19 research outputs found
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Quality of life of patients with epilepsy living in Kingston, Jamaica
Quality of life in epilepsy has not been documented in the English-speaking Caribbean. The aim of this study was to explore the quality of life of persons with epilepsy (PWE) living in Jamaica and determine the impact of socioeconomic factors by examining two socially distinct groups in semiprivate (Epilepsy Centre of Jamaica) and public (Kingston Public Hospital) outpatient clinics. One hundred nine consecutive patients were interviewed. Quality of life was assessed using the Quality of Life in Epilepsy-31 inventory (QOLIE-31). Both groups were matched for gender, epilepsy syndrome, epilepsy duration, and number of antiepileptic drugs. Predictors of quality of life included number of antiepileptic drugs (P=0.039), epilepsy duration (P<0.05), and functional status (P<0.001). Neither seizure frequency nor socioeconomic status predicted QOLIE-31 scores. Mean QOLIE-31 total score (61.57 vs 49.2, P<0.001) and QOLIE-31 subscale scores (with the exception of the Seizure Worry score [53.8 vs 48.2, P=0.08]) were significantly higher than the corresponding t scores. The QOLIE-31 can reliably be used in Jamaica. Our findings suggest Jamaicans living with epilepsy perceive themselves as having a better than expected quality of life
Prevalence of Vertebral Artery Origin Stenosis in a Multirace-Ethnic Posterior Circulation Stroke Cohort: Miami Stroke Registry (MIAMISR)
Vertebral artery origin stenosis is an important etiology for stroke in the posterior circulation. Data from the Oxford Vascular Study and New England Registry show a prevalence of vertebral artery origin disease of 26-32%. These populations are largely comprised of Caucasians. The prevalence of vertebral artery origin disease in multirace-ethnic stroke population is unknown.
The study aims to assess the prevalence of vertebral artery origin stenosis in a multirace population with posterior circulation stroke.
The Miami Stroke Registry is a prospective registry which offers enrollment to consecutive patients admitted with a diagnosis of stroke/transient ischemic attack. Baseline demographics, vascular risk factors, and stroke topography in the posterior circulation were analyzed. All vascular imaging studies were reviewed for the presence of vertebral artery origin stenosis, and stroke etiology was adjudicated by TOAST classification.
Mean age of the population was 63 ± 13 years; 149 (70%) were men. Among cases, 123 were Hispanic (58%), almost one third 70 (32%) were of African descent, and 15 (7%) were white. The most common stroke etiology was small vessel occlusion (27%), followed by large artery intracranial disease 25% (posterior cerebral arteries, basilar and vertebral arteries), cardioembolic 19%, and cryptogenic 16%. Vertebral artery origin stenosis/occlusion was present in 28 (13.1%) patients, of whom only 2 (0.9%) were bilateral; it was attributed as the direct cause of stroke in 11 (5.2%) patients.
We found a lower prevalence of vertebral artery origin stenosis in a predominately non-white population with posterior circulation stroke than previously reported. Vertebral artery origin stenosis was a direct cause of posterior circulation stroke in only 5.2% of patients
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Early hospital readmission following stroke: the Florida Stroke Registry
Background Hospital readmission is an important indicator of poor transition of care post-stroke. Data on characteristics of patients at highest risk for readmission is limited and necessary to inform effective interventions. The goal is to identify risk factors at hospital discharge that predict 30-day readmission in the Florida Stroke Registry (FSR). Methods The study population included 45,877 patients discharged home or to rehabilitation with an ischemic stroke or intracerebral hemorrhage in the FSR between 2017 and 2019. The FSR is a voluntary statewide registry of stroke patients from 167 hospitals using data from Get With the Guideline-Stroke. Readmissions were ascertained by propensity matching FSR with the Florida Agency for Healthcare Administration dataset, which includes all hospital admissions in Florida. The primary outcome was 30-day hospital readmission for any cause, and secondary outcomes were vascular-related and stroke readmissions specifically. Multivariable logistic regression models identified patient characteristics that independently predicted 30-day readmissions, including sociodemographics, stroke clinical characteristics, in-hospital treatment, medical history, discharge status, and hospital characteristics. Results A hospital readmission within 30 days was experienced in 12% of cases; 6% had a vascular-related readmission, and 3% a recurrent stroke. The following characteristics were independently associated with an increased risk of all-cause