHD patients with AF. Purpose To investigate the risk of developing IS in younger patients with CHD and AF compared to non-CHD control patients with AF. Method Using data from the National Swedish Patient Register and Cause of Death register, all CHD and born in Sweden between 1970 and 2017 with history of AF were identified. The Swedish total population register was used to identify age and sex matched controls. Among the matched controls, non-CHD patients AF were identified and used as reference group. CHD and non-CHD patients were followed from onset of AF until index IS, death or end of study (31st December 2017). Cox proportional hazard regression model with hazard ratio (HR) and 95% confidence interval (CI) was used to estimate the risk of IS in CHD patients with AF compared with non-CHD controls with AF. Results A total of 951 CHD with AF and 606 non-CHD controls with AF were identified. With ages ranging from 0 to 47 years, the median age was 25.6 and 30.7 years for CHD and non-CHD respectively. In patients with CHD and AF, 2.9% of patients (n=28) developed IS during follow up (mean follow up 34 years, SD ± 11.2), compared 0.5% (n=3) in non-CHD controls with AF (mean follow up 37 years, SD ± 9.5 years). The unadjusted HR for IS in CHD patients with AF compared with non-CHD controls with AF was 4.61 (95% CI1.39–15.25). When adjusted for age, sex, hypertension and heart failure, the risk of IS was more than five times higher (HR 5.16, 95% CI 1.52–17.46) in CHD patients compared with non-CHD patients. The adjusted HR for developing IS in non-complex CHD with AF compared with matched controls was 4.56 (95% CI 1.00–20.79). For patients born 1970–1989 the HR of IS was 7.35 (95% CI 1.70–31.75). Conclusion In this nationwide, register-based cohort study, the absolute number of IS among younger CHD patients with AF was relatively low. However, the risk for developing IS was more than 5 times higher compared to non-CHD patients with AF; highlighting the need of stroke score models in younger population, particularly to CHD patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish state under an agreement between the Swedish government and city Councils

Impact of non-adherence to direct oral anticoagulants amongst Swedish patients with non-valvular atrial fibrillation: results from a real-world cost-utility analysis

Aims A third of non-valvular atrial fibrillation (NVAF) patients are non-adherent to direct oral anticoagulants (DOACs). Estimates of the economic value of full adherence and the cost of two types of adherence improving interventions are important to healthcare planners and decision-makers. Methods A cost-utility analysis estimated the impact of non-adherence over a 20-year horizon, for a patient cohort with a mean age of 77 years, based on data from the Stockholm Healthcare database of NVAF patients with incident stroke between 2011 and 2018. Adherence was defined using a medication possession ratio (MPR) cut-off of 90%; primary outcomes were the number of ischemic strokes and associated incremental cost–utility ratio. Results Hypothetical comparisons between cohorts of 1,000 patients with varying non-adherence levels and full adherence (MPR >90%) predicted an additional number of strokes ranging from 117 (MPR = 81–90%) to 866 (MPR <60%), and years of life lost ranging from 177 (MPR = 81– 90%) to 1,318 (MPR < 60%; discounted at 3%). Chronic disease co-management intervention occurring during each DOAC prescription renewal and patient education intervention at DOAC initiation will be cost-saving to the health system if its cost is below SEK 143 and SEK 4,655, and cost-effective if below SEK 858 and SEK 28,665, respectively. Conclusion Adherence improving interventions for NVAF patients on DOACs such as chronic disease co-management and patient education can be cost-saving and cost-effective, within a range of costs that appear reasonable to the Swedish healthcare system.

Trends in stroke admissions before, during and post-peak of the COVID-19 pandemic: A one-year experience from the Qatar stroke database.

Several reports document a decrease in the rates of stroke hospital admissions during the covid-19 pandemic. There is very little information whether the admission rates will change as the infection is controlled. We report on our rates of admissions before, during and following the peak of covid-19 infections in a prospective database from Qatar. The stroke admissions in the six months prior to COVID-19 pandemic averaged 229/month. There was a decrease to 157/month in March-June during the peak of the pandemic. In the 6 months following the peak, as covid-19 numbers began to decrease, the average numbers increased back to 192/month. There was an increase in severe ischemic strokes and decreased in functional recovery. The decreased admissions were mainly driven by fewer stroke mimics. Patients presenting with ischemic stroke or cerebral hemorrhage remained unchanged. Fewer stroke mimics presenting to the hospital can explain the fewer admissions and poor outcome at the height of the covid-19 pandemic. The continued decrease in the number of ischemic stroke and stroke mimic admissions following the pandemic peak requires more study.

