GLORIA

GEOMAR Library Ocean Research Information Access

X

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    Online Resource
    Online Resource
    Pre-Stroke CHADS〈sub〉2〈/sub〉 and CHA〈sub〉2〈/sub〉DS〈sub〉2〈/sub〉-VASc Scores Are Useful in Stratifying Three-Month Outcomes in Patients with and without Atrial Fibrillation
    S. Karger AG ; 2013
    In:  Cerebrovascular Diseases Vol. 36, No. 4 ( 2013), p. 273-280
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 36, No. 4 ( 2013), p. 273-280
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 CHADS 〈 sub 〉 2 〈 /sub 〉 and CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc scores are validated tools for assessing stroke risk in patients with atrial fibrillation (AF). We investigated whether these scores are associated with 3-month stroke outcomes and evaluated the utility of these scores in stratifying 3-month stroke outcomes in both patients with and without AF. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We analysed 6,612 acute ischaemic stroke patients from the Virtual International Stroke Trials Archive who received either placebo or ineffective active treatments not associated with significant cardiac complications. Outcomes included 3-month mortality, good functional outcomes defined as modified Rankin Scale score ≤1 and serious cardiac adverse events (SCAEs) defined as one of acute coronary syndrome, symptomatic heart failure, cardiopulmonary arrest, life-threatening arrhythmia and cardiac death. The association between the pre-stroke CHADS 〈 sub 〉 2 〈 /sub 〉 and CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc scores and 3-month stroke outcomes was assessed using binary logistic regression. The utility of the two scores in estimating 3-month stroke outcomes was assessed using area under the receiver operator characteristic curves (AUC) and compared using the & #x03C7; 〈 sup 〉 2 〈 /sup 〉 test. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 In this cohort, 26.5% had AF, 35.3% received IV tissue plasminogen activator (tPA), 17.7% died, 25.1% achieved good functional outcomes and 9.5% had ≥1 SCAE at 3 months. High-risk (≥2) pre-stroke CHADS 〈 sub 〉 2 〈 /sub 〉 and CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc scores are both associated with 3-month mortality (CHADS 〈 sub 〉 2 〈 /sub 〉 : odds ratio, OR, 2.33, 95% confidence interval 1.81-3.00; CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc: OR 3.01, 2.00-4.80), good functional outcomes (CHADS 〈 sub 〉 2 〈 /sub 〉 : OR 0.47, 0.39-0.57; CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc: OR 0.55, 0.42-0.71) and SCAEs (CHADS 〈 sub 〉 2 〈 /sub 〉 : OR 1.76, 1.28-2.42; CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc: OR 2.69, 1.53-4.73) after adjusting for baseline differences in neurological impairment, tPA use and AF. The pre-stroke CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc score is better than the CHADS 〈 sub 〉 2 〈 /sub 〉 score in estimating 3-month stroke outcomes in both patients with and without AF (p ≤ 0.005 in all AUC comparisons). High-risk pre-stroke CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc score has high sensitivity for mortality (AF: 0.96, 0.94-0.98; no AF: 0.88, 0.86-0.91) and negative predictive value for SCAE (AF: 0.93, 0.87-0.96; no AF: 0.96, 0.95-0.97) within 3 months. Low risk pre-stroke CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc score has high specificity for good functional outcome (AF: 0.99, 0.98-0.994; no AF: 0.94, 0.93-0.95) at 3 months. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 The pre-stroke CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc score appears to be a simple tool for identifying patients at lower risk of poor outcomes and serious cardiac complications within 3 months following ischaemic stroke in patients with and without AF.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000353670
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
    detail.hit.zdb_id: 1482069-9
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 2
    Online Resource
    Online Resource
    Frequent Early Cardiac Complications Contribute to Worse Stroke Outcome in Atrial Fibrillation
    S. Karger AG ; 2011
    In:  Cerebrovascular Diseases Vol. 32, No. 5 ( 2011), p. 454-460
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 32, No. 5 ( 2011), p. 454-460
