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- Asplund, Kjell, et al.
(author)
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End of life after stroke : a nationwide study of 42,502 deaths occurring within a year after stroke
- 2018
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In: European Stroke Journal. - : Sage Publications. - 2396-9873 .- 2396-9881. ; 3:1, s. 74-81
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Journal article (peer-reviewed)abstract
- Introduction: In the scientific literature, there is very limited empirical information on end-of-life issues after stroke in the scientific literature. The present nationwide study describes the circumstances surrounding deaths that occur within a year after a stroke. Patients and methods: Datasets from three nationwide Swedish registers (on stroke, palliative care and cause of death) were linked. Basic information was available for 42,502 unselected cases of death that occurred within a year after a stroke and more detailed information was available for 16,408 deaths. Odds ratios for characteristics of end-of-life care were calculated by logistic regression. Results: In the late phase after stroke (three months to one year), 46% of patients died in a nursing home, whereas 37% of patients died in a hospital after readmission and 10% of patients died at home. Eleven per cent of deaths were reported as being unexpected. A next of kin was present at 49% of deaths. The frequency of unattended deaths (neither next of kin nor staff were present at the time of death) ranged from 5% at home with specialised home care to 25% in hospitals. Discussion: This is, by far, the largest study published on end-of-life issues after stroke. Major differences between countries in healthcare, community services, family structure and culture may limit direct transfer of the present results to other settings. Conclusion: There is considerable discordance between presumed good death' late after stroke (dying at home surrounded by family members) and the actual circumstances at the end of life.
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- Cameron, AC, et al.
(author)
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Professional guideline versus product label selection for treatment with IV thrombolysis: An analysis from SITS registry
- 2018
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In: European stroke journal. - : SAGE Publications. - 2396-9881 .- 2396-9873. ; 3:1, s. 39-46
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Journal article (peer-reviewed)abstract
- Thrombolysis usage in ischaemic stroke varies across sites. Divergent advice from professional guidelines and product labels may contribute. Patients and methods We analysed SITS-International registry patients enrolled January 2010 through June 2016. We grouped sites into organisational tertiles by number of patients arriving ≤2.5 h and treated ≤3 h, percentage arriving ≤2.5 h and treated ≤3 h, and numbers treated ≤3 h. We assigned scores of 1–3 (lower/middle/upper) per variable and 2 for onsite thrombectomy. We classified sites as lower efficiency (summed scores 3–5), medium efficiency (6–8) or higher efficiency (9–11). Sites were also grouped by adherence with European product label and ESO guideline: ‘label adherent’ (>95% on-label), ‘guideline adherent’ (≥5% off-label, ≥95% on-guideline) or ‘guideline non-adherent’ (>5% off-guideline). We cross-tabulated site-efficiency and adherence. We estimated the potential benefit of universally selecting by ESO guidance, using onset-to-treatment time-specific numbers needed to treat for day 90 mRS 0–1. Results A total of 56,689 patients at 597 sites were included: 163 sites were higher efficiency, 204 medium efficiency and 230 lower efficiency. Fifty-six sites were ‘label adherent’, 204 ‘guideline adherent’ and 337 ‘guideline non-adherent’. There were strong associations between site-efficiency and adherence (P < 0.001). Almost all ‘label adherent’ sites (55, 98%) were lower efficiency. If all patients were treated by ESO guidelines, an additional 17,031 would receive alteplase, which translates into 1922 more patients with favourable three-month outcomes. Discussion Adherence with product labels is highest in lower efficiency sites. Closer alignment with professional guidelines would increase patients treated and favourable outcomes. Conclusion Product labels should be revised to allow treatment of patients ≤4.5 h from onset and aged ≥80 years.
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| 4. |
- Danielsson, Anna, 1957, et al.
(author)
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PREVALENCE OF ANXIETY WITHIN THE FIRST YEAR AFTER STROKE: A SYSTEMATIC REVIEW AND METAANALYSIS
- 2018
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In: European stroke journal. Vol. 3 Issue 1_suppl.. - : SAGE Publications. - 2396-9873 .- 2396-9881.
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Conference paper (peer-reviewed)abstract
- Background and Aims: Anxiety is associated with decreased quality of life and depression, but gets less attention than other psychological consequences after stroke. The aim was to estimate prevalence of anxiety in the first year after stroke. Method: Searches in EMBASE, MEDLINE, PsycINFO, Cochrane Library, Amed and CINAHL were conducted in May 2015 and April 2017. Included were studies of populations with a hemorrhagic or ischemic stroke or transient ischemic attack, anxiety categorized on a rating scale during the first year after stroke. Two reviewers independently screened and included studies and assessed quality using a checklist. Studies using the Hospital Anxiety and Depression Scale – Anxiety (n 31) were included in a meta- analysis using the random effects model. Heterogeneity was assessed using the Q-test and I2 was used to estimate heterogeneity. Results: Of 4453 titles screened, 37 studies were included comprising 13756 participants with mean ages from 52 to 79 years, assessed within 2 weeks to 1 year after stroke. Most studies were of medium quality. The pooled prevalence of anxiety within the first year was 29.3% [(95% CI 24.8 – 33.8), (I2¼97%, p<0.00001)] which is higher than previously shown. Frequency 0-2 weeks post stroke was 34.8% (95% CI 24.9 – 44.6%), 2 weeks -3 months 23.2 (95% CI 16.3–30.1%) and 3 -12 months 35.6% (95% CI 17.7–54.3. Conclusion: One third of the stroke population may have an anxiety disorder and the prevalence seems to increase, why routine screening may be worth considering in order to provide appropriate interventions.