Abstract TMP83: Comparison Of Clinical Features And Vessel Involvement In Isolated Reversible Cerebral Vasoconstriction Syndrome And Associated Posterior Reversible Encephalopathy Syndrome

Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) may co-occur with brain MRI T2/FLAIR sequence changes, and posterior reversible encephalopathy syndrome (PRES) may be associated with cerebral vasoconstriction. Both entities with overlapping features may be considered as a single group. We compared the isolated RCVS group to the overlapping group to investigate clinical and radiological features, with a focus on vessel involvement. Methods: We performed a retrospective study of adult patients admitted to a tertiary medical center from February 2008 until February 2018 and who were diagnosed with PRES or RCVS. Overlap cases consisting of PRES with vasoconstriction and RCVS with reversible MRI T2/FLAIR changes were compared to isolated RCVS cases. Clinical and radiological features of both groups were compared with each other. Involved vessel segments were classified as internal carotid artery, M1 and M2 middle cerebral artery, A1 and A2 anterior cerebral artery, P1 and P2 posterior cerebral artery, vertebral artery, and basilar artery. Severity was also graded (1-49% or &gt;49%). Appropriate statistical tests were used to compare the variables and significant findings reported. Results: There were 86 cases with isolated RCVS and 44 cases of overlap. Seizures (19, 43%) and encephalopathy (13, 30%) were common in the overlap group, whereas headache was common in the isolated RCVS group (79, 92%). Immunosuppressant use was more often present in the overlap group (9, 20%), but there were no differences in antidepressant, cocaine, or marijuana use. Intracerebral hemorrhage was more common in the overlap group (12/44, p=0.003), but there were similar numbers of ischemic strokes and subarachnoid hemorrhages. There were no differences in the number or location of segments involved or stenosis severity between the groups. Home discharge was more frequent among pure RCVS (73, 85%) than among overlap patients (27, 61%, p=0.004). Conclusion: Clinical presentations and short-term prognosis differed among isolated RCVS and group with PRES-RCVS overlap characteristics. There was no difference in vascular involvement between the groups.

Prevalence and Clinical Characteristics of Lacunar Stroke: A Hospital-Based Study.

Lacunar stroke (LS) is responsible for one-quarter of the overall number of ischemic strokes with long-term complications and carries health and economic issues for patients and health care systems. Therefore, we aimed to investigate lacunar versus non-lacunar strokes in a tertiary academic center. From February 2016 to July 2019, all patients admitted to the stroke unit were retrospectively reviewed. We included LS patients and compared them to other TOAST subtypes. Hemorrhagic stroke and conditions mimicking stroke were excluded. Regression analysis was done to determine LS predictors and outcomes. A 35.5% rate of LS among 989 ischemic stroke patients was found. Most patients (71.9%) were males. Lower National Institutes of Health Stroke Scale (NIHSS) scores at admission and negative history for cardiac diseases were predictors for LS in our population. At discharge, LS patients had low NIHSS scores and shorter hospitalization periods compared to non-LS patients. In conclusion, LS was prevalent among ischemic stroke patients in our cohort. Future studies are highly needed with long follow-up intervals to identify the stroke recurrence, complications, and outcomes.

Concomitant left atrial appendage occlusion in patients undergoing cardiac surgery.

The Left Atrial Appendage Occlusion Study (LAAOS III) was a multicenter, randomized controlled trial that included patients undergoing cardiac surgery who also had atrial fibrillation. The trial recruited 4811 participants, of which 2400 patients were randomized to undergo left atrial appendage (LAA) occlusion surgery, while 2411 participants had isolated cardiac surgery. The aim of the study was to determine whether concomitant occlusion of the LAA prevents ischemic stroke or systemic embolism. The study also evaluated the efficacy and safety of concomitant LAA occlusion in patients undergoing cardiac surgery. The number of ischemic strokes or systemic embolisms was significantly lower in the LAA occlusion group [114 (4.8%) vs. 68 (7.0%)] compared to the no-occlusion surgery group. There was also no increase in hospital length of stay or hospitalization for heart failure. It is expected that based on the findings of the LAAOS III study, the recommendations for concomitant LAA occlusion will be upgraded from the current class IIB to class I.

