Family history of stroke is associated with large- and small-vessel etiology: a systematic review and meta-analysis.

BACKGROUND: Several studies have investigated the association between family history of stroke (FHS) and stroke etiology, recurrence or mortality, however the results have been discrepant. We conducted a systematic review with meta-analysis to further evaluate the associations. MATERIALS AND METHODS: We searched Scopus database using the term "family history" AND "stroke" up to December 2023 to identify observational studies and systematic reviews reporting both the prevalence of FHS and the rates of stroke etiology or recurrence or mortality. Case reports, series and narrative reviews were excluded. We used odds ratio as a common measure of association and I2 to determine heterogeneity of effects across studies. RESULTS: We have identified 22 articles (130 999 patients, 53% female), which met the pre-specified inclusion criteria. After pooling the results, FHS was associated with large-vessel (OR, 1.24, 95%CI [1.07-1.44]), as well as small-vessel (OR, 1.17, 95%CI [1.05-1.31]), but not cardioembolic stroke etiology (OR, 0.74, 95%CI [0.60-0.90]). There was no relationship between FHS and stroke recurrence (OR, 1.16, 96%CI [0.84-1.61]), nor mortality (0.94, 95%CI [0.63-1.41]). CONCLUSIONS: FHS is associated with large- and small-vessel stroke etiology, but not stroke recurrence or mortality. These findings might be useful to physicians caring for stroke patients in their everyday practice.

Family history of stroke - a useful clue for the primary care physician and stroke neurologist: a narrative review.

Purpose: The heritability of ischemic stroke is a complex mechanism, involving the contribution of genetic traits and environmental factors, which is why in everyday practice clinicians often rely on the broad term "family history of stroke", defined as the case of any first-degree relative who has had a stroke. The aim of this review is to update the available data regarding family history of stroke in primary and secondary stroke prevention by searching the electronic Scopus database for the phrase TITLE-ABS-KEY ("family history" AND "stroke"). Views: A total of 140 articles met the pre-specified criteria and were included in the review. The prevalence of family history of stroke ranged from 37% in stroke-free individuals to 52% in patients with ischemic stroke. In primary prevention, family history of stroke was associated with increased risk of stroke, transient ischemic attack, stroke risk factors and stroke-like symptoms. In patients with ischemic stroke, it was more often associated with small- and large-vessel disease, though not with a cardioembolic etiology. Family history of stroke did not influence long-term functional outcomes after rehabilitation. In young stroke victims, it was related to symptom severity and the risk of a second stroke. Conclusions: Consideration of family history of stroke in everyday practice may carry useful information both for primary care physicians and stroke neurologists.

An optimal model of long-term post-stroke care.

Stroke is a major healthcare challenge that is increasing worldwide. The burden of stroke is significant for the affected individuals as well as for the general population; high-quality care is needed to reduce its negative impacts. This article synthesized information from systematic reviews, guidelines, and primary literature on stroke care and post-stroke rehabilitation and proposes an optimal strategy for long-term post-stroke care. It also highlights the unmet needs of patients who experienced a stroke in terms of early diagnosis of complications and adequate, comprehensive therapy.

An Analysis of the Incidence and Cost of Intracranial Aneurysm and Subarachnoid Haemorrhage Treatment between 2013 and 2021.

