scholarly journals Multiple Chronic Conditions and Functional Outcome after Ischemic Stroke: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 54 (3) ◽  
pp. 205-213 ◽  
Author(s):  
Xiaqing Jiang ◽  
Lewis B. Morgenstern ◽  
Christine T. Cigolle ◽  
Edward S. Claflin ◽  
Lynda D. Lisabeth
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Functional Outcome ◽  
Chronic Conditions ◽  
Meta Analysis ◽  
Multiple Chronic Conditions

scholarly journals Prevalence and predictors of medication non-adherence among patients with multimorbidity: A systematic review protocol

2019 ◽  
Vol 2 ◽  
pp. 29
Author(s):  
Louise Foley ◽  
James Larkin ◽  
Richard Lombard-Vance ◽  
Andrew W. Murphy ◽  
Gerard J. Molloy
Keyword(s):  
Systematic Review ◽  
Full Text ◽  
Chronic Conditions ◽  
Data Extraction ◽  
Meta Analysis ◽  
Intervention Development ◽  
Evidence Base ◽  
Multiple Chronic Conditions ◽  
Review Protocol ◽  
Form Quality

Introduction: Patients with multimorbidity are expected to adhere to complex medication regimens in order to manage their multiple chronic conditions. It has been reported the likelihood of adherence decreases as patients are prescribed more medications. Much medication adherence research to date is dominated by a single-disease focus, which is at odds with the rising prevalence of multimorbidity and may artificially underestimate the complexity of managing chronic illness. This review aims to describe the prevalence of medication non-adherence among patients with multimorbidity, and to identify potential predictors of non-adherence in this population. Methods: A systematic review will be conducted and reported according to PRISMA guidelines. PubMed, EMBASE, CINAHL and PsycINFO will be searched using a predefined search strategy from 2009–2019. Quantitative studies will be considered eligible for review if prevalence of medication non-adherence among adults with two or more chronic conditions is reported. Studies will be included in the review if available in English full text. Titles and abstracts will be screened by single review, with 20% of screening cross-checked by a second reviewer. Full-text articles will be screened by two independent reviewers, noting reasons for exclusions. Data extraction will be performed using a predefined extraction form. Quality and risk of bias assessment will be conducted using criteria for observational studies outlined by Sanderson et al. (2007). A narrative synthesis and, if feasible, meta-analysis will be conducted. Discussion: By exploring medication non-adherence from a multimorbidity perspective, the review aims to inform an evidence base for intervention development which accounts for the rising prevalence of patients with multiple chronic conditions.  Study registration: The systematic review is prospectively registered in PROSPERO (CRD42019133849); registered on 12 June 2019.

scholarly journals New Index for Multiple Chronic Conditions Predicts Functional Outcome in Ischemic Stroke

Neurology ◽  
2020 ◽  
Vol 96 (1) ◽  
pp. e42-e53
Author(s):  
Xiaqing Jiang ◽  
Lu Wang ◽  
Lewis B. Morgenstern ◽  
Christine T. Cigolle ◽  
Edward S. Claflin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Chronic Conditions ◽  
Synergistic Effects ◽  
Characteristic Curve ◽  
Machine Learning Techniques ◽  
Validation Dataset ◽  
Multiple Chronic Conditions ◽  
Corpus Christi ◽  
Neurologic Disorders