Decreased Stroke Applications During Pandemic: Collateral Effects of COVID-19

Objective: Our study aimed to investigate the effects of the pandemic on human behavior and stroke management by comparing hospital admissions made due to stroke during the pandemic period with the same period of the previous year. Materials and Methods: This retrospective study was conducted on patients with stroke admitted to our hospital between April 1st, 2020, and May 31st, 2020, and April 1st, 2019, and May 31st, 2019. Strokes were divided into three subgroups: ischemic stroke, hemorrhagic stroke, and transient ischemic attack (TIA). The total number of strokes, stroke subtypes, vascular risk factors, sociodemographic and clinical characteristics, National Institutes of Health Stroke Scale (NIHSS) scores, presence of large vessel occlusion, thrombolytic therapy use, intensive care unit requirement, and in-hospital mortality values were compared for both periods. Results: A total of 133 patients, 75 males, 58 females, 44 during the pandemic period and 89 in the previous year, were included in the study. The mean age of the patients was 71.29 +/- 13.12 years. During the pandemic period, compared with the same period one year ago, there was a 50% decrease in the number of strokes, a 44% decrease in the number of ischemic strokes, a 62.5% decrease in the number of intracranial hemorrhages, and an 87.5% decrease in the number of TIA. During the pandemic period, the rate of patients who received intravenous thrombolytic therapy, the rate of patients with large vessel occlusion, the inhospital mortality rate, and the mean NIHSS scores were found to be significantly higher during the pandemic, but the rate of patients who had a minor stroke was significantly lower. Conclusion: The pandemic period has brought along many unknowns. It is a matter of curiosity how the effects of the pandemic on human behavior and functioning in health institutions will affect the diagnosis, treatment, and long-term follow-up of diseases other than coronavirus disease-2019.

Possible Associations between Space Weather and the Incidence of Stroke

The aim of our study was to detect the possible association between daily numbers of ischemic strokes (ISs) and hemorrhagic strokes (HSs) and space weather events. The daily numbers of ISs, subarachnoid hemorrhages (SAHs), and intracerebral hemorrhages (ICHs) were obtained from Kaunas Stroke Register during the period of 1986 to 2010. We used time- and season-stratified multivariate Poisson regression. We analyzed data of 597 patients with SAH, 1147 patients with ICH, and 7482 patients with IS. Strong/severe geomagnetic storms (GSs) were associated with an increase in the risk of SAH (by 58%) and HS (by 30%). Only GSs occurring during 6:00–12:00 UT were associated with the risk of IS. Low geomagnetic activity (GMA) was associated with the risk of ICH, HS, and IS (Rate Ratios with 95% CI were 2.51 (1.50–4.21), 2.33 (1.50–3.61), and 1.36 (1.03–1.81), respectively). The days of ≥ X9 class solar flare (SF) were associated with a 39% higher risk of IS. The risk of HS occurrence was greater than two times higher on the day after the maximum of a strong/severe solar proton event (SPE). These results showed that GSs, very low GMA, and stronger SFs and SPEs may be associated with an increased risk of different subtypes of stroke.

Abstract WMP54: Estimates of the U.S. Burden of Pregnancy-Associated Stroke Attributable to Common Vascular Risk Factors

Background: The incidence of pregnancy-associated stroke may be increasing. The degree to which this increase is associated with increases in common stroke risk factors is uncertain. Methods: We used the National Inpatient Sample (NIS) and National Health and Nutrition Examination Survey (NHANES) to estimate the change between 1999 through 2014 in the prevalence of common stroke risk factors among women 12-45 years of age. These risk factors were hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, or eclampsia), which was ascertained using NIS, and diabetes mellitus, obesity, and smoking, which were ascertained using NHANES. We extracted previously published relative risk estimates for the association between each risk factor and ischemic stroke in pregnant women. Using these estimates, we calculated the attributable risk and expected number of ischemic strokes among pregnant women with each risk factor. We used the NIS to estimate the trend in ischemic strokes documented during a hospitalization for labor and delivery, and modeled trends in such strokes attributable to changes in the prevalence of each stroke risk factor over time. Results: The rate of ischemic stroke increased from 7.7 (95% CI, 5.0-10.5) per 100,000 deliveries in 1999-2000 to 12.7 (95% CI, 9.5-15.9) per 100,000 deliveries in 2013-2014 (Fig). Based on changes in the prevalence of hypertensive disorders of pregnancy, diabetes, obesity, and smoking between 1999 and 2014, the expected increase in pregnancy-associated stroke attributable to these risk factors would be approximately 10%, in contrast to the nearly 65% relative increase in strokes documented during pregnancy hospitalizations during this period. Conclusions: Changes in the prevalence of common stroke risk factors explain a small fraction of the apparent increase in pregnancy-associated stroke in the U.S. during the past 2 decades.

