Independent predictors of ischemic stroke in the elderly

Forti, Paola; Maioli, Fabiola; Procaccianti, Gaetano; Nativio, Valeria; Lega, Maria Vittoria; Coveri, Maura; Zoli, Marco; Sacquegna, T.

doi:10.1212/wnl.0b013e31827b1a41

Cited by 77 publications

(39 citation statements)

References 40 publications

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“…This scenario justifies the concern not only with the logistical support to the elderly, but also with the economic management and the actual effectiveness of intensive support in this population. The results of this study agree with the literature with regard to increased occurrence of stroke in elderly (13,19,20) , which reinforces the need for preventive measures to risk factors for stroke (20) , especially in primary attention and through active aging philosophy, with targeted actions not only to the elderly but also to the younger, seeking thereby prevent risks and reduce stroke hospitalization.…”

Section: Discussionsupporting

confidence: 90%

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Morbidade hospitalar por acidente vascular encefálico e cobertura fonoaudiológica no Estado da Paraíba, Brasil

Lima

Pernambuco

2017

Audiol., Commun. Res.

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Introduction: Stroke is a neurological disease associated with hospital morbidity, and its sequels requires speech-language therapy care. Purpose: To analyze the profile of hospital morbidity from stroke and its relation to speech therapy coverage in the state of Paraiba, Brazil. Methods: Ecological type study, carried out with data obtained from the Brazilian Hospital Information System (SIH / SUS -Sistema de Informações Hospitalares / Sistema Único de Saúde) and the National Registry of Health Facilities (CNES -Cadastro Nacional de Estabelecimentos de Saúde) in the years of 2010 and 2014, considering the number of approved inpatient hospital authorization, sex, age, average amount spent per admission, average length of stay and the number of speech-language therapists in the public hospital system. It was calculated the rate of hospitalization, the incidence rate of hospitalization from stroke and the proportion of hospitalization from stroke in relation to speech-language therapy coverage. Results: There was a decline in hospitalizations from stroke in the State of Paraiba, between 2010 and 2014. There was a higher concentration of hospitalizations outside the metropolitan area of João Pessoa, in both years, increase of 9.8% in the amount spent per admission and a seven day stay on average in the hospital. The number of hospitalizations was higher in individuals of 60 years or older, with a similar proportion of either sex. The number of Speech-language therapists linked to the public hospital system increased 82.8% in 2014, however, with the highest concentration in the metropolitan region of João Pessoa. In both years, the proportion of hospitalizations from stroke in relation to speech therapy coverage was higher outside the João Pessoa metropolitan area. Conclusion: In the state of Paraiba, between 2010 and 2014, there was a decline in stroke hospitalization, greater concentration of admissions of elderly individuals outside the metropolitan region of João Pessoa, with the same proportion between the sexes. Speech-language therapy coverage was scarce in the most remote areas of the capital.

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Section: Discussionsupporting

confidence: 90%

“…Among patients older than 65, stroke stands out as a major cause of hospitalization and prolonged hospitalization (19) . This scenario justifies the concern not only with the logistical support to the elderly, but also with the economic management and the actual effectiveness of intensive support in this population.…”

Section: Discussionmentioning

confidence: 99%

Morbidade hospitalar por acidente vascular encefálico e cobertura fonoaudiológica no Estado da Paraíba, Brasil

Lima

Pernambuco

2017

Audiol., Commun. Res.

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“…In fact stroke's incidence increases with age in both genders, with an incidence of 38% in adults over 75 years old. [2][3][4] However, despite stroke's high prevalence in the elderly, intravenous alteplase (intravenous recombinant tissue plasminogen activator [IV-rtPA]), the only approved treatment for pharmacological revascularization in acute ischemic stroke, is licensed only in Europe for use in patients younger than 80 years old. 5 This seems to be related with frequent under-representation or exclusion of patients over the age of 80 years from clinical trials leading to uncertainty about the risk-benefit profile in these patients.…”

