Skip header and navigation

Refine By

34 records – page 1 of 4.

Age disparities in stroke quality of care and delivery of health services.

https://arctichealth.org/en/permalink/ahliterature149008
Source
Stroke. 2009 Oct;40(10):3328-35
Publication Type
Article
Date
Oct-2009
Author
Gustavo Saposnik
Sandra E Black
Antoine Hakim
Jiming Fang
Jack V Tu
Moira K Kapral
Author Affiliation
Stroke Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. saposnikg@smh.toronto.on.ca
Source
Stroke. 2009 Oct;40(10):3328-35
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Aging - physiology - psychology
Atrial Fibrillation - drug therapy - prevention & control
Cohort Studies
Cost of Illness
Deglutition Disorders - diagnosis - prevention & control - therapy
Emergency Medical Services - standards - statistics & numerical data - trends
Female
Health Policy
Health Services - economics
Hospital Units - standards - statistics & numerical data - trends
Hospitalization - economics
Humans
Longevity
Male
Middle Aged
Mortality - trends
Ontario
Outcome Assessment (Health Care) - economics
Patient Discharge - economics
Pneumonia - epidemiology
Prospective Studies
Quality of Health Care - statistics & numerical data - trends
Quality of Life
Severity of Illness Index
Stroke - complications - mortality - therapy
Thrombolytic Therapy - statistics & numerical data - trends
Warfarin - therapeutic use
Abstract
Limited information is available on the effect of age on stroke management and care delivery. Our aim was to determine whether access to stroke care, delivery of health services, and clinical outcomes after stroke are affected by age.
This was a prospective cohort study of patients with acute ischemic stroke in the province of Ontario, Canada, admitted to stroke centers participating in the Registry of the Canadian Stroke Network between July 1, 2003 and March 31, 2005. Primary outcomes were the following selected indicators of quality stroke care: (1) use of thrombolysis; (2) dysphagia screening; (3) admission to a stroke unit; (4) carotid imaging; (5) antithrombotic therapy; and (6) warfarin for atrial fibrillation at discharge. Secondary outcomes were risk-adjusted stroke fatality, discharge disposition, pneumonia, and length of hospital stay.
Among 3631 patients with ischemic stroke, 1219 (33.6%) were older than 80 years. There were no significant differences in stroke care delivery by age group. Stroke fatality increased with age, with a 30-day risk adjusted fatality of 7.1%, 6.5%, 8.8%, and 14.8% for those aged 59 or younger, 60 to 69, 70 to 79, and 80 years or older, respectively. Those aged older than 80 years had a longer length of hospitalization, increased risk of pneumonia, and higher disability at discharge compared to those younger than 80. This group was also less likely to be discharged home.
In the context of a province-wide coordinated stroke care system, stroke care delivery was similar across all age groups with the exception of slightly lower rates of investigations in the very elderly. Increasing age was associated with stroke severity and stroke case-fatality.
PubMed ID
19696418 View in PubMed
Less detail

Applying the evidence: do patients with stroke, coronary artery disease, or both achieve similar treatment goals?