Autoarterial remodeling of the common carotid artery bifurcation in treatment of stenotic lesions

Carotid endarterectomy is the main operation carried out for prevention of ischaemic stroke in haemodynamically significant stenoses of the bifurcation of the common carotid artery. Despite the literature data demonstrating some advantages of eversion carotid endarterectomy over the classical technique there arises a series of complicated, as yet unsolved problems. This concerns the control of the distal portion of an atherosclerotic plaque in prolonged lesions of the internal carotid artery, the absence of a temporary bypass graft, necessity of prosthetic repair of the internal carotid artery in detachment of the distal border of the plaque. We suggested a new technique of carotid endarterectomy making it possible to widen visual removal of atheromatous masses from the internal carotid artery, to improve the control of the distal portion of the plaque in a prolonged lesion of the internal carotid artery. We carried out a comparative assessment of efficacy and safety of the new method of carotid endarterectomy versus the classical variant in a randomized study. The proposed technique of carotid endarterectomy turned out to be compatible by safety and demonstrated similar results with the classical carotid endarterectomy by the number of ischaemic strokes, transitory ischaemic attacks, and myocardial infarctions in the early and remote postoperative periods. When comparing the groups by efficiency, the primary efficacy endpoint, including cases of restenosis >50% according to the findings of ultrasonographic examination of the brachiocephalic arteries, all cases of ischaemic events (acute impairments of cerebral circulation, transitory ischaemic attacks), as well as the presence of the clinical picture of cranial nerve paresis demonstrated a significant advantage of the new technique versus the comparison group at the expense of a lower incidence of restenoses in the area of the operation during the whole period of follow up. In the group of autoarterial remodelling, the composite endpoint of outcomes occurred in 6 patients (6.1%) and in the group with the classic carotid endarterectomy - in 19 (19.6%) patients, p=0.005.

Ligation of Left Atrial Appendage during Off-Pump Coronary Surgery

The main purpose of this article is to evaluate an impact of epicardial ligation of the left atrial appendage (LAA) in patients with atrial fibrillation (AF) undergoing off-pump coronary artery bypass grafting (OPCAB) on the development of ischemic stroke and mortality. From 2009 to 2013, a total of 125 patients (86.4% men, mean age 64 ± 7 years, 95% confidence interval: 61-65 years) received a combined OPCAB and LAA ligation because of coronary artery disease and AF. All the subjects were divided into two groups: group 1 (n = 57)-LAA ligation during OPCAB, group 2 (n = 68) without LAA ligation during OPCAB. Primary endpoints were postoperative incidence of ischemic stroke and mortality. No difference in the number of ischemic stroke (0 vs. 5.9%) and death (0 vs. 4.4%) in both groups during the hospital period (p > 0.05). Median overall follow-up was 41 (22-61) months: without difference for groups (p > 0.05). During follow-up, there was a difference in the number of ischemic stroke (0 vs. 17.6%, p < 0.001), while there was no difference in mortality in two study groups (5.3 vs. 16.2%, p > 0.05). Epicardial ligation of LAA during OPCAB in patients with AF may reduce the risk of ischemic stroke in long-term follow-up and does not affect the mortality.