Section: Introductionmentioning

confidence: 99%

Thrombolysis in Patients Aged over 80 Years Is Equally Effective and Safe

Pego

Nunes

Ferreira

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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Background: Despite stroke's high prevalence in the elderly, intravenous thrombolysis is licensed in Europe only for patients younger than 80 years old. We aimed to compare the functional outcomes and complication rates in patients older versus younger than 80 years old treated with intravenous thrombolysis. Methods: A retrospective observational study of patients who received intravenous thrombolysis in a stroke unit between January 1, 2009, and June 30, 2012, was conducted. Variables were compared between 2 subgroups (≤80 and >80 years). Results: Overall, 512 patients underwent intravenous thrombolysis, of which 13.1% were over 80 years. The mean age was 65.4 years in the younger subgroup and 82.9 years in the older subgroup. Prior independence rates did not differ between the subgroups. Prevalence of atrial fibrillation and cardioembolic stroke was higher in the older subgroup (P = .004 and .026). Only 3% of the elderly with atrial fibrillation were taking oral anticoagulants. Symptoms-to-needle time was lower in the older subgroup (P = .048). Stroke severity was higher in patients over 80 years (P = .026). There was significant improvement in the National Institutes of Health Stroke Scale score 7 days after intravenous thrombolysis (P < .001) in both subgroups. The proportion of patients with 3 months' favorable outcome and independence, hemorrhagic transformation, and mortality rates were similar in both subgroups. Conclusions: Elderly patients' benefits and outcomes from intravenous thrombolysis treatment were identical to the younger subgroup without excess hemorrhagic transformation or mortality. These results favor the use of intravenous thrombolysis in patients over 80 years. Key Words: Stroke-elderlythrombolysis-over 80 years.

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“…Guan et al showed patient with large artery infarction accompanied by low T3 level had severe neural damage leading to worse prognosis (14). Although several studies confirmed that serum T3 level is indeed an independent predictor of post stroke outcome still there are controversies regarding the association between thyroid hormone levels and post stroke recovery (15,16). An experimental data have shown that exogenous T3 administration helped in reducing the size of cerebral infarct and improve neurological deficit but there is still no conclusive answer whether treatment of low T3 level in acute stroke would improve the condition or not (17).…”

Section: Discussionmentioning

confidence: 99%

Low T3 Level and Prognosis of Acute Ischemic Stroke: A Comparative Analysis

Rahman

Haque

et al. 2018

Bangladesh J. Nuclear Med.

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Objectives: Neuroendocrine profile is significantly altered in acute ischemic stroke. Increasing evidences suggested that low T3 levels immediately following acute ischemic stroke is associated with greater stroke severity, higher mortality rates and poorer functional outcome. The objective of this study was to see the possible association of serum T3 level with severity of acute ischemic stroke as well as post stroke recovery. Material & Methods:It was a prospective cross sectional study. From October 2014 to June 2015 patients with acute ischemic stroke, presented within 48 hours of onset of symptoms having radiologically confirmed cerebral infarct were enrolled in this study. Blood for thyroid hormone estimation was collected within 48 hours of onset of symptom. Neurological impairment and improvement were assessed using National Institute of Health Stroke Scale (NIHSS) score together with modified Rankin Scale (mRS) on admission day and at 4 weeks post stroke follow-up visit. Result:A total 83 patients met all inclusion criteria were studied. Mean age was 63.4 ± 15.6 years (range 47-79 years). Among eighty three patients 49 (59%) had normal T3 level and rest 34 (41%) had low T3 level. Mean T3 level was 0.4 ± 0.3 ng/ml and 1.8 ±0.5 ng/ml in lowT3 and normal T3 level group respectively. Based on NIHSS scores on admission, a much higher portion of patients (73.5%) belonged to lowT3 level group fell into moderate-to-severe category while majority of patients (53.0%) fell into mild category for normal T3 level group. In post stroke follow up, about 63.2 % patients with normal T3 level showed favorable neurological functional improvement compared to 38.2% having low T3 level (Chi square=4.9, P<0.05). Conclusion:In patients with acute ischemic stroke lower T3 level elevated the risk of poor functional outcome.

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Independent predictors of ischemic stroke in the elderly

Cited by 77 publications

References 40 publications

Morbidade hospitalar por acidente vascular encefálico e cobertura fonoaudiológica no Estado da Paraíba, Brasil

Morbidade hospitalar por acidente vascular encefálico e cobertura fonoaudiológica no Estado da Paraíba, Brasil

Thrombolysis in Patients Aged over 80 Years Is Equally Effective and Safe

Low T3 Level and Prognosis of Acute Ischemic Stroke: A Comparative Analysis

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