Post-stroke Period Research Articles

Abstract WP207: Switching Antiplatelets In Breakthrough Ischemic Stroke: Long Term Outcomes And Safety

Introduction: Previous studies have shown that switching antiplatelets after having an ischemic stroke on aspirin may have better outcomes. However, these studies included patients who were switched to dual antiplatelets, which have an established benefit in the immediate post-stroke period. The purpose of this study is to assess outcomes in patients who continue aspirin versus switch to clopidogrel after having a cerebrovascular event on aspirin. Methods: We retrospectively identified patients within 14 Southern California hospitals using ICD-9 and ICD-10 codes who had a diagnosis of ischemic stroke on aspirin from January 2017-December 2019. Outcomes included recurrent hospital admission or emergency room visit for ischemic stroke, TIA, or intracranial hemorrhage up to two years post index event. Patients were grouped by which antiplatelet was prescribed at discharge. Those prescribed dual antiplatelets or an anticoagulant were excluded. Cox regression analysis was used to estimate risk of readmission. Results: Of the 580 patients who met the inclusion criteria, 372 (64%) continued aspirin and 208 (36%) switched to clopidogrel. Those with coronary artery disease (55.0% versus 45.0%, p = 0.015), dyslipidemia (61.4% versus 38.6%, p = 0.001), diabetes (59.5% versus 40.5%, p = 0.007), and a higher NIHSS score (mean 6.06 +/- 6.96 SD versus 4.08 +/- 4.32 SD, p = 0.001) were more likely to be discharged on aspirin. There were no differences in recurrent ischemic stroke {18.8% versus 15.4%, HR 1.12 (95% CI, 0.74-1.72), p = 0.587}, ischemic stroke plus TIA {19.9% versus 18.3%, HR (95% CI, 0.84-1.86), p = 0.253}, systemic embolism {25.5% versus 21.6%, HR 1.16 (95% CI, 0.82-1.66), p = 0.413} or intracranial hemorrhage {3.2% versus 2.4%, HR 0.94 (95% CI, 0.34-2.70), p = 0.919} between those discharged on aspirin versus clopidogrel, respectively. Conclusion: This study suggests that switching antiplatelets after having an ischemic stroke on aspirin may not be warranted.

Abstract TP197: Early Direct Oral Anticoagulants Therapy After Ischemic Stroke In Patients With And Without Atrial Fibrillation:A Pooled Analysis Of Five Studies

Introduction: Early anticoagulation after acute ischemic stroke is usually avoided due to the risk of hemorrhagic transformation (HT). We aimed to assess the rate of radiological HT associated with direct oral anticoagulant (DOAC) initiation within 48 hours vs. > 48 hours in the post-stroke period. Methods: A pooled analysis of five studies of DOAC initiation within 14 days of ischemic stroke onset was conducted. The primary endpoint was incident radiographic HT on follow-up imaging. Secondary endpoints included symptomatic HT, new parenchymal hemorrhage (PH1 or asymptomatic PH2), recurrent systemic events, systemic hemorrhagic complications, mortality within the study period, final modified Rankin Scale score. The results were reported as odds ratio (OR) with 95% confidence interval (CI). Results: A total of 468 patients were enrolled. Median infarct volume was 1.35 (0-7.5) ml, and National Institutes of Health Stroke Scale was 1 (0-3). Incident radiographic HT was seen on follow-up scan in 29 patients. DOAC initiation within 48 hours from index event onset was not associated with incident HT (adjusted OR 0.67, [0.31 - 1.50] P =0.34). No patients developed symptomatic HT. Conversely, 25 patients developed recurrent ischemic events, 64% of which occurred within 14 days. Initiating DOAC within 48 hours of onset was not associated with a reduction in the risk of recurrent ischemic events (OR 0.47, [0.19 - 1.20] P =0.12). In contrast to HT, recurrent ischemic events were associated with poor functional outcomes (OR=6.8, [2.95 - 15.63], p<0.0001). Conclusions: Early DOAC initiation after stroke was not associated with increased incident HT risk. Recurrent ischemic events were common and associated with poor outcomes. These data may be useful for estimating outcome rates and sample size calculations in future trials of early versus late DOAC initiation after AF-related stroke.