ObjectiveTo determine whether a new index for multiple chronic conditions (MCCs) predicts poststroke functional outcome (FO), we developed and internally validated the new MCC index in patients with ischemic stroke.MethodsA prospective cohort of patients with ischemic stroke (2008–2017) was interviewed at baseline and 90 days in the Brain Attack Surveillance in Corpus Christi Project. An average of 22 activities of daily living (ADL)/instrumental ADL (IADL) items measured the FO score (range 1–4) at 90 days. A FO score >3 (representing a lot of difficulty with ADL/IADLs) was considered unfavorable FO. A new index was developed using machine learning techniques to select and weight conditions and prestroke impairments.ResultsPrestroke modified Rankin Scale (mRS) score, age, congestive heart failure (CHF), weight loss, diabetes, other neurologic disorders, and synergistic effects (dementia × age, CHF × renal failure, and prestroke mRS × prior stroke/TIA) were identified as important predictors in the MCC index. In the validation dataset, the index alone explained 31% of the variability in the FO score, was well-calibrated (p = 0.41), predicted unfavorable FO well (area under the receiver operating characteristic curve 0.81), and outperformed the modified Charlson Comorbidity Index in predicting the FO score and poststroke mRS.ConclusionsA new MCC index was developed and internally validated to improve the prediction of poststroke FO. Novel predictors and synergistic interactions were identified.Classification of EvidenceThis study provides Class II evidence that in patients with ischemic stroke, an index for MCC predicts FO at 90 days.

scholarly journals Prevalence and predictors of medication non-adherence among patients with multimorbidity: A systematic review protocol

2021 ◽  
Vol 2 ◽  
pp. 29
Author(s):  
Louise Foley ◽  
James Larkin ◽  
Richard Lombard-Vance ◽  
Andrew W. Murphy ◽  
Gerard J. Molloy
Keyword(s):  
Systematic Review ◽  
Full Text ◽  
Chronic Conditions ◽  
Data Extraction ◽  
Meta Analysis ◽  
Intervention Development ◽  
Evidence Base ◽  
Multiple Chronic Conditions ◽  
Review Protocol ◽  
Form Quality

Introduction: Patients with multimorbidity are expected to adhere to complex medication regimens in order to manage their multiple chronic conditions. It has been reported the likelihood of adherence decreases as patients are prescribed more medications. Much medication adherence research to date is dominated by a single-disease focus, which is at odds with the rising prevalence of multimorbidity and may artificially underestimate the complexity of managing chronic illness. This review aims to describe the prevalence of medication non-adherence among patients with multimorbidity, and to identify potential predictors of non-adherence in this population. Methods: A systematic review will be conducted and reported according to PRISMA guidelines. PubMed, EMBASE, CINAHL and PsycINFO will be searched using a predefined search strategy from 2009–2019. Quantitative studies will be considered eligible for review if prevalence of medication non-adherence among adults with two or more chronic conditions is reported. Studies will be included in the review if available in English full text. Titles and abstracts will be screened by single review, with 20% of screening cross-checked by a second reviewer. Full-text articles will be screened by two independent reviewers, noting reasons for exclusions. Data extraction will be performed using a predefined extraction form. Quality and risk of bias assessment will be conducted using criteria for observational studies outlined by Sanderson et al. (2007). A narrative synthesis and, if feasible, meta-analysis will be conducted. Discussion: By exploring medication non-adherence from a multimorbidity perspective, the review aims to inform an evidence base for intervention development which accounts for the rising prevalence of patients with multiple chronic conditions.  Study registration: The systematic review is prospectively registered in PROSPERO (CRD42019133849); registered on 12 June 2019.

scholarly journals Small Vessel Disease Burden and Outcomes of Mechanical Thrombectomy in Ischemic Stroke: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Tao Xu ◽  
You Wang ◽  
Jinxian Yuan ◽  
Yangmei Chen ◽  
Haiyan Luo
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Functional Outcome ◽  
Intracranial Hemorrhage ◽  
Mechanical Thrombectomy ◽  
Small Vessel Disease ◽  
Meta Analysis ◽  
Poor Functional Outcome ◽  
Vessel Disease