The incidence of unruptured intracranial aneurysms (UIAs) amounts to 3.2% among adults. The annual risk of aneurysm rupture is 2-10% and it results in subarachnoid haemorrhage (SAH). The aim of this study is to assess changes in the incidence of unruptured intracranial aneurysms and subarachnoid haemorrhages in Poland between 2013 and 2021 and the cost associated with their in-hospital treatment in the acute phase. The analysis was based on the National Health Fund database. Patients diagnosed with UIA and SAH and hospitalised between 2013 and 2021 were chosen. The statistical analysis was performed with an assumed significance level of α = 0.05. The ratio between the prevalence of SAH and UIA diagnoses was 4:6. The proportion of women in relation to men was higher in both diagnoses. The highest proportions of patients with diagnoses SAH and UIA were found in highly urbanised provinces. The value of medical services in 2021 compared to 2013 increased by 81.8%. The highest values in this period were recorded in Mazowieckie province, and the lowest were recorded in Opolskie province. The overall number of patients hospitalised with diagnosis of UIA or SAH did not decrease, but the risk of aneurysm rupture probably decreased, which resulted in lower incidence of SAH in subsequent years of observation. The recorded changes in the dynamics of the value of medical services per patient or per hospitalisation largely coincided. However, it is difficult to speculate on expected value levels as not all provinces showed linear changes in the value of services provided.

Reliability of the modified Rankin Scale in clinical practice of stroke units and rehabilitation wards.

Introduction: The Modified Rankin Scale (mRS) is the most common tool to quantify post-stroke disability in everyday practice and by certified raters in clinical trials. However, interobserver variability may affect reliability of retrospective observational studies, including clinical registries. Our aim was to assess real-life consistency between neurologists and physical and rehabilitation medicine physicians using mRS to rate post-stroke disability of patients transferred directly from stroke unit (SU) to rehabilitation ward (RW). Methods: This is a retrospective analysis of 132 consecutive acute stroke patients transferred from single tertiary SU to RW located in the same hospital in Poland. Patients were assessed by one rater from each department at the day of transfer. We distinguished between physicians previously certified in using mRS for clinical trials and not-certified physicians using mRS in everyday practice. Results: mRS at discharge from SU and on admission to RW was recorded for 105 of 132 patients. The overall agreement was 70.5% (kappa 0.55). Similar agreement was observed in the subset of 30 patients rated by certified physicians in both departments (70.0%, kappa 0.57) and in the subset of 61 patients rated by a pair of certified neurologist and not-certified rehabilitation physician (73.8%, kappa 0.58). Conclusions: Everyday consistency between raters from SU and RW in using mRS is modest as in previous validation studies. However, it may be considered sufficient for the purpose of observational studies or stroke registries. It emphasizes the need for easily accessible training in conventional mRS or implementation of specialized tools with predefined questions.

Voluntary Unemployment Is Associated With Increased Prevalence of Stroke and its Risk Factors in Middle-Aged Adults.

OBJECTIVE: The aim of the study is to investigate the association between the prevalence of stroke, its risk factors, and occupational status, with a differentiation between voluntary and involuntary unemployment. METHODS: This is a cross-sectional study, which included 3013 individuals aged 40 to 65 years. We compared the prevalence of stroke, comorbidities, self-reported stroke-like symptoms, healthy behaviors, and knowledge about stroke among the voluntarily and involuntarily unemployed versus the employed. RESULTS: Voluntary unemployment was associated with increased chances of stroke (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.05-3.57), hypertension (OR, 1.18; 95% CI, 1.06-1.32), diabetes (OR, 1.16; 95% CI, 1.01-1.35), and obesity (OR, 1.16; 95% CI, 1.05-1.29). Involuntary job loss was associated with increased odds of hypertension (OR, 1.69; 95% CI, 1.16-2.50) and more frequent self-reported stroke-like symptoms. CONCLUSIONS: We found higher chances of stroke among the voluntarily unemployed middle-aged adults, presumably because of increased prevalence of hypertension, diabetes, and obesity.

Family History of Stroke is Associated with Greater Prevalence of Certain Risk Factors and Self-Reported Stroke Symptoms.