Телереабилитация пациентов, перенесших инсульт: современные тенденции в системе здравоохранения России

With age, the risk of stroke increases significantly, but at the same time, there are tendencies for an increase in its prevalence in young and middle-aged people, which determines the urgency of the problem of rehabilitation treatment after stroke both in the world and in Russia. The use of digital technologies in neurorehabilitation can be very multifaceted and extensive. Telerehabilitation as an innovative direction of telemedicine is an important aspect within the framework of the national project «Healthcare» and the program «Digital Economy of the Russian Federation». P u r p o s e of the study is to analysis of the Russian experience of organizing and conducting telerehabilitation of post-stroke period in the context of the digital transformation of the healthcare system in Russia. M a t e r i a l s a n d m e t h o d s . The article used technologies for searching and selecting information using search engines (www.google.ru, www.yandex.ru), specialized and bibliographic databases (PubMed, eLIBRARY.RU), methods of analysis and synthesis, analytical data processing. R e s u l t s . The study showed that telerehabilitation has a high clinical value of adherence to the treatment of patients of post-stroke period and is not a separate type of medical activity, but an innovative therapeutic and prophylactic method that expands the possibilities of therapy and improves the process of interaction in the «doctor-patient» and «doctor-doctor» communication systems. This technology of restorative telemedicine makes it possible to increase the level of scientific knowledge, skills and abilities of healthcare organizers and medical workers in order to strengthen the national healthcare system of Russia, as well as to rationally use the scientific and practical potential of digital solutions in interdisciplinary interaction of specialists dealing with medical neurorehabilitation, significantly expanding the coverage of the population telerehabilitation services after a stroke. F i n d i n g s . Despite the positive experience of some medical organizations in Russia in the use of telerehabilitation, this direction is still in its infancy and is likely to develop in the coming years for the rehabilitation of many stroke patients, which will help healthcare organizers, doctors and patients and other interdisciplinary specialists effectively and interact seamlessly in the digital health ecosystem in the context of the development of patient-centered medicine.

The Impact of Cortical Cerebral Microinfarcts on Functional Outcomes in Patients With Ischemic Stroke.

The present study examined cortical cerebral microinfarcts (CMIs) on a 3T magnetic resonance imaging and investigated the impact of CMIs on the comprehensive functional outcomes during the post-stroke rehabilitation period. Patients with acute phase of first-ever ischemic stroke were retrospectively recruited (n = 62) and divided into 2 groups with and without CMIs. Clinical parameters including age, sex, stroke lesion laterality, location, the National Institutes of Health Stroke Scale score, as well as history of hypertension, dyslipidemia, diabetes mellitus, and smoking were obtained. Functional outcomes were assessed twice at baseline and one month later with the Korean version of the Mini-Mental State Examination, the Berg balance scale (BBS), and the functional independence measure. Partial correlation and multiple linear regression analyses were used to examine the relationship between the presence of CMIs and the change in functional outcomes. At least one CMI was reported in 27 patients, who were older (p = 0.043). The presence of CMIs was significantly associated with functional impairment in all 3 functional outcomes, after controlling for confounding factors (p < 0.05). CMIs might contribute to poor functional outcomes during the post-stroke rehabilitation period. These results suggest that CMIs should be considered when establishing rehabilitation treatment strategies or making a prognosis.

Medication-Adherence and Management of Risk Factors for Secondary Prevention of Stroke Using Smartphone-Based Application: Protocol for MAMORs-Randomized Controlled Trial.