Abstract 141: Using Geographic Information Systems (GIS) to Analyze Statewide Regional Data - A Feasibility Project from the Kentucky Stroke Encounter Quality Improvement Project (SEQIP)

Background: The Stroke Encounter Quality Improvement Project (SEQIP) is a collaboration between certified stroke centers, the AHA/ASA and the Kentucky Department for Public Health (KDPH) to implement statewide QI initiatives to improve the care of stroke patients. From 2009 to 2018, 23 hospital in Kentucky participating in SEQIP have entered 76,222 stroke patient records into Get With The Guidelines® (GWTG) / Patient Management Tool™ (PMT). Purpose: Geographic information systems (GIS) tools can expand our understanding of care and outcomes based on patient location. The purpose of this project was to demonstrate the methods of linking a disease management registry with GIS mapping and analysis program,) to understand challenges when performing this link, and to derive meaningful insight on stroke care and outcomes by zip code. Methods: Stroke data from GWTG and PMT was compiled and downloaded by KDPH. The information was converted to a database file for use in ArcGIS. After excluding those who had missing or incomplete zip codes, records were Geocoded annually from 2009 to 2018. The data were then matched to one of 945 zip codes in Kentucky. Data were summarized by zip code, calendar year by the number of ischemic strokes; number IV alteplase administration; rate ischemic stroke receiving IV alteplase; number and rate of ischemic stroke patients arriving to hospital by EMS, privately owned vehicle or transfer; and median time from last known well to hospital arrival; and medical history of hypertension. Additional data including hospitals, certified stroke centers, drive time analysis, etc. were added to maps. Results: Mapping GWTG and PMT stroke data is feasible and may allow for additional analysis by location. Conclusion: Using GIS mapping and methodology can assist hospital stroke coordinators and public health officials in developing and implementing interventions to improvement stroke care and outcomes. Further analysis including socioeconomic, demographic and marketing/consumer preference data is planned to better understand variations by zip codes. This feasibility project provides an example of a useful application of GIS analyses applied to data registry including GWTG and PMT.

PMD15 - Economic Burden of Atrial Fibrillation in Japan

The burden of AF including stroke related costs is considered to remain substantial. The objective of this study is to assess the annual health care cost of AF in Japan. A systematic literature review was conducted through searching MEDLINE and Ichushi-Web to identify evidence used in the analysis. We estimated the total number of patients with AF in Japan based on the prevalence rate of AF and the size of Japanese population. Total costs included treatment costs of major events associated with AF (stroke and bleedings), AF treatment costs and post-event long-term care costs. AF patients are assumed to be treated with warfarin, DOACs, or no treatment. Annual drug costs and outpatient costs were included and dosage of each drugs were correlated to relevant observational studies. The incidence rates of ischemic stroke (IS), hemorrhagic stroke (HS), intracranial hemorrhage (ICH) and gastrointestinal bleeding and average cost of each event were retrieved from the literature. Treatment costs of stroke and ICH were estimated by severity of disability. Annual number of IS, HS, ICH and gastrointestinal bleeding was estimated to be approximately 23,000, 8,500, 9,400 and 14,000, respectively. The annual medical cost and long-term care cost per patient was estimated to be JPY 104,000 - 145,000. The number of AF patients in Japan was 1.32 million in 2017, therefore, the nation-wide annual medical cost and long-term care cost of AF was estimated to be approximately JPY 137.5 billion - 191.4 billion over this period. The annual medical cost and long-term care cost of AF in Japan was high. As the prevalence of AF tends to be higher in the elderly population, the incidence of AF will further increase making the impact of the burden more enormous in Japan due to a large proportion of the population entering old age.

Relationship between weather conditions and admissions for ischemic stroke and subarachnoid hemorrhage.

AimTo assess impacts of different weather conditions on hospitalizations of patients with ischemic strokes and subarachnoid hemorrhages (SAH) in South Florida.MethodsDiagnostic data of patients with spontaneous SAH and strokes were recorded between June 2010 and July 2013. Daily synchronous forecast charts were collected from the National Weather Service and the whole data were matched prospectively. The incidence rate ratio (IRR) was calculated.ResultsIncreased incidence rate of ischemic stroke was consistent with the daily lowest and highest air pressure (IRR 1.03, P = 0.128 and IRR 0.98, P = 0.380, respectively), highest air temperature (IRR 0.99, P = 0.375), and presence of hurricanes or storms (IRR 0.65, P = 0.054). Increased incidence of SAH cases was consistent with daily lowest and highest air pressure (IRR 0.87, P < 0.001 and IRR 1.08, P = 0.019, respectively) and highest air temperature (IRR 0.98, P < 0.001). Presence of hurricanes and/or tropical storms did not influence the frequency of SAH. We found no relationship between the presence of fronts and the admissions for ischemic stroke or SAH.ConclusionHigher number of ischemic stroke and SAH cases can be expected with the daily lowest and highest air pressure, highest air temperature. Presence of hurricanes or tropical storms increased the risk of ischemic stroke but not the SAH. These findings can help to develop preventive health plans for cerebrovascular diseases.

