RESUMEN
BACKGROUND: Poststroke cognitive impairment (PSCI) occurs in about 60% of patients with stroke in the first year after stroke. However, the question regarding risks of recurrent stroke and mortality in patients with PSCI remains controversial. The goal of this study was to conduct a meta-analysis of published literature to estimate the risks of stroke recurrence and mortality associated with PSCI. METHODS AND RESULTS: Electronic databases were screened for eligible studies published from 1990 to 2023. The primary end points of this study were recurrent stroke and mortality. Pooled estimates were calculated as hazard ratios (HR) with 95% CIs. Meta-regression analyses evaluated moderating effects of PSCI severity, study design, and study period on recurrent stroke and mortality. Pooled data from 27 studies comprised 39 412 patients with ischemic stroke. Nine studies evaluated the association between PSCI and risk of stroke recurrence that showed the hazard of recurrent stroke risk was significantly higher in patients with PSCI compared with those without it (HR, 1.59 [95% CI, 1.29-1.94]; I2=52.2%). Eighteen studies examined the impact of PSCI on mortality risk. The pooled hazard of mortality was significantly higher in the group with PSCI relative to the non-PSCI group (HR, 2.07 [95% CI, 1.65 -2.59]; I2=89.3%). Meta-regressions showed that the average effect of PSCI on mortality risk differed across study period and study design. CONCLUSIONS: Based on this meta-analysis PSCI was statistically significantly associated with increased risks of recurrent stroke and all-cause mortality. Poststroke neurocognitive assessment may identify patients at a higher risk who may require more aggressive interventions for secondary prevention.
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Disfunción Cognitiva , Recurrencia , Accidente Cerebrovascular , Humanos , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiología , Disfunción Cognitiva/diagnóstico , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/epidemiología , Factores de Riesgo , Medición de RiesgoRESUMEN
BACKGROUND AND OBJECTIVES: Markers of white matter (WM) injury on brain MRI are important indicators of brain health. Different patterns of WM atrophy, WM hyperintensities (WMHs), and microstructural integrity could reflect distinct pathologies and disease risks, but large-scale imaging studies investigating WM signatures are lacking. This study aims to identify distinct WM signatures using brain MRI in community-dwelling adults, determine underlying risk factor profiles, and assess risks of dementia, stroke, and mortality associated with each signature. METHODS: Between 2005 and 2016, we measured WMH volume, WM volume, fractional anisotropy (FA), and mean diffusivity (MD) using automated pipelines on structural and diffusion MRI in community-dwelling adults aged older than 45 years of the Rotterdam study. Continuous surveillance was conducted for dementia, stroke, and mortality. We applied hierarchical clustering to identify separate WM injury clusters and Cox proportional hazard models to determine their risk of dementia, stroke, and mortality. RESULTS: We included 5,279 participants (mean age 65.0 years, 56.0% women) and identified 4 distinct data-driven WM signatures: (1) above-average microstructural integrity and little WM atrophy and WMH; (2) above-average microstructural integrity and little WMH, but substantial WM atrophy; (3) poor microstructural integrity and substantial WMH, but little WM atrophy; and (4) poor microstructural integrity with substantial WMH and WM atrophy. Prevalence of cardiovascular risk factors, lacunes, and cerebral microbleeds was higher in clusters 3 and 4 than in clusters 1 and 2. During a median 10.7 years of follow-up, 291 participants developed dementia, 220 had a stroke, and 910 died. Compared with cluster 1, dementia risk was increased for all clusters, notably cluster 3 (hazard ratio [HR] 3.06, 95% CI 2.12-4.42), followed by cluster 4 (HR 2.31, 95% CI 1.58-3.37) and cluster 2 (HR 1.67, 95% CI 1.17-2.38). Compared with cluster 1, risk of stroke was higher only for clusters 3 (HR 1.55, 95% CI 1.02-2.37) and 4 (HR 1.94, 95% CI 1.30-2.89), whereas mortality risk was increased in all clusters (cluster 2: HR 1.27, 95% CI 1.06-1.53, cluster 3: HR 1.65, 95% CI 1.35-2.03, cluster 4: HR 1.76, 95% CI 1.44-2.15), compared with cluster 1. Models including clusters instead of an individual imaging marker showed a superior goodness of fit for dementia and mortality, but not for stroke. DISCUSSION: Clustering can derive WM signatures that are differentially associated with dementia, stroke, and mortality risk. Future research should incorporate spatial information of imaging markers.
