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Background and PurposeThe decline in stroke mortality in the United States may have resulted from declining incidence, improved survival of stroke patients, or both. We previously reported that stroke patients who were 30 to 74 years old and were treated in Minneapolis/St Paul hospitals in 1990 survived longer than did their counterparts in 1980. In the present study, we examined trends in the rate of hospitalized stroke in Minneapolis/St Paul between 1980 and 1990.MethodsFor 1980, 1985, and 1990, we obtained lists of discharge codes (International Classification of Diseases, 9th revision) from Minneapolis/St Paul hospitals, identified hospitalizations for acute cerebrovascular disease, and randomly selected 50% of the cases for medical record abstraction. We counted stroke events in five different ways, which were based on discharge codes as well as diagnostic criteria, and computed age-adjusted stroke rates for each year. Stroke mortality in the population was computed for 1960 through 1994.Results20%. Among women, there was a sharp contrast between trends that relied on discharge codes and trends that relied on diagnostic criteria: the former indicated a decline (4% to 19%), whereas the latter indicated some increase. For the second half of the 1980s, most measures of stroke attack rate in men, all measures of stroke attack rate in women, and measures of stroke incidence in both sexes did not indicate a decline in stroke occurrence in the population. Mortality from stroke among 30- to 74-year-old residents of Minneapolis/St Paul, which declined rapidly during the 1970s and early 1980s, declined slowly, if at all, during the second half of the 1980s and early 1990s.ConclusionsThe incidence of stroke may have declined among 30- to 74-year-old residents of Minneapolis/St Paul in the early 1980s. However, we found little indication of such a trend between 1985 and 1990, a period of slow decline or no decline in stroke mortality in that population. (Stroke. 1997;28:275-279.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeInformation on the incidence of vascular disease in women of reproductive age has been limited. These diseases are rare in this age group, and a large population base is required for reliable estimation of incidence.MethodsFor a case-control study of vascular disease and low-dose oral contraceptive use, we used emergency department logs and hospital admission and discharge records to ascertain fatal and nonfatal cases of first-ever stroke and myocardial infarction (MI) in women 15 to 44 years of age who were members of a large California HMO. Incidence rates of stroke and MI were calculated on the basis of these data.ResultsThe incidence of MI not associated with pregnancy was 5.0 per 100 000 women-years. The incidence of stroke not associated with pregnancy was 10.7 per 100 000 women-years. MI was very rare until age 35 years. At every age, about half of hemorrhagic strokes were due to subarachnoid hemorrhage.ConclusionsThe incidence rates of stroke and MI are low in women of reproductive age in the United States. (Stroke. 1997;28:280-283.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeDecline in stroke mortality in recent decades has been well documented in the United States and other countries. This study, based on a well-defined population with comprehensive medical records available for research purposes, seeks to explain decline in stroke mortality among older persons between 1967 and 1985. The study specifically explores the competing explanatory mechanisms of decreased incidence of stroke versus decreased case-fatality rate.Methodsor=to65 years of age enrolled in a large group model HMO in a metropolitan community. All new hospitalized and a sample of nonhospitalized strokes were ascertained, and samples of first-ever strokes were studied. Incidence, case-fatality rates, survival times, and comorbidities were compared across cohorts.ResultsThere was no significant change in stroke incidence over time; however, 1-month case fatality declined dramatically from 33% in 1967 through 1971 to 18% in 1981 through 1985 (P<.01); median survival increased from 213 to 1092 days. Indices of reduced severity included declines in coma from 27% to 12% (P<.01) and in wheelchair- or bed-bound status from 40% to 30% (P=.067). Cases with and without CT scan in 1981 to 1985, when this procedure became widely available in the health plan, were similar in severity, thereby reducing the possibility of ascertainment bias.ConclusionsIn this well-defined older population, stroke has become a less lethal and disabling though no less common disease. This finding fails to support the "compression of morbidity" hypothesis while supporting a model of delayed progression for stroke in this age group. (Stroke. 1997;28:284-290.