scholarly journals Trial design and pilot phase results of a cluster-randomised intervention trial to improve stroke care after hospital discharge – The structured ambulatory post-stroke care program (SANO)

2020 ◽  
pp. 239698732091059 ◽  
Author(s):  
Felizitas A Eichner ◽  
Christopher J Schwarzbach ◽  
Moritz Keller ◽  
Karl Georg Haeusler ◽  
Gerhard F Hamann ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Hospital Discharge ◽  
Complex Intervention ◽  
Trial Design ◽  
National Level ◽  
Stroke Care ◽  
Pilot Phase ◽  
Post Stroke ◽  
Hospitalised Patients

Introduction Previous studies showed insufficient control of cardiovascular risk factors (CVRF) and high stroke recurrence rates among ischemic stroke patients in Germany. Currently, no structured secondary prevention program exists in clinical routine. We present the trial design and pilot phase results of a complex intervention to improve stroke care after hospital discharge in Germany. Patients and methods SANO is a cluster-randomized trial with 30 participating regions across Germany aiming to enrol 2,790 patients (drks.de, DRKS00015322). Study intervention combines both structural and patient-centred elements. Study development was based on the Medical Research Council framework for complex interventions. In 15 intervention regions, a cross-sectoral multidisciplinary network is established to enhance CVRF control as well as detection and treatment of post-stroke complications. Recommendations on CVRF are based on high-quality secondary prevention guidelines. Study physicians use motivational interviewing and agree with patients on therapeutic targets. While hospitalised, patients also receive dietary counselling and a health-passport to track their progress. During regular visits, CVRF management and potential complications are monitored. The intervention is compared to 15 regions providing usual care. The primary endpoint is the combination of recurrent stroke, myocardial infarction and death assessed 12 months after enrolment and adjudicated in a blinded manner. Results Eighteen patients were enrolled in a pilot phase that demonstrated feasibility of patient recruitment and study procedures. Conclusion SANO is investigating a program to reduce outcome events after ischemic stroke by implementing a complex intervention. If successful, the program may be implemented in routine care on national level in Germany.

Recurrent vascular events in patients with ischemic stroke/TIA and atrial fibrillation in relation to secondary prevention at hospital discharge

2004 ◽  
Vol 116 (24) ◽  
pp. 834-838 ◽  
Author(s):  
Susanne Tentschert ◽  
Silvia Parigger ◽  
Veronika Dorda ◽  
Kathrin Bittner ◽  
Daniel Unterbuchschachner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Hospital Discharge ◽  
Vascular Events

Associations between Ischemic Stroke Follow-Up, Socioeconomic Status, and Adherence to Secondary Preventive Drugs in Southern Sweden: Observations from the Swedish Stroke Register (Riksstroke)

2017 ◽  
Vol 48 (1-2) ◽  
pp. 32-38 ◽  
Author(s):  
Teresa Ullberg ◽  
Eva-Lotta Glader ◽  
Elisabet Zia ◽  
Jesper Petersson ◽  
Marie Eriksson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Antihypertensive Agents ◽  
Educational Status ◽  
Antiplatelet Drugs ◽  
First Year ◽  
Southern Sweden ◽  
Post Stroke ◽  
Stroke Register

Background: Currently, the knowledge that one has on adequate stroke follow-up practices is limited. We report associations between 90-day stroke follow-up, socio-economy and adherence to secondary prevention in southern Sweden. Methods: Data on 5,602 patients with ischemic stroke January 1, 2008-December 31, 2010, were obtained from Riksstroke and linked to official registers for information on education, birth country, doctor's follow-ups, and secondary prevention. Primary adherence at 4 months and persistence at 14 months post-stroke were calculated for warfarin, statins, antihypertensive, and antiplatelet drugs. Results: The 90-day follow-up rate was 75%. Patients not receiving a 90-day follow-up had lower age-adjusted OR of persistent drug use at 14 months for antihypertensive agents (OR = 0.74, 95% CI 0.60-0.91) and for antiplatelet drugs (OR = 0.72, 95% CI 0.60-0.87). Drug adherence rates 14 months post-stroke were 85% for antiplatelet drugs, 69% for warfarin, 88% for antihypertensive agents, and 76% for statins. One in three patients discontinued using one or more drug class within 14 months, and nonadherence was associated with activities of daily living dependency at 3 months (age-adjusted OR 0.63, 95% CI 0.57-0.69), but not with age, gender, or educational status. Conclusions: The use of secondary preventive drugs decreases over the first year after stroke and remains suboptimal. Specific reasons for nonadherence warrant further study.