https://arctichealth.org/en/permalink/ahliterature152667
Source
Stroke. 2009 Apr;40(4):1417-24
Publication Type
Article
Date
Apr-2009
Author
Gustavo Saposnik
Shaun G Goodman
Lawrence A Leiter
Raymond T Yan
David H Fitchett
Neville H Bayer
Amparo Casanova
Anatoly Langer
Andrew T Yan
Author Affiliation
Division of Cardiology, Canadian Heart Research Centre and Terrence Donnelly Heart Centre, University of Toronto, Canada. saposnikg@smh.toronto.on.ca
Source
Stroke. 2009 Apr;40(4):1417-24
Date
Apr-2009
Language
English
Publication Type
Article
Keywords
Aged
Antihypertensive Agents - therapeutic use
Blood pressure
Canada - epidemiology
Coronary Artery Disease - drug therapy - epidemiology
Evidence-Based Medicine
Female
Fibrinolytic Agents - therapeutic use
Guideline Adherence
Humans
Hypolipidemic Agents - therapeutic use
Lipids - blood
Male
Middle Aged
Multivariate Analysis
Outpatients - statistics & numerical data
Prospective Studies
Registries
Risk factors
Sex Distribution
Stroke - drug therapy - epidemiology
Treatment Outcome
Abstract
The importance of early and aggressive initiation of secondary prevention strategies for patients with both coronary artery disease (CAD) and cerebrovascular disease (CVD) is emphasized by multiple guidelines. However, limited information is available on cardiovascular protection and stroke prevention in an outpatient setting from community-based populations. We sought to evaluate and compare differences in treatment patterns and the attainment of current guideline-recommended targets in unselected high-risk ambulatory patients with CAD, CVD, or both.
This multicenter, prospective, cohort study was conducted from December 2001 to December 2004 among ambulatory patients in a primary care setting. The prospective Vascular Protection and Guidelines-Oriented Approach to Lipid-Lowering Registries recruited 4933 outpatients with established CAD, CVD, or both. All patients had a complete fasting lipid profile measured within 6 months before enrollment. The primary outcome measure was the achievement of blood pressure (BP)
PubMed ID
19213947 View in PubMed
Less detail

Association between weekend hospital presentation and stroke fatality.

https://arctichealth.org/en/permalink/ahliterature139618
Source
Neurology. 2010 Nov 2;75(18):1589-96
Publication Type
Article
Date
Nov-2-2010
Author
Jiming Fang
Gustavo Saposnik
Frank L Silver
Moira K Kapral
Author Affiliation
Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, Canada.
Source
Neurology. 2010 Nov 2;75(18):1589-96
Date
Nov-2-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada - epidemiology
Cohort Studies
Female
Holidays
Hospital Mortality
Humans
Male
Middle Aged
Outcome Assessment (Health Care) - statistics & numerical data
Patient Admission - statistics & numerical data
Personnel Staffing and Scheduling
Stroke - epidemiology - mortality - therapy
Time Factors
Abstract
Previous studies have found higher stroke case fatality in patients admitted to the hospital on weekends compared to weekdays, but the reasons for this association are not known.
This was a cohort study using data from the Registry of the Canadian Stroke Network. We included consecutive patients with acute stroke or TIA seen in the emergency department or admitted to the hospital at 11 stroke centers in Ontario, Canada, between July 1, 2003, and March 30, 2008 (n = 20,657). We compared in-hospital stroke care and 7-day all-cause stroke case fatality rates between patients seen on weekends and weekdays, with adjustment for stroke severity and other baseline factors.
Overall rates of hospital presentation were lower on weekends compared to weekdays, with lower rates of weekend presentation among individuals with minor stroke and TIA compared to those with more severe strokes. Stroke care, including admission to a stroke unit, neuroimaging, and dysphagia screening, was similar in those treated on weekends and weekdays. All-cause 7-day fatality rates were higher in patients seen on weekends compared to weekdays (8.1% vs 7.0%), even after adjustment for age, sex, stroke severity, and comorbid conditions (adjusted hazard ratio 1.12, 95% confidence interval 1.00 to 1.25).
Stroke fatality is higher with weekend compared to weekday admission, even after adjustment for case mix.
Notes
Comment In: Neurology. 2011 Aug 16;77(7):700-1; author reply 70121844529
PubMed ID
21041782 View in PubMed
Less detail

Atrial fibrillation in ischemic stroke: predicting response to thrombolysis and clinical outcomes.

