Interventions for depression and its potential outcomes are required.

Background and Purpose— Rates of stroke incidence and mortality vary across populations with important differences between socioeconomic groups worldwide. Knowledge of existing disparities in stroke risk is important for effective stroke prevention and management strategies. This review updates the evidence for associations between socioeconomic status and stroke. Summary of Review— Studies were identified with electronic searches of MEDLINE and EMBASE databases (January 2006 to July 2011) and reference lists from identified studies were searched manually. Articles reporting the association between any measure of socioeconomic status and stroke were included. Conclusions— The impact of stroke as measured by disability-adjusted life-years lost and mortality rates is >3-fold higher in low-income compared with high- and middle-income countries. The number of stroke deaths is projected to increase by >30% in the next 20 years with the majority occurring in low-income countries. Higher incidence of stroke, stroke risk factors, and rates of stroke mortality are generally observed in low compared with high socioeconomic groups within and between populations worldwide. There is less available evidence of an association between socioeconomic status and stroke recurrence or temporal trends in inequalities. Those with a lower socioeconomic status have more severe deficits and are less likely to receive evidence-based stroke services, although the results are inconsistent. Poorer people within a population and poorer countries globally are most affected in terms of incidence and poor outcomes of stroke. Innovative prevention strategies targeting people in low socioeconomic groups are required along with effective measures to promote access to effective stroke interventions worldwide.

Background and Purpose-The longer-term natural history of depression after stroke is poorly understood. We estimate frequency, predictors, and associations of depression up to 5 years after stroke in a population-based study. Methods-Data from 3689 patients registered in the South London Stroke Register 1995 to 2006 were used. Baseline data included age, sex, ethnicity, socioeconomic status, and stroke severity. At 3 months and at 1, 3, and 5 years, survivors were assessed for depression (Hospital Anxiety and Depression; depression subscale score Ͼ7 indicates depression), cognition, disability, activity, accommodation, employment, and social networks. Associations with depression were investigated with logistic regression. Data are reported with OR and 95% CI. Results-Depression frequencies were 33% (30%-36%), 28% (25%-30%), 32% (30%-35%), and 31% (27%-34%) at 3 months and at 1, 3, and 5 years after stroke, respectively. Forty-eight percent of patients were not depressed at any time point; 49% to 55% of depressed patients at 1 assessment remained depressed at follow-up; and 15% to 20% of patients at each assessment were new cases. Predictors of depression included stroke severity, inability to work, and impaired cognition. Associations with depression at follow-up included impaired cognition, lack of family support, institutionalization, inability to work, functional dependence, and low activity level. Conclusions-Frequency of depression up to 5 years after stroke is 30%; however, it is a dynamic situation with recovery and new cases diagnosed over time. These findings support the need for regular assessment of depression and its associated factors and for the development of effective interventions to reduce depression after stroke.

This study investigates the association between the treatment with heparin and mortality in patients admitted with Covid-19. Routinely recorded, clinical data, up to the 24th of April 2020, from the 2075 patients with Covid-19, admitted in 17 hospitals in Spain between the 1st of March and the 20th of April 2020 were used. The following variables were extracted for this study: age, gender, temperature, and saturation of oxygen on admission, treatment with heparin, hydroxychloroquine, azithromycin, steroids, tocilizumab, a combination of lopinavir with ritonavir, and oseltamivir, together with data on mortality. Multivariable logistic regression models were used to investigate the associations. At the time of collecting the data, 301 patients had died, 1447 had been discharged home from the hospitals, 201 were still admitted, and 126 had been transferred to hospitals not included in the study. Median follow up time was 8 (IQR 5–12) days. Heparin had been used in 1734 patients. Heparin was associated with lower mortality when the model was adjusted for age and gender, with OR (95% CI) 0.55 (0.37–0.82) p = 0.003. This association remained significant when saturation of oxygen < 90%, and temperature > 37 °C were added to de model with OR 0.54 (0.36–0.82) p = 0.003, and also when all the other drugs were included as covariates OR 0.42 (0.26–0.66) p < 0.001. The association between heparin and lower mortality observed in this study can be acknowledged by clinicians in hospitals and in the community. Randomized controlled trials to assess the causal effects of heparin in different therapeutic regimes are required.

Depression is independently associated with poor health outcomes.