OBJECTIVES: Family history of stroke increases stroke risk, however mechanisms underlying this association remain unclear. We investigated whether family history of stroke is related to increased prevalence of stroke risk factors, unhealthy behaviors and self-reported stroke symptoms in middle-aged adults. MATERIALS AND METHODS: In a cross-sectional study conducted from November 2018 to January 2021 in 100 primary care facilities in Poland we evaluated adults aged 40-65 years (n = 2207, women 57.4%, median age 55 years) for stroke risk factors, healthy behaviors, family history of stroke, self-reported stroke symptoms and stroke knowledge using structured questionnaires. Patients were categorized based on family history of stroke defined as ≥1 first-degree relative with documented stroke. RESULTS: Family history of stroke was reported by 571 (25.9%) individuals who were older (median age 56 vs. 54 years, p = 0.00001) and after adjustment for age more frequently suffered from hypertension (61.5% vs. 53.7%, p = 0.024) and prior transient ischemic attack (2.1% vs. 0.9%, p = 0.019), but not other risk factors. However, they were less obese (34.5% vs. 39.1%, p = 0.03). Women, but not men, with family history of stroke (n = 339, 26.8%) had greater prevalence of atrial fibrillation (7.4% vs. 3.9%, p = 0.037). Family history of stroke was associated with higher prevalence of any self-reported stroke symptom (32.9% vs. 23.2%, p < 0.00001), but not with unhealthy dietary behaviors or low level of knowledge about stroke. CONCLUSIONS: Family history of stroke is associated with greater prevalence of certain risk factors and self-reported stroke symptoms, which indicates the need for closer surveillance of middle-aged individuals at risk.

Botulinum toxin type-A preparations are not the same medications - basic science (Part 1).

Botulinum neurotoxin type A (BoNT/A) formulations are widely used in clinical practice. Although they share a common mechanism of action resulting in presynaptic block in acetylocholine release, their structure and pharmacological properties demonstrate some similarities and many differences. Bioequivalence has been discussed since the onset of the clinical use of BoNT/A. In this review, we provide an update on the studies and compare the molecular structure, mechanisms of action, diffusion and spread, as well as immunogenicity and dose equivalence of onabotulinumtoxinA, abobotulinumtoxinA and incobotulinumtoxinA.

Botulinum toxin type-A preparations are not the same medications - clinical studies (Part 2).

The growing number of Botulinum neurotoxin type A (BoNT/A) preparations on the market has resulted in a search for pharmacological, clinical and pharmacoeconomic differences. Patients are occasionally switched from one botulinum toxin formulation to another. The aim of this paper was to review studies that have made direct comparisons of the three major BoNT/A preparations presently on the market: ona-, abo- and incobotulinumtoxinA. We also review the single medication Class I pivotal and occasionally Class II-IV studies, as well as recommendations and guidelines to show how effective doses have been adopted in well-established indications such as blepharospasm, hemifacial spasm, cervical dystonia and adult spasticity. Neither direct head-to-head studies nor single medication studies between all preparations allow the formation of universal conversion ratios. All preparations should be treated as distinct medications with respect to their summary of product characteristics when used in everyday practice.

Real-world effectiveness of abobotulinumtoxinA (Dysport®) in adults with upper limb spasticity in routine clinical practice: an observational study.

