6 research outputs found
Comparison of the impact of atrial fibrillation on the risk of early death after stroke in women versus men
BACKGROUND: Atrial fibrillation (AF) is considered a predictive factor of poor clinical outcome in patients with an ischemic stroke (IS). This study addressed whether the impact of AF on the in-hospital mortality after first ever IS is different according to the patient’s gender. METHODS: We prospectively studied 1678 patients with first ever IS consecutively admitted to two University Hospitals. We recorded demographic data, vascular risk factors, and the stroke severity (NIHSS) at admission analyzing their impact on the in-hospital mortality and on the combined mortality-dependency at discharge using a Cox proportional hazards model. Two variable interactions between those factors independently related to in-hospital mortality and combined mortality-dependency at discharge were tested. RESULTS: Overall in-hospital mortality was 11.3%. Cox proportional hazards model showed that NIHSS at admission (HR: 1.178 [95% CI 1.149–1.207]), age (HR: 1.044 [95% CI 1.026–1.061]), AF (HR: 1.416 [95% CI 1.048–1.913]), male gender (HR: 1.853 [95% CI 1.323–2.192) and ischemic heart disease (HR: 1.527 [95% CI 1.063–2.192]) were independent predictors of in-hospital mortality. A significant interaction between gender and AF was found (p = 0.017). Data were stratified by gender, showing that AF was an independent predictor of poor outcome just for woman (HR: 2.183 [95% CI 1.403–3.396]; p < 0.001). The independent predictors of combined mortality-disability at discharge were NIHSS at admission (HR: 1.052 [95% CI 1.041–1.063]), age (HR: 1.011 [95% CI 1.004–1.018]), AF (HR: 1.197 [95% CI 1.031–1.390]), ischemic heart disease (HR: 1.222 [95% CI 1.004–1.488]), and smoking (HR: 1.262 [95% CI 1.033–1.541]). CONCLUSIONS: The impact of AF is different in the twogenders and appears as a specific ischemic stroke predictor of in-hospital mortality just for women
The Mataró Stroke Registry: A 10-year registry in a community hospital
Introduction: A prospective stroke registry leads to improved knowledge of the disease. We present data on the Mataró Hospital Registry. Methods: In February 2002 a prospective stroke registry was initiated in our hospital. It includes sociodemographic data, previous diseases, and clinical, topographic, aetiological and prognostic data. We have analysed the results of the first 10 years. Results: A total of 2165 patients have been included, 54.1% male, mean age 73 years. The most frequent vascular risk factor was hypertension (65.4%). Median NIHSS on admission: 3 (interquartile range, 1–8). Stroke subtype: 79.7% ischaemic strokes, 10.9% haemorrhagic, and 9.4% TIA. Among ischaemic strokes, the aetiology was cardioembolic in 26.5%, large-vessel disease in 23.7%, and small-vessel in 22.9%. The most frequent topography of haemorrhages was lobar (47.4%), and 54.8% were attributed to hypertension. The median hospital stay was 8 days. At discharge, 60.7% of the patients were able to return directly to their own home, and 52.7% were independent for their daily life activities. After 3 months these percentages were 76.9% and 62.9%, respectively. Hospital mortality was 6.5%, and after 3 months it was 10.9%. Conclusions: Our patient's profile is similar to those of other series, although the severity of strokes was slightly lower. Length of hospital stay, short-term and medium-term disability, and mortality rates are good, if we compare them with other series. Resumen: Introducción: Un registro prospectivo de ictus permite mejorar el conocimiento de la historia natural de la enfermedad. Presentamos los datos del Registro del Hospital de Mataró. Métodos: En febrero de 2002 se inició en nuestro hospital el registro prospectivo de pacientes ingresados con un ictus agudo. Se recogen variables sociodemográficas, antecedentes, clínicas, topográficas, etiológicas y pronósticas. Analizamos los resultados obtenidos después de los primeros 10 años de registro. Resultados: Se han registrado 2.165 pacientes, el 54,1% varones, con una edad media de 73 años. El factor de riesgo más frecuente es la hipertensión (65,4%). Mediana de la NIHSS al ingreso: 3 (rango intercuartílico, 1–8). Un 79,7% han sido infartos cerebrales, un 10,9% hemorragias y un 9,4% AIT. De los isquémicos, la etiología ha sido cardioembólica en el 26,5%, aterotrombótica en el 23,7% y lacunar