https://arctichealth.org/en/permalink/ahliterature118791
Source
Stroke. 2013 Jan;44(1):99-104
Publication Type
Article
Date
Jan-2013
Author
Gustavo Saposnik
David Gladstone
Roula Raptis
Limei Zhou
Robert G Hart
Author Affiliation
MSc, FAHA, FRCPC, Stroke Outcomes Research Center, Department of Medicine, St. Michael's Hospital, University of Toronto, 55 Queen St E, Toronto, Ontario, M5C 1R6, Canada. saposnikg@smh.ca
Source
Stroke. 2013 Jan;44(1):99-104
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Atrial Fibrillation - diagnosis - epidemiology - therapy
Brain Ischemia - diagnosis - epidemiology - therapy
Canada - epidemiology
Female
Humans
Male
Middle Aged
Predictive value of tests
Registries
Stroke - diagnosis - epidemiology - therapy
Thrombolytic Therapy - trends
Treatment Outcome
Abstract
Atrial fibrillation (AF) increases the risk of stroke and is associated with poor stroke outcomes. Limited tools are available to evaluate clinical outcomes and response to thrombolysis in stroke patients with AF.
We applied the iScore (http://www.sorcan.ca/iscore), a validated risk score, to consecutive patients with an acute ischemic stroke admitted to stroke centers in the Registry of the Canadian Stroke Network. The main outcome considered was a favorable outcome (defined as a modified Rankin scale 0-2) at discharge after thrombolysis. Secondary outcomes included intracerebral hemorrhage, death at 30 days, and at 1 year stratified by terciles of the iScore.
Among 12 686 patients with an acute ischemic stroke, 2185 (17.2%) had AF. Overall, AF patients had higher risk of death at 30 days (22.3% versus 10.2%; P
PubMed ID
23168456 View in PubMed
Less detail

The Canadian Neurological Scale and the NIHSS: development and validation of a simple conversion model.

https://arctichealth.org/en/permalink/ahliterature143286
Source
Cerebrovasc Dis. 2010;30(2):120-6
Publication Type
Article
Date
2010
Author
Yongchai Nilanont
Chulaluk Komoltri
Gustavo Saposnik
Robert Côté
Silvia Di Legge
Yaping Jin
Naraporn Prayoonwiwat
Niphon Poungvarin
Vladimir Hachinski
Author Affiliation
Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. siysl@mahidol.ac.th
Source
Cerebrovasc Dis. 2010;30(2):120-6
Date
2010
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Aged
Aged, 80 and over
Chi-Square Distribution
Female
Health Status Indicators
Humans
Linear Models
Male
Middle Aged
Models, Statistical
National Institutes of Health (U.S.)
Observer Variation
Ontario
Predictive value of tests
Prospective Studies
Reproducibility of Results
Retrospective Studies
Severity of Illness Index
Stroke - diagnosis - physiopathology - psychology
Thailand
United States
Young Adult
Abstract
The Canadian Neurological Scale (CNS) and the National Institutes of Health Stroke Scale (NIHSS) are among the most reliable stroke severity assessment scales. The CNS requires less extensive neurological evaluation and is quicker and simpler to administer.
Our aim was to develop and validate a simple conversion model from the CNS to the NIHSS.
A conversion model was developed using data from a consecutive series of acute-stroke patients who were scored using both scales. The model was then validated in an external dataset in which all patients were prospectively assessed for stroke severity using both scales by different observers which consisted of neurology residents or stroke fellows.
In all, 168 patients were included in the model development, with a median age of 73 years (20-94). Men constituted 51.8%. The median NIHSS score was 6 (0-31). The median CNS score was 8.5 (1.5-11.5). The relationship between CNS and NIHSS could be expressed as the formula: NIHSS = 23 - 2 x CNS. A cohort of 350 acute-stroke patients with similar characteristics was used for model validation. There was a highly significant positive correlation between the observed and predicted NIHSS score (r = 0.87, p
PubMed ID
20501997 View in PubMed
Less detail

Detection and treatment of post stroke depression: results from the registry of the Canadian stroke network.