In LMICs, the medication adherence and risk factor control are suboptimal in the post-stroke follow-up period. With shortage of physicians, smartphone-based interventions can help stroke survivors in secondary stroke prevention. We aim to validate a digital innovative technology-based intervention to improve the awareness, medication adherence, control of risk factors through timely intervention of physician among the stroke survivors. MAMOR is a smartphone-based application to improve the stroke awareness by heath education materials, reminders to timely adherence of medication, alerts on control of risk factors, video files, and timely physician intervention. The study will involve development of the app using contextual research (Delphi qualitative method) followed by a randomized, single center, double arm-controlled trial with 1:1 assignment. The app will be evaluated over a period of 6 months with a target to enroll 192 participants. Process evaluation will be conducted. The sample size was calculated as 192, considering medication adherence of 43.8%, 20% increase in medication adherence by app, power of 80%, and 10% loss to follow-up. The primary outcome will be medication adherence, changes in the lifestyle and behavioral and control of vascular risk factors. The secondary outcome will include vascular events and functional outcome. This study will be one among the few studies for secondary prevention of stroke through digital technology innovation in LMICs with resource constraints. The evidences generated from this study will provide translational evidence for other similar settings for stroke survivors.

Chapter 25 - Rehabilitation of visual perception in cortical blindness

Blindness is a common sequela after stroke affecting the primary visual cortex, presenting as a contralesional, homonymous, visual field cut. This can occur unilaterally or, less commonly, bilaterally. While it has been widely assumed that after a brief period of spontaneous improvement, vision loss becomes stable and permanent, accumulating data show that visual training can recover some of the vision loss, even long after the stroke. Here, we review the different approaches to rehabilitation employed in adult-onset cortical blindness (CB), focusing on visual restoration methods. Most of this work was conducted in chronic stroke patients, partially restoring visual discrimination and luminance detection. However, to achieve this, patients had to train for extended periods (usually many months), and the vision restored was not entirely normal. Several adjuvants to training such as noninvasive, transcranial brain stimulation, and pharmacology are starting to be investigated for their potential to increase the efficacy of training in CB patients. However, these approaches are still exploratory and require considerably more research before being adopted. Nonetheless, having established that the adult visual system retains the capacity for restorative plasticity, attention recently turned toward the subacute poststroke period. Drawing inspiration from sensorimotor stroke rehabilitation, visual training was recently attempted for the first time in subacute poststroke patients. It improved vision faster, over larger portions of the blind field, and for a larger number of visual discrimination abilities than identical training initiated more than 6 months poststroke (i.e., in the chronic period). In conclusion, evidence now suggests that visual neuroplasticity after occipital stroke can be reliably recruited by a range of visual training approaches. In addition, it appears that poststroke visual plasticity is dynamic, with a critical window of opportunity in the early postdamage period to attain more rapid, more extensive recovery of a larger set of visual perceptual abilities.

December 2021 Stroke Highlights

December 2021 <i>Stroke</i> Highlights

HEART FUNCTIONAL STATE IN PATIENTS AFTER ISCHEMIC STROKE

This article discusses the functional status of the heart in patients after ischemic stroke. The widespread introduction of cardiological diagnostic methods into angioneurological practice not onlyexpanded the understanding of the causes of ischemic stroke, but also demonstrated the fact that a number of serious cardiac diseases can be asymptomatic for a long time and manifest as a stroke. Therefore, the study of the state of the cardiovascular system (CVS) is one of the main conditions for improving the treatment of patients in the post-stroke period and improving the immediate and long-term prognosis

End-of-Life Care Decision-Making in Stroke.

Stroke is one of the leading causes of death and long-term disability in the United States. Though advances in interventions have improved patient survival after stroke, prognostication of long-term functional outcomes remains challenging, thereby complicating discussions of treatment goals. Stroke patients who require intensive care unit care often do not have the capacity themselves to participate in decision making processes, a fact that further complicates potential end-of-life care discussions after the immediate post-stroke period. Establishing clear, consistent communication with surrogates through shared decision-making represents best practice, as these surrogates face decisions regarding artificial nutrition, tracheostomy, code status changes, and withdrawal or withholding of life-sustaining therapies. Throughout decision-making, clinicians must be aware of a myriad of factors affecting both provider recommendations and surrogate concerns, such as cognitive biases. While decision aids have the potential to better frame these conversations within intensive care units, aids specific to goals-of-care decisions for stroke patients are currently lacking. This mini review highlights the difficulties in decision-making for critically ill ischemic stroke and intracerebral hemorrhage patients, beginning with limitations in current validated clinical scales and clinician subjectivity in prognostication. We outline processes for identifying patient preferences when possible and make recommendations for collaborating closely with surrogate decision-makers on end-of-life care decisions.