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- E., Svensson, et al.
(author)
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Risk factors for spontaneous intracerebral hemorrhage
- 2018
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In: European Stroke Journal. - : SAGE Publications. - 2396-9881 .- 2396-9873. ; 3:1 Suppl, s. 60-61
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Conference paper (other academic/artistic)abstract
- Background and Aims: Results from prior studies of risk factors for intracerebral hemorrhage (ICH) are inconsistent. Few studies have investigated risk factors measured before the event and separately for different locations of ICH. We investigated risk factors for incident ICH in the population-based Malmö Diet and Cancer cohort. Method: Baseline information, assessed by a questionnaire and in a physical examination, was gathered from 28,416 subjects without a history of ICH. ICH cases (n=333) were identified using local and national patient registers during follow-up (mean follow-up time 18.4 years), validated by review of hospital records, and classified as lobar or non-lobar. Potential risk factors were studied using Cox regression. Results: The following factors were significantly (p
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| 7. |
- Mazya, MV, et al.
(author)
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Minor stroke due to large artery occlusion. When is intravenous thrombolysis not enough? Results from the SITS International Stroke Thrombolysis Register
- 2018
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In: European stroke journal. - : SAGE Publications. - 2396-9881 .- 2396-9873. ; 3:1, s. 29-38
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Journal article (peer-reviewed)abstract
- Beyond intravenous thrombolysis, evidence is lacking on acute treatment of minor stroke caused by large artery occlusion. To identify candidates for additional endovascular therapy, we aimed to determine the frequency of non-haemorrhagic early neurological deterioration in patients with intravenous thrombolysis-treated minor stroke caused by occlusion of large proximal and distal cerebral arteries. Secondary aims were to establish risk factors for non-haemorrhagic early neurological deterioration and report three-month outcomes in patients with and without non-haemorrhagic early neurological deterioration. Method We analysed data from the SITS International Stroke Thrombolysis Register on 2553 patients with intravenous thrombolysis-treated minor stroke (NIH Stroke Scale scores 0–5) and available arterial occlusion data. Non-haemorrhagic early neurological deterioration was defined as an increase in NIH Stroke Scale score ≥4 at 24 h, without parenchymal hematoma on follow-up imaging within 22–36 h. Findings The highest frequency of non-haemorrhagic early neurological deterioration was seen in 30% of patients with terminal internal carotid artery or tandem occlusions (internal carotid artery + middle cerebral artery) (adjusted odds ratio: 10.3 (95% CI 4.3–24.9), p < 0.001) and 17% in extracranial carotid occlusions (adjusted odds ratio 4.3 (2.5–7.7), p < 0.001) versus 3.1% in those with no occlusion. Proximal middle cerebral artery-M1 occlusions had non-haemorrhagic early neurological deterioration in 9% (adjusted odds ratio 2.1 (0.97–4.4), p = 0.06). Among patients with any occlusion and non-haemorrhagic early neurological deterioration, 77% were dead or dependent at three months. Conclusions Patients with minor stroke caused by internal carotid artery occlusion, with or without tandem middle cerebral artery involvement, are at high risk of disabling deterioration, despite intravenous thrombolysis treatment. Acute vessel imaging contributes usefully even in minor stroke to identify and consider endovascular treatment, or intensive monitoring at a comprehensive stroke centre, for patients at high risk of neurological deterioration.
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| 8. |
- Norrving, Bo, et al.
(author)
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Action Plan for Stroke in Europe 2018–2030
- 2018
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In: European Stroke Journal. - : SAGE Publications. - 2396-9873 .- 2396-9881. ; 3:4, s. 309-336
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Journal article (peer-reviewed)abstract
- Two previous pan-European consensus meetings, the 1995 and 2006 Helsingborg meetings, were convened to review the scientific evidence and the state of current services to identify priorities for research and development and to set targets for the development of stroke care for the decade to follow. Adhering to the same format, the European Stroke Organisation (ESO) prepared a European Stroke Action Plan (ESAP) for the years 2018 to 2030, in cooperation with the Stroke Alliance for Europe (SAFE). The ESAP included seven domains: primary prevention, organisation of stroke services, management of acute stroke, secondary prevention, rehabilitation, evaluation of stroke outcome and quality assessment and life after stroke. Research priorities for translational stroke research were also identified. Documents were prepared by a working group and were open to public comments. The final document was prepared after a workshop in Munich on 21–23 March 2018. Four overarching targets for 2030 were identified: (1) to reduce the absolute number of strokes in Europe by 10%, (2) to treat 90% or more of all patients with stroke in Europe in a dedicated stroke unit as the first level of care, (3) to have national plans for stroke encompassing the entire chain of care, (4) to fully implement national strategies for multisector public health interventions. Overall, 30 targets and 72 research priorities were identified for the seven domains. The ESAP provides a basic road map and sets targets for the implementation of evidence-based preventive actions and stroke services to 2030.
