Cumulative risk of stroke recurrence over the last 10 years: a systematic review and meta-analysis

Lin, Beilei; Zhang, Zhenxiang; Mei, Yongxia; Wang, Chongjian; Xu, Hui; Liu, Lamei; Wang, Wenna

doi:10.1007/s10072-020-04797-5

Cited by 65 publications

(51 citation statements)

References 57 publications

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“…In a recent systematic review, the pooled recurrence rate of 32 studies in stroke survivors (>50 years) was 18.1% at 5 years after first stroke. 41 The incidence rate of stroke recurrence in our data is consistent with external data. Furthermore, SHARE data have been treated as a valid data source to estimate the economic burden of stroke across European countries.…”

Section: Discussionsupporting

confidence: 91%

Memory Trajectories Before and After First and Recurrent Strokes

Richards

Werring

et al. 2022

Neurology

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Background and objectivesThe evidence on timing of memory change after first and recurrent strokes is limited and inconsistent. We investigated memory trajectories before and after first and recurrent strokes in eighteen European countries, and tested whether the country-level acute stroke care was associated with memory change after stroke.MethodsData were from the Survey of Health, Ageing and Retirement in Europe (2004–2019). Incident first and recurrent strokes were identified among baseline stroke-free individuals. Within each country, each participant with incident stroke (case group) was matched with a stroke-free individual (control group) using the Propensity Score Matching. We applied multilevel segmented linear regression to quantify acute and accelerated memory changes (measured by the sum score of immediate and delayed word recall tests; 0–20 words) before and after first and recurrent strokes in both groups. Associations between stroke and memory were compared between countries with different levels of acute stroke care indicators.ResultsThe final analytical sample included 35,164 participants who were stroke-free at baseline (≥50 years). 2,362 incident first and 341 recurrent strokes between 2004 and 2019 were identified. In case group, mean acute decreases in memory scores were 0.48 (95% confidence interval: 0.31, 0.65) and 1.14 (95% confidence interval: 0.80, 1.48) words after first and recurrent stroke, respectively, independent of a range of confounders. No such acute decreases were observed in control group after a hypothetical non-stroke onset date. In both groups, memory declined over time but decline rates were similar (-0.07 [95% confidence interval: -0.10, -0.05] versus -0.06 [95% confidence interval: -0.08, -0.05] words per year). The mean acute decreases in memory scores after first and recurrent strokes were smaller in countries with better access to endovascular treatment.DiscussionWe found acute decreases but not accelerated declines in memory after first and recurrent strokes. Improved endovascular therapy might be associated with smaller memory loss after stroke but more evidence based on individual-level data is needed. More effort should be made in early assessment and intensive prevention of stroke among the ageing population, and promoting access to and delivery of acute stroke care among patients with stroke.

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Section: Discussionsupporting

confidence: 91%

Memory Trajectories Before and After First and Recurrent Strokes

Richards

Werring

et al. 2022

Neurology

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Section: Introductionmentioning

confidence: 99%

“…Patients with acute ischemic stroke or transient ischemic attack (TIA) suffer from approximately 10% to 17% risk of recurrent stroke during the first year after symptom onset. 1,2 Inten-sive quality improvement in adherence to performance measures was showed to improve the prognosis of stroke. 3 In recent years, there has been substantial decrease in the risk of stroke recurrence, 4,5 mainly due to improvement of ischemic stroke and TIA management, especially increased adherence to guide-line-based secondary prevention medications (e.g., antithrombotic, antihypertensive, antidiabetic, lipid-lowing and anticoagulant treatment).…”