Background: Cerebral small vessel disease (SVD) is prevalent in the population, especially among elderly individuals. Substantial uncertainties remain about the clinical relevance of SVD with outcomes of mechanical thrombectomy (MT) in acute ischemic stroke (AIS).Objectives: This systematic review and meta-analysis was performed to evaluate the association between SVD and clinical outcomes in patients with AIS undergoing MT.Methods: We systematically searched the Medline, Embase, and Cochrane databases for relevant clinical studies. The exposure of SVD mainly included leukoaraiosis, cerebral microbleeds (CMBs), and lacunes. The pooled OR was used to calculate the association between each subtype of SVD and outcomes of MT. The primary outcome was poor functional outcome, which was defined as a modified Rankin Scale score (mRS) ≥3 at 90 days after MT. The secondary outcomes included mortality at 90 days, in-hospital mortality, intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH), successful recanalization and futile recanalization (FR), early neurological improvement, and early neurological deterioration (END) after MT.Results: Overall, 20 studies with 5,189 patients with AIS undergoing MT were included. High leukoaraiosis burden (HLB) at baseline was associated with increased risks of poor functional outcome at 90 days (OR 2.70, 95% CI 2.01–3.63; p < 0.001; 10 studies; n = 2,004), in-hospital mortality (OR 4.06, 95% CI 1.48–11.13; p = 0.006; 2 studies; n = 314), FR (OR 5.00, 95% CI 2.86–8.73; p < 0.001; 3 studies; n = 493), and END (OR 2.65, 95% CI 1.09–6.45; 1 study; n = 273) after MT. HLB (VSS 3–4 or FS ≥ 2) at baseline was not associated with mortality at 90 days, ICH, or sICH after MT. CMBs at baseline were found to be associated with increased risks of poor functional outcome at 90 days (OR 1.84, 95% CI 1.17–2.90; p = 0.008; 2 studies; n = 1,924) after MT. We found no association between the presence of lacunes and poor functional outcome at 90 days after MT.Conclusions: In patients with AIS undergoing MT, HLB and CMBs were associated with increased risks of unfavorable outcomes after MT.

Multiple Chronic Conditions Explain Ethnic Differences in Functional Outcome Among Patients With Ischemic Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Xiaqing Jiang ◽  
Lewis B. Morgenstern ◽  
Christine T. Cigolle ◽  
Lu Wang ◽  
Edward S. Claflin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Chronic Conditions ◽  
Ethnic Difference ◽  
Effect Modification ◽  
Multiple Chronic Conditions ◽  
White People ◽  
Discharge Data ◽  
Stroke Outcomes ◽  
Hispanic White

Background and Purpose: Mexican Americans (MAs) have worse stroke outcomes and a different profile of multiple chronic conditions (MCC) compared with non-Hispanic White people. MCC has implications for stroke treatment, complications, and poststroke care, which impact poststroke functional outcome (FO). We sought to assess the contribution of MCC to the ethnic difference in FO at 90 days between MAs and non-Hispanic White people. Methods: In a prospective cohort of ischemic stroke patients (2008–2016) from Nueces County, Texas, data were collected from patient interviews, medical records, and hospital discharge data. MCC was assessed using a stroke-specific and function-relevant index (range, 0–35; higher scores greater MCC burden). Poststroke FO was measured by an average score of 22 activities of daily living (ADLs) and instrumental ADLs at 90 days (range, 1–4; higher scores worse FO). The contribution of MCC to the ethnic difference in FO was assessed using Tobit regression. Effect modification by ethnicity was examined. Results: Among the 896 patients, 70% were MA and 51% were women. Mean age was 68±12.2 years; 33% of patients were dependent in ADL/instrumental ADLs (FO score >3, representing a lot of difficulty with ADL/instrumental ADLs) at 90 days. MAs had significantly higher age-adjusted MCC burden compared with non-Hispanic White people. Patients with high MCC score (at the 75th percentile) on average scored 0.70 points higher in the FO score (indicating worse FO) compared with those with low MCC score (at the 25th percentile) after adjusting for age, initial National Institutes of Health Stroke Scale, and sociodemographic factors. MCC explained 19% of the ethnic difference in FO, while effect modification by ethnicity was not statistically significant. Conclusions: MAs had a higher age-adjusted MCC burden, which partially explained the ethnic difference in FO. The prevention and treatment of MCC could potentially mitigate poststroke functional impairment and lessen ethnic disparities in stroke outcomes.

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