A lthough depression is a recognized outcome of stroke, 1 most studies investigating depression after stroke have limitations, including selection bias, short follow-up, and small sample size. 2,3 The prevalence of depression in the first few years after stroke has been reported in several studies. 2 Nonetheless, evidence is poor or lacking on other estimates of the long-term natural history of depression, such as the poststroke incidence, cumulative incidence, time of onset, duration, and recurrence rate.2 Interventions for depression after stroke only show limited effect. Whether these interventions had been started at the right time after stroke and given for an adequate length of time to obtain maximal sustained response has been questioned. 4 In this article, the poststroke incidence, cumulative incidence, prevalence, time of onset, duration, and recurrence rate of depression up to 15 years after stroke are estimated in a population-based study. MethodsFirst in a lifetime stroke patients were recruited from the South London Stroke Register (SLSR), a prospective population-based stroke register covering an inner-city population of 271 817. 5 Data from patients, registered in the SLSR between January 1, 1995, and December 31, 2009, and followed up between April 1, 1995 (first 3 months of follow-up assessments), and August 31, 2010, were used (patients at registration, N=4022).Patients were registered during the acute phase of stroke and were then followed up for 3 months after stroke, 1 year after stroke, and annually thereafter. The World Health Organization definition of stroke was used.6 Follow-up was by postal questionnaire or interview, depending on the capacity of patient to fill in the questionnaire. Such capacity was judged by the patient, the next of kin, or the field worker in a preceding follow-up assessment. Patients unable to complete the follow-up questionnaire, and those not returning them by post, were telephoned to arrange face-to-face interviews or have another follow-up questionnaire posted. Patients who could not be followed up at one time point remained registered and were contacted again for the following annual assessment. At follow-up, patients were Background and Purpose-Evidence on the natural history of depression after stroke is still insufficient to inform prognosis and treatment strategies. This study estimates the incidence, cumulative incidence, prevalence, time of onset, duration, and recurrence rate of depression up to 15 years after stroke. Methods-Data from patients registered in the South London Stroke Register between 1995 and 2009 were used (N=4022 at registration. Maximum number of participants for these analyses n=1233). Depression was assessed in all patients with the Hospital Anxiety and Depression Scale (scores >7=depression) 3 months after stroke, 1 year after stroke, and annually thereafter up to 15 years after stroke. Inverse probability weighting was used to calculate the estimates accounting for missing data. Results-The poststroke incidence of depression range...

anxiety is a frequent problem affecting stroke survivors in the long term. Clinicians should pay attention to patients at risk of anxiety since it is associated with lower QoL and depression.

Objective: To identify explanatory factors for the association between depression and increased mortality up to 5 years after stroke. Methods:In this cohort study, data from the South London Stroke Register (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) were used. Patients (n 5 3,722) were assessed at stroke onset. Baseline data included sociodemographics and stroke severity. Follow-up at 3 months included assessment for depression with the Hospital Anxiety and Depression Scale (scores $7 5 depression). Associations between depression at 3 months and mortality within 5 years of stroke were estimated with Cox regression models adjusted for age, sex, ethnicity, and stroke severity, and subsequently adjusted for possible explanatory factors for the association. These factors, introduced into the model individually, included comorbidities at baseline, smoking and alcohol use, compliance with medication, treatment with selective serotonin reuptake inhibitors (SSRIs), social support, and activities of daily living at 3 months.Results: A total of 1,354 survivors were assessed at 3 months: 435 (32.1%) had depression and 331 (24.4%) died within 5 years. Survivors with depression had a greater risk of mortality (hazard ratio [HR] 1.41 [95% confidence interval (CI) 1.13-1.77]; p 5 0.002). The association between depression and mortality was strongest in patients younger than 65 years. Adjustment for comorbidities, smoking and alcohol use, SSRI use, social support, and compliance with medication did not change these associations. SSRIs started after stroke were associated with higher mortality, independently of depression at 3 months (HR 1.72 [95% CI 1.34-2.20]; p , 0.001).Conclusion: Depression after stroke is associated with higher mortality, particularly among younger patients. Stroke survivors taking SSRIs have an increased mortality. The association between depression and mortality is not explained by other individual medical factors. Neurology ® 2014;83:2007-2012 GLOSSARY CI 5 confidence interval; GCS 5 Glasgow Coma Scale score; HADS 5 Hospital Anxiety and Depression Scale; HR 5 hazard ratio; SLSR 5 South London Stroke Register; SSRI 5 selective serotonin reuptake inhibitor.Depression has a prevalence of around 30% in the long term after stroke, with most patients developing their first symptoms shortly after the acute event.1,2 Depression after stroke is more prevalent among those with severe strokes, disability, and cognitive impairment, and has been found to be independently associated with higher mortality.3,4 A number of medical and social factors have been proposed to underlie the relationship between depression and mortality. They include younger age, lifestyle factors such as smoking and heavy alcohol use, lack of compliance with medication, comorbidities such as diabetes and heart failure, use of antidepressants, and social isolation.5-12 These explanatory factors have been reported in studies not specifically investigating stroke survivors 5,6,[8][9][...