AbobotulinumtoxinA (aboBoNT-A, Dysport®) is used in clinical practice as a well-tolerated and effective therapy for muscle spasticity. AboBoNT-A has been shown to reduce upper and lower limb spastic paresis in clinical trials, demonstrating improvements in muscle tone and limb function. This open-label, multicentre, observational, non-interventional study was the first to investigate aboBoNT-A's efficacy in adult patients with upper limb spasticity (ULS) in routine clinical practice in Poland. All enrolled patients received ≥1 aboBoNT-A injection cycles, per routine clinical practice (full analysis set, FAS), and ≥1 rehabilitation session. Patients attended a baseline visit (V1) and two follow-up visits (V2, V3) for retreatment, depending on the investigator's assessment of individual patient needs, with a mean interval (SD) between injections of 4.4 (1.4) and 4.5 (1.2) months. The primary effectiveness endpoint was patient- and physician-based evaluation using the Clinical Global Impression-Improvement Scale (CGII), a validated 7-point scale (1 = very much improved to 7 = very much worse) relative to baseline. CGI-I has not previously been used as a primary endpoint in studies evaluating ULS. Secondary endpoints included muscle tone in shoulder, elbow, carpal joint, and finger muscles, measured by the Modified Ashworth Scale (MAS), and muscle strength according to the Medical Research Council scale (MRC). Of 108 enrolled patients (FAS), 92 (85.2%) completed the study and 57 (52.8%) were included in the per protocol (PP) population. AboBoNT-A improved patient conditions in 96.4% and 98.6% at V2 and V3 (investigator assessment) and 92.8% and 98.6% (as reported by patient) of patients, respectively. Significant reductions in muscle tone from baseline were observed at both visits (p < 0.0001-0.0077) across muscle groups. Increased muscle strength by cumulative MRC was observed at V2 (p = 0.0566) and V3 (p = 0.0282) versus baseline. Safety was consistent with the known profile of aboBoNT-A. In conclusion, aboBoNT-A treatment is beneficial in patients with post-stroke ULS in routine clinical practice, assessed by patients and investigators.

Effect of medical complications on the after-stroke rehabilitation outcome.

BACKGROUND: Post-stroke rehabilitation should begin immediately and continue while improvement is seen. After stroke, patients are at risk of developing medical complications, which can hinder optimal recovery. OBJECTIVE: We aimed to determine the incidence of complications occurring during early inpatient rehabilitation and to assess their influence on patients' functionality. METHODS: For 1075 patients (585 men), we recorded neurological deficits, activities of everyday living, functionality before and after rehabilitation, and the incidence of complications. The main measure of functional outcome was the discharge Barthel Index score. RESULTS: At least one complication was reported by 76.9% of patients, and 20% experienced three or more complications. The most common problems were: urinary tract infection (23.2%), depression (18.9%), falls (17.9%), unstable hypertension (17.6%), and shoulder pain (14.9%). Patients with a severe discharge disability were 2.5-fold more likely to experience complications than subjects with a mild disability. CONCLUSIONS: Complications during the post stroke rehabilitation process had a significantly decreased chance for improvement. Knowledge of the most common type of complications, as well as their early prevention and treatment, may improve patient outcomes.

Carotid intima media thickness and blood biomarkers of atherosclerosis in patients after stroke or myocardial infarction.

AIM: To test if circulating levels of markers of inflammation, endothelial function, and chronic infections, as well as association between these markers and carotid intima media thickness (CIMT), depend on the stage of atherosclerosis expressed as a history of a major vascular event. METHODS: The associations were analyzed separately in 75 healthy controls, 79 patients 3-6 months after the first-ever non-cardioembolic ischemic stroke (IS), and 37 patients 3-6 months after the first-ever myocardial infarction (MI). Data were collected prospectively in 2005. We measured high sensitivity C-reactive protein (hs-CRP), procalcitonin, E-selectin, intercellular adhesion molecule-1 (ICAM-1), serum level of immune complexes (IC), and identified antibodies against Herpes simplex virus type 1 (HSV), Cytomegalovirus, Chlamydia pneumonia, and Helicobacter pylori. Correlations with CIMT were determined using Pearson R and verified after adjustment for age, sex, hypertension, diabetes, and statin therapy. RESULTS: Median ICAM-1 concentration was significantly lower in controls than in post-IS patients (188 µg/L vs 215 µg/L), and significantly lower in post-IS patients than in post-MI patients (215 µg/L vs 260 µg/L). Control patients also had significantly lower IC level (0.03 U/L) and HSV antibody index (6.0) compared to both post-IS (0.6 U/L, 9.6) and post-MI (0.4 U/L, 9.2) patients. CIMT was correlated with age (Pearson R=0.38, P=0.001) in the control group, immune complexes (R=0.26, P=0.023) in the post-IS group, and with hs-CRP (R=0.40, P=0.017) in the post-MI group. These correlations were confirmed using multiple regression analysis. CONCLUSIONS: Our study supports linear correlations between CIMT and IC and hs-CRP levels. However, these associations seem to depend on the type of vascular burden.

