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1.
Cardiovasc Ther ; 2021: 6622651, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34257706

RESUMO

Objectives: To assess mean systolic and diastolic blood pressure (SBP and DBP) levels in patients ≥50 years with uncontrolled hypertension (HTN) and evaluate the correlation between BP and stroke risk. It also assessed therapeutic drug classes prescribed in these patients. Methods: A cross-sectional, observational study was conducted at 176 outpatient centers across India, including patients aged ≥50 years with elevated SBP (≥140 mmHg). The relationship between stroke risk, calculated using Stroke Riskometer™, and mean SBP, mean DBP, and other risk factors was evaluated using Pearson correlation coefficient and logistic regression analysis. Results: The study included 3791 patients (men, 60.0%; mean age: 62.1 ± 8.3 years; mean BMI: 27 kg/m2) with mean SBP 157.3 ± 12.8 mmHg and mean DBP 89.8 ± 9.7 mmHg. Five-year stroke risk in 33.9% and 10-year stroke risk in 70% patients were moderate to severe. A ~4% increase in both 5- and 10-year stroke risk with each 1 mmHg increase in mean SBP (p < 0.0001) was seen. However, mean DBP did not exhibit any significant correlation with 5-year (p = 0.242) or 10-year (p = 0.8038) stroke risk. There was a positive correlation between mean SBP and patient age, comorbid diabetes, and smoking and alcohol habits (p < 0.0001). Comorbid diabetes and smoking increased 5- and 10-year stroke risk by 2- to 5-fold. Irrespective of the risk category, most patients received antihypertensive therapy with an angiotensin receptor blocker. Conclusion: Findings corroborate an association between stroke risk and mean SBP. These real-world clinical findings indicate that efforts are required to improve primary prevention of stroke and reduce the prevalence of recurrent stroke in India.


Assuntos
Pressão Sanguínea/fisiologia , Hipertensão/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-34205106

RESUMO

Background and Objectives: Stroke is a strong risk factor for recurrent cardiovascular disease (CVD) incidents. The risk of post-stroke CVD incidents can be reduced by eliminating the most relevant risk factors. The aim of the study was to compare the incidence of recurrent CVD events and to determine the quantitative and qualitative differences in CVD risk factors over the 5-year follow-up period in patients with ischemic stroke (IS) and haemorrhagic stroke (ICH) with the use of ICF classification categories to present these differences. Materials and Methods: The study was retrospective. The study groups included 55 post-IS patients and 47 post-ICH patients. The results were translated into the categories from the International Classification of Functioning, Disability and Health (ICF) classification. Results: As compared to post-ICH patients, post-IS patients were significantly more frequently observed to have recurrent CVD incidents (p < 0.001), including fatal CVD incidents (p = 0.003). More risk factors in total were identified in both post-IS patients (p = 0.031) and post-ICH patients (p = 0.002) who had a recurrent CVD incident. Post-IS patients were more often found to have arterial blood pressure higher than 140/90 mmHg (p = 0.045). On the other hand, post-ICH patients were more frequently observed to have carotid artery stenosis in the range of 50-69% (p = 0.028) and an eGFR of <15 mL/min/1.73 m2 (p = 0.001). Conclusions: The type of primary stroke determines the type and incidence of risk factors as well as the recurrence rate of CVD incidents over a 5-year follow-up period. Patients after IS have a higher risk of recurrence of CVD events, including fatal ones in the 5-year follow-up compared to patients after ICH. In addition, post-IS patients who have a recurrent CVD event over a 5-year follow-up have more risk factors for a CVD event than ICH. The ICF classification can be useful for assessing and analysing risk factors for recurrent CVD incidents, which can help to improve the effectiveness of secondary prevention.


Assuntos
Acidente Vascular Cerebral , Seguimentos , Humanos , Recidiva , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
4.
J Interv Cardiol ; 2021: 9917407, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34220370

RESUMO

Objectives: Several randomized controlled trials (RCTs) consistently reported better clinical outcomes with radial as compared to femoral access for primary percutaneous coronary intervention (PCI). Nevertheless, heterogeneous use of potent antiplatelet drugs, such as Gp IIb/IIIa inhibitors (GPI), across different studies could have biased the results in favor of radial access. We performed an updated meta-analysis and meta-regression of RCTs in order to appraise whether the use of GPI had an impact on pooled estimates of clinical outcomes according to vascular access. Methods: We computed pooled estimates by the random-effects model for the following outcomes: mortality, major adverse cardiovascular events (death, myocardial infarction, stroke, and target vessel revascularization), and major bleedings. Additionally, we performed meta-regression analysis to investigate the impact of GPI use on pooled estimates of clinical outcomes. Results: We analyzed 14 randomized controlled trials and 11090 patients who were treated by radial (5497) and femoral access (5593), respectively. Radial access was associated with better outcomes for mortality (risk difference 0.01 (0.00, 0.01), p=0.03), MACE (risk difference 0.01 (0.00, 0.02), p=0.003), and major bleedings (risk difference 0.01 (0.00, 0.02), p=0.02). At meta-regression, we observed a significant correlation of mortality with both GPI use (p=0.011) and year of publication (p=0.0073), whereas no correlation was observed with major bleedings. Conclusions: In this meta-analysis, the use of radial access for primary PCI was associated with better clinical outcomes as compared to femoral access. However, the effect size on mortality was modulated by GPI rate, with greater benefit of radial access in studies with larger use of these drugs.


