Primary Diagnosis Of Stroke Research Articles

Frailty among stroke patients and its effects on hospital outcomes

BackgroundAlthough assessment of frailty is increasingly being included in routine practice, its effects on hospital outcomes is not well studied. In this study, we used a national database to estimate the effects of frailty on hospital outcomes among stroke patients. MethodsThis study was a retrospective analysis of data from Nationwide Inpatient Sample (NIS) database collected during the years 2016 to 2019. Adult patients 45 years and older with a primary diagnosis of stroke were included for the analysis. Primary outcome was frequency of frailty among stroke patients. Secondary outcomes were in-hospital mortality, prolonged length of stay, mechanical ventilation, and acute renal failure. Frailty levels were assessed by using the Hospital Frailty Risk Score (HFRS). ResultsAmong 2,031,085 stroke hospitalizations, 362,140 (17.8 %) were non-frail, 1,333,000 (65.6 %) were pre-frail, and 335,945 (16.6 %) were frail. Regression analysis showed that the odds of mortality were significantly higher among frail (aOR, 2.82, 95 % CI: 2.63–3.04) and pre-frail (aOR, 1.62, 95 % CI: 1.53–1.73) patients, compared to non-frail patients. Similarly, the odds of mechanical ventilation were significantly higher among frail (aOR, 9.72, 95 % CI: 8.84–10.69) and pre-frail (aOR, 3.41, 95 % CI: 3.12–3.73) patients. The odds of acute renal failure were significantly higher among frail (aOR, 6.96, 95 % CI: 6.62–7.33) and pre-frail (aOR, 2.94, 95 % CI: 2.80–3.08) patients. ConclusionCollaborative efforts by neurologists, neurosurgeons, and physiatrists towards identifying frailty and incorporating it in risk estimation measures could help improve management strategies, resource utilization, and optimization of patient outcomes among frail stroke patients.

Association of Rate of Functional Recovery With Therapy Time and Content Among Adults With Acquired Brain Injuries in Inpatient Rehabilitation

ObjectiveTo examine associations among the time and content of rehabilitation treatment with self-care and mobility functional gain rate for adults with acquired brain injury. DesignRetrospective cohort study using electronic health record and administrative billing data. SettingInpatient rehabilitation unit at a large, academic medical center. ParticipantsAdults with primary diagnosis of stroke, traumatic brain injury, or nontraumatic brain injury admitted to the inpatient rehabilitation unit between 2012 and 2017 (N=799). InterventionsNot applicable. Main Outcome MeasuresGain rate in self-care and mobility function, using the Functional Independence Measure. Hierarchical regression models were used to identify the contributions of baseline characteristics, units, and content of occupational therapy, physical therapy, and speech-language pathology treatment to functional gain rates. ResultsMedian length of rehabilitation stay was 10 days (interquartile range, 8-13d). Patients received an mean of 10.62 units of therapy (SD, 2.05) daily. For self-care care gain rate, the best-fitting model accounted for 32% of the variance. Occupational therapy activities of daily living units were positively associated with gain rate. For mobility gain rate, the best-fitting model accounted for 37% of the variance. Higher amounts of physical therapy bed mobility training were inversely associated with mobility gain rate. ConclusionsMore activities of daily living in occupational therapy is associated with faster improvement on self-care function for adults with acquired brain injury, whereas more bed mobility in physical therapy was associated with slower improvement. A potential challenge with value-based payments is the alignment between clinically appropriate therapy activities and the metrics by which patient improvement are evaluated. There is a risk that therapists and facilities will prioritize activities that drive improvement on metrics and deemphasize other patient-centered goals.

Stroke Risk Reduction in Migraine Patients Using Propranolol: Evidence from Two Large-Scale Real-World Data Analyses.

Propranolol, a non-selective beta-blocker, is commonly used for migraine prevention, but its impact on stroke risk among migraine patients remains controversial. Using two large electronic health records-based datasets, we examined stroke risk differences between migraine patients with- and without- documented use of propranolol. This retrospective case-control study utilized EHR data from the Vanderbilt University Medical Center (VUMC) and the All of Us Research Program. Migraine patients were first identified based on the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria using diagnosis codes. Among these patients, cases were defined as those with a primary diagnosis of stroke following the first diagnosis of migraine, while controls had no stroke after their first migraine diagnosis. Logistic regression models, adjusted for potential factors associated with stroke risk, assessed the association between propranolol use and stroke risk, stratified by sex and migraine subtype. A Cox proportional hazards regression model was used to estimate the hazard ratio (HR) for stroke risk at 1, 2, 5, and 10 years from baseline. In the VUMC database, 378 cases and 15,209 controls were identified, while the All of Us database included 267 cases and 6,579 controls. Propranolol significantly reduced stroke risk in female migraine patients (VUMC: OR=0.52, p=0.006; All of Us: OR=0.39, p=0.007), but not in males. The effect was more pronounced for ischemic stroke and in females with migraines without aura (MO) (VUMC: OR=0.60, p=0.014; All of Us: OR=0.28, p=0.006). The Cox model showed lower stroke rates in propranolol-treated female migraine patients at 1, 2, 5, and 10 years (VUMC: HR=0.06-0.55, p=0.0018-0.085; All of Us: HR=0.23, p=0.045 at 10 years). Propranolol is associated with a significant reduction in stroke risk, particularly ischemic stroke, among female migraine without aura patients. These findings suggest that propranolol may benefit stroke prevention in high-risk populations.