Temporal trends in vascular risk factors and etiology of urban Polish stroke patients from 1995 to 2013.

BACKGROUND: Despite estimates about general trends in stroke epidemiology worldwide, there are only a few reports of detailed longitudinal data and none of them reflects the economic transition that occurred in Central and Eastern Europe over the last two decades. The aim of this study was to investigate long term trends in risk factors and their pre-stroke control as well as acute stroke clinical presentation and etiology in Polish urban setting. METHODS: This is a retrospective registry-based analysis of consecutive acute stroke patients from a highly urbanized area (Warsaw, Poland) admitted to a single stroke center between 1995 and 2013. Patients were divided into four time periods: 1995-1999 (n=529), 2000-2004 (n=1253), 2005-2009 (n=1320) and 2010-2013 (n=871). RESULTS: During the study period 3973 first-ever stroke patients were admitted. The proportion of ischaemic strokes (88.2% to 90.9%) and male patients (45.2% to 46.2%) remained stable throughout the whole study period. Admitted patients became older (72, 73, 74 and 76years, consecutive time periods), were more likely to be diagnosed with hypertension (from 61.1% to 72.8%) and disable (84.3% to 67.4%) prior to stroke. There was an increase in pre-stroke use of antihypertensives in patients with hypertension (from 77.8% to 90.5%), antiplatelets in patients with coronary artery disease (from 33.9% to 56.5%), vitamin K antagonists in patients with atrial fibrillation (from 6.3% to 39.8%) and statins (from 7.6% to 26.3%). There was a decrease in mean stroke severity (9, 11, 8 and 6 points on the National Institutes of Stroke Scale) on admission and the proportion of strokes attributed to small-vessel disease (22.0%, 20.0%, 10.6% and 8.3%). CONCLUSIONS: Over the last two decades the profile of urban Polish stroke patients has changed significantly and it can be attributed to marked economic improvement in Poland since 1990s. Increasing age and better management of pre-existing vascular risk factors were accompanied by decreasing stroke severity and lower proportion of strokes attributed to small-vessel disease.

Neuropsychological and neurological sequelae of out-of-hospital cardiac arrest and the estimated need for neurorehabilitation: a prospective pilot study.

BACKGROUND: Diffuse brain injury is a key component of post-cardiac arrest syndrome reported in 30-80% of survivors of out-of-hospital cardiac arrest (OHCA). It is responsible for a high mortality rate, and is a common cause of cognitive and neurological deficits and disability. Symptom variability and dynamics and the rehabilitation potential remain poorly understood. AIM: To investigate symptom prevalence, type, and severity and the natural course of recovery within 12 months after OHCA, and to estimate neurorehabilitation needs. METHODS: Study participants were selected from OHCA survivors admitted consecutively to a cardiac intensive care unit (CICU) serving 250,000 of Warsaw's inhabitants, according to the following inclusion criteria: first ever nontraumatic, normothermic cardiac arrest, age ≤ 75 years; cardiology ward survival until discharge, and no history of pre-existing brain disease. Patients' cognitive and neurological status and disability were evaluated in the first days after onset and three, six and 12 months later. Neuropsychological assessment focused on attention, memory, executive, linguistic and visuo-spatial abilities. Neurological examination included assessment of cranial nerves, muscle strength and tone, deep tendon reflexes, cerebellar function, sensory function, and gait. The general psychophysical state was classified using the Disability Rating Scale. Patients' neurorehabilitation needs were determined using data collected three months post-OHCA. This data was used to estimate future demands for such resources in Poland. RESULTS: During a 28-month study period, of 69 OHCA patients admitted to the CICU, 29 met the study criteria (33 survived until discharge from cardiology unit; four did not meet further criteria). Severe consciousness disorders were most frequent in the early post-OHCA phase (28%); no unresponsive patients were identified 12 months later. Of responsive patients who were capable of at least minimal co-operation, 100% (early after OHCA) to 57% (12 months after OHCA) had cognitive impairment, usually with neurological symptoms. Memory impairment was the most common and severe problem, followed by executive, attentional, language and visuo-spatial dysfunctions. The prevalence of neurological deficits ranged from 88% (early after OHCA) to 43% (12 months after OHCA). Due to acquired deficits, between 71% (early post-OHCA) and 36% (12 months post-OHCA) of patients were significantly disabled and often dependent. Although dysfunctions tended to improve, over 50% of the patients remained impaired 12 months post-OHCA, and over 30% were significantly disabled. We estimated that about 800 OHCA survivors/year in Poland will develop symptoms requiring neurorehabilitation. CONCLUSIONS: Cognitive and neurological symptoms are common after cardiac arrest brain injury. Establishing specialised neurorehabilitation centres is essential for treating these patients.