Assuntos
Intervenção Coronária Percutânea/métodos , Inibidores da Agregação Plaquetária/uso terapêutico , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Artéria Femoral , Hemorragia/epidemiologia , Humanos , Artéria Radial , Ensaios Clínicos Controlados Aleatórios como Assunto , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Acidente Vascular Cerebral/epidemiologia
5.
Medicina (Kaunas) ; 57(6)2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34207100

RESUMO

Background and Objectives: A hospital-based stroke registry is a useful tool for systematic analyses of the epidemiology, clinical characteristics, and natural course of stroke. Analyses of stroke registry data can provide information that can be used by health services to improve the quality of care for patients with this disease. Materials and Methods: Data were collected from the Riga East University Hospital (REUH) Stroke Registry in order to evaluate the etiology, risk factors, clinical manifestations, treatment, functional outcomes, and other relevant data for acute stroke during the period 2016-2020. Results: During a five-year period, 4915 patients (3039 females and 1876 males) with acute stroke were registered in the REUH Stroke Registry. The causative factors of stroke were cardioembolism (45.7%), atherosclerosis (29.9%), lacunar stroke (5.3%), stroke of undetermined etiology (1.2%), and stroke of other determined causes (1.2%). The most frequent localizations of intracerebral hemorrhage were subcortical (40.0%), lobar (18.9%), and brainstem (9.3%). The most prevalent risk factors for stroke were hypertension (88.8%), congestive heart failure (71.2%), dyslipidemia (46.7%), and atrial fibrillation (44.2%). In addition, 1018 (20.7%) patients were receiving antiplatelet drugs, 574 (11.7%) were taking statins, and 382 (7.7%) were taking anticoagulants. At discharge, 35.5% of the patients were completely independent (mRS (modified Rankin Scale) score: 0-2), while 49.5% required some form of assistance (mRS score: 3-5). The intrahospital mortality rate was 13.7%, although it was higher in the hemorrhage group (30.9%). Conclusions: Our stroke registry data are comparable to those of other major registries. Analysis of stroke registry data is important for improving stroke care and obtaining additional information for stroke studies.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Hemorragia Cerebral/epidemiologia , Feminino , Hospitais , Humanos , Masculino , Sistema de Registros , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
6.
Medicina (Kaunas) ; 57(5)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34069433

RESUMO

Background and Objectives: The Coronavirus disease 2019 (COVID-19) pandemic caused significant disruption to established medical care systems globally. Thus, this study was aimed to compare the admission and outcome variables such as number of patient and its severity, acute recanalisation therapy given pre-post COVID-19 at a primary stroke centre located in Malaysia. Methods: This cross-sectional hospital-based study included adult ischaemic stroke patients. Variables of the study included the number of ischaemic stroke patients, the proportions of recanalisation therapies, stroke severity during admission based on the National Institutes of Health Stroke Scale, functional outcome at discharge based on the modified Rankin Scale, and relevant workflow metrics. We compared the outcome between two six-month periods, namely the pre-COVID-19 period (March 2019 to September 2019) and the COVID-19 period (March 2020 to September 2020). Results: There were 131 and 156 patients, respectively, from the pre-COVID-19 period and the COVID-19 period. The median door-to-scan time and the median door-to-reperfusion time were both significantly shorter in the COVID-19 period (24.5 min versus 12.0 min, p = 0.047) and (93.5 min versus 60.0 min, p = 0.015), respectively. There were also significantly more patients who received intravenous thrombolysis (7.6% versus 17.3%, p = 0.015) and mechanical thrombectomy (0.8% versus 6.4%, p = 0.013) in the COVID-19 period, respectively. Conclusions: The COVID-19 pandemic may not have caused disruptions of acute stroke care in our primary stroke centre. Our data indicated that the number of ischaemic stroke events remained stable, with a significant increase of recanalisation therapies and better in-hospital workflow metrics during the COVID-19 pandemic period. However, we would like to highlight that the burden of COVID-19 cases in the study area was very low. Therefore, the study may not have captured the true burden (and relevant delays in stroke patient management) during the COVID-19 pandemic. The effect of the pandemic crisis is ongoing and both pre-hospital and in-hospital care systems must continue to provide optimal, highly time-dependent stroke care services.