Thrombocytopenia and In-hospital outcomes in patients with acute ischemic stroke undergoing intravenous thrombolysis: Findings from a nationwide registry study in China

Background and ObjectiveOur study aimed to evaluate the associations between platelet count (PC) and in-hospital outcomes for patients with stroke after rt-PA intravenous thrombolysis. MethodsWe identified patients who had been hospitalized with a primary diagnosis of stroke and had received rt-PA intravenous thrombolysis from June 2015 to July 2019 at participating hospitals in the Chinese Stroke Center Alliance. PC measured before intravenous thrombolysis was categorized into the following four groups: severe thrombocytopenia (PC < 100 × 109/L), mild thrombocytopenia (100 ≤ PC < 150 × 109/L), normal PC (150 ≤ PC ≤ 450 × 109/L), and thrombocythemia (PC > 450 × 109/L). Outcomes were determined from clinical data collected during hospitalization. The primary clinical outcome was symptomatic intracranial hemorrhage (sICH). Secondary outcomes were mortality, bleeding events, gastrointestinal (GI) hemorrhage, and in-hospital stroke recurrence. We used multivariate logistic regression models to evaluate the associations between PC and outcomes. ResultsWe included 44,882 individuals with a median age of 66 years, of whom 34.7 % were female, 951 (2.1 %) had severe thrombocytopenia, 7218 (16.1 %) had mild thrombocytopenia, 36,522 (81.4 %) had a normal PC, and 191 (0.4 %) had thrombocythemia. Both severe and mild thrombocytopenia groups had higher risks of bleeding events (adjusted OR 1.30; 95 % CI,1.01-1.67; p = 0.045; adjusted OR 1.32; 95 % CI,1.19-1.46; p < 0.001) and sICH (adjusted OR 1.48;95 % CI,1.13-1.94; p = 0.005; adjusted OR 1.43;95 % CI,1.27-1.60; p < 0.001) than the normal PC group. Patients with 100 ≤ PC < 150 × 109/L also had a higher risk of in-hospital stroke recurrence (adjusted OR 1.12; 95 % CI,1.02-1.22; p = 0.02). ConclusionsIntravenous thrombolysis brings a high risk of sICH given PC < 150 × 109/L, especially PC < 100 × 109/L. It indicated that PC < 100 × 109/L is a reasonable contraindication to thrombolysis.

Utilizing machine learning to facilitate the early diagnosis of posterior circulation stroke

BackgroundPosterior Circulation Syndrome (PCS) presents a diagnostic challenge characterized by its variable and nonspecific symptoms. Timely and accurate diagnosis is crucial for improving patient outcomes. This study aims to enhance the early diagnosis of PCS by employing clinical and demographic data and machine learning. This approach targets a significant research gap in the field of stroke diagnosis and management.MethodsWe collected and analyzed data from a large national Stroke Registry spanning from January 2014 to July 2022. The dataset included 15,859 adult patients admitted with a primary diagnosis of stroke. Five machine learning models were trained: XGBoost, Random Forest, Support Vector Machine, Classification and Regression Trees, and Logistic Regression. Multiple performance metrics, such as accuracy, precision, recall, F1-score, AUC, Matthew’s correlation coefficient, log loss, and Brier score, were utilized to evaluate model performance.ResultsThe XGBoost model emerged as the top performer with an AUC of 0.81, accuracy of 0.79, precision of 0.5, recall of 0.62, and F1-score of 0.55. SHAP (SHapley Additive exPlanations) analysis identified key variables associated with PCS, including Body Mass Index, Random Blood Sugar, ataxia, dysarthria, and diastolic blood pressure and body temperature. These variables played a significant role in facilitating the early diagnosis of PCS, emphasizing their diagnostic value.ConclusionThis study pioneers the use of clinical data and machine learning models to facilitate the early diagnosis of PCS, filling a crucial gap in stroke research. Using simple clinical metrics such as BMI, RBS, ataxia, dysarthria, DBP, and body temperature will help clinicians diagnose PCS early. Despite limitations, such as data biases and regional specificity, our research contributes to advancing PCS understanding, potentially enhancing clinical decision-making and patient outcomes early in the patient’s clinical journey. Further investigations are warranted to elucidate the underlying physiological mechanisms and validate these findings in broader populations and healthcare settings.

