Early and Delayed Fatality of Stroke in Kolkata, India: Results From a 7-Year Longitudinal Population-Based Study

Ray, Biman Kanti; Hazra, Avijit; Ghosal, Malay Kumar; Banerjee, Tapas Kumar; Chaudhuri, Arijit; Singh, Vineeta; Das, Shyamal Kumar

doi:10.1016/j.jstrokecerebrovasdis.2011.09.002

Cited by 42 publications

(60 citation statements)

References 29 publications

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“…In a study of 47,593 women from India, men were more likely than women to die at 30 days even though they were younger in age at the time of stroke onset (p < 0.003; OR, 1.6; 95% CI, 1.17-2.10). The mean survival time after index stroke was 10.2 months for men and 4.7 months for women survival experience in men became less favorable overtime (P 5.762; log-rank test) [24]. This is in contrast to some other studies from the same region that have reported a 30-day case fatality rate of 41.08% (men, 38.18%; women, 43.24%), with women at greater risk of dying at 30 days.…”

Section: Resultsmentioning

confidence: 99%

Implications of Female Sex on Stroke Risk Factors, Care, Outcome and Rehabilitation: An Asian Perspective

2015

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Background: Stroke affects 16.9 million people annually and the greatest burden of stroke is in low- and middle-income countries, where 69% of all strokes occur. Stroke risk factors, mortality and outcomes differ in developing countries as compared to the developed world. We performed a literature review of 28 articles pertaining to epidemiology of stroke in Asian women, stroke risk factors, gender-related differences, and stroke outcomes. Summary: Asian women differ from women worldwide due to differences in stroke awareness, risk factor profile, stroke subtypes, and social issues that impact stroke care. While Asian men have a higher incidence of stroke as compared to women overall, the long- and short-term outcomes in Asian women tend to be poorer. Both conventional and gender-specific risk factors contribute to stroke risk. Oral contraceptive use and addictions such as tobacco and alcohol are less prevalent among Asian women due to socio cultural differences. There is however, a much higher preponderance of pregnancy-related stroke and cardio-embolic stroke secondary to rheumatic heart disease and heavy use of chewing tobacco. The overall outcome is poor due to poor access to health care and lack of resources. Key Messages: Our review exposed the gaps in our knowledge about stroke risk factors and differences in stroke care provided to Asian women. While there are sociocultural barriers that impede the provision of immediate care to these stroke patients, much needs to be done by way of prevention of recurrent stroke and treatment of risk factors.

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Section: Resultsmentioning

confidence: 99%

Implications of Female Sex on Stroke Risk Factors, Care, Outcome and Rehabilitation: An Asian Perspective

2015

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“…The mortality rate of stroke has reduced to half in high-income countries but only 15% in low-and middle-income countries (LMICs) [1]. In LMICs, stroke patients are younger than those in high-income countries [2,3,4], use tobacco more often [5,6,7], have a greater prevalence of diabetes mellitus, hypertension, cardiovascular diseases, dyslipidemia and obesity [4,8], have lower prevalence of atrial fibrillation [9,10], and have a greater case fatality rate [11]. It is uncertain whether current healthcare systems in most LMICs are well equipped to deal with this enormous burden of stroke.…”

Section: Introductionmentioning

confidence: 99%

Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review

et al. 2017

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Background: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services. Aims and Objectives: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care. Methods: A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included. Results: We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible. Conclusion: In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority.

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“…In fact, most frequencies of comorbidities prior to the index event exceeded the rates previously described in previous stroke cohorts [11,12,14,26,27]. A quarter of our patients were classified as having a very severe burden of comorbidities (CCI), which resulted in the maximum mortality risk along the follow-up.…”

Section: Discussionmentioning

confidence: 58%

Multimorbidities Are Associated to Lower Survival in Ischaemic Stroke: Results from a Brazilian Stroke Cohort (EMMA Study)

Castro¹,

Alencar²,

Benseñor³

et al. 2017

Cerebrovasc Dis

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Background: Stroke prognosis is related to the multimorbidity profile. Moreover, performing an individual evaluation of most common cerebrovascular risk factors (CVRF) not always identifies patients with poor prognosis. Thus, we decided to evaluate multimorbidity profile, focusing on the Charlson Comorbidity Index (CCI) validated by Goldstein for ischaemic stroke (IS) patients, a score that measures a burden of comorbidities and its related mortality in the long-term survival of the EMMA Study (Study of Stroke Mortality and Morbidity). Methods: Nine hundred fifty-nine individuals (median age 70 years) had validated data on the diagnosis of IS, main CVRF and clinical comorbidities pre index event such as atrial fibrillation (AF), stroke recurrence, diabetes, hypertension, heart failure and cancer. CCI modified by Goldstein was calculated, which includes 17 clinical conditions with scores ranging from 1 to 6 (0-31 points). Survival analyses were performed by Kaplan-Meier curves and Cox logistic regression models (cumulative hazard ratio [HR] with [95% CI]) for all-cause mortality at 180 days, and every 3 years up to 9-year follow-up. Mortality analyzes were performed by CCI categorized according to weight added to comorbidities (Reference group: zero, moderate: 1, severe: 2 and very severe: ≥3 points). We also tested the modification effect of AF and stroke recurrence including these conditions in the CCI. Results: The overall survival rate was 47% (508 deaths/959). The worst survival (577, 95% CI 381-773 days) and the highest risk of death after stroke were observed in the very severe CCI group (HR 3.18; 95% CI 2.16-4.69) up to 9 years. The inclusion of previous AF and stroke in the CCI slightly increased the risk of death for very severe CCI (HR 3.27; 95% CI 2.07-5.18). Conclusions: A high burden of comorbidities represented an independent predictor of poor prognosis increasing the risk of dying by 2 to 3 times among IS up to 9 years in the EMMA study. The inclusion of other CVRF such as AF and stroke recurrence slightly modified all-cause mortality risk.

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Early and Delayed Fatality of Stroke in Kolkata, India: Results From a 7-Year Longitudinal Population-Based Study

Cited by 42 publications

References 29 publications

Implications of Female Sex on Stroke Risk Factors, Care, Outcome and Rehabilitation: An Asian Perspective

Implications of Female Sex on Stroke Risk Factors, Care, Outcome and Rehabilitation: An Asian Perspective

Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review

Multimorbidities Are Associated to Lower Survival in Ischaemic Stroke: Results from a Brazilian Stroke Cohort (EMMA Study)

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