Impact of BDNF -196 G>A and BDNF -270 C>T polymorphisms on stroke rehabilitation outcome: sex and age differences.

BACKGROUND: Genetic factors, including gene polymorphisms, are promising in determining stroke rehabilitation outcome. Brain-derived neurotrophic factor (BDNF) is one of the most attractive because of its role in neuroplasticity and brain repair. OBJECTIVE: The aim of present study was to assess the role of BDNF -196 G≯A (val66met) and -270 C≯T on clinical parameters and functional outcome in patients with ischemic and hemorrhagic stroke. Additional analyses according to sex and age (≤55 and ≯55 years) were performed. METHODS: Three hundred thirty-eight patients (287 with ischemic and 51 with hemorrhagic stroke) were evaluated in terms of neurological deficit (National Institute of Heath Stroke Scale [NIHSS]), activities of daily living (Barthel Index [BI]), and everyday functionality (Rankin score [RS]) before and after rehabilitation. BDNF polymorphism genotyping was performed by polymerase chain reaction restriction fragment length polymorphism analysis. RESULTS: In multivariative analysis, unfavorable outcome of stroke rehabilitation (RS ≥2) was associated with independent factors: ischemic stroke (odds ratio [OR], 2.59; 95% CI, 1.03-6.47), female gender (OR, 2.80; 95% CI, 1.39-5.64), depression (OR, 4.24; 95% CI, 1.45-12.35), falls (OR, 2.61; 95% CI, 1.16-5.87), and BDNF -196 GG polymorphism (OR, 2.18; 95% CI, 1.09-4.35). The differences of functional parameters measured with BI and RS on admission and at discharge are apparent only for comparisons between patients ≤55 and ≯55 years old carrying BDNF -196 GA+AA genotypes but not in those carrying -196 GG genotype; the differences were evident in women but not in men. CONCLUSIONS: BDNF -196 G≯A polymorphism might affect functional outcome of stroke rehabilitation, but this hypothesis needs further verification.

Pharmacotherapy prior to and in acute ischaemic stroke. The use of pharmacotherapy and drug-associated outcomes in real world practice - findings from the Polish Hospital Stroke Registry.