Abstract WP48: Prescription Rate for Antihyperglycemic Medication With Proven Cardiovascular Benefit at Discharge in Stroke Patients Not Equal Among Payer Sources

Background: Mortality doubles in stroke patients when Diabetes Mellitus (DM) is present. Target: Type 2 Diabetes SM (TT2DM) is an American Heart Association® (AHA) initiative focused on providing evidence-based guideline (EBG) resources to mitigate risk in hospitalized stroke patients with DM. Participating Get With The Guidelines® (GWTG)-Stroke hospitals track EBG data to improve outcomes. TT2DM initiative has10 EBG data elements related to stroke and the DM subpopulation. The measure&amp;nbsp; Antihyperglycemic Medication with Proven Cardiovascular (CVD) Benefit at Discharge in Stroke Patients with DM (AMPB) has low compliance. Further data analysis was needed. Methods: GWTG®-Stroke DM reports specific to AMPB were reviewed from Jan.1, 2020-Dec. 21, 2022, from 51 Wisconsin Coverdell Stroke hospitals. Analysis comprised of 5,045 patients with a primary diagnosis of stroke and history of DM or newly identified DM in the denominator. The numerator was satisfied when patients were prescribed a GLP-1 Receptor Agonist or SGLT-2 Inhibitor at discharge. Measure compliance was further delineated according to payment source. Payer sources were identified as: self-pay, Medicaid, Medicare, and Private/HMO. Findings: In the specified timeframe, 11.7% of patients received AMPB. Compliance variation exists across payer source. Only 2.3% identified as self-pay were prescribed AMPB at discharge. Differences in compliance rates were 10% for Medicare, 13.5% Medicaid, and 15.3% with private insurance/HMO. Conclusions: Discharge prescription rate for AMPB has low compliance, further variation exists among patient payer sources. Items for consideration are higher cost of medication and thus payer status are driving factors in prescribing rates. Additional barriers may exist as discharge clinicians may not feel DM management is their responsibility, along with existing medication knowledge gaps. Providing EBC requires shared decision making to ensure proper follow up. Engaging a multidisciplinary approach at discharge to verify insurance coverage, alternate cost options, and follow-up needs may enhance compliance. Future considerations are to assess race “within” payer source to gauge if there is disparate care.

In hospital outcomes and mortality predictors of multiple myeloma on stroke hospitalizations: A multivariable logistic regression study on the National Inpatient Sample Database.

e20048 Background: Multiple Myeloma (MM) patients have a higher risk of stroke due to a hypercoagulable state. A study by Liu et al. 2014 reported a 1.23 times higher incidence of stroke in MM patients compared to the matched cohort. Another study by Lee et al. 2016 reported a 5-year estimated cumulative incidence rate of 7.45%. Bortezomib therapy is an independent risk factor for stroke. However, data on the inpatient outcomes of MM on stroke hospitalizations is limited. Therefore, we conducted a nationwide population-based study investigating in-hospital outcomes and mortality predictors of MM in stroke hospitalizations. Methods: The national inpatient sample database from 2016-2019 was queried to identify patients with a primary diagnosis of stroke and stratified based on the presence of MM as a secondary diagnosis. The adjusted odds ratios (aOR) of in-hospital outcomes were calculated using multivariable logistic regression using STATA v.17 software. The primary outcome was in-hospital mortality. Results: A total of 2,028,240 weighted hospitalizations with stroke were identified between 2016-2019, of which 4,240 were associated with MM. On adjusted analysis, stroke-MM patients have statistically significant higher odds of in-hospital mortality (aOR 1.33, CI 1.01-1.40, P&lt;0.001). Furthermore, the presence of fluid and electrolyte imbalance, complicated diabetes mellitus, and coagulopathy were found to be independent predictors of mortality. However, the odds of major adverse cardiovascular events (MACE), acute myocardial infarction (AMI), and cardiac arrest were similar between stroke patients with and without MM. Bleeding risk was not assessed, given the low sample size. Additionally, no significant statistical difference was found between the two cohorts regarding the length of hospital stay and cost of hospital stay. Conclusions: Stroke patients with MM have significantly higher odds of in-hospital mortality than those without MM. Given the increased mortality risk, physicians should pay particular attention to optimizing the modifiable risk factors of stroke. Large-scale prospective trials are needed to identify the patients at the highest risk. [Table: see text]

Exploring Stroke Risk Factors and Outcomes in Sexual and Gender Minority People.