readmission: Medicare or Medicaid insurance, large artery atherosclerosis as the stroke mechanism, increased stroke severity, diabetes, atrial fibrillation, peripheral vascular disease, coronary artery disease, prior stroke, chronic renal insufficiency, and depression. The following characteristics were independently associated with a decreased risk of all-cause readmission: ambulation, treated dyslipidemia, tPA treatment, discharge mRS 0–2, and treatment at a comprehensive stroke center. Conclusions The risk of 30-day hospital readmission was substantial, modifiable, and impacted by insurance status, medical history, stroke etiology and severity, stroke care, and functional status at discharge. These findings can inform strategies to target high-risk patients who can benefit from interventions to improve transitions of care post-stroke
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Disparities in transitions of acute stroke care: The transitions of care stroke disparities study methodological report
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Abstract TP49: State of the Florida Stroke Coordinator: Hospital Inventory Survey Insights
Abstract only Background: Stroke coordinators (SC’s) are essential leaders of certified stroke centers which facilitate evidence-based stroke care, improving patient outcomes. Although this role has existed since the 1970’s, significant variability of responsibilities and staffing exists. Evidence based recommendations for SC staffing are scarce. Purpose: Utilizing the 2023 Florida Stroke Registry Hospital Inventory Survey (HIS), we describe current SC roles, responsibilities, and challenges in Florida. Methods: The Florida Stroke Registry (FSR), with state funding, tracks and measures Florida’s stroke center performance. FSR recently deployed the FSR HIS, a ten-part questionnaire examining various aspects of stroke program infrastructure. The survey was disseminated to 171 sites with 38 responses in the first wave. This is preliminary data from an HIS section focusing on SC staffing, workload, resources, and perceived challenges. Results: Responding sites all report a designated SC. Figure 1 describes SC’s Status (full vs. part-time), onboarding, and resources. Of note, only 35% of SC’s manage stroke full-time at a single site, SC turnover rate is high with 63% in the role <4 yrs. Stroke coordinators abstract for multiple databases, even with data abstractor support. In free-text responses, 58% (19/33) of SC’s cited lack of time and/or corporate structure for adequate program management as the biggest challenges in their role. Discussion: The preliminary study highlights significant challenges with high SC turnover, heavy workloads, and insufficient support. Stroke programs lack clear recommendations from certifying bodies for program personnel based on program volume. Future directions of FSR HIS include conducting additional dissemination waves, and an analysis of optimal stroke program staffing by cross-referencing certification level, patient volume and SC resources
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Abstract TMP32: Race and Ethnic Differences in Rehabilitation and Functional Recovery Post-Stroke Within the Florida Stroke Registry - Transitions of Care
Abstract only Introduction: Historically, non-Hispanic black (NHB) and Hispanic stroke survivors have been discharged at a poorer functional level than non-Hispanic whites (NHW). The purpose of this study was to examine race and ethnic differences in rehabilitation prescription and participation at time of discharge (DC) and in modified Rankin Scale (mRS) at 30- and 90-days post-stroke. Methods: The Transitions of Stroke Care Disparities Study is designed to reduce disparities and optimize post-stroke care in hospital-to-home transitions. Survivors of ischemic stroke and intracerebral hemorrhage from a subset of 165 hospitals in the Florida Stroke Registry were included in the Get with the Guidelines-Stroke® (GWTG-S) database. Race and ethnicity, therapy prescription and participation, and mRS were extracted from GWTG-S, and by self-report at 30- and 90-days after DC. Race and ethnic differences were assessed in therapy prescription, participation, and mRS using binary logistic regression adjusted for age, sex, stroke severity (NIHSS), and DC walking ability. Results: In 1,129 stroke survivors (mean age 64y, 45% women, 55% NHW, 23% NHB, 22% Hispanic, 76% independent walkers at DC), 29% were prescribed inpatient and 50% outpatient rehabilitation at DC. Multivariable analysis showed NHW were significantly less likely to be prescribed inpatient therapy compared to NHB [OR 0.56, 95%CI (0.35-0.88)] or Hispanics [OR 0.50, 95%CI (0.31-0.80)]. Hispanic individuals [OR 1.69, 95%CI (1.20-2.38)] were significantly less likely to be prescribed outpatient therapy compared to NHW or NHB. No differences in therapy participation were seen between NHW and NHB [OR 1.16, 95%CI (0.69-1.97)] or Hispanics [OR 1.41, 95%CI (0.82-2.43)]. No differences in mRS were seen between NHW and NHB [30-days, OR 0.85, 95% CI (0.52-1.39); 90-days, OR 0.68, 95%CI (0.42-1.11)] or Hispanics [30-days, OR 0.63, 95% CI (0.37-1.10); 90-days, OR 0.61, 95%CI (0.36-1.03)]. Conclusions: Although there were significant race and ethnic differences in therapy prescription setting, no race and ethnic differences were seen in therapy participation or in mRS at either 30- or 90-days. Further research is warranted to examine race and ethnic differences in stroke recurrence and readmission rates