Assuntos
Isquemia Encefálica , COVID-19 , Acidente Vascular Cerebral , Adulto , Estudos Transversais , Humanos , Malásia/epidemiologia , Pandemias , SARS-CoV-2 , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Trombectomia , Terapia Trombolítica , Tempo para o Tratamento , Resultado do Tratamento
7.
BMC Public Health ; 21(1): 1059, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34082746

RESUMO

BACKGROUND: As a country with one-fifth of the global population, China has experienced explosive growth in ischaemic stroke (IS) burden with significant ethnic and geographic disparities. The aim of this study was to examine the differences in potentially modifiable risk factors for ischaemic stroke among the Han population and two ethnic minorities (Tujia and Miao). METHODS: A case-control study was conducted with 324 cases of first-ever ischaemic stroke from the hospitals of the Xiangxi Tujia and Miao Autonomous Prefecture and 394 controls from communities covering the same area between May 1, 2018, and April 30, 2019. Structured questionnaires were administered, and physical examinations were performed in the same manner for cases and controls. Univariate and multivariate logistic regression analyses with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were used to examine the association between risk factors and ischaemic stroke. An additive model was used to study the interaction between the modifiable risk factors and ethnicity with R software. RESULTS: Higher high-sensitivity C-reactive protein levels (OR 50.54, 95%CI 29.76-85.85), higher monthly family income (4.18, 2.40-7.28), increased frequency of hot pot consumption (2.90, 1.21-6.93), diabetes mellitus (2.62, 1.48-4.62), a higher apolipoprotein (Apo)B/ApoA1 ratio (2.60, 1.39-4.85), hypertension (2.52, 1.45-4.40) and moderate-intensity physical activity (0.50, 0.28-0.89) were associated with ischaemic stroke. There was an additive interaction between the ApoB/ApoA1 ratio and ethnicity in the Tujia and Miao populations with first-ever ischaemic stroke (the relative excess risk due to the interaction was 5.75, 95% CI 0.58 ~ 10.92; the attributable proportion due to the interaction was 0.65, 95% CI 0.38 ~ 0.91; the synergy index was 3.66, 95% CI 1.35 ~ 9.93). CONCLUSIONS: This is the first case-control study examining modifiable risk factors for ischaemic stroke among the Han population and two ethnic minorities (Tujia and Miao) in China. Some differences were observed in the impact of risk factors among these ethnic groups. Our results may help interpret health-related data, including surveillance and research, when developing strategies for stroke prevention.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/epidemiologia , Estudos de Casos e Controles , China/epidemiologia , Grupos Étnicos , Humanos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
8.
BMC Public Health ; 21(1): 1088, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098909

RESUMO

BACKGROUND: The aim of our study was to evaluate the risk for comorbid cardio- and cerebrovascular diseases in the working-aged migraine population of Finland. METHODS: A total of 1505 cases who reported diagnosed migraine and 3010 controls from a cohort of 11,596 cases in the Finnish Health and Social Support Study were included. The study material was linked with two registers. ICD diagnoses I63 for ischemic stroke (IS), I21 - I22 for acute myocardial infarction (AMI), and G43 for transient ischemic attack (TIA) among study participants were drawn from the national Finnish Care Register for Health Care at the follow-up in 2012. Reimbursed triptan prescriptions were drawn from the national Social Security Institution (SII) data. The self-reported vascular risk factors were hypertension, high cholesterol values, any diabetes, myocardial infarction, stroke, and TIA. Odds Ratios (OR) with 95% confidence (95% CI) intervals were assessed for diagnosed stroke, myocardial infarction, and TIA. RESULTS: Migraineurs were mostly female (82%) and ≥ 54 years old (62%). Triptans were reimbursed among 34.7% of migraineurs. A self-reported hypertension (21%), high serum cholesterol (38%), and any diabetes (7%) were more common among migraineurs vs controls (p < 0.05). There was no risk for AMI. The risk for TIA (OR 3.20, 95% CI 1.45-7.05) and IS (2.57, 95% CI 1.28-5.17) among migraineurs vs controls remained high after adjustment for self-reported hypertension, obesity, and smoking. The risk was higher among women in two groups ≥54 years (3.25, 95% CI 1.35-7.84 and 5.0, 95% CI 1.94-12.89, respectively). The average age for IS in migraine was 57.5 years and for TIA 58.2 years among women, and 52.8 years and 50.3 years among men, respectively. CONCLUSION: Cardiovascular risk should be screened in the aging migraine population, and hormonal and other migraine-related risk factors should be considered, especially among women. Efficacious attack treatment with triptans should be offered to migraine patients who do not show contraindications.