scholarly journals Karakteristik dan Periode Kekambuhan Stroke pada Pasien dengan Stroke Berulang di Rumah Sakit Margono Soekardjo Purwokerto Kabupaten Banyumas

2018 ◽  
Vol 3 (1) ◽  
Author(s):  
Meida Laely Ramdani
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Low Income ◽  
Recurrent Stroke ◽  
Sampling Technique ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Post Stroke ◽  
Duration Of Illness

Background: Patients who had stroke recurrence after the first stroke have a high risk of disability as well as high rates of morbidity and mortality. Incidence of stroke recurrence can be prevented by controlling risk factors and secondary prevention among post stroke patient, and also tent of the duration of the occurrence of recurrent stroke after the first attack. Objective: The purpose of this study was to determine the characteristics and stroke recurrence periods of post stroke patients.Methods: Cross sectional study design was used in this study. Total 73 recurrent stroke patients age 18-60 years old were selected using consecutive sampling technique. This study was conducted on patients during their follow up in the outpatient department of unit neurology, Margono Soekardjo Purwokerto Hospital during November-December 2015. The characteristics of the recurrent stroke patients include sex, age, education, occupation, and income. This study also describes type of stroke and duration of illness. The periods of recurrent stroke patients divided in to three time periods (≤ 6-month, 7-12 month, >12 month). Results: 73 recurrent stroke patients showed 56% were female, age group 39-60 years old was 97,5%, 60,3% have low education (below senior high school), 64,7% work as public and private employees. Income of respondents were low income 53,4%. Ischemic stroke was the majority (87,7%), no history family of stroke 64,4%, 1-5 years duration of illness and periods of stroke recurrence >12 month was 45,20%.Conclusion:  Ischemic stroke is the biggest case of recurrent stroke, so that we need to emphasize the importance of secondary prevention including medication and treatment. Background: Patients who had stroke recurrence after the first stroke have a high risk of disability as well as high rates of morbidity and mortality. Incidence of stroke recurrence can be prevented by controlling risk factors and secondary prevention among post stroke patient, and also tent of the duration of the occurrence of recurrent stroke after the first attack. Objective: The purpose of this study was to determine the characteristics and stroke recurrence periods of post stroke patients.Methods: Cross sectional study design was used in this study. Total 73 recurrent stroke patients age 18-60 years old were selected using consecutive sampling technique. This study was conducted on patients during their follow up in the outpatient department of unit neurology, Margono Soekardjo Purwokerto Hospital during November-December 2015. The characteristics of the recurrent stroke patients include sex, age, education, occupation, and income. This study also describes type of stroke and duration of illness. The periods of recurrent stroke patients divided in to three time periods (≤ 6-month, 7-12 month, >12 month). Results: 73 recurrent stroke patients showed 56% were female, age group 39-60 years old was 97,5%, 60,3% have low education (below senior high school), 64,7% work as public and private employees. Income of respondents were low income 53,4%. Ischemic stroke was the majority (87,7%), no history family of stroke 64,4%, 1-5 years duration of illness and periods of stroke recurrence >12 month was 45,20%.Conclusion:  Ischemic stroke is the biggest case of recurrent stroke, so that we need to emphasize the importance of secondary prevention including medication and treatment.

scholarly journals Clinical profile, in-hospital outcome and associated factors of stroke after the start of a standard organized stroke care unit at university of Gondar hospital, northwest Ethiopia.