en el 22,9%. La localización más frecuente de las hemorragias ha sido lobar (47,4%), y se han atribuido a hipertensión el 54,8%. La mediana de la estancia hospitalaria ha sido de 8 días. Al alta, un 60,7% pudieron volver directamente al domicilio y un 52,7% eran independientes para las actividades de la vida diaria. A los 3 meses, las cifras fueron 76,9 y 62,9% respectivamente. La mortalidad intrahospitalaria ha sido del 6,5% y a los 3 meses del 10,9%. Conclusiones: El perfil de los pacientes en nuestra área no difiere de las otras series, aunque la severidad de los ictus ha sido discretamente menor. Constatamos unas cifras óptimas de estancia hospitalaria y de discapacidad y mortalidad tanto a corto como a medio plazo. Keywords: Stroke, Stroke registry, Epidemiology, Prognosis, Outcome, Cerebrovascular disease, Palabras clave: Ictus, Registro de ictus, Epidemiología, Pronóstico, Evolución, Enfermedad cerebrovascula
Rapid assessment of transient ischaemic attack in a hospital with no on-call neurologist
Background: Risk of stroke soon after a transient ischaemic attack (TIA) is high. Urgent care can reduce this risk. Our aim is to describe and evaluate the efficacy of rapid assessment of TIA patients in a hospital without a neurologist available 24 h a day. Methods: In February 2007, we set up a protocol of rapid management of patients with symptoms consistent with acute TIA, with the aim of prioritising urgent care and reducing hospital admissions, without increasing risk of recurrences. We analyse our results since the protocol was implemented with particular focus on the analysis of delay in neurological and neurovascular assessment, percentage and reasons for hospitalisation, and stroke recurrence rates after 3 months. Results: Four hundred and eleven patients were studied, with a final diagnosis of TIA in 282 (68.6%). Among other diagnoses, the most frequent were a vasovagal reaction (5.6%), and a confusional syndrome (4.6%). Delay between emergency arrival and neurovascular assessment was <24 h in 82% of cases, and <48 h in 93%. After neurological evaluation, 28.7% of the patients were immediately admitted to hospital (most common causes: severe stenosis of a large artery and crescendo TIA). The incidence of ischaemic stroke in TIA patients was 3.55% after 3 months, and 70% of them suffered the recurrence within the first week after the initial TIA. Conclusions: In a hospital without a neurologist available 24 h a day, an early assessment and management of TIA patients can be carried out in accordance with the guidelines, and may avoid hospitalisation in most cases without increasing recurrence rates. Resumen: Introducción: Los pacientes que presentan un ataque isquémico transitorio (AIT) tienen un alto riesgo de tener un ictus a corto plazo. Una atención urgente puede reducir dicho riesgo. El objetivo es describir y comprobar la eficacia de un protocolo de atención rápida a estos pacientes en un hospital sin guardias de neurología. Métodos: En febrero del 2007 se puso en marcha en nuestro hospital un protocolo de evaluación rápida del AIT, con el objetivo de priorizar la atención urgente y disminuir ingresos hospitalarios sin aumentar riesgo de recurrencias. Se analizan los resultados tras los primeros 5 años, incidiendo especialmente en los tiempos de valoración neurológica y neurovascular, motivos de ingreso y tasa de recurrencia a los 90 días. Resultados: Han sido evaluados 411 pacientes, de los cuales 282 (68,6%) fueron finalmente AIT. Entre los otros diagnósticos, los más frecuentes han sido el episodio vasovagal (5,6%) y el cuadro confusional (4,6%). La demora entre la llegada a Urgencias y la valoración del neurólogo fue <24 h en el 82% de casos y <48 h en el 93,9%. Tras la valoración neurológica, se decidió el ingreso en el 28,7% de pacientes (causas más frecuentes: hallazgos en el Doppler y AIT de repetición). A los 3 meses, 10 pacientes (3,55%) presentaron un ictus, 7 de ellos (70%) en la primera semana desde el episodio. Conclusiones: En un hospital sin guardias de neurología, es posible una evaluación rápida de los pacientes con AIT, de acuerdo con las recomendaciones de las guías, evitando la mayoría de ingresos y con un bajo índice de recurrencias. Keywords: Transient ischaemic attack, Stroke, Recurrence, Urgent care, Management, Prognosis, Palabras clave: Ataque isquémico transitorio, Ictus, Recurrencia, Atención urgente, Gestión, Pronóstic