Assuntos
Doenças Cardiovasculares , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Idoso , Doenças Cardiovasculares/epidemiologia , Feminino , Finlândia/epidemiologia , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
9.
Egypt J Immunol ; 28(1): 33-45, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34147052

RESUMO

Some studies reported a high prevalence of ischemic stroke in hepatitis C virus patients, other several studies have suggested that hepatitis C virus (HCV) may act as a trigger for autoimmune diseases and autoantibodies including Anti-Neutrophil Cytoplasmic Antibody (ANCA) which predispose to vasculitis. Because vasculitis is a risk factor for ischemic stroke, we investigated the association of the hepatitis C virus with ANCA in first-ever ischemic stroke patients. This study included 67 Egyptian patients with first-ever ischemic stroke. These patients were clinically examined and investigated for HCV infection by chemiluminescence & Real Time-PCR, and ANCA antibodies by ELISA. Forty-two patients (62.7%) had HCV infection. Twenty-nine (43.2%) of them were cytoplasmic- Antineutrophil Cytoplasmic Antibodies (c-ANCA) positive, while none was perinuclear- Antineutrophil Cytoplasmic Antibodies (p-ANCA) positive. Comparison between c-ANCA positive and ANCA negative patients showed that 82.8% and 47.4% had anti-HCV antibody, respectively, with P-value 0.003. The c-ANCA level correlated significantly with age, and HCV antibody level. No statistically significant difference was found in both the consciousness and stroke severity between the negative and positive c- ANCA patients. However, patients with positive c-ANCA had smaller and multiple cerebral infarctions with P-value 0.002 and 0.01 respectively. Multiple regression analysis showed that the number and size of cerebral infarctions were independent predictors of c-ANCA positivity with P value 0.02, and 0.03 respectively. In conclusion, c-ANCA level correlates with HCV antibody and may predispose to ischemic stroke by a possible ANCA associated vasculitis.


Assuntos
Isquemia Encefálica , Hepatite C , AVC Isquêmico , Acidente Vascular Cerebral , Anticorpos Anticitoplasma de Neutrófilos , Isquemia Encefálica/epidemiologia , Egito/epidemiologia , Ensaio de Imunoadsorção Enzimática , Hepacivirus , Hepatite C/complicações , Hepatite C/epidemiologia , Humanos , Acidente Vascular Cerebral/epidemiologia
10.
Wiad Lek ; 74(4): 923-928, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34156005

RESUMO

OBJECTIVE: The aim: To determine the frequency of HSV1, HSV2, VZV, CMV, EBV, HHV6 and influenza virus detection in patients with ischemic stroke in different seasons. PATIENTS AND METHODS: Materials and methods: 144 patients with ischemic stroke were examined: 78 (54.2%) women and 66 (45.8%) men, mean age of 63.1 ± 0.8 years. Detection of the herpesvirus DNA and the influenza virus RNA was performed using PCR monthly in 12 patients. RESULTS: Results: A manifestation of a viral infection was detected in 32 (22.2%) and virus genomes were observed in 29 (90.6%) patients. Viral infection frequency is significantly lower in summer, compared to winter-autumn; p=0.033. HSV1 and HHV6 were the most common (19 (52.8%) and 16 (44.4%)); VZV was the least common (5 (13.9%)). Influenza virus RNA was detected in 10 (27.8%) patients. In winter-autumn the frequency of HSV1, HSV2, HHV6 viruses detection is significantly higher, compared to the spring-summer (p<0.05), and the difference is almost significant for the influenza virus (p=0.060) and the EBV (p=0.060). Association of stroke occurrence with the presence of two or more types of viruses is more common in winter, compared to the summer season: 11 (30.6%) vs. 3 (8.3%), p=0.017. CONCLUSION: Conclusions: Prevention and treatment of herpesvirus infections exacerbations, in particular HSV1 and HSV2, which significantly increase in winter, compared to summer, is an important direction of stroke prevention measures in risk groups.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Orthomyxoviridae , Acidente Vascular Cerebral , Vírus , Isquemia Encefálica/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estações do Ano , Acidente Vascular Cerebral/epidemiologia
11.
Neurol India ; 69(3): 547-559, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34169841

RESUMO

Background: Stroke is a heterogeneous disorder comprising of clinical subtypes and many risk factors, also alluded to as cerebrovascular disorders (CVDs). Increase in the global burden of stroke in developed and developing countries has been alarming. To galvanize the efforts towards the prevention and treatment, there is a need for robust data on the burden of stroke. Objective: The aim of this study was to estimate the burden of stroke, a systematic review of community-based studies was conducted. Material and Methods: Systematic search of PubMed and Google Scholar for studies from January 1960 to December 2018 was done. The articles were screened and the data was retrieved and sorted into incidence, prevalence and mortality rates. Meta-analysis was done on Medcalc statistical software version 19.2.6. Results: Prevalence rate of stroke for total population inclusive of urban and rural population, varied from 44.54 to 150/100000.For the urban population prevalence rate was 45 to 487/100000 and 55 to 388.4/100000 for rural population. The incidence rate varied from 33 to 123/100000 in the urban population and in the rural population it was estimated to be 123.57/100000. The 30 days case fatality rate of stroke varied from 41.08% to 42.06% in urban population and 18% to 46.3%.in the rural population. Conclusions: Systematic review and meta-analysis reveal that the stroke burden in India is quite high.