Cerebrovascular disease in sexual and gender minority (SGM) people remains poorly understood. Our primary objective was to describe the epidemiology and outcomes in a sample of SGM people with stroke. As a secondary objective, we compared this group with non-SGM people with stroke to assess for significant differences in risk factors or outcomes. This was a retrospective chart review study of SGM people admitted to an urban stroke center with primary diagnosis of stroke (ischemic or hemorrhagic). We evaluated stroke epidemiology and outcomes, summarizing with descriptive statistics. We then matched 1 SGM person to 3 non-SGM people by year of birth and year of diagnosis to compare demographics, risk factors, inpatient stroke metrics, and outcomes. A total of 26 SGM people were included in the analysis: 20 (77%) had ischemic strokes, 5 (19%) intracerebral hemorrhages, and 1 (4%) subarachnoid hemorrhage. Compared with non-SGM people (n = 78), stroke subtypes showed a similar distribution (64 (82%) ischemic strokes, 12 (15%) intracerebral hemorrhages, 1 (1%) subarachnoid hemorrhage, and 1 nontraumatic subdural hematoma, p > 0.05) but suspected ischemic stroke mechanisms had a different distribution (χ2 = 17.56, p = 0.01). Traditional stroke risk factors were similar between the 2 groups. The SGM group seemed to have higher rates of nontraditional stroke factors, including HIV (31% vs 0%, p < 0.01), syphilis (19% vs 0%, p < 0.01), and hepatitis C (15% vs 5%, p < 0.01) but were more likely to be tested for these risk factors (χ2 = 15.80, p < 0.01; χ2 = 11.65, p < 0.01; χ2 = 7.83, p < 0.01, respectively). SGM people were more likely to have recurrent strokes (χ2 = 4.39, p < 0.04) despite similar follow-up rates. SGM people may have different risk factors, different mechanisms of stroke, and higher risk of recurrent stroke compared with non-SGM people. Standardized collection of sexual orientation and gender identity would enable larger studies to further understand disparities, leading to secondary prevention strategies.

Association of Cognitive Impairment With Rate of Functional Gain Among Older Adults With Stroke.

This study explored the association between cognitive impairment at admission with self-care and mobility gain rate (amount of change per week) during a post-acute care stay (admission to discharge) for older adults with stroke. Retrospective cohort study. Four inpatient rehabilitation and 6 skilled nursing facilities. A total of 100 adults with primary diagnosis of stroke; mean age 79years (SD 7.7); 67% women. Retrospective cohort study. We evaluated the extent to which cognitive impairment at admission explained variation in weekly gain rate separately for self-care and mobility. Additional covariates were occupational and physical therapy minutes per day, self-care and mobility function at admission, age, and number of comorbidities. Participants were classified as having severe (n= 16), moderate (n= 39), or mild (n= 45) cognitive impairment at admission. Occupational therapy minutes per day (β= 0.04; P < .01) and Functional Independence Measure (FIM) self-care function at admission (β= 0.48; P < .01) were both significantly associated with self-care gain rate (Adjusted R2= 0.18); cognitive impairment group, age, and number of comorbidities were not significant. Only FIM mobility function at admission (β= 0.29; P < .001) was significantly associated with mobility gain rate (Adjusted R2= 0.18); cognitive impairment group, physical therapy minutes, age, and number of comorbidities were not significant. These results provide preliminary evidence that patients with stroke who have severe cognitive impairment may benefit from intensive therapy services as well as less severely impaired patients, particularly occupational therapy for improvement in self-care function.