https://arctichealth.org/en/permalink/ahliterature136628
Source
Int J Geriatr Psychiatry. 2011 Nov;26(11):1195-200
Publication Type
Article
Date
Nov-2011
Author
Nathan Herrmann
Dallas Seitz
Hadas Fischer
Gustavo Saposnik
Andrew Calzavara
Geoff Anderson
Paula Rochon
Author Affiliation
Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. n.herrmann@utoronto.ca
Source
Int J Geriatr Psychiatry. 2011 Nov;26(11):1195-200
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Analysis of Variance
Antidepressive Agents - therapeutic use
Canada - epidemiology
Depressive Disorder - diagnosis - drug therapy - epidemiology - etiology
Disability Evaluation
Female
Humans
Length of Stay
Male
Mass Screening - statistics & numerical data
Prevalence
Prospective Studies
Risk factors
Severity of Illness Index
Stroke - psychology
Abstract
Depression occurs in approximately one-third of patients following stroke based on studies that screen entire stroke populations. Less is known about the detection and treatment of post stroke depression (PSD) in routine clinical practice.
This was a prospective cohort study of 7643 consecutive stroke patients >66 years of age, from 13 designated stroke centres in Ontario, Canada. PSD was defined as (a) presence of strong evidence of depression documented in the patient chart plus a prescribed antidepressant and a psychiatric consult, or (b) prescription of a new antidepressant following admission. The prevalence of PSD was determined and patients with and without PSD were compared on a variety of measures. Patients admitted to specialized stroke units were compared to patients admitted to standard units in order to determine if PSD detection and treatment rates differed.
PSD was diagnosed in 4.8%, and 6.7% were treated with a new antidepressant. Patients with PSD had more severe strokes, more functional handicap, longer hospital stays and were less likely to be discharged home (all p?
PubMed ID
21360753 View in PubMed
Less detail

Disparities in management patterns and outcomes of patients with non-ST-elevation acute coronary syndrome with and without a history of cerebrovascular disease.

https://arctichealth.org/en/permalink/ahliterature144314
Source
Am J Cardiol. 2010 Apr 15;105(8):1083-9
Publication Type
Article
Date
Apr-15-2010
Author
Tony C Lee
Shaun G Goodman
Raymond T Yan
Francois R Grondin
Robert C Welsh
Barry Rose
Gabor Gyenes
Rodney H Zimmerman
Real Brossoit
Gustavo Saposnik
John J Graham
Andrew T Yan
Author Affiliation
Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Source
Am J Cardiol. 2010 Apr 15;105(8):1083-9
Date
Apr-15-2010
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - diagnosis - epidemiology - therapy
Aged
Aged, 80 and over
Canada - epidemiology
Cerebrovascular Disorders - complications - epidemiology
Coronary Angiography
Diagnosis, Differential
Early Diagnosis
Electrocardiography
Female
Follow-Up Studies
Healthcare Disparities - statistics & numerical data
Humans
Male
Middle Aged
Morbidity - trends
Myocardial Revascularization
Prospective Studies
Registries
Risk factors
Survival Rate - trends
Thrombolytic Therapy
Time Factors
Treatment Outcome
Abstract
Cerebrovascular (CVD) disease is commonly associated with coronary artery disease and adversely affects outcome. The goal of the present study was to examine the temporal management patterns and outcomes in relation to previous CVD in a contemporary "real-world" spectrum of patients with acute coronary syndrome (ACS). From 1999 to 2008, 14,070 patients with non-ST-segment elevation ACS were recruited into the Canadian Acute Coronary Syndrome I (ACS I), ACS II, Global Registry of Acute Coronary Events (GRACE/GRACE(2)), and Canadian Registry of Acute Coronary Events (CANRACE) prospective multicenter registries. We stratified the study patients according to a history of CVD and compared their treatment and outcomes. Patients with a history of CVD were older, more likely to have pre-existing coronary artery disease, elevated creatinine, higher Killip class, and ST-segment deviation on admission. Despite presenting with greater GRACE risk scores (137 vs 117, p
PubMed ID
20381657 View in PubMed
Less detail

Do all age groups benefit from organized inpatient stroke care?