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Demencia , Vida Independiente , Accidente Cerebrovascular , Sustancia Blanca , Humanos , Masculino , Femenino , Demencia/epidemiología , Demencia/patología , Demencia/diagnóstico por imagen , Demencia/mortalidad , Anciano , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/patología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/patología , Accidente Cerebrovascular/diagnóstico por imagen , Persona de Mediana Edad , Factores de Riesgo , Imagen por Resonancia Magnética , Análisis por Conglomerados , Atrofia/patologíaRESUMEN
BACKGROUND AND PURPOSE: A stroke or a cerebrovascular accident is a common cause of death and a leading cause of long-term, severe disability in both developed and developing countries. The most recent global burden of disease report states that there were 11.9 million new cases of stroke worldwide; stroke accounts for nearly 1 in 8 deaths globally (12%, 6.5 million deaths) and claims a life every 5 s, making it the second most common cause of death worldwide. The goal of the study was to identify the most important factors influencing stroke patients' time to death at Gambella General Hospital. METHODS: Data was gathered from patient files in a hospital using a retrospective study methodology, spanning the period from September 2018 to September 2020. R 3.4.0 statistical software and STATA version 14.2 were used for data entry and analysis. The survival time was compared using the log-rank tests and the Kaplan-Meier survival curve. The fitness of the Cox proportional hazard model was examined. RESULTS: The final model that was fitted was the log-logistic AFT model. A statistically significant correlation was defined as having a p value of less than 0.05 and the accelerated factor (γ) with its 95% confidence interval was employed. Eight days was the total median death time (95% CI 6-10). Significant predictors for shortened mortality time were age (γ = 0.94; 95% CI (0.0.920-0.980), hypertension (γ = 0.63; 95% CI (0.605-0.660), and baseline complications (γ = 0.24; 95% CI (0.223-0.256). CONCLUSIONS: The shortened timing of death was significantly predicted by age, hypertension, and baseline complications. In light of the study's findings, health administrators and caregivers should work to improve society's overall health.
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Hospitales Generales , Accidente Cerebrovascular , Humanos , Masculino , Femenino , Etiopía/epidemiología , Persona de Mediana Edad , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/epidemiología , Anciano , Estudios Retrospectivos , Adulto , Factores de Tiempo , Anciano de 80 o más Años , Factores de Riesgo , Modelos de Riesgos ProporcionalesRESUMEN
This study pooled data from SPRINT (Systolic Blood Pressure Intervention Trial) and ACCORD-BP (Action to Control Cardiovascular Risk in Diabetes Blood Pressure) trial to estimate the treatment effect of intensive BP on stroke prevention, and investigate whether stroke risk score impacted treatment effect. Of all the potential manifestations of the hypertension, the most severe outcomes were stroke or death. A composite endpoint of time to death or stroke (stroke-free survival [SFS]), whichever occurred first, was defined as the outcome of interest. Participants without prevalent stroke were stratified into stroke risk tertiles based on the predicted revised Framingham Stroke Risk Score. The stratified Cox model was used to calculate the hazard ratio (HR) for the intensive BP treatment. 834 (5.92%) patients had SFS events over a median follow-up of 3.68 years. A reduction in the risk for SFS was observed among the intensive BP group as compared with the standard BP group (HR: 0.76, 95% CI: 0.65, 0.89; risk difference: 0.98([0.20, 1.76]). Further analyses demonstrated the significant benefit of intensive BP treatment on SFS only among participants having a high stroke risk (risk tertile 1: 0.76 [0.52, 1.11], number needed to treat [NNT] = 861; risk tertile 2: 0.87[0.65, 1.16], NNT = 91; risk tertile 3: 0.69[0.56, 0.86], NNT = 50). Intensive BP treatment lowered the risk of SFS, particularly for those at high risk of stroke.
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Antihipertensivos , Presión Sanguínea , Hipertensión , Accidente Cerebrovascular , Humanos , Masculino , Femenino , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/prevención & control , Persona de Mediana Edad , Hipertensión/tratamiento farmacológico , Hipertensión/complicaciones , Anciano , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/mortalidad , Factores de Riesgo , Modelos de Riesgos ProporcionalesRESUMEN
INTRODUCTION: Hospital overcrowding where patient admissions exceed capacity is associated with worse outcomes in Emergency Department. Developments in emergency stroke care have been associated with improvements in stroke outcome but are dependent on effective, organised care. We examined if overcrowding in the hospital system was associated with negative changes in stroke outcome. METHODS: Data on overcrowding were obtained from the Irish Nurses and Midwives Organisation (INMO) 'Trolley Count' database recording the number of patients cared for on trolleys/chairs in all acute hospitals each midnight. These were compared with quarterly data from the Irish National Audit of Stroke from 2013 to 2021 inclusive. Variables analysed were inpatient mortality rate, thrombolysis rate for ischaemic stroke, median door to needle time and median length of stay. RESULTS: 579449 patient episodes were recorded by Trolley Watch over the period, (Quarterly Median 16719.5, range 3389-27015). Average Quarterly Thrombolysis rate was 11.3% (sd 1.3%) Median Quarterly Inpatient Mortality rate was 11.8% (Range 8.9-14.0%). Median Quarterly Length of stay was 9 days (8-11 days). Median quarterly door to needle was 65 min (45-80 min). Q1 was typically the worst for overcrowding with on average 19777 incidences (sd 4786). This was significantly higher than for Q2 (mean 13540 (sd 4785) p = 0.005 t-test) and for Q3 (mean 14542 (sd 4753) p = 0.03). No significant correlation was found between quarterly Trolley watch episodes and inpatient mortality (r = 0.084, p = 0.63), median length of stay r=-0.15, p = 0.37) or thrombolysis rate (r = 0.089 p = 0.61). There was an unexpected significant negative correlation between trolley watch data and median door to needle time (r=-0.36, p = 0.03). CONCLUSION: Despite increasing hospital overcrowding, stroke services still managed to preserve standard of care. We could find no association between levels of overcrowding and deterioration in selected indices of patient care.