Assuntos
Acidente Vascular Cerebral , Humanos , Incidência , Índia/epidemiologia , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
12.
Soc Sci Med ; 281: 114088, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34118684

RESUMO

OBJECTIVE: Partners can be beneficial for patients experiencing stressful health events such as a stroke/transient ischemic attack (TIA). During such events, however, partners may exacerbate early distress. The present study tested whether having a cohabiting partner modified the association between patients' early perceptions of threat (e.g., feeling vulnerable, helpless) and longer-term posttraumatic stress symptoms (PTSS). METHODS: Participants (N = 328) were drawn from an observational cohort study of patients evaluated for stroke/TIA at an urban academic hospital between 2016 and 2019. Participants self-reported emergency department (ED) threat perceptions and PTSS secondary to the stroke/TIA at three days and one month post-event. RESULTS: Cohabiting partner status modified the association of ED threat with early PTSS. Patients with a cohabiting partner exhibited a positive association between ED threat and early PTSS, B = 0.12, p < .001; those without a cohabiting partner did not, B = 0.04, p = .067. A cohabiting partner was protective only for patients who initially reported low levels of ED threat, as patients with a cohabiting partner who reported low levels of ED threat also had lower early PTSS, B = -0.15, p = .016; at high levels of ED threat, a cohabiting partner was not protective, B = -0.02, p = .68. ED threat was associated with PTSS at one month, B = 0.42, p < .001, but cohabiting partner status did not modify the association. CONCLUSIONS: ED threat perceptions were positively associated with early PTSS only for patients with a cohabiting partner. For patients who do not initially experience a stroke/TIA event as threatening, cohabiting partners may help patients maintain psychological equanimity.


Assuntos
Ataque Isquêmico Transitório , Transtornos de Estresse Pós-Traumáticos , Acidente Vascular Cerebral , Estudos de Coortes , Serviço Hospitalar de Emergência , Humanos , Ataque Isquêmico Transitório/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Acidente Vascular Cerebral/epidemiologia
13.
Int J Health Geogr ; 20(1): 31, 2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187473

RESUMO

PURPOSE: Rapid accessibility of (intensive) medical care can make the difference between life and death. Initial care in case of strokes is highly dependent on the location of the patient and the traffic situation for supply vehicles. In this methodologically oriented paper we want to determine the inequivalence of the risks in this respect. METHODS: Using GIS we calculate the driving time between Stroke Units in the district of Münster, Germany for the population distribution at day- & nighttime. Eight different speed scenarios are considered. In order to gain the highest possible spatial resolution, we disaggregate reported population counts from administrative units with respect to a variety of factors onto building level. RESULTS: The overall accessibility of urban areas is better than in less urban districts using the base scenario. In that scenario 6.5% of the population at daytime and 6.8% at nighttime cannot be reached within a 30-min limit for the first care. Assuming a worse traffic situation, which is realistic at daytime, 18.1% of the population fail the proposed limit. CONCLUSIONS: In general, we reveal inequivalence of the risks in case of a stroke depending on locations and times of the day. The ability to drive at high average speeds is a crucial factor in emergency care. Further important factors are the different population distribution at day and night and the locations of health care facilities. With the increasing centralization of hospital locations, rural residents in particular will face a worse accessibility situation.


Assuntos
Acesso aos Serviços de Saúde , Acidente Vascular Cerebral , Demografia , Alemanha , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Transportes
14.
Artigo em Inglês | MEDLINE | ID: mdl-34073370