223 READMISSION POST STROKE: RATES AND REASONS FOR READMISSION IN THE 18 MONTHS FOLLOWING HOSPITAL DISCHARGE

Abstract Background The Irish healthcare system faces the same challenges presented to healthcare systems worldwide, ageing populations and the increasing disease burden from chronic conditions. There is a need to respond to and meet these challenges placed on an already pressurized healthcare systems originally set up to respond to acute, episodic care. It would be beneficial to review reasons for unplanned readmissions post stroke to examine whether these readmissions could be predicted, targeted and prevented and whether there are individuals who could be targeted for intervention post hospital discharge, to reduce readmission rates post stroke. Methods Using data from the Hospital In-Patient Enquiry (HIPE) patients were identified who had been discharged with a primary diagnosis of stroke. Data was then examined to identify whether these patients had acute hospital readmissions in the 18-month period following discharge for stroke. Using HIPE and patient discharge letters we identified the reasons for these readmissions and categorized them accordingly. Results A total of 224 live stroke discharges were identified from 2018. 77 patients were readmitted within 18 months of discharge. In total these 77 patients accounted for 139 admissions. Of the 77 patients that were readmitted average Length of Stay (LOS) was 19 days. Of the 77, 12 were due to recurrent stroke while 49 presented with a new complaint that fell into one of the following four categories, pneumonia, falls/fractures, dementia related, medical complications/medication related Conclusion There is a need to identify the unmet needs of stroke patients post hospital discharge so as to reduce the number of readmissions. This would involve screening to identify those suitable to attend a specialist multidisciplinary six-month review clinic where these patients could have onward referral to the appropriate in hospital and community services including intensive dysphagia clinics, therapy-lead spasticity clinic, upper limb rehabilitation programmes, and medical social work support for unmet needs with links to the community.

Factors associated with emergency readmissions after acute stroke: A retrospective audit of two hospitals.

Emergency hospital readmissions within 30 days of discharge from hospital are considered a marker for the quality of hospital care, patient experience, the discharge process and integration with community services. This paper describes the frequency and variations in cause of emergency readmissions at 30 and 90 days following discharge after acute stroke from two stroke units. Retrospective data collection of Hospital Episodes Statistics (HES) and Sentinel Stroke National Audit Programme (SSNAP) of consecutive acute stroke hospital discharges over 24 months from 2017 to 2019 from two specialist stroke units in England. HES data were used to calculate the Charlson comorbidity index (CCI). Covariates were analysed for their association with readmission rate, including: age; gender; CCI; length of stay for first stroke admission; living alone; discharge to a care home; discharge receiving stroke specialist early supported discharge (ESD) rehabilitationand stroke severity as determined by National Institute for Health Stroke Scaleon stroke admission. From 2017 to 2019 there were 1999 live discharges with a primary diagnosis of stroke. Both hospitals had a trend of increasing readmission rates with increasing stroke severity and comorbidity. Longer length of stroke admission, especially for patients with increasing stroke severity, and patients receiving ESD rehabilitation after discharge reduced 90-day readmissions. This association was stronger at 90 days than at 30 days. Different readmission event rates were found at 30 and 90 days and when events were compared between the two hospitals. Understanding differences in readmission event rates between hospitals at 30 and 90 days can support local planning of patient needs in the first weeks after stroke discharge and to investigate ways for hospital to reduce the impact of readmission. It is recommended that stroke services use both 30 and 90-day readmissions to inform service evaluation and improvement.

Stroke care in people with and without schizophrenia: a retrospective, observational study

IntroductionSerious mental illness tends to course with a higher prevalence of comorbidities and schizophrenia is a disabling disease that affects approximately 1% of the world population. Worldwide, cerebrovascular accidents are an important cause of mortality and disability and in Portugal they are one of the leading causes of death in the general population. There is growing evidence that the prevalence of strokes is higher in people with schizophrenia, with pronounced age and gender variations.ObjectivesTo describe the sociodemographic and clinical differences among patients hospitalized with a primary diagnosis of cerebrovascular disease with and without a secondary diagnosis of schizophrenia in Portugal.MethodsWe performed a retrospective observational study using a natiowide hopitalization database containing all hosptalizations registered in Portuguese hosptals from 2008 to 2015. Based on the International Classification of diseases version 9, clinical modification, hospitalizations with a primary diagnosis of stroke were selected (431;433;434), and from those, the ones with a secundary diagnosis of schizophrenia (295.xx) were isolated for a sociodemographic and clinical comparative study. Comorbidities were analysed using the Chalson index score.ResultsEpisodes associated with a secondary diagnosis of schizophrenia were younger (mean: 66 vs 73.7 years; p&lt;0.001) and had longer median LoS (10.0 vs 8.0 days; p&lt;0.001). In-hospital mortality was lower in patients with schizophrenia (11.7% vs 13.2%).ConclusionsThe understanding of the association of cerebrovascular accidents with schizophrenia is complex. Although some studies show conflicting evidence, more attention should be given to the investigation of the incidence, prevalence and impact of cerebrovascular diseases within this particular population.DisclosureNo significant relationships.

