National data on stroke outcomes in Thailand

Kongbunkiat, Kannikar; Kasemsap, Narongrit; Thepsuthammarat, Kaewjai; Tiamkao, Somsak; Sawanyawisuth, Kittisak

doi:10.1016/j.jocn.2014.08.031

Cited by 24 publications

(26 citation statements)

References 20 publications

(35 reference statements)

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“…Based on Thai national data, the most common risk factors identified in stroke patients are hypertension (57%), smoking (27%), and diabetes (24%) [ 23 ]. Interestingly, nearly half of patients with hypertension and a majority of patients with diabetes or dyslipidemia could not name these diseases as risk factors for stroke.…”

Section: Discussionmentioning

confidence: 99%

Knowledge of Stroke Risk Factors and Warning Signs in Patients with Recurrent Stroke or Recurrent Transient Ischaemic Attack in Thailand

Saengsuwan

Suangpho

Tiamkao

2017

Neurology Research International

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Stroke is a global burden. It is not known whether patients who are most at risk of stroke (recurrent stroke or recurrent transient ischaemic attack) have enough knowledge of stroke risk factors and warning signs. The aim of this study was to assess the knowledge of stroke risk factors and warning signs in this high-risk population. We performed a cross-sectional questionnaire-based study of patients with recurrent stroke or recurrent TIA admitted to Srinagarind Hospital and Khon Kaen Hospital, Thailand. A total of 140 patients were included in the study (age 65.6 ± 11.3 years [mean ± SD], 62 females). Using an open-ended questionnaire, nearly one-third of patients (31.4%) could not name any risk factors for stroke. The most commonly recognized risk factors were hypertension (35%), dyslipidemia (28.6%), and diabetes (22.9%). Regarding stroke warning signs, the most commonly recognized warning signs were sudden unilateral weakness (61.4%), sudden trouble with speaking (25.7%), and sudden trouble with walking, loss of balance, or dizziness (21.4%). Nineteen patients (13.6%) could not identify any warning signs. The results showed that knowledge of stroke obtained from open-ended questionnaires is still unsatisfactory. The healthcare provider should provide structured interventions to increase knowledge and awareness of stroke in these patients.

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Section: Discussionmentioning

confidence: 99%

Knowledge of Stroke Risk Factors and Warning Signs in Patients with Recurrent Stroke or Recurrent Transient Ischaemic Attack in Thailand

Saengsuwan

Suangpho

Tiamkao

2017

Neurology Research International

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“…Patients started in the healthy state and were at risk of coronary intervention without an MI, MI, ischaemic stroke, haemorrhagic stroke, cardiovascular death or non-CVD death. Coronary interventions included coronary artery bypass graft (CABG) and [24] Annual probability of developing diabetes Varies by age and sex b [25] Annual probability of smoking cessation c Varies by age b [26] Increase in systolic blood pressure per year of age Varies by age and sex b [27] Myocardial Infarction Probability of CVD event being fatal/non-fatal MI 0.488 (0.450 to 0.520) [24] Probability of CABG after MI c 0.031 (0.024 to 0.039) [28] Probability of PCI after MI c 0.288 (0.268 to 0.308) [28] Probability of MI being fatal c 0.177 (0.161 to 0.195) [28] Stroke Probability of CVD event being fatal/non-fatal stroke 0.292 (0.250 to 0.320) [24] Probability of stroke being ischemic c 0.693 (0.690 to 0.700) [29] Probability of ischemic stroke being fatal c 0. Varies by time since last stroke d [30,[37][38][39] Probability that recurrent ischemic stroke is fatal c 0.270 (0.140 to 0.420) [37] Probability of recurrent hemorrhagic stroke in first year after initial c 0.057 (0.015 to 0.409) [37] Probability of recurrent hemorrhagic stroke in subsequent years c Varies by individual e [37] Probability that recurrent hemorrhagic stroke is fatal c 0.430 (0.070 to 0.930) [37] Probability of ischemic stroke after MI c Varies by gender and time since MI d [37][38][39][40] Probability that ischemic stroke after MI is fatal c 0.270 (0.140 to 0.…”