BACKGROUND AND PURPOSE: Stroke is a preventable disease and acute ischaemic stroke can be effectively treated. Specific pharmacotherapy is recommended in either prevention or acute ischemic stroke treatment. We aimed to evaluate the use and the early and late outcomes impact of drugs administered before and in acute ischaemic stroke in a real world practice. MATERIAL AND METHODS: Ischaemic stroke patients hospitalized between 1st March 2007 and 29th February 2008 and reported in Polish Hospital Stroke Registry were analysed. Fully anonymous data were collected with standardized, web-based questionnaire with authorized access. Multivariate regression models were used to adjust for case-mix and evaluate the impact of drugs used prior to or in acute ischaemic stroke on outcomes. The early outcomes were defined as in-hospital mortality or poor outcome (death or dependency - modified Rankin Scale  3) at hospital discharge, while late outcomes covered one-year survival. RESULTS: A total number of 26 153 ischaemic stroke patients (mean age: 71.8 years; females: 51.6%) was reported. The ana-lysis of pharmacotherapy showed that preventive use of hypo-tensive agents, anticoagulants in atrial fibrillation, antiplatelets and statins is inadequate. Regression models confirmed some expected drug benefits and additionally revealed that antihypertensive drugs or aspirin used prior to stroke and oral anticoagulants or statins used in hospital were associated with better stroke outcome. CONCLUSIONS: The prevention of ischaemic stroke needs to be monitored and improved. Evidence-based treatment of acute ischaemic stroke requires further promotion. The benefits of acute ischaemic stroke treatment with statins require to be confirmed in randomized controlled settings.

Pharmacotherapy prior to and in acute haemorrhagic stroke. The use of pharmacotherapy and drugs associated outcomes in real-world practice - findings from the Polish Hospital Stroke Registry.

BACKGROUND AND PURPOSE: Haemorrhagic stroke is associated with substantial mortality and disability, thus prevention and appropriate treatment of acute intracerebral haemorrhage is crucial. We aimed to evaluate the use and the early and late outcomes impact of drugs administered before and in acute haemorrhagic stroke in a real-world practice. MATERIAL AND METHODS: Haemorrhagic stroke patients hospitalized between 1st March 2007 and 29th February 2008 and reported in Polish Hospital Stroke Registry were analysed. Fully anonymous data were collected with standardized, authorized access, web-based questionnaire. Multivariate regression models were used to adjust for case-mix and evaluate the impact of drugs used prior to or in acute haemorrhagic stroke on outcomes. The early outcomes were defined as in-hospital mortality or poor outcome (death or dependency - modified Rankin Scale  3) at hospital discharge, while late outcomes covered one-year survival. RESULTS: A total of 3111 haemorrhagic stroke patients (mean age: 68.9 years; females: 46.7%) was reported. The analysis of pharmacotherapy showed low preventive use of hypotensive agents in hypertensive patients, high consumption of antibiotics and still overuse of vasoactive or neuroprotective compounds in acute haemorrhagic stroke. Regression models confirmed expected negative impact on stroke outcomes associated with oral anticoagulants but not antiplatelets and inconsistent impact of statins used prior to or in acute haemorrhagic stroke. CONCLUSIONS: Preventive underuse of hypotensive compounds contribute substantially to haemorrhagic stroke risk. The high consumption of antibiotics and neuroprotective or vasoactive compounds in haemorrhagic acute stroke reflect the need to improved quality and evidence-based clinical practice.

Organization of acute stroke services in Poland - Polish Stroke Unit Network development.

BACKGROUND AND PURPOSE: According to the recommendations of stroke organizations, every stroke patient should be treated in a specialized stroke unit (SU). We aimed to evaluate the development of the SU network in Poland during the past decade. MATERIAL AND METHODS: In Poland, stroke is treated mainly by neurologists. A questionnaire evaluating structure and staff of neurological departments was sent to all neurological departments in 2003, 2005 and 2007. In 2010, we collected data based on information from the National Health Fund. We divided departments into categories: with a comprehensive SU, with a primary SU unit, and departments without an SU. Primary SUs were further divided into class A SUs (fulfilling criteria of the National Programme of Prevention and Treatment of Stroke Experts - eligible for thrombolysis), class B (conditionally fulfilling criteria), and class C (not fulfilling criteria). RESULTS: Final analyses included 87.4% of departments (194/222) in 2003, 85.5% of departments (188/220) in 2005, and 83.1% of departments (182/219) in 2007. According to the above-mentioned classification there were 20 class A SUs in 2003, 58 in 2005 and 5 comprehensive and 51 class A SUs in 2007. In 2012, based on information from the National Health Fund there were 150 SUs, all fulfilling criteria for thrombolysis, 9 of them comprehensive SUs. CONCLUSIONS: The SU network in Poland is developing dynamically but thrombolysis and endovascular procedures are done too rarely. Now it is necessary to improve quality of stroke services and to make organizational changes in the in-hospital stroke pathways as well as to organize continuous education of medical staff.

