Trends in ischemic stroke outcomes in a rural population in the United States
The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018. This was...
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| Vydané v: | Journal of the neurological sciences Ročník 422; s. 117339 |
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| Hlavní autori: | , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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Netherlands
Elsevier B.V
15.03.2021
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| ISSN: | 0022-510X, 1878-5883, 1878-5883 |
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| Abstract | The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018.
This was a retrospective cohort study based on electronic health records (EHR) data. A comprehensive stroke database called “Geisinger NeuroScience Ischemic Stroke (GNSIS)” was built for this study. Clinical data were extracted from multiple sources, including EHR and quality data.
The cohort included in the study comprised of 8561 consecutive ischemic stroke patients (mean age: 70.1 ± 13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The one-year recurrence and all-cause mortality rates were 6.3% and 16.1%, respectively. Although the one-year stroke recurrence increased during the study period, the one-year stroke mortality rate decreased significantly. Age > 65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Cause-specific hazard model, diabetes, chronic kidney disease and age < 65 years were found to be associated with one-year ischemic stroke recurrence.
Although all-cause mortality after stroke has decreased, stroke recurrence has significantly increased in stroke patients from rural population between 2004 and 2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes, chronic kidney disease and age less than 65 years were predictors of ischemic stroke recurrence.
•Study cohort comprised of 8561 ischemic stroke patients from a rural population.•One-year all-cause mortality decreased between 2004 and 2018.•One-year stroke recurrence increased between 2004 and 2018.•Significant rise in stroke risk factors like hypertension, diabetes, dyslipidemia. |
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| AbstractList | AbstractIntroductionThe stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018. MethodsThis was a retrospective cohort study based on electronic health records (EHR) data. A comprehensive stroke database called “Geisinger NeuroScience Ischemic Stroke (GNSIS)” was built for this study. Clinical data were extracted from multiple sources, including EHR and quality data. ResultsThe cohort included in the study comprised of 8561 consecutive ischemic stroke patients (mean age: 70.1 ± 13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The one-year recurrence and all-cause mortality rates were 6.3% and 16.1%, respectively. Although the one-year stroke recurrence increased during the study period, the one-year stroke mortality rate decreased significantly. Age > 65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Cause-specific hazard model, diabetes, chronic kidney disease and age < 65 years were found to be associated with one-year ischemic stroke recurrence. ConclusionAlthough all-cause mortality after stroke has decreased, stroke recurrence has significantly increased in stroke patients from rural population between 2004 and 2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes, chronic kidney disease and age less than 65 years were predictors of ischemic stroke recurrence. The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018.INTRODUCTIONThe stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018.This was a retrospective cohort study based on electronic health records (EHR) data. A comprehensive stroke database called "Geisinger NeuroScience Ischemic Stroke (GNSIS)" was built for this study. Clinical data were extracted from multiple sources, including EHR and quality data.METHODSThis was a retrospective cohort study based on electronic health records (EHR) data. A comprehensive stroke database called "Geisinger NeuroScience Ischemic Stroke (GNSIS)" was built for this study. Clinical data were extracted from multiple sources, including EHR and quality data.The cohort included in the study comprised of 8561 consecutive ischemic stroke patients (mean age: 70.1 ± 13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The one-year recurrence and all-cause mortality rates were 6.3% and 16.1%, respectively. Although the one-year stroke recurrence increased during the study period, the one-year stroke mortality rate decreased significantly. Age > 65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Cause-specific hazard model, diabetes, chronic kidney disease and age < 65 years were found to be associated with one-year ischemic stroke recurrence.RESULTSThe cohort included in the study comprised of 8561 consecutive ischemic stroke patients (mean age: 70.1 ± 13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The one-year recurrence and all-cause mortality rates were 6.3% and 16.1%, respectively. Although the one-year stroke recurrence increased during the study period, the one-year stroke mortality rate decreased significantly. Age > 65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Cause-specific hazard model, diabetes, chronic kidney disease and age < 65 years were found to be associated with one-year ischemic stroke recurrence.Although all-cause mortality after stroke has decreased, stroke recurrence has significantly increased in stroke patients from rural population between 2004 and 2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes, chronic kidney disease and age less than 65 years were predictors of ischemic stroke recurrence.CONCLUSIONAlthough all-cause mortality after stroke has decreased, stroke recurrence has significantly increased in stroke patients from rural population between 2004 and 2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes, chronic