Abstract 273: Prescription Rate For Antihyperglycemic Medication With Proven Cvd Benefit At Discharge In Stroke Patients Not Equal Among Payer Sources

Mortality doubles in stroke patient with diabetes mellitus (DM). Target: Type 2 DiabetesSM (TT2DM) is an American Heart Association (AHA) initiative focused on providing evidence-based guideline (EBG) resources to mitigate risk in hospitalized stroke patients with DM. Get With The Guidelines® (GWTG)- Stroke hospitals track EBG data to improve patient outcomes. TT2DM initiative is comprised of 10 EBG data elements related to stroke and DM subpopulation. The measure Antihyperglycemic Medication with Proven CVD Benefit at Discharge in Stroke Patients with DM has low compliance. Methods: GWTG®-Stroke DM reports reviewed from January 1, 2020-June 30, 2021, from 50 Wisconsin Coverdell Stroke Program hospitals. Analysis of 2554 patients with primary diagnosis of stroke with history of or newly identified DM during hospitalization were in the denominator. Numerator met when patients were prescribed GLP-1 Receptor Agonist or SGLT-2 Inhibitor at discharge. Measure compliance was further delineated according to payment source documented. Patient payer source was identified as: Self-Pay, Medicaid, Medicare, and Private. Findings: In specified timeframe, 7.9% of patients received Antihyperglycemic Medication with Proven CVD Benefit at Discharge. Compliance variation exists across payer source. Differences in compliance rates were 2.2% Self-Pay, 6.4% for Medicare, 7.7% Medicaid, and 12.1% for Private. Conclusions: Discharge prescription rate for antihyperglycemic medication with proven CVD benefit at discharge in stroke patients has low compliance, further variation exists among payor sources. Items for consideration are higher cost of medication and thus payor status are driving factors in prescribing rates. Additional barriers may exist as discharge clinicians may not feel DM management is their responsibility, there may be a medication knowledge gap. Providing EBC requires shared decision making among patients and clinicians to ensure proper follow up. Engaging a multidisciplinary approach at discharge to verify insurance coverage, alternate cost options, and follow up needs may enhance compliance. Future considerations are to assess race “within” payor source to gauge if there is disparate care.

The effect of antihypertensive monotherapy and combination on blood pressure in stroke patients

Background: Stroke is a syndrome characterized by loss of focal and function of the rapidly developing CNS. Furthermore, hypertension is a known risk factor that occurs approximately 70% of the time, and lowering systolic BP from 1 to 3 mmHg effectively reduces the risk of stroke by 20 to 30%. Methods: An observational analytic design, using a retrospective medical record data collection in Malang City Hospital. A total of 113 patients met the inclusion criteria. In addition, the inclusion criteria include hospitalized patients with a primary diagnosis of stroke, ischemia or bleeding as evidenced by a head CT scan, having comorbid hypertension, and having received antihypertensive therapy. Meanwhile, the exclusion criteria were the BP data of the patient measured only once. Results: The results showed the ability of antihypertensive monotherapy and combinations to lower systolic BP by 33.62 ± 30.15 mmHg and 30.50 ± 29.47 mmHg (p = 0.744) in ischemic patients. In comparison, diastolic BP decreased by 6.86 ± 13.18 mmHg and 11.50 ± 16.26 mmHg (0.291), respectively. Moreover, the administration in bleeding stroke patients resulted in a decrease to 16.95 ± 17.89 mmHg and 22.82 ± 23.91 mmHg, (p = 0.029) for systolic, and 8.63 ± 14.63 mmHg and 8.71 ± 17.17 mmHg (p = 0.647) for diastolic BP, respectively. Furthermore, a combination of 4 antihypertensives drugs showed a better decrease in systolic BP in both patients (44.50 ± 21.63) compared to monotherapy, and a mixture of 2 as well as three drugs, by 27.02±27.05, 25.65 ± 29.97, and 25.37 ± 25.08 (p = 0.027), respectively. Conclusions: Combination therapy is recommended in stroke patients because BP can be better controlled.

The association between frailty of older stroke patients during hospitalization and one-year all-cause mortality: A multicenter survey in China

