Long-Term Fatal Outcomes in Subjects With Stroke or Transient Ischemic Attack

Patel, Anant B.; Kostis, John B.; Wilson, Alan C.; Shea, Michael L.; Pressel, Sara L.; Davis, Barry R.

doi:10.1161/strokeaha.107.500777

Cited by 26 publications

(8 citation statements)

References 19 publications

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“…20 However, the benefit of BP reduction regarding the risk of stroke was demonstrated in elderly patients treated for hypertension with thiazide-based therapy. 4,[21][22][23][24][25][26] Furthermore, late elderly hypertensive patients (X80 years old) showed a 30% reduction of the risk of stroke in association with the reduction of all-cause mortality during indapamide-based treatment. 4 It is also reported that CCBs favor the prevention of stroke compared with regimens based on diuretics or bblockers.…”

Section: Combination Therapy For Hypertension In the Elderly T Ogiharmentioning

confidence: 99%

Combination therapy for hypertension in the elderly: a sub-analysis of the Combination Therapy of Hypertension to Prevent Cardiovascular Events (COPE) Trial

et al. 2012

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The Combination Therapy of Hypertension to Prevent Cardiovascular Events (COPE) trial demonstrated that the calcium-channel blocker benidipine-based combination therapies with an angiotensin-receptor blocker (ARB), a b-blocker, or a thiazide diuretic (thiazide) were similarly effective in preventing cardiovascular events and achieving the target blood pressure (BP; o140/ 90 mm Hg). We further evaluated the efficacy and safety of these combination therapies in older (X65 years) and younger (o65 years) hypertensive patients. In this sub-analysis of the COPE trial 3293 patients (1533X65 years old and 1760 o65 years old) were randomly assigned to receive benidipine-based therapy with an ARB, a b-blocker or a thiazide. In each group, the average BP did not differ among the three treatment groups. The incidence of the primary cardiovascular composite end point in the older group was higher than in the younger group (12.7 vs. 8.3 per 1000 person-years, P¼0.023). The primary composite cardiovascular end point, achievement (%) of target BP, and cardiovascular hard composite end points were similar among the three treatment groups. However, the hazard ratios and 95% confidence intervals in older patients were 2.74 (1.08-6.96; b-blocker vs. thiazide, P¼0.022) for fatal and non-fatal stroke, and 2.47 (1.03-5.91; b-blocker vs. ARB, P¼0.043) for newonset diabetes. Thus, benidipine combined with an ARB, a b-blocker, or a thiazide was similarly effective in preventing cardiovascular events and achieving the target BP in both older and younger hypertensive patients. Further studies will be necessary to evaluate the usefulness of benidipine combined with a b-blocker in terms of the incidence of stroke and new-onset diabetes in older patients.

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Section: Combination Therapy For Hypertension In the Elderly T Ogiharmentioning

confidence: 99%

Combination therapy for hypertension in the elderly: a sub-analysis of the Combination Therapy of Hypertension to Prevent Cardiovascular Events (COPE) Trial

et al. 2012

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“…These include describing post-trial trajectories of outcomes to see whether they diminish with time [1], remain constant [2-4], or expand [5]; detecting new effects [6,7]; examining longer-term safety issues [2]; examining the downstream consequences of on-trial events [8]; examining post-trial treatment in the control group [9]; assessing the impact of withdrawal of therapy [10]; and establishing surrogate outcomes [11,12]. Post-trial follow-up also provides well-characterized cohorts for epidemiologic studies and for recruitment into new ancillary studies and clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Demographic and health factors associated with enrollment in posttrial studies: The women’s health initiative hormone therapy trials

et al. 2013

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Background After clinical trials end, continued follow-up of the assembled cohort often is desirable for additional research. Factors influencing participants’ decisions to consent to additional follow-up and how these shape post-trial cohorts have not been broadly studied. Purpose We examined how two re-enrollment campaigns and the passage of time altered features of the post-trial cohorts compared with the original Women’s Health Initiative Hormone Therapy clinical trials. Methods We examined associations that markers of socio-demography, health, lifestyle and on-trial experiences had with re-enrollment and contrasted the characteristics of successive post-trial cohorts with those of the original enrollees. Results The post-trial enrollment campaigns re-enrolled 81.1% and 82.5% of available women, respectively. Women who re-enrolled tended to have better health characteristics than those not re-enrolled. Compared to women of comparable age in the original cohort, women retained for the second post-trial follow-up less often had a history of cardiovascular disease [odds ratio OR=0.36], hypertension [OR=0.57], diabetes [OR=0.59], or measured cognitive deficit [OR=0.40]. These women more often had graduated from high school [OR=1.72] and had participated in other WHI trials [OR=1.76]. Limitations We have examined experience with creating follow-up cohorst from participants in a single study. Thus, our findings may not apply to other cohorts and protocols. Conclusions Post-trial enrollment in follow-up studies can be successful; however the characteristics of the resulting cohort may differ substantially from the originally assembled group of trial participants. Collection during the original trial of potential predictors of differential re-enrollment may facilitate re-enrollment.