kidney disease and age less than 65 years were predictors of ischemic stroke recurrence. The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018. This was a retrospective cohort study based on electronic health records (EHR) data. A comprehensive stroke database called “Geisinger NeuroScience Ischemic Stroke (GNSIS)” was built for this study. Clinical data were extracted from multiple sources, including EHR and quality data. The cohort included in the study comprised of 8561 consecutive ischemic stroke patients (mean age: 70.1 ± 13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The one-year recurrence and all-cause mortality rates were 6.3% and 16.1%, respectively. Although the one-year stroke recurrence increased during the study period, the one-year stroke mortality rate decreased significantly. Age > 65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Cause-specific hazard model, diabetes, chronic kidney disease and age < 65 years were found to be associated with one-year ischemic stroke recurrence. Although all-cause mortality after stroke has decreased, stroke recurrence has significantly increased in stroke patients from rural population between 2004 and 2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes, chronic kidney disease and age less than 65 years were predictors of ischemic stroke recurrence. •Study cohort comprised of 8561 ischemic stroke patients from a rural population.•One-year all-cause mortality decreased between 2004 and 2018.•One-year stroke recurrence increased between 2004 and 2018.•Significant rise in stroke risk factors like hypertension, diabetes, dyslipidemia. The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018. This was a retrospective cohort study based on electronic health records (EHR) data. A comprehensive stroke database called "Geisinger NeuroScience Ischemic Stroke (GNSIS)" was built for this study. Clinical data were extracted from multiple sources, including EHR and quality data. The cohort included in the study comprised of 8561 consecutive ischemic stroke patients (mean age: 70.1 ± 13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The one-year recurrence and all-cause mortality rates were 6.3% and 16.1%, respectively. Although the one-year stroke recurrence increased during the study period, the one-year stroke mortality rate decreased significantly. Age > 65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Cause-specific hazard model, diabetes, chronic kidney disease and age < 65 years were found to be associated with one-year ischemic stroke recurrence. Although all-cause mortality after stroke has decreased, stroke recurrence has significantly increased in stroke patients from rural population between 2004 and 2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes, chronic kidney disease and age less than 65 years were predictors of ischemic stroke recurrence. |
| ArticleNumber | 117339 |
| Author | Lambert, Clare Schirmer, Clemens M. Zand, Ramin Gupta, Mudit Azarpazhooh, M. Reza Holland, Neil Chaudhary, Durgesh Khan, Ayesha Avula, Venkatesh Griessenauer, Christoph J. Li, Jiang Shahjouei, Shima Abedi, Vida |
| Author_xml | – sequence: 1 givenname: Durgesh surname: Chaudhary fullname: Chaudhary, Durgesh organization: Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States – sequence: 2 givenname: Ayesha surname: Khan fullname: Khan, Ayesha organization: Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States – sequence: 3 givenname: Shima surname: Shahjouei fullname: Shahjouei, Shima organization: Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States – sequence: 4 givenname: Mudit surname: Gupta fullname: Gupta, Mudit organization: Phenomic Analytics and Clinical Data Core, Geisinger Health System, Danville, PA, United States – sequence: 5 givenname: Clare surname: Lambert fullname: Lambert, Clare organization: Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States – sequence: 6 givenname: Venkatesh surname: Avula fullname: Avula, Venkatesh organization: Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States – sequence: 7 givenname: Clemens M. surname: Schirmer fullname: Schirmer, Clemens M. organization: Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States – sequence: 8 givenname: Neil surname: Holland fullname: Holland, Neil organization: Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States – sequence: 9 givenname: Christoph J. surname: Griessenauer fullname: Griessenauer, Christoph J. organization: Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States – sequence: 10 givenname: M. Reza surname: Azarpazhooh fullname: Azarpazhooh, M. Reza organization: Stroke Prevention and Atherosclerosis Research Center, Department of Clinical Neurological Sciences, Western University, London, ON, Canada – sequence: 11 givenname: Jiang surname: Li fullname: Li, Jiang organization: Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA, United States – sequence: 12 givenname: Vida surname: Abedi fullname: Abedi, Vida organization: Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA, United States – sequence: 13 givenname: Ramin surname: Zand fullname: Zand, Ramin email: ramin.zand@gmail.com organization: Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33592506$$D View this record in MEDLINE/PubMed |
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| Keywords | Recurrent stroke All-cause mortality Trends Ischemic stroke Outcomes |
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| SubjectTerms | Aged Aged, 80 and over All-cause mortality Atrial Fibrillation Brain Ischemia - epidemiology Humans Ischemic Stroke Male Middle Aged Neurology Outcomes Proportional Hazards Models Recurrent stroke Retrospective Studies Risk Factors Rural Population Stroke - epidemiology Stroke - therapy Trends United States - epidemiology |
| Title | Trends in ischemic stroke outcomes in a rural population in the United States |
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