RESUMO

Introduction: The use of vitamin K antagonists (VKAs) in non-valvular atrial fibrillation (NVAF) is complicated due to the narrow therapeutic margin they present and their unpredictable dose-response relationship. Most studies are based on warfarin, with the results being extrapolated to acenocoumarol. However, studies comparing the two treatments in terms of the degree of anticoagulation control are scarce, justifying the present study. Main factors associated with poor control of time in therapeutic range (TTR) of anticoagulated patients are also studied. Methods: Cross-sectional study, with real-world data from patients treated in primary care (PC). Data were obtained from the System for the Improvement of Research in PC (SIDIAP) database, covering 60,978 NVAF-anticoagulated patients from 287 PC centres in 2018. Descriptive statistics were derived, and odds ratios were estimated by multivariate logistic regression. Results: 41,430 patients were considered: 93% were being treated with acenocoumarol and 7% with warfarin. There was no difference in poor control of TTR between the two types of VKA treatment, acenocoumarol and warfarin (38.9 vs. 38.4; p = 0.610). Poor anticoagulation control was mainly associated with advanced alcoholism (OR = 1.38), liver failure (OR = 1.37) and intracranial haemorrhage (OR = 1.35) as well as female sex, age < 60 years, cardiovascular history, diabetes mellitus and other variables. Conclusions: There is no association between poor anticoagulation control and the type of VKA treatment administered. Factors associated with poor control of TTR must be considered in clinical practice to improve control and decision-making.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Acenocumarol/uso terapêutico , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Atenção Primária à Saúde , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Varfarina/uso terapêutico
15.
BMC Public Health ; 21(1): 1183, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-34154554

RESUMO

BACKGROUND: To date, little is known about cardiovascular disease risks among older adults with non-valvular atrial fibrillation by their association with diabetes and osteoarthritis status, based on longitudinal data with substantial amounts of non-white individuals. The objective of this study was to examine the risks for three cardiovascular diseases: stroke, acute myocardial infarction (AMI), and heart failure (HF), by diabetes and osteoarthritis status among older adults with non-valvular atrial fibrillation in Hawaii. METHODS: We conducted a retrospective observational cohort study for older adults (65 years and older) with non-valvular atrial fibrillation using the Hawaii Medicare data 2009-2017. Their risks for the three cardiovascular diseases by diabetes and osteoarthritis status (diabetes, osteoarthritis, diabetes and osteoarthritis, and without diabetes and osteoarthritis) were examined by multivariable Cox proportional hazard regression models. RESULTS: The analysis included 19,588 beneficiaries followed up for a maximum of 3288 days (diabetes: n = 4659, osteoarthritis: n = 1978, diabetes and osteoarthritis: n = 1230, without diabetes and osteoarthritis: n = 11,721).  Among them, those diagnosed with the cardiovascular diseases were identified (stroke: diabetes n = 837, osteoarthritis n = 315, diabetes and osteoarthritis n = 184, without diabetes and osteoarthritis n = 1630)(AMI: diabetes n = 438, osteoarthritis n = 128, diabetes and osteoarthritis n = 118, without diabetes and osteoarthritis n = 603)(HF: diabetes n = 2254, osteoarthritis n = 764, diabetes and osteoarthritis n = 581, without diabetes and osteoarthritis n = 4272). After adjusting for age, sex, race/ethnicity, and other potential confounders, those with diabetes and osteoarthritis had higher risks for HF (hazard ratio: 1.21 95% confidence interval: 1.10-1.33) than those without diabetes and osteoarthritis. They also had higher risks than those with osteoarthritis for HF. Those with diabetes had higher risks for all three cardiovascular diseases than the other three groups. CONCLUSIONS: Variation in cardiovascular disease risks for older adults with non-valvular atrial fibrillation in Hawaii exists with diabetes and osteoarthritis status.


Assuntos
Fibrilação Atrial , Diabetes Mellitus , Insuficiência Cardíaca , Infarto do Miocárdio , Osteoartrite , Acidente Vascular Cerebral , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Diabetes Mellitus/epidemiologia , Hawaii/epidemiologia , Insuficiência Cardíaca/epidemiologia , Humanos , Medicare , Infarto do Miocárdio/epidemiologia , Osteoartrite/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Estados Unidos
16.
J Stroke Cerebrovasc Dis ; 30(8): 105912, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34130105

RESUMO

BACKGROUND/OBJECTIVE: While postoperative stroke is a known complication of Transcatheter Aortic Valve Implantation (TAVI), predictors of early stroke occurrence have not been specifically reviewed. The objective of this study was to estimate the predictors and incidence of stroke during the first 30 days post-TAVI. METHODS: A cohort of 506 consecutive patients having undergone TAVI between January 2017 and June 2019 was extracted from a prospective database. Preoperative, intraoperative and postoperative characteristics were analyzed by univariate analysis followed by logistic regression to find predictors of the occurrence of stroke or death within the first 30 days after the procedure. RESULTS: Incidence of stroke within 30 days post-TAVI was 4.9%, [CI 95% 3.3-7.2], i.e., 25 strokes. Four out of the 25 patients (16%) with a stroke died within 30 days post-TAVI. After logistic regression analysis, the predictors of early stroke related to TAVI were: CHA2Ds2VASc score ≥ 5 (odds ratio [OR] 2.62; 95% CI: 1.06-6.49; p = .037), supra-aortic access vs. femoral access (OR: 9.00, 95%CI: 2.95-27.44; p = .001) and introduction post-TAVI of a single vs. two or three antithrombotic agents (OR: 5.13; CI 95%: 1.99 to 13.19; p = .001). Over the 30-day period, bleeding occurred in 28 patients (5.5%), in 25 of whom, it was associated with femoral or iliac artery access injury. Anti-thrombotic regimen was not associated with bleeding; two patients out of 48 (4.1%) bled with a single anti-thrombotic regimen vs. 26 patients out of 458 (5.6%) with a dual or triple anti-thrombotic regimen (p = 0.94). The overall 30-day mortality rate was 3.9%, [95% CI 2.5-6.0]. Patients with a single post-TAVI antithrombotic agent (OR: 44.07 [CI 95% 13.45-144.39]; p < .0001) and patients with previous coronary artery bypass surgery or coronary artery stenting (OR: 6.16, [CI 95% 1.99-21.29]; p = .002) were at significantly higher risk of death within the 30-day period. CONCLUSION: In this large-scale single-center retrospective study, a single post-TAVI antithrombotic regimen independently predicted occurrence of early stroke or death. Dual or triple antithrombotic regimen was not associated with a higher risk of bleeding and should be considered as an option in patients undergoing TAVI.