Blood Pressure Management After Endovascular Thrombectomy.

Endovascular thrombectomy (EVT) has changed the landscape of acute stroke therapy and has become the standard of care for selected patients presenting with anterior circulation large-vessel occlusion (LVO) stroke. Despite successful reperfusion, many patients with LVO stroke do not regain functional independence. Particularly, patients presenting with extremes of blood pressure (BP) or hemodynamic variability are found to have a worse clinical recovery, suggesting blood pressure optimization as a potential neuroprotective strategy. Current guidelines acknowledge the lack of randomized trials to evaluate the optimal hemodynamic management during the immediate post-stroke period. Following reperfusion, lower blood pressure targets may be warranted to prevent reperfusion injury and promote penumbral recovery, but adequate BP targets adjusted to individual patient factors such as degree of reperfusion, infarct size, and overall hemodynamic status remain undefined. This narrative review outlines the physiological mechanisms of BP control after EVT and summarizes key observational studies and clinical trials evaluating post-EVT BP targets. It also discusses novel treatment strategies and areas of future research that could aid in the determination of the optimal post-EVT blood pressure.

The use of elements of occupational therapy in the rehabilitation of speech of persons in the post-stroke period

The article is devoted to the problem of rehabilitation of persons in the post-stroke period. The aim of the study was to use elements of occupational therapy in the rehabilitation of speech of persons in the post-stroke period. The authors, based on the position of the researchers, consider stroke as a medi- cal and social problem that needs to be solved in our society, since it is a common cause of disability of patients, caused in most cases not only by motor disorders, but also by violations of the articulatory apparatus, which leads to social isolation of a person. The article reveals the problems of speech restoration as one of the most important elements of complex rehabilitation of persons in the post-stroke period. The authors, based on their practical work with people in the post-stroke period, clearly and consistently show that among the predominant dis- orders after a stroke is speech loss or its defects. The authors propose the problems of speech recovery in the post-stroke period with the help of elements of occupational therapy. According to the authors, in the course of experimental work, the use of occupational therapy elements leads to “forced” com- munication, training of nervous processes, correct interaction of various systems in the brain, motivation of communicative activity, and therefore, to the restoration of speech. For the first time in Kazakhstan, the article describes the experience of solving the problem of speech after a stroke of Kazakh-speaking people, based on the features of the language they spoke before the stroke. The authors describe the long-term work of the authors themselves with the use of elements of oc- cupational therapy to restore the speech of persons in the post-stroke period, which gave positive results. The results of the study can be used by speech therapists, psychologists, social workers in practical work. It is possible to apply the results of the study in the practice of rehabilitation work after a stroke. Key words: post-stroke period, speech disorders, speech rehabilitation, elements of occupational therapy, examination, formation, result.

Development of Supportive-Educative Range of Motion Exercise for Post-stroke Patients: A Pilot Study

The purpose of this pilot study was to assess of home care intervention on post-stroke related outcome of range of motion and muscle strength. Sample in 40 participants were divided into the intervention group and control group and included in this study according to the following criteria: post-stroke period of &lt;12 months with hemiparesis, age of ≥18 years, and willingness to participate in the study. The intervention was carried out by nurses by providing education for 2 consecutive days and mentoring for 5 consecutive days, while the control group was given standard care and measured using a grip track, handheld dynamometer, and goniometer examination on June to September 2019. For the intervention group, paired t-test analysis confirmed a significant increase in the mean upper extremity muscle strength before (35.770 ± 46.063) and after (51.073 ± 50.866) the 7 day intervention ( p = .002), whereas the control group showed a value 36.570 ± 33.684 and then 31.400 ± 31.760 p = .256 and lower extremity strength before (3.627 ± 1.585) and after (4.365 ± 1.698) the 7-days intervention ( p = .000), whereas the control group showed a value 3.657 ± 1.671 and then 4.043 ± 1.849 p = .013. Almost all the items assessed from Range of Motion (ROM) in the upper and lower extremities showed a significant increase ( p &lt; .05). Supportive-educative ROM exercise significantly contributed to an increase in the average muscle strength and ROM in post-stroke patients.