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Aglomeración , Mortalidad Hospitalaria , Accidente Cerebrovascular , Humanos , Irlanda , Accidente Cerebrovascular/terapia , Accidente Cerebrovascular/mortalidad , Tiempo de Internación/estadística & datos numéricos , Femenino , Servicio de Urgencia en Hospital/estadística & datos numéricos , Masculino , Terapia Trombolítica/estadística & datos numéricos , Anciano , Auditoría Médica , Tiempo de Tratamiento/estadística & datos numéricos , Persona de Mediana EdadRESUMEN
BACKGROUND: The association between poor social relationships and post-stroke mortality remains uncertain, and the evidence regarding the relationship between poor social relationships and the risk of stroke is inconsistent. In this meta-analysis, we aim to elucidate the evidence concerning the risk of stroke and post-stroke mortality among individuals experiencing a poor social relationships, including social isolation, limited social networks, lack of social support, and loneliness. METHODS: A thorough search of PubMed, Embase, and the Cochrane Library databases to systematically identify pertinent studies. Data extraction was independently performed by two researchers. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using either a random-effects or fixed-effects model. Sensitivity analyses were conducted to evaluate the reliability of the results. Random-effects meta-regression was performed to explore the sources of heterogeneity in stroke risk estimates between studies. Assessment for potential publication bias was carried out using Egger's and Begg's tests. RESULTS: Nineteen studies were included, originating from 4 continents and 12 countries worldwide. A total of 1,675,707 participants contributed to this meta-analysis. Pooled analyses under the random effect model revealed a significant association between poor social relationships and the risk of stroke (OR = 1.30; 95%CI: 1.17-1.44), as well as increased risks for post-stroke mortality (OR = 1.36; 95%CI: 1.07-1.73). Subgroup analyses demonstrated associations between limited social network (OR = 1.52; 95%CI = 1.04-2.21), loneliness (OR = 1.31; 95%CI = 1.13-1.51), and lack of social support (OR = 1.66; 95%CI = 1.04-2.63) with stroke risk. The meta-regression explained 75.21% of the differences in reported stroke risk between studies. Random-effect meta-regression results indicate that the heterogeneity in the estimated risk of stroke may originate from the continent and publication year of the included studies. CONCLUSION: Social isolation, limited social networks, lack of social support, and feelings of loneliness have emerged as distinct risk factors contributing to both the onset and subsequent mortality following a stroke. It is imperative for public health policies to prioritize the multifaceted influence of social relationships and loneliness in stroke prevention and post-stroke care. TRIAL REGISTRATION: The protocol was registered on May 1, 2024, on the Prospero International Prospective System with registration number CRD42024531036.
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Soledad , Aislamiento Social , Apoyo Social , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/psicología , Accidente Cerebrovascular/epidemiología , Aislamiento Social/psicología , Soledad/psicología , Factores de Riesgo , Relaciones InterpersonalesRESUMEN
BACKGROUND: Stroke is rapidly developing clinical signs of focal/ global disturbance of cerebral function, with symptoms lasting more than 24 h and leading to death. Data showed that stroke deaths in Ethiopia reached nearly seven percent of total deaths. Despite this report, there is a paucity of investigations about the problem. OBJECTIVE: To determine in-hospital mortality and its associated factors among hospitalized stroke patients in Hiwot Fana Comprehensive Specialized University Hospital and Jugal General Hospital, eastern Ethiopia from September 2016-August 2022 G.C. METHODS: A retrospective cohort study was conducted among hospitalized stroke patients. A sample size of 395 medical records was selected from a total of 564 stroke patients by a simple random sampling technique. The data was analyzed by SPSS version 26 using bivariable and multivariable cox-regression models. A p-value of 0.05 and less at a 95% confidence interval was used to establish a statistically significant association. RESULTS: Of the total, 109 (27.6%) died in the hospital while 57.2% and 15.2% of them were discharged with improvement and against medical advice, respectively. Age greater than 65 (AHR = 4.71, 95% CI = 1.11-19.96), creatinine level > 1.2 mg/dl (AHR = 1.54, 95% CI = 1.0-2.39), and co-morbidity with atrial fibrillation (AHR = 1.48, 95% CI = 1.0-2.21) were significantly associated with in-hospital mortality. CONCLUSION: In-hospital mortality was found in more than a quarter of stroke patients. Mortality was more likely increased among the patients with age > 65, serum creatinine level > 1.2 mg/dl, and atrial fibrillation. Hence, these high-risk patients need to be monitored.