Weekend versus weekday admissions in Polish stroke centres -- could admission day affect prognosis in Polish ischaemic stroke patients?

BACKGROUND AND PURPOSE: Disparities in resources, access to the expertise and healthcare providers both at hospital and before admission, or patients' awareness of stroke symptoms can cause differences in weekend and weekday stroke severity and prognosis. The aim of the study was to explore differences in baseline characteristics and outcomes of ischaemic stroke patients admitted on weekdays and weekends. MATERIAL AND METHODS: A questionnaire based on the WHO Step Stroke and Swedish Stroke Registry was used to collect data on patients admitted to centres participating in the POLKARD Hospital Stroke Registry between June 1st, 2004 and May 31st, 2005. To ensure the quality, only centres reporting at least 100 patients were analysed. Clinical characteristics and early outcomes (death rate and poor outcome defined as modified Rankin scale score of 3 or above) were compared between patients admitted on weekdays and weekends. RESULTS: A total of 19667 ischaemic stroke patients, including 5924 admitted during weekends, were reported by 72 stroke centres. Weekend patients were older, more often disabled prior to stroke and more commonly presented with atrial fibrillation and coronary heart disease. Weekend patients were more likely to present consciousness disturbances at admission. More patients admitted on weekends died during hospitalization or had poor outcome at discharge than weekday patients (15.9% and 59.8% vs. 14.1% and 55.3%, respectively). After adjusting for baseline severity of stroke and case-mix, the regression model showed that weekend ischaemic stroke patients had worse prognosis (odds of 1.137 and 1.147 for death and poor outcome, respectively). CONCLUSIONS: Admissions on weekends are associated with higher mortality and poor outcome, and that can be only partially explained by differences in baseline characteristics of admitted patients.

Development of early comprehensive stroke inpatient rehabilitation in Poland - current status and future requirements.

BACKGROUND AND PURPOSE: Every stroke patient should undergo early rehabilitation. We aimed to evaluate accessibility, development and needs in early stroke inpatient rehabilitation in Poland. MATERIAL AND METHODS: A questionnaire evaluating rehabilitation departments was prepared and sent (in 2004 and 2008) to rehabilitation wards in Poland, where stroke patients are treated and undergo early rehabilitation. We divided departments into classes: class A - having comprehensive rehabilitation (physiotherapy minimum 60 minutes/day, speech therapy minimum 30 minutes/5 days/week, rehabilitation of other cognitive impairments minimum 30 minutes/5 days/week, group physiotherapy); B - having the possibility of all types of therapy, but done less frequently; C - physiotherapy and speech therapy; D - physiotherapy and cognitive rehabilitation; E - only physiotherapy. RESULTS: In 2004, we obtained responses from 115 of 172 (66.9%) rehabilitation departments. According to prespecified criteria there were 11 class A, 31 class B, 28 class C, 4 class D, and 41 class E wards. In 2008, we received response from 89 of 149 (59.7%) rehabilitation departments. According to prespecified criteria there were 17 class A, 40 class B, 22 class C, 0 class D, and 10 class E wards. In 2004, 159 beds and in 2008, 294 beds in class A departments were available for stroke patients. The minimal number of needed but lacking beds was 604 in 2004 and 469 in 2008. CONCLUSIONS: Development of departments providing early comprehensive stroke rehabilitation from 2004 to 2008 is marked, but still insufficient. In 2008, 19% of rehabilitation departments could provide comprehensive stroke rehabilitation and this was 38.5% of beds actually needed.