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| 9. |
- Rejnö, Åsa, 1970-, et al.
(author)
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Creating dignified encounters in unexpected sudden death by stroke : communication as the key
- 2018
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In: European Stroke Journal. - : SAGE Publications. - 2396-9873 .- 2396-9881. ; 3:1_suppl., s. -292
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Journal article (other academic/artistic)abstract
- Background and Aims: Communication is present in all encounters in stroke care and of importance to create a caring relation. A good relation between patients, next of kin and health care staff is crucial, not least in unexpected sudden death by stroke. The aim of the study was to illuminate communication and its meaning in unexpected sudden death by stroke, as experienced by next of kin and stroke team members. Method: The design is a secondary analysis of qualitative data from a project on unexpected sudden death by stroke. Material from four interview studies from the project with all in all twelve next of kin of patients who had died due to the acute stroke during hospital stay and twentyseven stroke team members from stroke units were utilized. Data were analysed with qualitative content analysis. Results: The analysis reveals communication as the foundation for care and caring in acute stroke care. The overarching theme foundation for dignified encounters in care is built up by six themes illuminating the meaning of communication in unexpected sudden death by stroke. Conclusion: Communication and its meaning in unexpected sudden death by stroke as experienced by next of kin and stroke team members is one key to create dignified encounters in care when unexpected sudden death by stroke occurs. It gives ground for unanimity about care and possibility to maintain and uphold dignity in care when acknowledging the next of kin familiarity with the patient, giving ground for a person centeredness despite the patients sever illness.
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| 10. |
- Rudberg, Ann-Sofie, et al.
(author)
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Long-term health-related quality of life, survival and costs by different levels of functional outcome six months after stroke
- 2018
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In: European Stroke Journal. - : SAGE PUBLICATIONS LTD. - 2396-9873 .- 2396-9881. ; 3:2, s. 157-164
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Journal article (peer-reviewed)abstract
- Introduction: Information about the impact of functional outcome after stroke is currently missing on health-related quality of life, survival and costs. This information would be valuable for health economic evaluations and for allocation of resources in stroke health care. Patients and methods: Data on 297 Swedish patients included in the Third International Stroke Trial were analysed including functional outcome at six months (measured by Oxford Handicap Scale), health-related quality of life up to 18 months (EQ-5D-3L) and survival up to 36 months. We used record linkage to collect data on costs up to 36 months, using national patient registers. Results: Patients with a better functional outcome level at six months had a significantly better health-related quality of life at 18 months (p<0.05), better long-term survival (p<0.05) and lower costs (p<0.001), for all time points up to 36 months. The difference in costs was mainly due to differences in days spent in hospital (p<0.005). Discussion: This study showed an association between functional outcome at six months and health-related quality of life up to 18 months, and costs up to 36 months. Conclusion: Functional outcome six months after stroke is an important determinant of health-related quality of life, survival and costs over 36 months. Effective interventions aimed at reducing short-term disability levels are therefore also expected to reduce the overall burden of stroke.
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| 11. |
- Wouters, Anke, et al.
(author)
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Multimodal magnetic resonance imaging to identify stroke onset within 6 h in patients with large vessel occlusions
- 2018
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In: European Stroke Journal. - : SAGE Publications. - 2396-9873 .- 2396-9881. ; 3:2, s. 185-192
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Journal article (peer-reviewed)abstract
- Introduction: Mechanical thrombectomy within 6 h after stroke onset improves the outcome in patients with large vessel occlusions. The aim of our study was to establish a model based on diffusion weighted and perfusion weighted imaging to provide an accurate prediction for the 6 h time-window in patients with unknown time of stroke onset. Patients and methods: A predictive model was designed based on data from the DEFUSE 2 study and validated in a subgroup of patients with large vessel occlusions from the AXIS 2 trial. Results: We constructed the model in 91 patients from DEFUSE 2. The following parameters were independently associated with <6 h time-window and included in the model: interquartile range and median relative diffusion weighted imaging, hypoperfusion intensity ratio, core volume and the interaction between median relative diffusion weighted imaging and hypoperfusion intensity ratio as predictors of the 6 h time-window. The area under the curve was 0.80 with a positive predictive value of 0.90 (95%CI 0.79–0.96). In the validation cohort (N = 90), the area under the curve was 0.73 (P for difference = 0.4) with a positive predictive value of 0.85 (95%CI 0.69–0.95). Discussion: After validation in a larger independent dataset the model can be considered to select patients for endovascular treatment in whom stroke onset is unknown. Conclusion: In patients with large vessel occlusion and unknown time of stroke onset an automated multivariate imaging model is able to select patients who are likely within the 6 h time-window.
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