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Mortalidad Hospitalaria , Hospitales Públicos , Accidente Cerebrovascular , Humanos , Masculino , Femenino , Etiopía/epidemiología , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Factores de Riesgo , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/diagnóstico , Medición de Riesgo , Factores de Tiempo , Anciano de 80 o más Años , Adulto , Factores de Edad , Pronóstico , Comorbilidad , Pacientes InternosRESUMEN
BACKGROUND: The prevalence of stroke disability associated with high BMI has significantly increased over the past three decades. However, it remains uncertain whether high body-mass index (BMI) exerts a similar impact on the disease burden of different stroke subtypes. The aim of this study is to assess the long-term trends of stroke and subtypes mortality attributable to high BMI in China between 1990 and 2019. METHODS: Data on stroke and subtypes mortality attributable to high BMI in China was extracted in the Global Burden of Disease (GBD) 2019. The trends of age-standardized mortality rate (ASMR) were calculated using the linear regression and age-period-cohort framework. RESULTS: The changing trend of ASMR on stroke attributable to high BMI in China differed among subtypes, with an estimated annual percentage change (EAPC) and 95%CI of 2.04 (1.86 to 2.21) for ischemic stroke (IS), 0.36 (-0.03 to 0.75) for intracerebral hemorrhage (ICH), and - 4.62 (-5.44 to -3.78) for subarachnoid hemorrhage (SAH). Net and local drift analyses revealed a gradual increase in the proportion of older people with IS and a gradual increase in the proportion of younger people with hemorrhagic strokes. The cohort and period rate ratios varied by subtype, showing an increasing trend for IS and ICH but a decreasing trend for SAH. The stroke mortality attributable to high BMI increased significantly with age for IS and ICH, peaking between ages 50-70 for SAH. Notably, males had higher ASMR related to stroke but exhibited slighter declines or higher growth compared to females in China. Moreover, the population affected by fatal strokes tended to be older among females but more evenly distributed across a wider age range encompassing both younger and older individuals. CONCLUSION: The research findings indicate a rising trend in the ASMR of stroke and subtypes attributable to high BMI in China from 1990 to 2019, with different patterns of change for different subtypes, genders and ages. Consequently, it is imperative for public health authorities in China to formulate guidelines for specific stroke subtypes, genders and ages to prevent the burden of stroke attributable to high BMI.
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Índice de Masa Corporal , Accidente Cerebrovascular , Humanos , China/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Adulto , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/epidemiología , Anciano de 80 o más Años , Carga Global de Enfermedades , Accidente Cerebrovascular Hemorrágico/mortalidad , Accidente Cerebrovascular Hemorrágico/epidemiología , Hemorragia Subaracnoidea/mortalidadRESUMEN
BACKGROUND: Individuals with diabetes exhibit a higher risk of cardiovascular disease and mortality compared to healthy individuals. Following a transient ischemic attack (TIA) the risk of stroke and death increase further. Physical activity engagement after a TIA is an effective way of secondary prevention. However, there's a lack of research on how individuals with diabetes modify physical activity levels and how these adjustments impact survival post-TIA. This study aimed to determine the extent to which individuals with diabetes alter their physical activity levels following a TIA and to assess the impact of these changes on mortality. METHODS: This was a nationwide longitudinal study, employing data from national registers in Sweden spanning from 01/01/2003 to 31/12/2019. Data were collected 2 years retro- and prospectively of TIA occurrence, in individuals with diabetes. Individuals were grouped based on decreasing, remaining, or increasing physical activity levels after the TIA. Cox proportional hazards models were fitted to evaluate the adjusted relationship between change in physical activity and all-cause, cardiovascular, and non-cardiovascular mortality. RESULTS: The final study sample consisted of 4.219 individuals (mean age 72.9 years, 59.4% males). Among them, 35.8% decreased, 37.5% kept steady, and 26.8% increased their physical activity after the TIA. A subsequent stroke occurred in 6.7%, 6.4%, and 6.1% of individuals, while death occurred in 6.3%, 7.3%, and 3.7% of individuals, respectively. In adjusted analyses, participants who increased their physical activity had a 45% lower risk for all-cause mortality and a 68% lower risk for cardiovascular mortality, compared to those who decreased their physical activity. CONCLUSIONS: Positive change in physical activity following a ΤΙΑ was associated with a reduced risk of mortality. Increased engagement in physical activity should be promoted after TIA, thereby actively supporting individuals with diabetes in achieving improved health outcomes.
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Diabetes Mellitus , Ejercicio Físico , Ataque Isquémico Transitorio , Sistema de Registros , Conducta de Reducción del Riesgo , Humanos , Ataque Isquémico Transitorio/mortalidad , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/prevención & control , Ataque Isquémico Transitorio/epidemiología , Masculino , Femenino , Anciano , Suecia/epidemiología , Estudios Longitudinales , Medición de Riesgo , Persona de Mediana Edad , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Diabetes Mellitus/epidemiología , Anciano de 80 o más Años , Factores de Tiempo , Factores de Riesgo , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/prevención & control , Prevención Secundaria , Resultado del Tratamiento , Factores Protectores , Estudios Retrospectivos , Causas de Muerte , RecurrenciaRESUMEN
BACKGROUND: Stroke represents a significant health crisis in the United States, claiming approximately 140,000 lives annually and ranking as the fifth leading cause of death. OBJECTIVE: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) for 2005 to 2008, this study examines the correlation between various sleep characteristics and both stroke morbidity and all-cause mortality among U.S. adults. METHODS: We applied logistic regression, Cox regression, and subgroup analyses to a sample of 7,827 adults aged 18 and older from NHANES 2005-2008. The study focused on six sleep characteristics: duration of sleep, sleep onset latency, snoring frequency, number of awakenings, frequency of leg spasms during sleep, and daytime sleepiness, analyzing their impacts on stroke incidence and mortality rates. RESULTS: Participants had an average age of 45.80 ± 0.45 years, with females accounting for 48.13 % of the sample. Analysis revealed significant associations between sleep duration, onset latency, number of awakenings, leg spasms, and daytime sleepiness with stroke incidence. However, these associations weakened with increasing confounders. Additionally, stroke patients showed a higher likelihood of using sleep aids. The influence of sleep disturbances on stroke appeared more pronounced in females and younger demographics. An association was also noted between the number of awakenings, sleep duration, and stroke mortality rates CONCLUSIONS: The study reinforces the critical role of maintaining healthy sleep patterns in preventing strokes and enhancing stroke prognosis, emphasizing specific sleep disturbances as potential risk factors.