2019 ◽  
Author(s):  
Seid Getahun Abdella ◽  
Nebiyu Bekele Gebi ◽  
Ermias Shenkutie Gerffie ◽  
Koku Sisay Tamirat
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Regression Model ◽  
Hospital Stay ◽  
Functional Impairment ◽  
Associated Factors ◽  
Stroke Care ◽  
Post Stroke ◽  
Stroke Disability

Abstract Background: Epidemiological transitions and widespread risk factors made stroke common health problem in sub-Saharan countries in the early age. Stroke management largely depends on non-drug interventions. Stroke care units are facilities in hospitals which increased patient survival, return home, and regain independence in daily activities. This study was aimed to assess clinical profile, in-hospital outcome and its associated factors of stroke after the start of a standard organized stroke care unit in the study area. Method: An institution based cross-sectional study was employed from July 2015 to September 2017. A total of 151 stroke patients with computed tomography (CT) scan result were included in the study. Data were collected using structured questionnaire from secondary sources of patient medical records. In-hospital mortality and poor post-stroke disability (greater functional impairment, when Modified Rankin Scale score (mRS) ≥3) were outcome variables. Binary logistic regression model was fitted to identify predictor variables. Adjusted Odds Ratio (OR) with a 95% confidence interval (CI) used to assess the strength of association. Variables with p-value less than 0.05 in the multi-variable regression model was considered as significantly associated with the dependent variables. Result: Ischemic stroke (60.3%) subtype was the most common. The median age at presentation was 65 (IQR: 55-75) years. Hypertension (49.7%) and carotid atherosclerosis (54.7%) were the most commonly identified risk factors. Overall in-hospital mortality was 9.3% (95% CI: 5.2%-15.1%), poor post-stroke disability was 55.6% (95%CI: 47.3%-63.7%), and median length of hospital stay was 10 (IQR: 7-14) days. Being male (AOR=0.19, 95%CI: 0.038 0.97), longer in-hospital stays (AOR=0.21, 95%CI: 0.048 0.93) were significant predictors of in-hospital mortality. Furthermore increased ICP (AOR=2.81, 95%CI: 1.22 6.92) was also the predictor of poor post-stroke disability at discharge. Conclusion: Ischemic stroke was the most common stroke subtype. In-hospital mortality was relatively lower. However, greater functional impairment was high at discharge. Stroke morality was observed lower among male and longer in-hospital stay patients, while evidence of increased intracranial pressure was associated with poor post-stroke disability at discharge.

Abstract TP290: Differences in Alteplase Treatment by Urban, Suburban and Rural Regions Across a Large Western State

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Meghan McCausland ◽  
Jim Jansen
Keyword(s):  
Ischemic Stroke ◽  
Hospital Discharge ◽  
Rural Areas ◽  
Regional Differences ◽  
Stroke Care ◽  
Stroke Patients ◽  
Rural Residents ◽  
Discharge Data ◽  
Stroke Treatment ◽  
Rural And Urban

Introduction: Stroke patients in rural areas face multiple barriers to receiving stroke treatment, in comparison to their urban/suburban counterparts. There are many factors that may contribute to differences in treatment. Establishing whether or not regional differences in care exist is the first step in improving the stroke care system. The objective of this study was to first examine alteplase treatment in a large western state to determine if there are differences in treatment across rural and urban/suburban regions and what demographic factors contribute to those differences. Methods: This study analyzed 30,245 ischemic stroke patients admitted to 124 hospitals in rural and urban/suburban regions. Using 2015 - 2018 hospital discharge data, this study examined regional differences in alteplase treatment. The Rural Urban Commuting Areas (RUCA) system was used to determine rural status based off of the patient’s residence. Hospital discharge data identified ischemic stroke hospitalizations and whether or not patients received alteplase. US Census data were used to identify additional demographic factors, including income and education, at a geographic level. Key Results: Among those discharged with a diagnosis of ischemic stroke, results showed a 3% disparity in alteplase treatment between urban/suburban (10%) and rural residents (7%). Rural residents received treatments less often than those in urban/suburban locations. Those living in an urban/suburban region were 1.4 times more likely to receive alteplase than those living in a rural region (RR: 1.4, 95% CI: 1.3-1.6). Conclusion: This study identified differences in alteplase treatment across regions. Key results indicated that rural residents may face additional challenges in stroke treatment that require special consideration in stroke systems of care quality improvement efforts. Multiple factors such as distance from care, perceptions of the importance of ambulance and aid services, and availability of advanced stroke care can all play a crucial role in patients receiving adequate care quickly. Additional research is needed in the area of access to and perceptions of stroke care in rural areas to determine the best possible solutions to these challenges.