The Role of Social Connection/Engagement in Episodic Memory Change in Stroke.

Positive associations between social connection/engagement and cognitive function are well documented. However, little is known about whether social connection/engagement can buffer the impact of serious brain injury such as stroke on cognitive functioning. Participants were 898 individuals with incident stroke from the Health and Retirement Study between 1998 and 2012. Multilevel modeling was used to examine how social connection/engagement was associated with episodic memory pre- and poststroke. Models controlled for age, gender, education, race/ethnicity, number of health conditions, and functional health. Participants who were lonely prestroke recalled significantly fewer words at the time of stroke, and participants who had children residing within 10 miles prestroke showed significantly less decline in word recall over time. Participants who provided help to others prestroke showed less stroke-related decline in word recall. Within-person increase in partnered status, having friends, and helping others were related to better word recall in the poststroke period. Higher prestroke levels of social connection/engagement predicted better episodic memory at stroke, a smaller decline in episodic memory with stroke, and less decline in episodic memory over time. Increases in social connection/engagement from pre- to poststroke also predicted better poststroke episodic memory. Beyond the widely documented benefits of social connection/engagement to well-being, they may also increase cognitive stimulation and cognitive reserve and thus contribute to stroke recovery in the cognitive domain. Social connection/engagement is an important and modifiable risk factor in older adults.

High Risk Features Contributing to 30-Day Readmission After Acute Ischemic Stroke: A Single Center Retrospective Case-Control Study.

Risk of 30-day stroke readmission has been attributed to medical comorbidities, stroke severity, and hospitalization metrics. The leading etiologies appear to vary across institutions and remain a moving target. We hypothesized that patients with increased medical complexity have higher odds of 30-day readmission and the immediate time after discharge may be most vulnerable. We aimed to characterize patients with 30-day readmission after acute ischemic stroke (IS) and identify predictors of post-IS readmission. We performed a retrospective case-control study analyzing post-IS 30-day readmission between January 2016-December 2019 using data from Mount Sinai Hospital's Get With The Guidelines database. We performed chi square analyses and multivariate adjusted logistic regression model including age, sex, coronary artery disease (CAD), renal insufficiency (RI), history of prior stroke or TIA, length of stay (LOS) > 7, and NIHSS ≥ 5. 6.7% (n = 115) of 1,706 IS encounters had 30-day readmission. The 115 cases were compared to 1,591 controls without 30-day readmission. In our adjusted model, CAD (OR = 1.7, p = 0.01), history of prior stroke or TIA (OR = 1.6, p = 0.01), LOS >7 (OR = 1.7, p = 0.02), and NIHSS ≥ 5 (OR = 4.5, p < 0.001) predicted 30-day readmission. 65% (n = 75) of readmitted patients had readmission within 14 days post-discharge. Patients with post-IS 30-day readmission were more likely to have complex medical comorbidities and history of stroke or TIA compared to controls. Patients with more severe stroke and longer LOS may benefit from individualized transition of care plans and closer follow up during the vulnerable 30-day post-stroke period.