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Encuestas Nutricionales , Trastornos del Sueño-Vigilia , Sueño , Accidente Cerebrovascular , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología , Incidencia , Estudios Transversales , Factores de Riesgo , Adulto , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/diagnóstico , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/mortalidad , Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Sueño-Vigilia/fisiopatología , Factores de Tiempo , Causas de Muerte , Adulto Joven , Adolescente , Medición de Riesgo , Anciano , Calidad del Sueño , Factores de Edad , Factores SexualesRESUMEN
BACKGROUND: Patients with atrial fibrillation and severe chronic kidney disease have higher risks of bleeding, thromboembolism, and mortality. However, optimal anticoagulant choice in these high-risk patients remains unclear. METHODS AND RESULTS: Using deidentified electronic health records from the Optum Labs Data Warehouse, adults with atrial fibrillation and severe chronic kidney disease (estimated glomerular filtration rate <30 mL/min per 1.73 m2) initiating warfarin, apixaban, or rivaroxaban between 2011 and 2021 were included. Using inverse probability of treatment weighting, adjusted risks of major bleeding, stroke/systemic embolism, and death were compared among agents. A total of 6794 patients were included (mean age, 78.5 years; mean estimated glomerular filtration rate, 24.7 mL/min per 1.73 m2; 51% women). Apixaban versus warfarin was associated with a lower risk of major bleeding (incidence rate, 1.5 versus 2.9 per 100 person-years; subdistribution hazard ratio [sub-HR], 0.53 [95% CI, 0.39-0.70]), and similar risks for stroke/systemic embolism (incidence rate, 1.9 versus 2.4 per 100 person-years; sub-HR, 0.80 [95% CI, 0.59-1.09]) and death (incidence rate, 4.6 versus 4.5 per 100 person-years; HR, 1.03 [95% CI, 0.82-1.29]). Rivaroxaban versus warfarin was associated with a higher risk of major bleeding (incidence rate, 4.9 versus 2.9 per 100 person-years; sub-HR, 1.65 [95% CI, 1.10-2.48]), with no difference in risks for stroke/systemic embolism and death. Apixaban versus rivaroxaban was associated with a lower risk of major bleeding (sub-HR, 0.53 [95% CI, 0.36-0.78]). CONCLUSIONS: These real-world findings are consistent with potential safety advantages of apixaban over warfarin and rivaroxaban for patients with atrial fibrillation and severe chronic kidney disease. Further randomized trials comparing individual oral anticoagulants are warranted.
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Anticoagulantes , Fibrilación Atrial , Embolia , Hemorragia , Pirazoles , Piridonas , Insuficiencia Renal Crónica , Rivaroxabán , Accidente Cerebrovascular , Warfarina , Humanos , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/complicaciones , Fibrilación Atrial/mortalidad , Femenino , Masculino , Anciano , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/mortalidad , Hemorragia/inducido químicamente , Hemorragia/epidemiología , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/mortalidad , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificación , Warfarina/efectos adversos , Warfarina/uso terapéutico , Rivaroxabán/efectos adversos , Rivaroxabán/uso terapéutico , Rivaroxabán/administración & dosificación , Embolia/prevención & control , Embolia/epidemiología , Embolia/etiología , Pirazoles/efectos adversos , Pirazoles/uso terapéutico , Piridonas/efectos adversos , Piridonas/uso terapéutico , Piridonas/administración & dosificación , Administración Oral , Medición de Riesgo , Anciano de 80 o más Años , Factores de Riesgo , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Incidencia , Inhibidores del Factor Xa/efectos adversos , Inhibidores del Factor Xa/uso terapéutico , Inhibidores del Factor Xa/administración & dosificaciónRESUMEN
BACKGROUND: Previous studies have demonstrated conflicting results regarding the effects of rehabilitation therapy on poststroke mortality. We aimed to investigate the association between rehabilitation therapy, including both inpatient and outpatient treatment, within the first 6 months after stroke and long-term all-cause mortality in patients with stroke using the Korean National Health Insurance System data. METHODS: A total of 10â 974 patients newly diagnosed with stroke using the International Classification of Diseases, Tenth Revision, codes (I60-I64) between 2003 and 2019 were enrolled and followed up for all-cause mortality until 2019. Follow-up for mortality began 6 months after the index event. Poststroke patients were categorized into 3 groups according to the frequency of rehabilitation therapy: no rehabilitation therapy, ≤40 sessions and >40 sessions. Cox proportional hazards models were used to assess the mortality risk according to rehabilitation therapy stratified by disability severity measured based on activities of daily living 6 months after stroke onset. RESULTS: Within 6 months after stroke, 6738 patients (61.4%) did not receive rehabilitation therapy, whereas 2122 (19.3%) received ≤40 sessions and 2114 (19.3%) received >40 sessions of rehabilitation therapy. Higher frequency of rehabilitation therapy was associated with significantly lower poststroke mortality in comparison to no rehabilitation therapy (hazard ratio [HR], 0.88 [95% CI, 0.79-0.99]), especially among individuals with severe disability after stroke (mild to moderate: HR, 1.02 [95% CI, 0.77-1.35]; severe: HR, 0.74 [95% CI, 0.62-0.87]). In the context of stroke type, higher frequency of rehabilitation therapy was associated with reduced mortality rates compared with no rehabilitation therapy only in patients with hemorrhagic stroke (ischemic: HR, 1.04 [95% CI, 0.91-1.18]; hemorrhagic: HR, 0.60 [95% CI, 0.49-0.74]). CONCLUSIONS: We found a positive association between rehabilitation therapy within 6 months after stroke onset and long-term mortality in patients with stroke. A higher frequency of rehabilitation therapy would be recommended for poststroke patients, especially those with hemorrhagic stroke and severe disability.