Assuntos
Estenose da Valva Aórtica/cirurgia , Fibrinolíticos/efeitos adversos , Acidente Vascular Cerebral/epidemiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Bases de Dados Factuais , Quimioterapia Combinada , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/mortalidade
17.
J Stroke Cerebrovasc Dis ; 30(8): 105931, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34157669

RESUMO

OBJECTIVES: The Quality in Acute Stroke Care (QASC) protocol is a multidisciplinary approach to implement evidence-based treatment after acute stroke that reduces death and disability. This study sought to evaluate the cost-effectiveness of implementing the QASC protocol across Australia, from a healthcare and a societal perspective. MATERIALS AND METHODS: A decision-analytic model was constructed to reflect one-year outcomes post-stroke, aligned with the stroke severity categories of the modified Rankin scale (mRS). Decision analysis compared outcomes following implementation of the QASC protocol versus no implementation. Population data were extracted from Australian databases and data inputs regarding stroke incidence, costs, and utilities were drawn from published sources. The analysis assumed a progressive uptake and efficacy of the QASC protocol over five years. Health benefits and costs were discounted by 5% annually. The cost of each year lived by an Australian, from a societal perspective, was based on the Australian Government's 'value of statistical life year' (AUD 213,000). RESULTS: Over five years, the model predicted 263,722 strokes among the Australian population. The implementation of the QASC protocol was predicted to prevent 1,154 deaths and yield a gain of 876 years of life (0.003 per stroke), and 3,180 quality-adjusted life years (QALYs) (0.012 per stroke). There was an estimated net saving of AUD 65.2 million in healthcare costs (AUD 247 per stroke) and AUD 251.7 million in societal costs (AUD 955 per stroke). CONCLUSIONS: Implementation of the QASC protocol in Australia represents both a dominant (cost-saving) strategy, from a healthcare and a societal perspective.


Assuntos
Protocolos Clínicos , Custos de Cuidados de Saúde , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Melhoria de Qualidade/economia , Indicadores de Qualidade em Assistência à Saúde/economia , Acidente Vascular Cerebral/terapia , Austrália/epidemiologia , Redução de Custos , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Avaliação da Deficiência , Estado Funcional , Humanos , Incidência , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Resultado do Tratamento
18.
J Cardiothorac Surg ; 16(1): 185, 2021 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-34174918

RESUMO

BACKGROUND: The Freestyle® bioprosthesis is used for pathologies of the aortic root. Additional resection of the ascending aorta and the proximal arch in dissections or aneurysms might be indicated. The aim was to assess mid-term outcome regarding prosthetic performance, stroke, reoperations, and survival in various pathologies comparing patients with and without additional procedures on the ascending aorta and proximal arch focusing on the standardised technique of unilateral antegrade cerebral perfusion under moderate hypothermia. METHODS: Retrospective data analysis of 278 consecutive patients after Freestyle® root replacement between September 2007 and March 2017. Patients were divided in three categories due to the pathology of the aortic root (re-operation vs endocarditis vs dissection). Two groups based on the aortic anastomosis technique (open arch anastomosis (OA) versus non-open arch anastomosis (non-OA) were compared (119 OA vs 159 non-OA). Cardiovascular risk, previous cardiac events, intra- and postoperative data were evaluated. Inferential statistics were performed with Mann-Whitney U-test. Nominal and categorical variables were tested with Fisher-Freeman-Halton exact test. Kaplan-Meier estimate was used to assess survival. RESULTS: The follow-up rate was 90% (median follow-up: 39.5 months). There were differences in the indication (endocarditis: OA 5 (4.2%) vs non-OA 36 (24%), p < 0.0001; dissection: OA 13 (10.9%) vs non-OA 2 (1.3%); p = 0.0007). OA patients had less perioperative stroke (1 (1%) vs 15 (10%), p = 0.001) and shorter hospital stay (9 vs 12 days, p = 0.0004). There were no differences in the mortality (in-hospital: OA 8 (7%) vs non-OA 8 (5%); p = 0.6; death at follow-up: OA 5 (5%) vs non-OA 15 (11%); p = 0.1). Overall valve performance showed a well-functioning valve in 97.3% at follow-up. CONCLUSION: The valve performance showed excellent results regardless of the initial indication. The incidence of stroke was lower in patients receiving an open arch anastomosis using unilateral antegrade cerebral perfusion without elevated mortality or prolonged hospital stay.