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Abstract 96: Temporal Trends in Vascular Risk Factor Burden Among Young Adults With Ischemic Stroke: The Florida Stroke Registry
Abstract only Introduction: While ischemic stroke (IS) in the young (18-55) is thought to have different etiologies than in older patients, a rise in vascular risk factors (VRFs) among young adults may translate to an IS risk profile similar to the older population. We aimed to examine the prevalence of VRFs and temporal trends in VRF burden among young patients presenting with IS. Methods: Data was prospectively collected by Get With the Guidelines-Stroke® hospitals participating in the Florida Stroke Registry between January 2010 and December 2022. Patients aged 18-55 with a diagnosis of IS were included and separated into two age groups: 18-35 and 36-55. VRFs included hypertension, dyslipidemia, obesity, smoking, atrial fibrillation, coronary artery disease, heart failure, diabetes, and sleep apnea. Multimorbidity was defined as having ≥4 VRFs. Results: 47,792 patients with IS were included (43% female, median age 49, 51% white), comprising 4,275 patients aged 18-35 (8.9%) and 43,517 aged 36-55 (91.1%). The prevalence of each VRF was higher among patients aged 36-55 vs 18-35 (all p values <0.001), and only 15.3% of patients aged 36-55 and 40.0% of patients aged 18-35 had 0 VRFs. African American patients with IS had a significantly higher prevalence of multimorbidity than white or non-white Hispanic patients; specifically in those aged 18-35 (6.1% vs 3.5% vs 3.5%, p <0.001), while those aged 36-55 demonstrated a smaller difference (17.6% vs 17.2% vs 15.4% p <0.001).VRF burden worsened across the study period, with an increase in multimorbidity from 11.2% to 21.7% in patients 36-55 (p<0.0001) and from 1.3% to 6.6% in patients 18-35 (p= 0.0006). Conclusions: Increasingly, young stroke patients have traditional VRFs. The prevalence of multimorbidity disproportionately affects African American patients and has significantly increased over the past 12 years. Efforts targeting VRFs reduction must start as early as possible in light of the rise in VRF burden amongst young IS patients
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Abstract TMP64: Time-Trends and Determinants of Dual Antiplatelet Therapy Prescription After Acute Moderate-to-Severe Non-Cardioembolic Ischemic Stroke
Abstract only Introduction: Short-term dual antiplatelet therapy (DAPT) lowers the risk of early stroke recurrence after mild non-cardioembolic ischemic stroke (NCIS) and high-risk transient ischemic attack. However, DAPT benefit in moderate-to-severe NCIS is unknown. We sought to investigate time-trends and determinants of DAPT prescription after moderate-to-severe NCIS in the Florida Stroke Registry (FSR). Methods: Within 168 FSR-participating hospitals, between January 2010 and September 2022, we analyzed NCIS patients with NIHSS score >3, without other indication(s) for DAPT (e.g., carotid stenting) or systemic anticoagulation, hemorrhagic complications, and whom received at least one antiplatelet agent upon discharge. Using single antiplatelet therapy (SAPT) as comparison, we assessed DAPT determinants through logistic regression models adjusted for demographics, hospital characteristics, clinical presentation, vascular risk factors and stroke subtype. Results: Out of 283,264 ischemic stroke patients during the study period, 53,282 had moderate-to-severe NCIS (mean age 68 +/-14 years, 50% women, median presenting NIHSS score 7 [interquartile range 6]). DAPT was prescribed in 15,107 (28.4%) and SAPT in 38,175 (71.6%). DAPT prescription increased from 24.2% in 2010 to 44.8% in 2022 (Figure 1). Independent determinants of DAPT prescription are shown in Table 1. Conclusion: DAPT prescription after moderate-to-severe NCIS is common now, and has nearly doubled over the past decade. Major DAPT determinants were premorbid SAPT and large-artery atherosclerosis. Further research may determine DAPT efficacy and safety in this population
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Factors and Behaviors Related to Successful Transition of Care After Hospitalization for Ischemic Stroke
Our objective is to describe adoption of the posthospitalization behaviors associated with successful transition of care and related baseline characteristics.