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeThe applicability of prospective carotid endarterectomy protocols to the general population has been questioned. Outcomes for asymptomatic patients undergoing carotid endarterectomy were compared with the results of the Asymptomatic Carotid Atherosclerosis Study (ACAS) patients treated concurrently at our institution.MethodsAsymptomatic patients undergoing carotid endarterectomies (n=277) from 1987 to 1993 (ACAS enrollment period) were reviewed. Primary end points were mortality, myocardial infarction, and stroke. Five subgroups were studied: (1) ACAS surgical patients; (2) ACAS-eligible patients not enrolled and ACAS surgeons; (3) ACAS-eligible patients not enrolled and non-ACAS surgeons; (4) ACAS-ineligible patients and ACAS surgeons; and (5) ACAS-ineligible patients and non-ACAS surgeons.ResultsACAS-eligible patients were younger (P=.014), had more severe carotid stenosis (P=.001), and had lower incidences of pulmonary (P=.015) and renal (P=.008) diseases compared with ineligible patients. Patient selection (ACAS eligibility) significantly improved outcomes for mortality (P=.014) and myocardial infarction (P=.006). Length of stay favored ACAS-eligible patients (P=.004). ACAS surgeons operated on more severely stenotic carotid lesions (P=.005) and on patients with a lower incidence of coronary artery disease (P=.007). There was no difference in outcomes between ACAS and non-ACAS surgeons.ConclusionsPatient selection was a significant factor in determining outcome. With strict adherence to ACAS enrollment guidelines, the conclusions of ACAS appear applicable to patients seen at our institution with asymptomatic carotid stenosis. (Stroke. 1997;28:291-296.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposePatients with stroke are at a high risk for falling. We assessed the fall incidence and risk factors for patients hospitalized as the result of an acute stroke.MethodsWe studied a cohort of 720 stroke patients from 23 hospitals in The Netherlands. The data were abstracted from the medical and nursing records.ResultsWe studied 346 women and 374 men with a median age of 75 years; 77% of the patients had had a cerebral infarct, 17% had had a hemorrhage, and 6% had had an undefined stroke. We recorded 104 patients (14%) who fell at least once; there were a total of 173 falls. The incidence of falls was 8.9/1000 patients per day. The daily incidence was 6.2/1000 patients for first falls and 17.9/1000 patients for second falls. Heart disease (relative risk [RR], 1.6; 95% confidence interval [CI], 1.0 to 2.4), mental decline (RR, 1.6; 95% CI, 1.0 to 2.4), and urinary incontinence (RR, 2.3; 95% CI, 1.3 to 4.1) were incremental risk factors for first falls, whereas the use of major psychotropic drugs lowered the fall risk (RR, 0.5; 95% CI, 0.3 to 0.8). The fall RR for patients with one previous fall was 2.2 (95% CI, 1.5 to 3.2), adjusted for the other risk factors. Most falls occurred during the day. Approximately 25% of the falls caused slight-to-severe injury, whereas three falls (2%) led to hip fractures.ConclusionsStroke patients have a high risk of falling. The identification of patients at risk may be a first step toward the implementation of fall-prevention measures for these patients. (Stroke. 1997;28:297-301.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeDiagnosis of hemorrhagic transformation (HT) could influence the prognosis and the management of acute ischemic stroke. The interobserver reliability of CT-scan HT classification is evaluated in the present study.MethodsFifty 5-day CT scans of patients enrolled in the Multicenter Acute Stroke Trial-Italy (MAST-I) were reviewed independently by two neuroradiologists and one neurologist with CT training. They evaluated the presence and type of intraparenchymal HT (hemorrhagic infarction types I, II, and III and intracerebral hemorrhage) (five-item scale), as well as the presence of intraventricular and/or subarachnoid bleeding according to standardized definitions.ResultsAgreement for exclusion of HT and intraventricular/subarachnoid bleeding was good between the neuroradiologists (kappa=0.70 and kappa=0.72) and excellent between the neurologist and each neuroradiologist (kappa=0.87 and kappa=0.77, kappa=0.83, and kappa=0.81, respectively). The overall agreement for the five-item HT scale between the two neuroradiologists was good (kappaw=0.65) because of discordance over the last three items. Better overall agreement was obtained with a three-item scale: no hemorrhage, petechial type I hemorrhagic infarction, and other HT (type II and type III hemorrhagic infarction and intracerebral hemorrhage) together (kappaw=0.82).ConclusionsExclusion of HT is a reliable CT diagnosis when made by neuroradiologists and also by a neurologist with CT training. Five- and three-item scales of HT types showed good to excellent reliability. The validity of the scale for predicting short- and long-term outcome should be evaluated in future studies. (Stroke. 1997;28:302-306.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeThe reliability of the National Institutes of Health Stroke Scale (NIHSS) has been established through testing its use in live and videotaped patients. This reliability testing has primarily focused on the use of the scale by neurologists. We sought to determine the reliability of the NIHSS as used by non-neurologists in the context of a clinical trial.MethodsIn anticipation of the initiation of a randomized trial of a new therapy for patients with acute ischemic stroke, 30 physician investigators (30% of whom were not neurologists) and 29 non-physician study coordinators were trained in the use of the NIHSS at an informational and training conference using standardized videotaped patient examinations. A series of 4 patients were rated initially. After 3 months, the same 4 patients were rerated, providing a measure of intraobserver reliability. An additional series of 4 new patients were also rated after 3 months and, with the initial 4 ratings, provided data for assessment of interobserver reliability.ResultsOverall, 28% of the raters had previous experience with the NIHSS, and 22% had previously used the videotapes as used in the present trial. The coefficients of determination (r2) were each greater than .95 when the means of the two ratings of the same 4 cases were