Assuntos
Anastomose Cirúrgica/métodos , Aneurisma Dissecante/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Endocardite/cirurgia , Idoso , Anastomose Cirúrgica/efeitos adversos , Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/mortalidade , Implante de Prótese Vascular/efeitos adversos , Feminino , Humanos , Hipotermia Induzida , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Perfusão , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
19.
J Stroke Cerebrovasc Dis ; 30(8): 105929, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34175577

RESUMO

OBJECTIVES: Low- to middle-income countries experience a marked rise in cardiovascular diseases, and have the highest incidence of HIV infection. Stroke data in HIV-positive patients is still scarce. This study compares risk factors and types of stroke between HIV-positive and -negative patients in South Africa. MATERIALS AND METHODS: We conducted a cross-sectional study at Kalafong Provincial Tertiary Hospital in Pretoria over a 10-month period. All adult patients presenting with an acute stroke were included. RESULTS: One hundred and forty consecutive patients with stroke were included, 23% were HIV-positive. The average age in the HIV-positive group was 41 years, compared to 61 years in the HIV-negative group (p < 0.01). Ischemic infarcts occurred in 80.7 and 19.3% were hemorrhagic, with no significant difference between the HIV-positive and -negative group (ischemic: 81% vs 80%; hemorrhagic: 19% vs 20%; p = 0.55). Small vessel infarcts occurred more frequently in HIV-positive patients (25% vs 9.3%; p < 0.02). While 78% of HIV-positive patients presented with concomitant infections, these were found in only 23% of HIV-negative patients (P < 0.001). Hypertension (81% vs 37.5%; p = 0.01) and dyslipidemia (62% vs 38%; p = 0.01) were more prevalent in the HIV-negative patients. Confounding variables were gender and age. Although more than half of the HIV-positive patients were on antiretroviral therapy, the majority (62.5%) showed virological non-suppression. CONCLUSIONS: HIV infection occurred in almost one-quarter of stroke patients and was seen more in the younger age group. Small vessel ischemic infarcts and underlying infections were more common in HIV-positive patients. The high number of HIV-positive patients with virological non-suppression is concerning and needs to be addressed.


Assuntos
Infecções por HIV/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Comorbidade , Estudos Transversais , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Medição de Risco , Fatores de Risco , África do Sul/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/terapia , Carga Viral
20.
BMJ Open ; 11(5): e048839, 2021 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059516

RESUMO

OBJECTIVE: The study aimed to examine the association between socioeconomic factors (SEFs) and oral anticoagulation (OAC) therapy and whether it was influenced by changing guidelines. We hypothesised that inequities in initiation of OAC reduced over time as more detailed and explicit clinical guidelines were issued. DESIGN: Register-based observational study. SETTINGS: All Danish patients with an incident hospital diagnosis of atrial fibrillation (AF), aged ≥30 years old and with high risk of stroke from 1 May 1999 to 2 October 2015 were included. Absolute risk differences (RD) (95% CI) were used to measure the association. PARTICIPANTS: 154 448 patients (mean age 78.2 years, men 47.3%). EXPOSURE: Education, family income and cohabiting status were the SEFs used as exposure. OUTCOME: A prescription of OAC within -30 to +90 days of baseline (incident AF). RESULTS: During 2002-2007, the crude RD of initiation of OAC for men with high education was 14.9% (12.8 to 16.9). Inequality reduced when new guidelines were published, and in 2013-2016 the crude RD was 5.6% (3.5 to 7.7). After adjusting for age, the RD substantially reduced. The same pattern was seen for cohabiting status, while inequality was smaller and more constant for income. CONCLUSION: Patients with low income, low education and living alone were associated with lower chance of being initiated with OAC. For education and cohabiting status, the crude difference reduced around 2011, when more detailed clinical guidelines were implemented in Denmark. Our results indicate that new guidelines might reduce inequality in OAC initiation and that new, high-cost drugs increase inequality.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Administração Oral , Adulto , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Humanos , Masculino , Fatores de Risco , Fatores Socioeconômicos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle
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