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Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Accidente Cerebrovascular/mortalidad , Estudios de Cohortes , República de Corea/epidemiología , Anciano de 80 o más Años , Actividades Cotidianas , AdultoRESUMEN
BACKGROUND AND AIMS: It has been reported that patients without standard modifiable cardiovascular (CV) risk factors (SMuRFs-diabetes, dyslipidaemia, hypertension, and smoking) presenting with first myocardial infarction (MI), especially women, have a higher in-hospital mortality than patients with risk factors, and possibly a lower long-term risk provided they survive the post-infarct period. This study aims to explore the long-term outcomes of SMuRF-less patients with stable coronary artery disease (CAD). METHODS: CLARIFY is an observational cohort of 32 703 outpatients with stable CAD enrolled between 2009 and 2010 in 45 countries. The baseline characteristics and clinical outcomes of patients with and without SMuRFs were compared. The primary outcome was a composite of 5-year CV death or non-fatal MI. Secondary outcomes were 5-year all-cause mortality and major adverse cardiovascular events (MACE-CV death, non-fatal MI, or non-fatal stroke). RESULTS: Among 22 132 patients with complete risk factor and outcome information, 977 (4.4%) were SMuRF-less. Age, sex, and time since CAD diagnosis were similar across groups. SMuRF-less patients had a lower 5-year rate of CV death or non-fatal MI (5.43% [95% CI 4.08-7.19] vs. 7.68% [95% CI 7.30-8.08], P = 0.012), all-cause mortality, and MACE. Similar results were found after adjustments. Clinical event rates increased steadily with the number of SMuRFs. The benefit of SMuRF-less status was particularly pronounced in women. CONCLUSIONS: SMuRF-less patients with stable CAD have a substantial but significantly lower 5-year rate of CV death or non-fatal MI than patients with risk factors. The risk of CV outcomes increases steadily with the number of risk factors.
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Factores de Riesgo de Enfermedad Cardiaca , Infarto del Miocardio , Sistema de Registros , Humanos , Femenino , Masculino , Anciano , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/mortalidad , Hipertensión/complicaciones , Hipertensión/epidemiología , Fumar/efectos adversos , Fumar/epidemiología , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/complicaciones , Dislipidemias/epidemiología , Dislipidemias/complicaciones , Enfermedad Crónica , Factores de Riesgo , Diabetes Mellitus/epidemiología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/prevención & controlRESUMEN
BACKGROUND: Significant age and sex differences have been reported at each stage of the stroke pathway, from risk factors to outcomes. However, there is some uncertainty in previous studies with regard to the role of potential confounders and selection bias. Therefore, using German nationwide administrative data, we aimed to determine the magnitude and direction of trends in age- or sex-specific differences with respect to admission rates, risk factors, and acute treatments of ischemic and hemorrhagic stroke. METHODS: We obtained and analyzed data from the Research Data Centres of the Federal Statistical Office for the years 2010 to 2020 with regard to all acute stroke hospitalizations, risk factors, treatments, and in-hospital mortality, stratified by sex and stroke subtype. This database provides a complete national-level census of stroke hospitalizations combined with population census counts. All hospitalized patients ≥15 years with an acute stroke (diagnosis code: I60-64) were included in the analysis. RESULTS: Over the 11-year study period, there were 3â 375â 157 stroke events; 51.2% (n=1â 728â 954) occurred in men. There were higher rates of stroke admissions in men compared with women for both ischemic (378.1 versus 346.7/100â 000 population) and hemorrhagic subtypes (75.6 versus 65.5/100â 000 population) across all age groups. The incidence of ischemic stroke admissions peaked in 2016 among women (354.0/100â 000 population) and in 2017 among men (395.8/100â 000 population), followed by a consistent decline from 2018 onward. There was a recent decline in hemorrhagic stroke admissions observed for both sexes, reaching its nadir in 2020 (68.9/100â 000 for men; 59.5/100â 000 for women). Female sex was associated with in-hospital mortality for both ischemic (adjusted odds ratio, 1.11 [1.09-1.12]; P<0.001) and hemorrhagic stroke (adjusted odds ratio, 1.18 [95% CI, 1.16-1.20]; P<0.001). CONCLUSIONS: Despite improvements in stroke prevention and treatment pathways in the past decade, sex-specific differences remain with regard to hospitalization rates, risk factors, and mortality. Better understanding the mechanisms for these differences may allow us to develop a sex-stratified approach to stroke care.