compared between (1) neurologists and other types of physicians, (2) physicians and study coordinators, (3) raters who had prior experience with the NIHSS and those without prior experience, and (4) raters who had used the videotapes in the past and those who had never viewed the tapes. The calculated r2s were greater than .98 for the initial rating of the first 4 cases and for the later rating of the 4 new cases. The slopes of the regression lines were all near 1, indicating that the raters were similarly calibrated. The intraclass correlation coefficients were .93 and .95, reflecting high levels of intraobserver and interobserver reliability.ConclusionsThese data extend the previously demonstrated reliability of the NIHSS to non-neurologists and show that both a variety of physician investigators and nurse study coordinators can be rapidly trained to reliably apply the scale in the context of an actual clinical trial. (Stroke. 1997;28:307-310.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeAtrial fibrillation (AF) is a risk factor for stroke. This study was undertaken to determine the influence of AF on the mortality of stroke patients and on the causes of death after a stroke event.MethodsPatients with first ischemic stroke who were 35 to 74 years old and registered in the FINMONICA stroke register during 1982 through 1992 were analyzed (n=6912). There were 642 patients with AF (9.3%) (mean age, 67 years) and 6270 patients without AF (90.3%) (mean age, 63 years). The association between AF and stroke mortality was investigated by use of logistic regression and Cox proportional hazards models.ResultsMortality was higher in the AF group both at 28 days (19.5% versus 14.4%, P<.001) and 1 year after the attack (30.5% versus 21.8%, P<.001). After adjustment for age and sex, the odds ratio for 28-day case fatality (AF versus non-AF) was 1.27 (95% CI, 1.03 to 1.56; P=.003), and that for 1-year mortality was 1.36 (95% CI, 1.14 to 1.63; P<.001). In the proportional hazards model, AF was a significant independent risk factor for 1-year mortality (hazard ratio, 1.26; 95% CI, 1.09 to 1.46; P=.002). Cardiac causes of death were more common in the AF group at the acute stage. In the course of 1 year, there were no differences in the distributions of causes of death.ConclusionsStroke patients with AF are at high risk of death both at the acute phase of stroke and during the subsequent year after the first acute stroke event. Mortality from cardiac diseases prevailed in the AF group during the acute phase of stroke. Careful cardiac evaluation and treatment are essential in patients with AF and stroke. (Stroke. 1997;28:311-315.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeAtrial fibrillation is a frequent disorder in the elderly and a known risk factor for cerebrovascular stroke. We investigated the association of atrial fibrillation with dementia and cognitive impairment in a large cross-sectional, population-based study in the elderly.MethodsOf the 6584 participants in the Rotterdam Study aged 55 to 106 years, detailed information on dementia status and ECG abnormalities was available. Dementia was diagnosed in three phases. First, participants were screened. Screen-positive subjects were tested further. Those with possible dementia underwent an extensive diagnostic workup. Dementia and dementia subtypes were diagnosed according to prevailing criteria. Cognitive impairment was defined as a Mini-Mental State Examination test score of <26 points for a nondemented subject.ResultsAtrial fibrillation was diagnosed in 195, dementia in 276, and cognitive impairment in 635 subjects. We found significant positive associations of atrial fibrillation with both dementia and impaired cognitive function (age- and sex-adjusted odds ratios, 2.3 [95% confidence interval, 1.4 to 3.7] and 1.7 [95% confidence interval, 1.2 to 2.5]), respectively). The strongest association was found not for vascular dementia but rather for Alzheimer's disease with cerebrovascular disease. The associations were stronger in women, and the relation with dementia was more pronounced in the relatively younger elderly. A history of stroke in subjects with atrial fibrillation could not account for these associations.ConclusionsDementia and subtypes Alzheimer's disease and vascular dementia may be related to atrial fibrillation even if no clinical stokes have occurred. (Stroke. 1997;28:316-321.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeMicroembolic signals (MES) are frequently observed by transcranial Doppler ultrasound after prosthetic heart valve implantation. Whether these MES are due to solid or gaseous particles is uncertain. We hypothesized that MES are gaseous and that if they are due to cavitation effects, their occurrence should respond to changes of dissolved oxygen concentration in the blood.MethodsTranscranial monitoring of MES was performed in five patients with prosthetic aortic valves, who inspired 100% oxygen through a facial mask. In one patient 100% oxygen was administered under hyperbaric (2.5 kPa) conditions in a hyperbaric chamber.ResultsInspiration of 100% oxygen reduced the total number of MES from 96/30 min to 2/30 min. Increasing the concentration of dissolved oxygen in the hyperbaric chamber led to an increase from 0.3 MES per minute (1.0 kPa) to 0.9 MES per minute (2.5 kPa).ConclusionsThe dependence of occurrence of MES in patients with prosthetic cardiac valves on the oxygen partial pressure in blood provides strong evidence that these microemboli are gaseous. (Stroke. 1997;28:322-325.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID