scholarly journals Diagnostic Accuracy of Transient Ischemic Attack from Physician Claims

2017 ◽  
Vol 44 (4) ◽  
pp. 397-403
Author(s):  
Jodi D. Edwards ◽  
Mieke Koehoorn ◽  
Lara A. Boyd ◽  
Boris Sobolev ◽  
Adrian R. Levy
Keyword(s):  
Diagnostic Accuracy ◽  
Transient Ischemic Attack ◽  
Hospital Admissions ◽  
Population Based ◽  
Discharge Data ◽  
Predictive Values ◽  
Physician Visits ◽  
Physician Billing ◽  
Ischemic Attack ◽  
The Impact

AbstractBackground:Hospitalization data underestimate the occurrence of transient ischemic attack (TIA). As TIA is frequently diagnosed in primary care, methodologies for the accurate ascertainment of a TIA from physician claims data are required for surveillance and health systems planning in this population. The present study evaluated the diagnostic accuracy of multiple algorithms for TIA from a longitudinal population-based physician billing database.Methods:Population-based administrative data from the province of British Columbia were used to identify the base population (1992–2007;N=102,492). Using discharge records for hospital admissions for acute ischemic stroke with a recent (<90 days) TIA as the reference standard, we performed receiver-operating characteristic analyses to calculate sensitivity, specificity, positive and negative predictive values and overall accuracy, and to compare area under the curve for each physician billing algorithm. To evaluate the impact of different case definitions on population-based TIA burden, we also estimated the annual TIA occurrence associated with each algorithm.Results:Physician billing algorithms showed low to moderate sensitivity, with the algorithm for two consecutive physician visits within 90 days showing the highest sensitivity at 37.7% (CI95%=37.4–38.1). All algorithms demonstrated high specificity and moderate to high overall accuracy, resulting in low positive predictive values (≤5%), low discriminability (0.53–0.57) and high false positive rates (1 – specificity). Population-based estimates of TIA occurrence were comparable to prior studies and declined over time.Conclusions:Physician billing data have insufficient sensitivity to identify TIAs but may be used in combination with hospital discharge data to improve the accuracy of estimating the population-based occurrence of TIAs.

scholarly journals The decrease in hospitalizations for transient ischemic attack and ischemic stroke, especially in mild cases, during the COVID-19 epidemic in Japan

2020 ◽  
Author(s):  
Hiroyuki Nagano ◽  
Daisuke Takada ◽  
Jung-ho Shin ◽  
Tetsuji Morishita ◽  
Susumu Kunisawa ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Hemorrhagic Stroke ◽  
Hospital Admissions ◽  
Health Care Systems ◽  
Number Of Patients ◽  
Stroke Diagnosis ◽  
Before And After ◽  
Ischemic Attack ◽  
The Impact

AbstractBackground and PurposeThe epidemic of the coronavirus disease 2019 (COVID-19) has affected health care systems globally. The aim of our study was to assess the impact of the COVID-19 epidemic on hospital admissions for stroke in Japan.MethodsWe analyzed administrative (Diagnosis Procedure Combination) data for cases of inpatients aged 18 years and older who were diagnosed with stroke (ischemic stroke, transient ischemic attack (TIA), hemorrhagic stroke, or subarachnoid hemorrhage (SAH)) and discharged from hospital during the period July 1, 2018 to June 30, 2020. The number of patients with each stroke diagnosis, various patient characteristics, and treatment approaches were compared before and after the epidemic. Changes in the trend of the monthly number of inpatients with each stroke diagnosis were assessed using interrupted time-series analyses.ResultsA total of 111,922 cases (ischemic stroke: 74,897 cases; TIA: 5,374 cases; hemorrhagic stroke: 24,779 cases; SAH: 6,872 cases) in 253 hospitals were included. The number of cases for all types of stroke decreased (ischemic stroke: -13.9%; TIA: -21.4%; hemorrhagic stroke: -9.9%; SAH: -15.2%) in April and May 2020, compared to the number of cases in 2019. Ischemic stroke and TIA cases, especially mild cases (modified Rankin Scale = 0), decreased, with a statistically significant change in trend between the before- and after-epidemic periods.ConclusionsThese data showed a marked reduction in the number of hospital admissions due to stroke during the COVID-19 epidemic. The change in Ischemic stroke and TIA cases, especially mild cases, was statistically significant.

scholarly journals Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2315-2321 ◽  
Author(s):  
Henrique Diegoli ◽  
Pedro S.C. Magalhães ◽  
Sheila C.O. Martins ◽  
Carla H.C. Moro ◽  
Paulo H.C. França ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Statistical Tests ◽  
Stroke Care ◽  
Population Based ◽  
Public Authorities ◽  
Stroke Incidence ◽  
Stroke Registry ◽  
Before And After ◽  
Ischemic Attack ◽  
The Impact

Background and Purpose: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, doctors and public authorities have demonstrated concern about the reduction in quality of care for other health conditions due to social restrictions and lack of resources. Using a population-based stroke registry, we investigated the impact of the onset of the COVID-19 pandemic in stroke admissions in Joinville, Brazil. Methods: Patients admitted after the onset of COVID-19 restrictions in the city (defined as March 17, 2020) were compared with those admitted in 2019. We analyzed differences between stroke incidence, types, severity, reperfusion therapies, and time from stroke onset to admission. Statistical tests were also performed to compare the 30 days before and after COVID-19 to the same period in 2019. Results: We observed a decrease in total stroke admissions from an average of 12.9/100 000 per month in 2019 to 8.3 after COVID-19 ( P =0.0029). When compared with the same period in 2019, there was a 36.4% reduction in stroke admissions. There was no difference in admissions for severe stroke (National Institutes of Health Stroke Scale score >8), intraparenchymal hemorrhage, and subarachnoid hemorrhage. Conclusions: The onset of COVID-19 was correlated with a reduction in admissions for transient, mild, and moderate strokes. Given the need to prevent the worsening of symptoms and the occurrence of medical complications in these groups, a reorganization of the stroke-care networks is necessary to reduce collateral damage caused by COVID-19.

scholarly journals Acute Stroke in Times of the COVID-19 Pandemic

Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 2224-2227 ◽  
Author(s):  
Carolin Hoyer ◽  
Anne Ebert ◽  
Hagen B. Huttner ◽  
Volker Puetz ◽  
Bernd Kallmünzer ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Hospital Admissions ◽  
Social Distancing ◽  
Admission Rates ◽  
Cerebrovascular Events ◽  
Number Of Patients ◽  
Before And After ◽  
Ischemic Attack ◽  
The Impact

Background and Purpose: This study aims to assess the number of patients with acute ischemic cerebrovascular events seeking in-patient medical emergency care since the implementation of social distancing measures in the coronavirus disease 2019 (COVID-19) pandemic. Methods: In this retrospective multicenter study, data on the number of hospital admissions due to acute ischemic stroke or transient ischemic attack and numbers of reperfusion therapies performed in weeks 1 to 15 of 2020 and 2019 were collected in 4 German academic stroke centers. Poisson regression was used to test for a change in admission rates before and after the implementation of extensive social distancing measures in week 12 of 2020. The analysis of anonymized regional mobility data allowed for correlations between changes in public mobility as measured by the number and length of trips taken and hospital admission for stroke/transient ischemic attack. Results: Only little variation of admission rates was observed before and after week 11 in 2019 and between the weeks 1 and 11 of 2019 and 2020. However, reflecting the impact of the COVID-19 pandemic, a significant decrease in the number of admissions for transient ischemic attack was observed (−85%, −46%, −42%) in 3 of 4 centers, while in 2 of 4 centers, stroke admission rates decreased significantly by 40% and 46% after week 12 in 2020. A relevant effect on reperfusion therapies was found for 1 center only (thrombolysis, −60%; thrombectomy, −61%). Positive correlations between number of ischemic events and mobility measures in the corresponding cities were identified for 3 of 4 centers. Conclusions: These data demonstrate and quantify decreasing hospital admissions due to ischemic cerebrovascular events and suggest that this may be a consequence of social distancing measures, in particular because hospital resources for acute stroke care were not limited during this period. Hence, raising public awareness is necessary to avoid serious healthcare and economic consequences of undiagnosed and untreated strokes and transient ischemic attacks.

scholarly journals Population-Based Study of Disability and Institutionalization After Transient Ischemic Attack and Stroke

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2854-2861 ◽  
Author(s):  
Ramon Luengo-Fernandez ◽  
Nicola L.M. Paul ◽  
Alastair M. Gray ◽  
Sarah T. Pendlebury ◽  
Linda M. Bull ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Care Home ◽  
Multivariate Regression Analysis ◽  
Population Based ◽  
Modified Rankin Scale ◽  
Term Outcome ◽  
Population Based Study ◽  
Long Term Outcome ◽  
Ischemic Attack ◽  
The Impact

Background and Purpose— Long-term outcome information after transient ischemic attack (TIA) and stroke is required to help plan and allocate care services. We evaluated the impact of TIA and stroke on disability and institutionalization over 5 years using data from a population-based study. Methods— Patients from a UK population-based cohort study (Oxford Vascular Study) were recruited from 2002 to 2007 and followed up to 2012. Patients were followed up at 1, 6, 12, 24, and 60 months postevent and assessed using the modified Rankin scale. A multivariate regression analysis was performed to assess the predictors of disability postevent. Results— A total of 748 index stroke and 440 TIA cases were studied. For patients with TIA, disability levels increased from 14% (63 of 440) premorbidly to 23% (60 of 256) at 5 years ( P =0.002), with occurrence of subsequent stroke being a major predictor of disability. For stroke survivors, the proportion disabled (modified Rankin scale >2) increased from 21% (154 of 748) premorbidly to 43% (273 of 634) at 1 month ( P <0.001), with 39% (132 of 339) of survivors disabled 5 years after stroke. Five years postevent, 70% (483 of 690) of patients with stroke and 48% (179 of 375) of patients with TIA were either dead or disabled. The 5-year risk of care home institutionalization was 11% after TIA and 19% after stroke. The average 5-year cost per institutionalized patient was $99 831 (SD, 67 020) for TIA and $125 359 (SD, 91 121) for stroke. Conclusions— Our results show that 70% of patients with stroke are either dead or disabled 5 years after the event. Thus, there remains considerable scope for improvements in acute treatment and secondary prevention to reduce postevent disability and institutionalization.

Temporal Patterns of Hospital Admissions for Transient Ischemic Attack: A Retrospective Population-based Study in the Emilia-Romagna Region of Italy

2009 ◽  
Vol 16 (2) ◽  
pp. 153-160 ◽  
Author(s):  
Roberto Manfredini ◽  
Fabio Manfredini ◽  
Benedetta Boari ◽  
Anna Maria Malagoni ◽  
Susanna Gamberini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Transient Ischemic Attack ◽  
Hospital Admissions ◽  
Temporal Patterns ◽  
Population Based ◽  
Cerebrovascular Events ◽  
Emilia Romagna Region ◽  
Common Risk Factors ◽  
Ischemic Attack ◽  
Autumn And Winter

Acute cerebrovascular events are not randomly distributed over time but show specific temporal patterns of occurrence. However, most studies focused stroke and little is known about transient ischemic attack. This study aimed to explore the existence of a temporal pattern of transient ischemic attack and the possible influence by the most common risk factors. The analysis included all hospital admissions with the ICD9-CM code for TIA, recorded in the database of the Emilia Romagna region of Italy (1998-2006; n = 43642, mean age 76.8 ± 11.5 years, 45.5% males). Transient ischemic attack was most frequent in autumn and winter and less common in spring and summer (P < 0.0001), with the highest number of cases in October and the lowest in February, and also most frequent on Monday (P < 0.0001). This study shows a seasonal and weekly pattern in occurrence of transient ischemic attack, independent of sex and the presence of the most common risk factors.

scholarly journals Increased Risk of Traffic Injury After a Cerebrovascular Event

Stroke ◽  
2018 ◽  
Vol 49 (12) ◽  
pp. 3006-3011
Author(s):  
Amy Y.X. Yu ◽  
Moira K. Kapral ◽  
Jiming Fang ◽  
Donald A. Redelmeier
Keyword(s):  
Transient Ischemic Attack ◽  
Motor Vehicle ◽  
Population Based ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Cerebrovascular Event ◽  
Traffic Injury ◽  
Increased Risk ◽  
Ischemic Attack ◽  
Serious Injuries

Background and Purpose— We aimed to determine the long-term risks of a motor vehicle collision after a cerebrovascular event and whether the risks were similar after left- or right-hemispheric events. Methods— We used a population-based registry to identify patients diagnosed with a transient ischemic attack or stroke (hemorrhagic or ischemic) between 2003 and 2013 in Ontario, Canada. Hemispheric laterality was determined using radiological and clinical findings. We identified subsequent serious injuries involving the patient as a driver using linked administrative data. Secondary outcomes included serious injuries involving the patient as a pedestrian, as a passenger, or other traumatic events (fall, fracture, ankle sprain). We used proportional hazard models accounting for death as a competing risk to test the association of hemispheric laterality and outcomes with and without adjustment for age, sex, discharge modified Rankin Scale score, home location, and prior driving record. Patients were followed through to 2017. Results— Among 26 144 patients with hemispheric cerebrovascular events, 377 subsequent serious traffic injuries as a driver (2.2 per 1000 person-year) were identified over a median follow-up of 6.4 person-years. The rate did not differ by laterality (adjusted hazard ratio, 1.00; 95% CI, 0.82–1.23). The risk of a serious traffic injury as a pedestrian was significantly higher after a right-sided than left-sided event (adjusted hazard ratio, 1.27; 95% CI, 1.02–1.58). Subsequent risks for other traumatic injuries did not differ by laterality of cerebrovascular event. Conclusions— The risk of a serious traffic injury as a pedestrian is substantially higher after a right-hemispheric cerebrovascular event compared with a left-sided event. Walking should be promoted for exercise in survivors of a stroke or transient ischemic attack, but these vulnerable road users may benefit from additional poststroke rehabilitation to optimize safety.

scholarly journals A Population-Based Study of Transient Ischemic Attack Incidence in Novosibirsk, Russia, 1987–1988 and 1996–1997

Stroke ◽  
2000 ◽  
Vol 31 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Valery L. Feigin ◽  
Sergey V. Shishkin ◽  
Georgii M. Tzirkin ◽  
Tatyana E. Vinogradova ◽  
Alexey V. Tarasov ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Population Based ◽  
Population Based Study ◽  
Ischemic Attack

Activation Products of the Haemostatic System in Coronary, Cerebrovascular and Peripheral Arterial Disease

2001 ◽  
Vol 85 (02) ◽  
pp. 234-239 ◽  
Author(s):  
M. L. Bots ◽  
F. Haverkate ◽  
P. Meijer ◽  
A. Hofman ◽  
C. Kluft ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Transient Ischemic Attack ◽  
Pressure Ratio ◽  
Arterial Disease ◽  
Population Based ◽  
Control Subjects ◽  
History Of ◽  
Ischemic Attack ◽  
Peripheral Arterial ◽  
D Dimer

SummaryTo determine the presence of a ‘hypercoagulable state’ as assessed by indices of thrombin and plasmin generation and of the amount of fibrin that is lysed, in patients with stable coronary, cerebral and peripheral arterial disease a population-based cross-sectional study was performed. From a population-based cohort comprising 7983 men and women aged 55 years and over, we randomly selected 127 subjects with a history of myocardial infarction, 124 with a history of stroke and/or transient ischemic attack, 131 patients with peripheral arterial disease and 263 control subjects in the same age group without arterial disease. Subjects using anticoagulant drugs were not selected. F1+2, TAT, and PAP were not associated with a history of cardiovascular events, nor with peripheral arterial disease. In contrast, positive associations were found for D-Dimer. Mean D-Dimer level was 40 μg/l (95% CI 35,44) in control subjects; 53 μg/l (47, 61) in those with a history of myocar-dial infarction and 51 μg/l (45, 58) in those with a history of stroke and or transient ischemic attack. D-Dimer increased gradually with increasing severity of peripheral atherosclerosis; a decrease in ankle/arm systolic blood pressure ratio of 0.1 was associated with an increase in D-Dimer of 3.9 μg/l (p<0.01). This was more pronounced in subjects with higher F1+2, TAT and PAP concentration. In conclusion, the markers of onset of coagulation F1+2, TAT and PAP are not associated with the presence of arterial disease, but increased levels of these markers are necessary for the positive association between D-Dimer and arterial disease.

scholarly journals Combined healthy lifestyle factors and risk of all-cause and cardiovascular first hospitalization

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Bonaccio ◽  
A Di Castelnuovo ◽  
S Costanzo ◽  
M Persichillo ◽  
A De Curtis ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Cox Regression ◽  
Healthy Lifestyle ◽  
Adult Population ◽  
Population Based ◽  
Lifestyle Factors ◽  
Inflammatory Biomarkers ◽  
Healthy Lifestyles ◽  
Italian Population ◽  
The Impact

Abstract Background We aimed to explore the association of combined healthy lifestyles with risk of first hospitalization for all-cause, cardiovascular disease (CVD), ischemic heart disease (IHD) and stroke in a southern Italian population-based cohort. We also investigated several biological mechanisms possibly on the pathway between lifestyles and health outcomes. Methods Longitudinal analysis on 23,161 men and women (aged≥35 y) recruited in the Moli-sani Study (2005-2010). We defined 4 healthy lifestyle factors as abstention from smoking; high adherence to Mediterranean diet; physical activity; absence of abdominal obesity. First hospital admissions for any and CVD-related causes were recorded by direct linkage with hospital discharge form registry. Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression. Results Over a median follow up of 7.2 y, we ascertained a total of 9,482 hospitalizations, 3,556 CVD, 939 IHD and 589 stroke-related hospital admissions. Adherence to all four healthy lifestyles, compared with none or 1, was associated with lower risk of hospitalization for any cause (HR = 0.82; 0.74-0.90), CVD (HR = 0.81;0.69-0.95) and IHD (HR = 0.63; 0.44-0.90) and, to a less extent, with stroke hospitalizations. Inflammatory biomarkers (e.g. C-reactive protein) were likely to partly explain the association between lifestyles and all-cause (14%) or CVD (15%) hospitalizations, while inflammation played a leading role towards risk of IHD (30%) and stroke-related hospital admissions (21%). Conclusions The impact of combined 4 healthy lifestyles on first hospitalization risk was considerable. Inflammatory biomarkers explained a large proportion of this association. Key messages Improvements to lifestyle reduce the risk of hospitalizations in a general adult population. Achieving a greater number of healthy behaviours has the potential to reduce the burden of hospitalizations and the associated healthcare costs.

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