ObjectiveFrailty is a common geriatric syndrome defined as multiple deficits, impairing the capacity to figure out insult. Previous studies have reported a significant association between frailty and mortality in stroke patients. This study aimed to explore the association between frailty and mortality among older Chinese stroke patients. MethodsThis study was a secondary analysis of a multicenter prospective cohort study conducted in older Chinese inpatients from October 2018 to February 2020, and patients with a primary diagnosis of stroke including hemorrhage and ischemia, were included in our study. Frailty of older inpatients with stroke from six hospitals was measured by the FRAIL scale, and a one-year follow-up was performed by well-trained nurses of these hospitals via telephone. Multivariable logistic regression was used to detect the association between frailty and one-year mortality. ResultsA total of 530 stroke patients with an average age of 72.94 (SD = 5.79) years were included in the present study. There were 37 (7.0%) hemorrhagic strokes and 493 (93.0%) ischemic strokes, with 228 (43.0%) females in this population. The prevalence of frailty was 22.5%. In the logistic regression model with adjustment for age, sex, instrumental activities of daily living (IADL), basic activities of daily living (ADL), education, history of falls, BMI, smoking, alcohol consumption, low handgrip strength, type of stroke and polypharmacy, stroke patients with frailty had an increased risk of one-year mortality compared to those without frailty (OR = 3.38, 95% CI: 1.22–9.37, P = 0.019). ConclusionOur study indicated that frailty was an independent risk factor for one-year all-cause mortality among older stroke patients in China. Frailty may be an essential factor for clinicians to consider before making a comprehensive treatment, and corresponding mixed interventions, including exercise training and nutritional programs, need to be conducted among older stroke patients.

One-year survival and prognostic factors for survival among stroke patients: The PROVE-stroke study.

Survival and prognostic factors following stroke occurrence differ between world regions. Studies investigating stroke features in the Middle-east region are scarce. We aimed to investigate 1-year survival and related prognostic factors of stroke patients in Central Iran. It is an observational analytical study conducted on patients registered in the Persian Registry of Cardiovascular Disease-Stroke (PROVE-Stroke) database. Records of 1703 patients admitted during 2015-2016 with the primary diagnosis of stroke in all hospitals of Isfahan, Iran were reviewed. Information regarding sociodemographic characteristics, clinical presentations, medications, and comorbidities were recorded. The living status of patients after 1 year from stroke was considered as 1-year survival. Among 1345 patients with the final diagnosis of stroke, 970 (72.1%) were alive at the 1 year follow-up and the mean survival time based on Kaplan-Meier procedure was estimated 277.33 days. The hemorrhagic and ischemic types of stroke were reported in 201 (15.0%) and 1141 (84.8%) patients, respectively. Age (hazard ratio [HR] = 1.07, 95% confidence interval [CI] = 1.05-1.09), diabetes (HR = 1.49, 95% CI = 1.07-2.06), history of stroke or transient ischemic attack (HR = 1.81, 95% CI = 1.30-2.52), history of warfarin usage (HR = 1.73, 95% CI = 1.11-2.71), hospital complications of hemorrhage (HR = 3.89, 95% CI = 2.07-7.31), sepsis (HR = 1.78, 95% CI = 1.18-2.68), and hydrocephalus (HR = 3.43, 95% CI = 1.34-8.79), and modified Rankin Scale (mRS) ≥3 at the time of hospital dicharge (HR = 1.98, 95% CI = 1.27-3.07), were predictors of 1-year survival. Predictors of 1-year survival can be categorized into unchangeable ones, such as age, diabetes, previous stroke, and mRS. The changeable factors, such as hospital complications of infection and hemorrhage, guide physicians to pay greater attention to reduce the risk of mortality following stroke.

Factors Related to Greater Functional Recovery after Suffering a Stroke.

Background: In a stroke, the importance of initial functional status is fundamental for prognosis. The aim of the current study was to investigate functional status, assessed by the Functional Independence Measure (FIM) scale, and possible predictors of functional outcome at discharge from inpatient rehabilitation. Methods: This is a retrospective study that was carried out at the Physical Medicine and Rehabilitation Service in A Coruña (Spain). A total of 365 consecutive patients with primary diagnosis of stroke were enrolled. The functional assessments of all patients were performed through the FIM. A descriptive and a bivariate analysis of the variables included in the study was made and a succession of linear regression models was used to determine which variables were associated with the total FIM at discharge. Results: Prior to having the stroke, 76.7% were totally independent in activities of daily living. The FIM scale score was 52.5 ± 25.5 points at admission and 83.4 ± 26.3 at hospital discharge. The multivariate analysis showed that FIM scores on admission were the most important predictors of FIM outcomes. Conclusions: Our study indicates that the degree of independence prior to admission after suffering a stroke is the factor that will determine the functionality of patients at hospital discharge.

Intensity of usual care physical therapy during inpatient rehabilitation for people with neurologic diagnoses.