scholarly journals Radiomics Derived Brain Age Predicts Functional Outcome After Acute Ischemic Stroke

2021 ◽  
Author(s):  
Martin Bretzner ◽  
Anna Bonkhoff ◽  
Markus Schirmer ◽  
Sungmin Hong ◽  
Adrian Dalca ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Brain Aging ◽  
Stroke Care ◽  
Smoking History ◽  
Stroke Patients ◽  
Prognostic Information ◽  
Stroke Outcomes ◽  
Post Stroke ◽  
The Impact ◽  
Brain Age

Abstract While chronological age is one of the most influential determinants of post-stroke outcomes, little is known of the impact of neuroimaging-derived biological brain age. We here first examine whether radiomics analysis of the texture of brain T2-FLAIR MRI images can be used to predict brain age in stroke patients. We then assess the clinical determinants of accelerated brain aging and, finally, its impact on post-stroke functional outcomes. Leveraging a multisite cohort of 4,163 ischemic stroke patients, we show that older-appearing patients have more hypertension, diabetes mellitus, prior strokes, and smoking history and are more likely to develop worse post-stroke outcomes than their younger-appearing counterparts. Our results strengthen the importance of preventive medicine for maintaining brain health in stroke patients as they age and suggest a novel methodology to capture previously undescribed prognostic information available on commonly acquired MRI sequences during routine stroke care.

Abstract P23: Age Disparities in Quality of Care and Clinical Outcomes in US Veterans With Ischemic Stroke

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Neale R Chumbler ◽  
Huanguang Jia ◽  
Xinli Li ◽  
Michael Phipps ◽  
Diana Ordin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Indicators ◽  
Stroke Care ◽  
Smoking Cessation Counseling ◽  
Early Ambulation ◽  
Post Stroke ◽  
Age Disparities ◽  
Patient Groups ◽  
Us Veterans

Background This is the first study of age disparities in ischemic stroke care quality and post-stroke outcomes across the Department of Veterans Affairs (VA) system. Methods This was a retrospective study of a national sample of US veterans admitted to VA medical centers for ischemic stroke between 10/1/06 and 9/30/07. The following 14 inpatient stroke quality indicators were assessed: 1) dysphagia screening before oral intake; 2) NIH Stroke Scale completion ; 3) thrombolysis; 4) DVT prophylaxis; 5) early antithrombotic therapy; 6) early ambulation; 7) fall risk assessment; 8) pressure ulcer risk assessment; 9) rehabilitation consultation); 10) antithrombotic therapy at discharge; 11) atrial fibrillation management; 12) lipid management; 13) smoking cessation counseling; and 14) stroke education. Post-stroke outcomes included: risk-adjusted mortality (in-hospital and 6-month post-stroke); and hospital readmission (30-day and 6-month). Four age categories were assigned (<65, 65-74, 75-84, and ≥85 years). We modeled each quality indicator (defined as pass or fail among eligible patients) using multivariable logistic regression adjusting for race, stroke severity, comorbidity, smoking status, APACHE II score, hospital geography, complexity and volume. Results Among the 3,937 US Veterans with ischemic stroke, the overall pass rate among the quality indicators was > 70% for 9 of the 14 processes of care. Patients ≥85 years old were less likely than younger patients to receive atrial fibrillation management, smoking cessation counseling, NIHSS documentation, and early ambulation (p < .05). Patients aged ≥85 years were more likely to have dysphagia screening (p < .05). Risk adjusted mortality was higher among patients aged ≥85 years compared with each of the younger patient groups in both in-hospital mortality (p < .0001) and 6-month mortality (p < .0001). The oldest patients also had higher 6-month hospital re-admission rates than each of the younger patient groups (p = .002). Conclusions Despite overall good quality of inpatient stroke care within the VA system, further work is needed to investigate possible associations between patient age, disparities in quality indicators and outcomes of post-stroke.