Section: Model Structurementioning

confidence: 99%

Statins for atherosclerotic cardiovascular disease prevention in people living with HIV in Thailand: a cost‐effectiveness analysis

et al. 2020

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Introduction: People living with HIV (PLHIV) have an elevated risk of atherosclerotic cardiovascular disease (CVD) compared to their HIV-negative peers. Expanding statin use may help alleviate this burden. However, the choice of statin in the context of antiretroviral therapy is challenging. Pravastatin and pitavastatin improve cholesterol levels in PLHIV without interacting substantially with antiretroviral therapy. They are also more expensive than most statins. We evaluated the cost-effectiveness of pravastatin and pitavastatin for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipidlowering therapy. Methods: We developed a discrete-state microsimulation model that randomly selected (with replacement) individuals from the TREAT Asia HIV Observational Database cohort who were aged 40 to 75 years, receiving antiretroviral therapy in Thailand, and not using lipid-lowering therapy. The model simulated each individual's probability of experiencing CVD. We evaluated: (1) treating no one with statins; (2) treating everyone with pravastatin 20mg/day (drug cost 7568 Thai Baht ($US243)/ year) and (3) treating everyone with pitavastatin 2 mg/day (drug cost 8182 Baht ($US263)/year). Direct medical costs and quality-adjusted life-years (QALYs) were assigned in annual cycles over a 20-year time horizon and discounted at 3% per year. We assumed the Thai healthcare sector perspective. Results: Pravastatin was estimated to be less effective and less cost-effective than pitavastatin and was therefore dominated (extended) by pitavastatin. Patients receiving pitavastatin accumulated 0.042 additional QALYs compared with those not using a statin, at an extra cost of 96,442 Baht ($US3095), giving an incremental cost-effectiveness ratio of 2,300,000 Baht ($US73,812)/QALY gained. These findings were sensitive to statin costs and statin efficacy, pill burden, and targeting of PLHIV based on CVD risk. At a willingness-to-pay threshold of 160,000 Baht ($US5135)/QALY gained, we estimated that pravastatin would become cost-effective at an annual cost of 415 Baht ($US13.30)/year and pitavastatin would become cost-effective at an annual cost of 600 Baht ($US19.30)/year. Conclusions: Neither pravastatin nor pitavastatin were projected to be cost-effective for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipid-lowering therapy. We do not recommend expanding current use of these drugs among PLHIV in Thailand without substantial price reduction.

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“…The cost of 50 mg Actilyse ® (alteplase; Boehringer Ingelheim, Ingelheim am Rhein, Germany) was US$629.87. 4 There are several factors associated with LOS as well as costs of stroke hospitalization such as age of the patient, stroke subtype, atrial fibrillation, stroke severity, and comorbidities. 5 – 7 …”

Section: Introductionmentioning

confidence: 99%

Impact of intravenous thrombolysis on length of hospital stay in cases of acute ischemic stroke

Kasemsap¹,

Vorasoot²,

Kongbunkiat³

et al. 2018

NDT

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BackgroundThere are limited data available on factors associated with length of stay (LOS) in cases of acute ischemic stroke according to Poisson analysis, which is more appropriate than other methods.Materials and methodsWe retrospectively reviewed medical summary charts of patients with acute ischemic stroke in 30 hospitals across northeast Thailand, with the main outcome as LOS. Poisson regression was used to examine factors associated with LOS.ResultsWe included 898 patients in the analysis; 460 (51.2%) were male. The median age (interquartile; IQR) was 58 (67–75) years and the median LOS was 5 (4–7) days. The median National Institute of Health Stroke Scale (NIHSS [IQR]) was 8 (4–13). Results of the analysis showed that, after controlling for age, stroke severity, atrial fibrillation, and thrombolytic use, significant variables associated with LOS were moderate stroke (incidence rate ratio [IRR] 95% confidence interval [CI] =1.15 [range 1.01–1.30], P=0.040), severe stroke (IRR [95% CI] =1.27 [1.09–1.47], P=0.002), thrombolytic use (IRR [95% CI] =0.68 [0.60–0.76], P<0.001), and atrial fibrillation (IRR [95% CI] =1.15 [1.02–1.30], P=0.023). After adjusting for complications, thrombolytic use remained significantly associated with decreased LOS (IRR [95% CI] =0.74 [0.67–0.83], P=0.001). Other significant factors were atrial fibrillation (IRR [95% CI] =1.14 [1.02–1.28], P=0.018), pneumonia (IRR [95% CI] =1.48 [1.30–1.68], P<0.001), and urinary tract infection (IRR [95% CI] =1.41 [1.14–1.74], P=0.001).ConclusionAccording to Poisson analysis, intravenous thrombolysis, atrial fibrillation, pneumonia, and urinary tract infection are associated with LOS in cases of acute ischemic stroke, regardless of age, stroke severity, comorbidities, or complications.

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National data on stroke outcomes in Thailand

Cited by 24 publications

References 20 publications

Knowledge of Stroke Risk Factors and Warning Signs in Patients with Recurrent Stroke or Recurrent Transient Ischaemic Attack in Thailand

Knowledge of Stroke Risk Factors and Warning Signs in Patients with Recurrent Stroke or Recurrent Transient Ischaemic Attack in Thailand

Statins for atherosclerotic cardiovascular disease prevention in people living with HIV in Thailand: a cost‐effectiveness analysis

Impact of intravenous thrombolysis on length of hospital stay in cases of acute ischemic stroke

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