Abstract WP215: Patients with Acute Ischemic Stroke Admitted to the Hospital Closest to the Epicenter of 2016 Kumamoto Earthquake

Background: 2016 Kumamoto Earthquake in 2016 is characterized by a huge foreshock of magnitude-6.5, a magnitude-7.3 mainshock, and numerous, sustained aftershocks. Objective: To elucidate the influence of the Kumamoto Earthquake to ischemic stroke by investigating acute stroke patients who were admitted to the acute hospital located closest to the epicenter of the foreshock and mainshock during 1 month. Methods: Acute ischemic stroke patients within 7 days of onset who were admitted during April 14 and May 13, 2016, and those admitted in the same period in 2015 were investigated. Patients’ characteristics, stroke severity, subtype, onset-admission time, and laboratory data were compared between 2015 and 2016. Results: A number of acute ischemic stroke patients increased by 1.2 times from 43 (14 women) to 69 (27 women), and age was younger in 2016 (median, 72 years; interquartile range, 65-81) than in 2015 (78; 67-85; p = 0.042). No differences were observed in background characteristics, vital signs, stroke severity, or stroke subtype between the two years. Onset-to-admission time was longer in 2016 than in 2015 (951 vs. 441 minutes, p = 0.023). Among laboratory data, platelet count was higher after the earthquake, whereas other data were similar in the two years. Conclusions: Number of ischemic stroke admitted to the closest to the epicenter increased than the previous year and the time from onset to admission prolonged. These data indicate that patients were transferred from wider area after huge earthquakes. An increment of platelet was the only change observed in laboratory data after the earthquake. Multicenter, longitudinal observation would be needed to clarify the effect of the earthquake to cerebrovascular events.

Net clinical benefit of warfarin in individuals with atrial fibrillation across stroke risk and across primary and secondary care

ObjectiveTo investigate net clinical benefit (NCB) of warfarin in individuals with atrial fibrillation (AF) across stroke risk and across primary and secondary care.MethodsWe conducted a linked electronic health record cohort...

Abstract WP94: Clinical Outcomes of Unruptured Cerebral Aneurysms Treated With Clipping or Coiling in Japan: The J-aspect Study

Background: Evaluation of the overall clinical outcomes of stroke care is important for improving institutional quality of care. We performed a nationwide survey in Japan to analyze cases of unruptured cerebral aneurysms using the diagnostic procedure combination (DPC). Methods and Results: Certified neurosurgical training institutions in Japan provided data from the DPC database on patients hospitalized with neurosurgical diseases between April 1, 2012 and March 31, 2013. Patients hospitalized owing to unruptured cerebral aneurysms were identified from the DPC database based on the International Classification of Diseases (ICD)-10 diagnosis code (I671). We excluded patients with emergency admissions. We compared the mortality rates, modified Rankin Scale (mRS) scores, postoperative complications of patients who underwent clipping and coiling. With respect to postoperative complications, we evaluated the ratio of an event of complication (brain infarction, brain hemorrhage and cardiac infarction) and the number of complications (scored using patient safety indicators: PSIs and hospital-acquired conditions: HACs). We used hierarchical logistic regression models to estimate the odds ratios (ORs) for in-hospital mortality and complications. We identified 6329 patients with unruptured cerebral aneurysms (3710 clipping, 2619 coiling). Patient characteristics, mortality rates, and mRS were similar between groups. Patients who underwent coiling had a significantly lower number of complications than patients who underwent clipping (PSIs: OR = 0.40; P &lt; 0.001, HACs: OR = 0.47; P = 0.001). Adversely, there was an increased likelihood of ischemic stroke in coiling patients compared with clipping patients (coiling: 7.2%; clipping: 4.7%; OR = 1.37; P = 0.011). 83.2% of coiling patients underwent MRI after the operation, compared with 37.3% of clipping patients. Conclusions: Our data demonstrated that coiling patients had lower number of post-operative complications and higher number of ischemic stroke than clipping patients. But the cause that higher number of coiling patients had ischemic stroke than clipping patients because higher number of coiling patients were underwent MRI after operation compared with clipping patients.