The Strength of the Corticospinal Tract Not the Reticulospinal Tract Determines Upper-Limb Impairment Level and Capacity for Skill-Acquisition in the Sub-Acute Post-Stroke Period

Background. Upper-limb impairment in patients with chronic stroke appears to be partly attributable to an upregulated reticulospinal tract (RST). Here, we assessed whether the impact of corticospinal (CST) and RST connectivity on motor impairment and skill-acquisition differs in sub-acute stroke, using transcranial magnetic stimulation (TMS)–based proxy measures. Methods. Thirty-eight stroke survivors were randomized to either reach training 3-6 weeks post-stroke (plus usual care) or usual care only. At 3, 6 and 12 weeks post-stroke, we measured ipsilesional and contralesional cortical connectivity (surrogates for CST and RST connectivity, respectively) to weak pre-activated triceps and deltoid muscles with single pulse TMS, accuracy of planar reaching movements, muscle strength (Motricity Index) and synergies (Fugl-Meyer upper-limb score). Results. Strength and presence of synergies were associated with ipsilesional (CST) connectivity to the paretic upper-limb at 3 and 12 weeks. Training led to planar reaching skill beyond that expected from spontaneous recovery and occurred for both weak and strong ipsilesional tract integrity. Reaching ability, presence of synergies, skill-acquisition and strength were not affected by either the presence or absence of contralesional (RST) connectivity. Conclusion. The degree of ipsilesional CST connectivity is the main determinant of proximal dexterity, upper-limb strength and synergy expression in sub-acute stroke. In contrast, there is no evidence for enhanced contralesional RST connectivity contributing to any of these components of impairment. In the sub-acute post-stroke period, the balance of activity between CST and RST may matter more for the paretic phenotype than RST upregulation per se.

Poor risk factor control among stroke survivors - A cross-sectional survey

Objectives: A cross-sectional survey was done to find out the prevalence and control status of cardiovascular risk factors among stroke survivors within a post-stroke period of 3 months to 1 year. Methodology: The data on the prevalence of risk factors were taken from past medical history and medical records. The risk factor control is defined as achieving the targeted levels of blood pressure, blood sugars and cholesterol. Data on a diet, physical activity, tobacco use, and alcohol consumption were also collected. Standard instruments were used to measure blood pressure, weight, height, and waist circumference (WC). The blood sugar and lipid values were taken from labratory reports. Results: Stroke survivors (N = 240) participated. Around 75% of the participants were obese or overweight. Normal WC was found only in 25% of the participants. Majority of the participants were not following a healthy diet (62.5%) or doing recommended physical activity (87.1%). The prevalence of diabetes (61.2%), hypertension (88.6%), and dyslipidemia (96%) were high among stroke survivors. The targeted level of diabetic control and hypertension control level was achieved by 26% and 36.2, respectively, while around 72% attained lipid control. Conclusion: The prevalence of cardiovascular risk factors is very high among stroke survivors, and it is poorly controlled.

Assessment of the effectiveness of antihypertensive therapy in the early post-stroke period of ischemic stroke based on indicators of arterial stiffness