Section: Introductionmentioning

confidence: 99%

Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

Pan

et al. 2021

J Stroke

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Background and Purpose Despite administration of evidence-based therapies, residual risk of stroke recurrence persists. This study aimed to evaluate the residual risk of recurrent stroke in acute ischemic stroke or transient ischemic attack (TIA) with adherence to guideline-based secondary stroke prevention and identify the risk factors of the residual risk.Methods Patients with acute ischemic stroke or TIA within 7 hours were enrolled from 169 hospitals in Third China National Stroke Registry (CNSR-III) in China. Adherence to guideline-based secondary stroke prevention was defined as persistently receiving all of the five secondary prevention medications (antithrombotic, antidiabetic and antihypertensive agents, statin and anticoagulants) during hospitalization, at discharge, at 3, 6, and 12 months if eligible. The primary outcome was a new stroke at 12 months.Results Among 9,022 included patients (median age 63.0 years and 31.7% female), 3,146 (34.9%) were identified as adherence to guideline-based secondary prevention. Of all, 864 (9.6%) patients had recurrent stroke at 12 months, and the residual risk in patients with adherence to guidelinebased secondary prevention was 8.3%. Compared with those without adherence, patients with adherence to guideline-based secondary prevention had lower rate of recurrent stroke (hazard ratio, 0.85; 95% confidence interval, 0.74 to 0.99; P=0.04) at 12 months. Female, history of stroke, interleukin-6 ≥5.63 ng/L, and relevant intracranial artery stenosis were independent risk factors of the residual risk.Conclusions There was still a substantial residual risk of 12-month recurrent stroke even in patients with persistent adherence to guideline-based secondary stroke prevention. Future research should focus on efforts to reduce the residual risk.

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“… 2 According to a recent systematic review (SR), the cumulative recurrence rate reached 7.7% and 9.5% 3 months and 6 months after stroke, respectively, with 13.2% and 34.8% of all stroke inpatients getting hospitalised due to the recurrence of stroke. 3 The poor functional, cognitive and psychological outcomes manifested after stroke, such as haemiplegia, aphasia and depression, have negative effects on a large proportion of long-term stroke survivors. 4 In some studies, it has been demonstrated that the good self-care after stroke can contribute to the recovery of various physiological functions for patients, thus improving the quality of their life.…”

Section: Introductionmentioning

confidence: 99%

Self-care interventions in stroke survivor–caregiver dyads: a protocol for systematic review and meta-analysis

et al. 2021

Self Cite

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IntroductionStroke is known as one of the leading causes of mortality and disability worldwide. Self-care plays a significant role in improving the quality of life, self-efficacy and many other outcomes of stroke survivors. However, it is a dyadic phenomenon where patient self-care and the caregiver contribution to self-care are inter-related in terms of predictors and outcomes. Currently, there is still no systematic assessment conducted to examine the overall effectiveness of self-care interventions carried out in stroke survivor–caregiver dyads and explore the effect on stroke survivor and/or caregiver outcomes.MethodsWe plan to conduct a systematic review and meta-analysis of the evidence regarding the self-care interventions carried out in stroke survivor–caregiver dyads. We will undertake a systematic search of multiple databases including PubMed, Web of Science, CINAHL, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials and four Chinese databases (CNKI, CBM, WANFANG and VIP) from inception to July 2021 for the purpose of collecting the relevant articles. The eligible studies are defined as those original researches, written in English or Chinese, on self-care interventions in stroke survivor–caregiver dyad samples. Two independent researchers will be deployed to identify the eligible trials according to the selection criteria and extract the relevant data. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist has been used for this protocol. We will use the Cochrane Risk for Bias tool to assess the risk of bias for randomised controlled trials.Ethics and disseminationIn our review, any identifiable patient data will be excluded, which removes the need for ethical approval and participant consent. The final results of our study will be published in an open-access peer-reviewed journal, and abstract will be presented at suitable national/international conferences.PROSPERO registration numberCRD42021239824.

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Cumulative risk of stroke recurrence over the last 10 years: a systematic review and meta-analysis

Cited by 65 publications

References 57 publications

Memory Trajectories Before and After First and Recurrent Strokes

Memory Trajectories Before and After First and Recurrent Strokes

Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

Self-care interventions in stroke survivor–caregiver dyads: a protocol for systematic review and meta-analysis

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