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Mortalidad Hospitalaria , Hospitalización , Accidente Cerebrovascular , Humanos , Masculino , Femenino , Alemania/epidemiología , Anciano , Persona de Mediana Edad , Hospitalización/estadística & datos numéricos , Hospitalización/tendencias , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapia , Accidente Cerebrovascular/mortalidad , Anciano de 80 o más Años , Adulto , Factores Sexuales , Factores de Edad , Accidente Cerebrovascular Isquémico/epidemiología , Accidente Cerebrovascular Isquémico/terapia , Adolescente , Adulto Joven , Bases de Datos Factuales , Accidente Cerebrovascular Hemorrágico/epidemiología , Accidente Cerebrovascular Hemorrágico/terapiaRESUMEN
Heart failure (HF) is a major health issue, affecting up to 2% of the adult population worldwide. Given the increasing prevalence of obesity and its association with various cardiovascular diseases, understanding its role in HFrEF outcomes is crucial. This study aimed to investigate the impact of obesity on in-hospital mortality and prolonged hospital stay in patients with heart failure with reduced ejection fraction (HFrEF). We conducted a retrospective analysis of 425 patients admitted to the cardiology unit at the University Clinical Hospital in Wroclaw, Poland, between August 2018 and August 2020. Statistical analyses were performed to evaluate the interactions between BMI, sex, and comorbidities on in-hospital mortality. Significant interactions were found between sex and BMI as well as between BMI and post-stroke status, affecting in-hospital mortality. Specifically, increased BMI was associated with decreased odds of in-hospital mortality in males (OR = 0.72, 95% CI: 0.55-0.94, p < 0.05) but higher odds in females (OR = 1.18, 95% CI: 0.98-1.42, p = 0.08). For patients without a history of stroke, increased BMI reduced mortality odds (HR = 0.78, 95% CI: 0.64-0.95, p < 0.01), whereas the effect was less pronounced in those with a history of stroke (HR = 0.89, 95% CI: 0.76-1.04, p = 0.12). In conclusion, the odds of in-hospital mortality decreased significantly with each 10% increase in BMI for males, whereas for females, a higher BMI was associated with increased odds of death. Additionally, BMI reduced in-hospital mortality odds more in patients without a history of cerebral stroke (CS) compared to those with a history of CS. These findings should be interpreted with caution due to the low number of observed outcomes and potential interactions with BMI and sex.
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Índice de Masa Corporal , Insuficiencia Cardíaca , Mortalidad Hospitalaria , Obesidad , Volumen Sistólico , Humanos , Masculino , Femenino , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Anciano , Estudios Retrospectivos , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/fisiopatología , Obesidad/epidemiología , Tiempo de Internación/estadística & datos numéricos , Anciano de 80 o más Años , Polonia/epidemiología , Factores de Riesgo , Factores Sexuales , Comorbilidad , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/epidemiologíaRESUMEN
Associations of biological aging with the development and mortality of cardiometabolic multimorbidity (CMM) remain unclear. Here we conducted a multistate analysis in 341,159 adults of the UK Biobank. CMM was defined as the coexistence of two or three cardiometabolic diseases (CMDs), including type 2 diabetes, ischemic heart disease and stroke. Biological aging was measured using the Klemera-Doubal Method Biological Age and PhenoAge algorithms. Over a median follow-up of 8.84 years, biologically older participants demonstrated robust higher risks from first CMD to CMM and then to death. In particular, adjusted hazard ratios for first CMD to CMM and for CMM to death were 1.15 (95% confidence interval (CI): 1.12, 1.19) and 1.26 (95% CI: 1.17, 1.35) per 1 s.d. increase in PhenoAge acceleration, respectively. Compared with frailty, Framingham Risk Score and Systematic Coronary Risk Evaluation 2 (SCORE2), biological aging measures yielded consistent substantial associations with CMM development. Accelerated biological aging may help identify individuals with CMM risks, potentially enabling early intervention and subclinical prevention.
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Envejecimiento , Factores de Riesgo Cardiometabólico , Diabetes Mellitus Tipo 2 , Multimorbilidad , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Reino Unido/epidemiología , Medición de Riesgo , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/mortalidad , Factores de Edad , Factores de Tiempo , Adulto , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/mortalidad , Pronóstico , Isquemia Miocárdica/mortalidad , Isquemia Miocárdica/epidemiología , Factores de RiesgoRESUMEN
PURPOSE: Acute myocardial infarction (AMI) and stroke are leading global causes of death and can be used to assess acute care quality. We examined the 30-day mortality trends after emergency department admission for AMI and stroke in Korea from 2008 to 2019, focusing on regional and income disparities. MATERIALS AND METHODS: The AMI and stroke patients admitted to hospitals in Korea were collected from the claims data. We analyzed age and sex-standardized 30-day mortality for AMI, as well as hemorrhagic and ischemic strokes. Disparities in mortality were analyzed using absolute differences and relative ratios between the Organization for Economic Cooperation Development (OECD) and Korea, and among income levels and regions in Korea. A 12-year joinpoint regression was used to determine the annual percent change and the average annual percent change. RESULTS: The trends in the 30-day AMI mortality of Korea were not significantly changed from 2008 to 2019; the gap remained at 1.2 between the OECD and Korea. Korea maintained lower mortality rates for hemorrhagic and ischemic stroke than the mean of OECD. In Korea, the 30-day hemorrhagic stroke mortality showed a constant decreasing trend for the higher-income group living in urban areas; it led to a widened gap based on income levels in urban areas. The 30-day mortality for ischemic stroke tended to decrease in the higher-income group and urban areas. CONCLUSION: National-level intervention is needed to manage regional and income-based disparities in AMI and stroke 30-day mortality. It is important to understand the variance in mortality rate by different geographical regions and income levels to establish an appropriate public health strategy.