Abstract W P348: Evaluating Gaps in the Continuum of Stroke Care

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Jenny P Tsai ◽  
Paula A Rochon ◽  
Stavroula Raptis ◽  
Susan E Bronskill ◽  
Chaim M Bell ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Medication Adherence ◽  
Acute Ischemic Stroke ◽  
Hospital Discharge ◽  
Stroke Care ◽  
Population Based ◽  
Lipid Lowering ◽  
P Value ◽  
One Year ◽  
Lipid Lowering Agents

Background and Purpose: Medication adherence is an important factor for secondary stroke prevention in ambulatory care. We aimed to evaluate short-term adherence to antihypertensive and lipid-lowering agents after a new ischemic stroke as a predictor of adherence at one and two years after discharge. Methods: A five-year cohort (2003-2008) of patients from eleven institutions participating in the Registry of the Canadian Stroke Network (RCSN) was linked to population-based administrative health records. Patients with a diagnosis of an acute ischemic stroke who were discharged home were included in the study. Medication adherence was assessed through documentation of a filled prescription at seven days, one year and two years from hospital discharge. Results: From 2003 to 2008, 6,437 ischemic stroke patients were discharged home from hospital. A total of 1126 patients filled a prescription for antihypertensive and lipid-lowering agents within 7 days of hospital discharge. Patients provided with a prescription at discharge were more likely to be adherent to antihypertensive and lipid-lowering agents at seven days than patients who did not receive a prescription . Adherence at one year (X% vs Y%, p-value=?) was higher in patients who demonstrated adherence at seven days from discharge for antihypertensive (93.8% vs 87.7%, p<0.0001), lipid-lowering agents (88% vs 81.9%, p<0.0001), or both (85.8% vs 79.9%, p<0.0001). Similar findings are noted at two years for antihypertensives (92.2% vs 87.7%, p=0.0003), lipid-lowering agents (82.6% vs 79.0%, p=0.0394), or both (81.1% vs 77.0%, p=0.0099). Conclusion: Filling prescriptions within one week of discharge from hospital for acute ischemic stroke predicts adherence for secondary preventive therapies at one and two years. Provision of a prescription at the time of discharge to both prior and new users of anti-hypertensive and lipid-lowering drugs is a simple and effective intervention to improve adherence to secondary preventive medications at seven days, one year and two years after ischemic stroke.

Safety and feasibility of post-stroke care and exercise after minor ischemic stroke or transient ischemic attack: MotiveS & MoveIT

2014 ◽  
Vol 34 (3) ◽  
pp. 401-407 ◽  
Author(s):  
H.M. Boss ◽  
S.M. Van Schaik ◽  
I.A. Deijle ◽  
E.C. de Melker ◽  
B.T.J. van den Berg ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Stroke Care ◽  
Post Stroke ◽  
Minor Ischemic Stroke ◽  
Ischemic Attack

Ischemic stroke outcome: A review of the influence of post-stroke complications within the different scenarios of stroke care

2016 ◽  
Vol 29 ◽  
pp. 9-21 ◽  
Author(s):  
Alejandro Bustamante ◽  
Teresa García-Berrocoso ◽  
Noelia Rodriguez ◽  
Victor Llombart ◽  
Marc Ribó ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Stroke Care ◽  
Stroke Outcome ◽  
Post Stroke
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