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“…Few studies report follow-up beyond 1 year, 9,10,24 -26 and these have included relatively few patients (approximately Ͻ1000) and/or have not described differences in mortality rates by sex, age, or comorbidity status 9,10,24 or cannot be considered representative, where cohorts were recruited into randomized controlled trials or included minor stroke. [25][26][27] Relative survival provides an unbiased estimate of cause-specific mortality risk compared with methods that rely on cause-of-death data. Relative survival quantifies the risk of death attributable to TIA in excess of the expected mortality in the age-and sex-matched general population.…”

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confidence: 99%

Relative Survival After Transient Ischaemic Attack

Gattellari

Goumas

Biost

et al. 2012

Stroke

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Background and Purpose-There is a lack of modern-day data quantifying the effect of transient ischemic attack (TIA) on survival, and recent data do not take into account expected survival. Methods-Data for 22 157 adults hospitalized with a TIA from July 1, 2000, to June 30, 2007, in New South Wales, Australia, were linked with registered deaths to June 30, 2009. We estimated survival relative to the age-and sex-matched general population up to 9-years after hospitalization for TIA comparing relative risk of excess death between selected subgroups. Results-At 1 year, 91.5% of hospitalized patients with TIA survived compared with 95.0% expected survival in the general population. After 5 years, observed survival was 13.2% lower than expected in relative terms. By 9 years, observed survival was 20% lower than expected. Females had higher relative survival than males (relative risk, 0.79; 95% CI, 0.69 -0.90; PϽ0.001). Increasing age was associated with an increasing risk of excess death compared with the age-matched population. Prior hospitalization for stroke (relative risk, 2.63; 95% CI, 1.98 -3.49) but not TIA (relative risk, 1.42; 95% CI, 0.86 -2.35) significantly increased the risk of excess death. Of all risk factors assessed, congestive heart failure, atrial fibrillation, and prior hospitalization for stroke most strongly impacted survival. Conclusions-This study is the first to quantify the long-term effect of hospitalized TIA on relative survival according to age, sex, and medical history. TIA reduces survival by 4% in the first year and by 20% within 9 years. TIA has a minimal effect on mortality in patients Ͻ50 years but heralds significant reduction in life expectancy in those Ͼ65 years. Key Words: follow-up Ⅲ relative survival Ⅲ transient ischaemic attack T ransient ischemic attack (TIA) is a recognized predictor of early stroke risk and its stroke outcomes have attracted intense interest. Early stroke rates vary 1,2 and recent studies report low early stroke risk with modern urgent TIA care. [3][4][5][6] In contrast to the emphasis on early stroke risk, detailed analyses of survival after TIA, and how survival varies by age, sex, and medical history have rarely been reported. Multicenter or population-based reports suggest that between 5% and 8% of patients will die within 6 months of their TIA, 7,8 and others report 5% to 15% dying by 1 year. 3,9 -11 However, the significance of these findings is uncertain. Given the advanced age at which TIA commonly occurs, it is unclear whether the observed mortality exceeds otherwise expected mortality.Calculating relative survival accounts for the "background risk" of death and identifies the excess risk of mortality above and beyond that expected from the age-and sex-matched general population. Previous population-based or multicenter studies reporting relative survival are only of historic interest with cohorts recruited from 1950 to 1988. 11-16 These studies are small-scale in terms of geographical scope and sample size (79 -330 participants), further lim...

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Long-Term Fatal Outcomes in Subjects With Stroke or Transient Ischemic Attack

Cited by 26 publications

References 19 publications

Combination therapy for hypertension in the elderly: a sub-analysis of the Combination Therapy of Hypertension to Prevent Cardiovascular Events (COPE) Trial

Combination therapy for hypertension in the elderly: a sub-analysis of the Combination Therapy of Hypertension to Prevent Cardiovascular Events (COPE) Trial

Demographic and health factors associated with enrollment in posttrial studies: The women’s health initiative hormone therapy trials

Relative Survival After Transient Ischaemic Attack

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