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Globally, stroke is the second leading cause of death, leading to a reduction in life expectancy and disability of patients. It seems important to study and introduce into practical health care both new approaches to stroke prevention and measures aimed at full recovery in the post-stroke period. Purpose To assess the antihypertensive therapy (AHT) in patients with arterial hypertension (AH) in the early post-stroke period of ischemic stroke (IS), based on indicators of arterial stiffness. Methods The study included 180 patients with hypertension (mean age 64 years) in the acute period of ischemic stroke (IS). Inclusion criteria in this trial: AH, age over 40 years, time from the onset of stroke no more than 48 hours. Arterial stiffness was assessed by an oscillometric method with an assessment of the 24-hour reflected wave transit time (RWTT), aortic augmentation index (AIxao)), arterial stiffness index (ASI), and pulse wave velocity (PWV). The indicators were assessed at the time of admission, at the time of discharge from the hospital (14-21 days) and 2 months after discharge. We determined endothelin-1 (ET-1) levels by ELISA at admission and 2 months after discharge. Retrospectively, patients were divided into 5 groups depending on the prescribed AHT: group 1 (48 patients) - ACEIs/ARBs, thiazide-like diuretics (TLDs), group 2 (46 people) - ACEIs/ARBs, nondihydropyridine calcium antagonists (ACs) and beta-blockers (BBs), group 3 (39 people) - ACEIs/ARBs and ACs, group 4 (26 patients) - ACEIs/ARBs and BBs, group 5 (21 people) - ACEIs/ARBs, TLDs and BBs. Results AHT showed a positive trend in terms of arterial stiffness in all 5 groups. Compared with the baseline values, the significant decrease in PWV (12.4 ± 1.7m/s vs 10.9 ± 1.8m/s, p &amp;lt; 0.01), AIxao (39.8 ± 6.3% vs 36.8 ± 5,2%, p &amp;lt; 0.001), ASI (167.9(127.0;174.5) vs 158.8(115.0;168.7)), p &amp;lt; 0.05), increased RWTT (98.0 ± 9.8ms vs 105.3 ± 7.5ms) in group 2 of patients were found. After 2 months, when comparing indicators between groups the significant decrease in PWV to 9.1(8.7; 11.6)m/s, p &amp;lt; 0.01), AIxao to 31.7(29.8;41.9)%, p &amp;lt; 0.01, an increase in RWTT to 107.7(102.4; 110.2)ms, p &amp;lt; 0.01 in the group of patients taking ACEIs/ARBs, ACs and BBs were detected. After 2 months after discharge, a significant decrease of ET-1 was also observed in group 2 (5.8 ± 2.2ng/ml vs 4.2 ± 1.8ng/ml). The combination of ACEs/ARBs and BBs showed the least effectiveness in reducing arterial stiffness. Conclusions The combination of ACEIs/ARBs, ACs and BBs showed the greatest efficiency in reducing the stiffness in patients with hypertension in the early post-stroke period of IS. It seems important for the functional recovery of patients in the post-stroke period to use the drug therapy aimed not only at lowering blood pressure, but also favorably affecting the arterial stiffness.

Facilitators and barriers to medication adherence among stroke survivors in India

Strict compliance with medication and life style modification are integral to secondary stroke prevention. This study was undertaken to find out medication adherence among stroke survivors and factors associated with it. Cross sectional survey among stroke survivors was conducted. Interview based self-reported medication adherence was defined as consumption at least >80% of their medications for last two weeks, based on last prescription. Structured interview using pretested interview schedule was done to collect other data. Sequential step wise logistic regression analysis was done to find out the facilitators and barriers to medication adherence. Two hundred and forty stroke survivors (mean age 58.64 ± 10.96 years; 25.4% females) with a mean post-stroke period of 6.65 ± 3.36 months were participated. Overall medication adherence was 43.8% (n = 105). Medication adherence was 34.3% (n = 134), 52.6% (n = 190) and 56.7% (n = 224) for antidiabetics, antihypertensives and statins respectively and was associated with risk factor control (Diabetes: Odds Ratio (OR) = 4.85; 95% Confidence Interval (CI) 2.12–11.08, Hypertension: OR = 3.42; 95% CI 1.83–6.4, Dyslipidaemia: OR = 3.88; 95% CI 1.96–4.04). Having daily routine (OR = 2.82; 95% CI 1.52–5.25), perceived need of medication (OR = 2.33; 95% CI 1.04–5.2) and perceived poor state of health (OR = 2.65; 95% CI 1.30–5.40) were facilitators. Memory issues (OR = 0.34; 95% CI 0.16–0.71), side effects (OR = 0.24; 95% CI 0.11–0.42) and financial constraints (OR = 0.46; 95% CI 0.24–0.91) were barriers to medication adherence. Establishing daily routines, periodic reminders, financial supports to buy medicines and patient education can enhance medication adherence to prevent future strokes.

Intra-Individual Variability of the Utility Weighted Modified Rankin Scale in the Initial Post-Stroke Period (1736)

Intra-Individual Variability of the Utility Weighted Modified Rankin Scale in the Initial Post-Stroke Period (1736)

April 2021 Stroke Highlights

April 2021 <i>Stroke</i> Highlights