Early, intense rehabilitation is essential to promote recovery after stroke, spinal cord injury (SCI), and traumatic brain injury (TBI). However, intensity of usual care rehabilitation interventions during inpatient rehabilitation are poorly characterized. To describe the intensity of usual care rehabilitation interventions completed during the subacute phase of recovery from neurologic injury. Observational. Inpatient rehabilitation facility. Twenty-two usual care physical therapy interventions were grouped into six categories: gait (four activities), functional (two), strengthening (four), aerobic (six), balance (four), and wheelchair (two). Patients admitted to inpatient rehabilitation with a primary diagnosis of stroke, SCI or TBI within 6months of injury. Cardiovascular intensity (physiological and perceived) was recorded during rehabilitation activity sessions. Physiological intensity was assessed by heart rate reserve (HRR) via a Polar A370 Fitness Watch and characterized as very light (<30%), light (30-39%), moderate (40-59%), vigorous (60-89%), and near maximal (≥90%). Perceived intensity was assessed using the Rating of Perceived Exertion scale. Patients (stroke n=16 [number of activity sessions=338/average session duration=16.4min]; SCI n=15 [299/27.4min]; TBI n=15 [340/14.2min]) participated. For patients with stroke, moderate-to-vigorous HRR was attained between 42% (aerobic exercise) to 55% (wheelchair propulsion) of activity sessions. For patients with SCI, moderate-to-vigorous HRR was attained between 29% (strength training) to 46% (gait training) of activity sessions. For patients with TBI, moderate-to-vigorous HRR was attained between 29% (balance activities) to 47% (gait training) of activity sessions. Associations between HRR and rate of perceived exertion were very weak across stroke (r=0.12), SCI (r=0.18), and TBI (r=0.27). Patients with stroke, SCI, and TBI undergoing inpatient rehabilitation achieve moderate-to-vigorous intensity during some usual care activities such as gait training. Patient perception of intensity was dissimilar to physiological response.

Increasing false positive diagnoses may lead to overestimation of stroke incidence, particularly in the young: a cross-sectional study

BackgroundStroke incidence is reportedly increasing in younger populations, although the reasons for this are not clear. We explored possible reasons by quantifying trends in neurologically focused emergency department (ED) visits, classification of stroke vs. TIA, and imaging use.MethodsWe performed a retrospective, serial, cross-sectional study using the National Hospital Ambulatory Medical Care Survey to examine time trends in age-stratified primary reasons for visit, stroke/TIA diagnoses, and MRI utilization from 1995 to 2000 and 2005–2015.ResultsFive million eight hundred thousand ED visits with a primary diagnosis of stroke (CI 5.3 M–6.4 M) were represented in the data. The incidence of neurologically focused reason for visits (Neuro RFVs) increased over time in both the young and in older adults (young: + 111 Neuro RFVs/100,000 population/year, CI + 94 − + 130; older adults: + 70 Neuro RFVs/100,000 population/year, CI + 34 − + 108). The proportion of combined stroke and TIA diagnoses decreased over time amongst older adults with a Neuro RFV (OR 0.95 per year, p < 0.01, CI 0.94–0.96) but did not change in the young (OR 1.00 per year, p = 0.88, CI 0.95–1.04). Within the stroke/TIA population, no changes in the proportion of stroke or TIA were identified. MRI utilization rates amongst patients with a Neuro RFV increased for both age groups.ConclusionsWe found, but did not anticipate, increased incidence of neurologically focused ED visits in both age groups. Given the lower pre-test probability of a stroke in younger adults, this suggests that false positive stroke diagnoses may be increasing and may be increasing more rapidly in the young than in older adults.

Factors Predicting Short Length of Stay in Hospice Patients With a Primary Diagnosis of Stroke

Stroke is the second leading cause of death globally among people aged 60+, yet only 9% of hospice decedents have a primary diagnosis of stroke and little research has examined their end-of-life care experiences. Late referral and admission to hospice is an indicator of poor end of-life-care quality. This project identified factors predicting short stays in hospice, defined as a length of stay (LOS) of 14 days or less, via chart review of 100 hospice patients with a primary diagnosis of stroke. Of the 98 patients with complete data, 89% died in hospice; 11% were live discharges. Most patients were female, married, and referred to hospice from a hospital. Only 21% of patients entered hospice with a completed advance directive. Approximately 75% (n=73) of patients had a short LOS. Binary logistic regression indicated that gender, race, marital status, and having an advance directive at hospice admission were unassociated with LOS. Controlling for demographics, patients referred from home were 74% less likely to have a short LOS (OR=.26, CI=.08-.83) compared to those referred from a hospital, with a mean LOS of 44 and 13 days, respectively. Including Palliative Performance Scale (PPS) score in the model attenuated the effect of referral location. For every ten percent increase in PPS, participants were 85% less likely to have a short LOS (OR=.15, CI=.07-.32). Advance care planning should be more widely promoted among patients at high risk for stroke. There are opportunities for earlier referral to hospice for patients with a diagnosis of stroke.