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Atrial fibrillation (AF) is associated with worse outcomes following ischemic stroke and more frequent cardiac complications in the general population. We aimed to establish whether early cardiac complications contribute to the poorer ischemic stroke outcomes in patients with AF, independent of baseline differences in age, stroke severity and cardiovascular risk factors. This might have important implications for acute stroke management in patients with AF. 〈 i 〉 Methods: 〈 /i 〉 We searched VISTA-Acute, an academic database containing standardized data for 28,131 patients from 30 randomized-controlled acute stroke trials and 1 stroke registry, for imaging-confirmed placebo-treated patients with complete documentation of baseline demographics, cardiovascular risk factors, presence or absence of AF, neurologic impairment [National Institutes of Health Stroke Scale (NIHSS)] , cardiac complications and 3-month outcome (modified Rankin Scale). A total of 2,865 patients from 6 randomized-controlled trials met the selection criteria, of whom 819 had AF. Binary logistic regression modeling was used to determine the independent effect of AF on stroke outcome and serious cardiac adverse events (SCAE), a composite end point including acute coronary syndrome, symptomatic heart failure, cardiopulmonary arrest, ventricular tachycardia, ventricular fibrillation and cardiac mortality. 〈 i 〉 Results: 〈 /i 〉 All patients were enrolled into the source trials within 24 h of stroke onset. At baseline, patients with AF were older (mean 75 vs. 67 years, p 〈 0.001) and had greater neurologic impairment (median NIHSS 15 vs. 13, p 〈 0.001). The median time to first cardiac adverse event was 3 days [median difference 0, 95% confidence interval (CI) 0–1, p = 0.06] for both patients with and without AF. SCAE occurred more frequently [14.2 vs. 6%, odds ratio (OR) = 2.58, 95% CI 1.97–3.37] in patients with AF, particularly cardiac mortality (4.9 vs. 2.6%, OR = 1.89, 95% CI 1.25–2.88), symptomatic heart failure (6.5 vs. 2.2%, OR = 3.01, 95% CI 2.01–4.50), and ventricular tachycardia and/or fibrillation (2.4 vs. 0.8%, OR = 3.18, 95% CI 1.64–6.16). At 3 months, AF was independently associated with SCAE (OR = 2.14, 95% CI 1.61–2.86) and early mortality (OR = 1.44, 95% CI 1.14–1.81) after adjusting for all baseline imbalances. 〈 i 〉 Conclusion: 〈 /i 〉 Early SCAE are common after stroke and are independently associated with the presence of AF. Given that many cardiac complications are potentially remediable, these results highlight the need for more rigorous surveillance for cardiac complications in acute ischemic stroke patients with AF.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000332028
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
    detail.hit.zdb_id: 1482069-9
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 3
    Online Resource
    Online Resource
    Aeromedical Retrieval for Stroke in Australia
    S. Karger AG ; 2020
    In:  Cerebrovascular Diseases Vol. 49, No. 3 ( 2020), p. 334-340
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 49, No. 3 ( 2020), p. 334-340
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Rural, remote, and Indigenous stroke patients have worse stroke outcomes than urban Australians. This may be due to lack of timely access to expert facilities. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 We aimed to describe the characteristics of patients who underwent aeromedical retrieval for stroke, estimate transfer times, and investigate if flight paths corresponded with the locations of stroke units (SUs) throughout Australia. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Prospective review of routinely collected Royal Flying Doctor Service (RFDS) data. Patients who underwent an RFDS aeromedical retrieval for stroke, July 2014–June 2018 (ICD-10 codes: I60–I69), were included. To define the locations of SUs throughout Australia, we accessed data from the 2017 National Stroke Audit. The main outcome measures included determining the characteristics of patients with an in-flight diagnosis of stroke, their subsequent pickup and transfer locations, and corresponding SU and imaging capacity. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The RFDS conducted 1,773 stroke aeromedical retrievals, consisting of 1,028 (58%) male and 1,481 (83.5%) non-Indigenous and 292 (16.5%) Indigenous patients. Indigenous patients were a decade younger, 56.0 (interquartile range [IQR] 45.0–64.0), than non-Indigenous patients, 66.0 (IQR 54.0–76.0). The most common diagnosis was “stroke not specified,” reflecting retrieval locations without imaging capability. The estimated median time for aeromedical retrieval was 238 min (95% confidence interval: 231–244). Patients were more likely to be transferred to an area with SU and imaging capability (both 〈 i 〉 p 〈 /i 〉 & #x3c; 0.0001). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Stroke patients living in rural areas were younger than those living in major cities (75 years, Stroke Audit Data), with aeromedically retrieved Indigenous patients being a decade younger than non-Indigenous patients. The current transfer times are largely outside the time windows for reperfusion methods. Future research should aim to facilitate more timely diagnosis and treatment of stroke.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000508578
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 1482069-9
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...