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Infarto del Miocardio , Accidente Cerebrovascular , Humanos , República de Corea/epidemiología , Infarto del Miocardio/mortalidad , Femenino , Masculino , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/epidemiología , Persona de Mediana Edad , Anciano , Adulto , Anciano de 80 o más Años , Disparidades en Atención de Salud/estadística & datos numéricosRESUMEN
BACKGROUND: The increasing prevalence of frailty has gained considerable attention due to its profound influence on clinical outcomes. However, our understanding of the progression of frailty and long-term clinical outcomes in older individuals with atrial fibrillation remains scarce. METHODS: Using data from 2012 to 2018 from a comprehensive claims database incorporating primary and hospital care records in Shizuoka, Japan, we selected patients aged ≥65 years with atrial fibrillation who initiated oral anticoagulant therapy. The trajectory of frailty was plotted using Sankey plots, illustrating the annual changes in their frailty according to the electronic frailty index during a 3-year follow-up after oral anticoagulant initiation, along with the incidence of clinical adverse outcomes. For deceased patients, we assessed their frailty status in the year preceding their death. RESULTS: Of 6247 eligible patients (45.1% women; mean age, 79.3±8.0 years) at oral anticoagulant initiation, 7.7% were categorized as fit (electronic frailty index, 0-0.12), 30.1% as mildly frail (>0.12-0.24), 35.4% as moderately frail (>0.24-0.36), and 25.9% as severely frail (>0.36). Over the 3-year follow-up, 10.4% of initially fit patients transitioned to moderately frail or severely frail. Conversely, 12.5% of severely frail patients improved to fit or mildly frail. Death, stroke, and major bleeding occurred in 23.4%, 4.1%, and 2.2% of patients, respectively. Among the mortality cases, 74.8% (N=1183) and 3.5% (N=55) had experienced moderately or severely frail and either a stroke or major bleeding in the year preceding their death, respectively. CONCLUSIONS: In a contemporary era of atrial fibrillation management, a minor fraction of older patients on oral anticoagulants died following a stroke or major bleeding. However, their frailty demonstrated a dynamic trajectory, and a substantial proportion of death was observed after transitioning to a moderately or severely frail state.
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Anticoagulantes , Fibrilación Atrial , Bases de Datos Factuales , Anciano Frágil , Fragilidad , Evaluación Geriátrica , Humanos , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/mortalidad , Anciano , Femenino , Masculino , Fragilidad/diagnóstico , Fragilidad/mortalidad , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Japón/epidemiología , Factores de Riesgo , Factores de Tiempo , Administración Oral , Medición de Riesgo , Factores de Edad , Resultado del Tratamiento , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Estudios Retrospectivos , Hemorragia/inducido químicamente , Hemorragia/epidemiología , Incidencia , PrevalenciaRESUMEN
BACKGROUND: The Valve Academic Research Consortium (VARC)-3 definition for neurologic events after transcatheter aortic valve replacement (TAVR) lacks clinical validation. OBJECTIVES: This study sought to determine the incidence, predictors, and clinical impact of neurologic events following TAVR as defined by VARC-3 criteria. METHODS: This was a multicenter study including 2,924 patients with severe aortic stenosis undergoing TAVR. Based on Neurologic Academic Research Consortium (NeuroARC) classification, neurologic events were classified as NeuroARC type 1 (stroke), NeuroARC type 2 (covert central nervous system injury), and NeuroARC type 3 (transient ischemic attack and delirium). Baseline, procedural, and follow-up data were prospectively collected in a dedicated database. RESULTS: After a median follow-up of 13 (7-37) months, neurologic events occurred in 471 patients (16.1%), NeuroARC type 1, 2, and 3 in 37.4%, 4.7%, and 58.0% of cases, respectively, and the majority (58.6%) were periprocedural. Advanced age, chronic kidney disease, atrial fibrillation, major vascular complications, and in-hospital bleeding determined an increased risk of periprocedural events (P < 0.03 for all). Neurologic events occurring during the periprocedural time frame were independently associated with a substantial increase in mortality at 1 year after the intervention (HR: 1.91; 95% CI: 1.23-2.97; P = 0.004). However, although NeuroARC type 1 was associated with an increased mortality risk (IRR: 3.38; 95% CI: 2.30-5.56; P < 0.001 and IRR: 21.7; 95% CI: 9.63-49.1; P < 0.001 for ischemic and hemorrhagic stroke, respectively), the occurrence of NeuroARC type 3 events had no impact on mortality. CONCLUSIONS: Neurologic events after TAVR were associated with poorer short- and long-term survival. This correlation was related to the type of NeuroARC event defined by the VARC-3 criteria. Given the negative impact on clinical outcomes, every attempt should be made to reduce the risk of neurologic complications after TAVR.