This study includes 550 participants in the Transition of Care Stroke Disparities Study, a prospective observational cohort derived from the Florida Stroke Registry. Participants had an ischemic stroke (2018-2021), discharged home or to rehabilitation, with modified Rankin Scale score=0-3 (44% women, 24% Black, 48% White, 26% Hispanic, 35% foreign-born). We collected baseline sociodemographic and clinical characteristics. A structured telephone interview at 30-day postdischarge evaluated outcomes including medication adherence, medical appointment attendance, outpatient therapy, exercise, diet modification, toxic habit cessation, and a calculated composite adequate transition of care measure. Multivariable analyses assessed the association of baseline characteristics with 30-day behaviors.
At 30 days, medication adherence was achieved by 89%, medical appointments by 82%, outpatient therapy by 76%, exercise by 71%, diet modification by 68%, toxic habit cessation by 35%, and adequate transition of care measure by 67%. Successful adequate transition of care participants were more likely to be used full-time (42% versus 31%,
=0.02), live with a spouse (60% versus 47%,
=0.01), feel close to ≥3 individuals (84% versus 71%,
<0.01), have history of dyslipidemia (45 versus 34%,
=0.02), have thrombectomy (15% versus 8%,
=0.02), but less likely to have a history of smoking (17% versus 32%,
<0.001), coronary artery disease (14% versus 21%,
=0.04), and heart failure (3% versus 11%,
<0.01). Multivariable logistic regression analyses revealed that multiple socio-economic factors and prestroke comorbid diseases predicted fulfillment of transition of care measures. There was no difference in outcomes during the Covid-19 pandemic (2020-2021) compared with prepandemic years (2018-2019).
One in 3 patients did not attain adequate 30-day transition of care behaviors. Their achievement varied substantially among different measures and was influenced by multiple socioeconomic and clinical factors. Interventions aimed at facilitating transition of care from hospital after stroke are needed.
URL: https://clinicaltrials.gov/; Unique identifier: NCT03452813
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Abstract WMP84: The Impact of Pre-Morbid Antidepressant Exposure on the Risk of Intracerebral Hemorrhage: The Florida Stroke Registry
Abstract only Antidepressants (AD), particularly selective serotonin reuptake inhibitors (SSRIs), are amongst the most frequently prescribed medications. Concerns have been raised regarding their potential increased risk of bleeding complications including intracerebral hemorrhage (ICH) as they are known to affect platelet function. In the large Florida Stroke Registry (FSR), we sought to determine if pre-morbid use of AD impacted the risk of ICH Methods: Data collected from Jan 2010-Jun 2023 in FSR, GWTG statewide stroke registry comprised of 170 hospitals in the state of Florida was used to identify ischemic (IS) and hemorrhagic stroke cases with and without prior use of AD. Multivariate regression with generalized estimating equations, were used to determine whether premorbid-AD use was associated with an increased risk of ICH vs. ischemic stroke Results: A total of 219,558 stroke cases were identified (mean age 70.26±14.45; 52% male), among those 14% had pre-morbid AD use (age 72.13±13.23, 39% male). Patients on pre-morbid AD (vs no AD) were more likely White (75% vs. 62%) female (61% vs. 46%), with higher rates of vascular risk factors [(HTN (83%), DM (40%), HLD (61%), prior TIA (39%)]. The percentage of ICH was 11% and 14% amongst AD users and non-AD users respectively. In a multivariate model adjusting by multiple covariates, prior use of AD was not associated with an increased likelihood of presenting with ICH as opposed to IS (OR=0.72, 0.42-1.21). In the sensitivity analysis of subgroups of patients with data regarding the class of AD (SSRIs, Non-SSRIs) (n=657) or prior antiplatelet or anticoagulant therapies (n=740) premorbid SSRI use (vs no AD use) was not associated with increase ICH risk (OR=1.39, 95%CI 0.81-2.38 and OR=0.84, 0.64-1.10) Discussion In this large registry-based study we did not find an association between prior use of AD and increased risk of ICH as opposed to IS. Additionally, our findings were consistent among stroke patients with prior use of either antiplatelet or anticoagulants. These findings challenge the prevailing literature notion that AD, particularly SSRIs are linked to an increased risk of hemorrhages of all type. However, clinicians should consider individual patient's presentation, comorbidities and preferences when prescribing A