https://arctichealth.org/en/permalink/ahliterature149394
Source
Stroke. 2009 Oct;40(10):3321-7
Publication Type
Article
Date
Oct-2009
Author
Gustavo Saposnik
Moira K Kapral
Shelagh B Coutts
Jiming Fang
Andrew M Demchuk
Michael D Hill
Author Affiliation
Stroke Research Unit, Division of Neurology, Department of Medicine, Stroke Outcome Research Canada, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. saposnikg@smh.toronto.on.ca
Source
Stroke. 2009 Oct;40(10):3321-7
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Age Distribution
Age Factors
Aged
Aged, 80 and over
Brain Ischemia - mortality - nursing - rehabilitation
Canada
Case-Control Studies
Cohort Studies
Cost of Illness
Emergency medical services
Female
Hospital Units - statistics & numerical data - trends
Humans
Inpatients - statistics & numerical data
Institutionalization
Length of Stay
Male
Middle Aged
National Health Programs
Outcome Assessment (Health Care)
Patient Care Team - statistics & numerical data - trends
Quality of Health Care - statistics & numerical data - trends
Risk Reduction Behavior
Stroke - mortality - nursing - therapy
Survival Rate
Treatment Outcome
Abstract
Organized inpatient stroke care consists of a multidisciplinary approach aimed at improving stroke outcomes. It is unclear whether elderly individuals benefit from these interventions to the same extent as younger patients. We sought to determine whether the reduction in mortality or institutionalization seen with organized stroke care was similar across all age groups.
This was a case-cohort study of patients with acute ischemic stroke seen between July 2003 and March 2005 and captured in the Registry of the Canadian Stroke Network. After stratifying by age category, we assessed for evidence of effect modification by age on the reduction in stroke fatality associated with stroke unit/organized care.
Among 3631 patients with ischemic stroke, stroke case-fatality at 30 days was lower for patients admitted to a stroke unit compared with those admitted to general medical wards (10.2% versus 14.8%; P80 years). Increasing levels of organized care were associated with lower stroke fatality or institutionalization. The beneficial effect of stroke units/organized care on survival was seen even after adjustment for multiple prognostic factors and after excluding patients on palliative approach. There was no evidence of effect modification by age in any analyses.
Stroke units and organized inpatient care reduce death or institutionalization with the same magnitude of effect across all age groups.
PubMed ID
19644068 View in PubMed
Less detail

Does a birthday predispose to vascular events?

https://arctichealth.org/en/permalink/ahliterature169140
Source
Neurology. 2006 Jul 25;67(2):300-4
Publication Type
Article
Date
Jul-25-2006
Author
Gustavo Saposnik
Akerke Baibergenova
Jason Dang
Vladimir Hachinski
Author Affiliation
Stroke Team, Department of Clinical Neurological Sciences, London Health Sciences Center, University of Western Ontario, Ontario, Canada. gsaposni@uwo.ca
Source
Neurology. 2006 Jul 25;67(2):300-4
Date
Jul-25-2006
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Birth Certificates
Causality
Comorbidity
Female
Heart Failure - epidemiology
Hospitalization - statistics & numerical data
Humans
Incidence
Ischemic Attack, Transient - epidemiology
Male
Middle Aged
Myocardial Infarction - epidemiology
Ontario - epidemiology
Risk Assessment - methods
Stress, Psychological - epidemiology
Stroke - epidemiology
Abstract
To examine the influence of birthdays on the onset and course of vascular events such as stroke, TIA, and acute myocardial infarction (AMI).
This population-based study included all emergency department (ED) admissions due to ischemic stroke, TIA, or AMI from April 2002 to March 2004 in Ontario, Canada. All cases were identified through the National Ambulatory Care Reporting System. Calculations of daily and weekly numbers of events were centered on the patient's birthday and the week of the birthday. Statistical analyses include binomial tests and logistic regression.
During the study period, there were 24,315 ED admissions with acute stroke, 16,088 with TIAs, and 29,090 with AMI. The observed number of vascular events during the birthday was higher than the expected daily number of visits for stroke (87 vs 67; p = 0.009), TIA (58 vs 44; p = 0.02), and AMI (97 vs 80; p = 0.027) but not for selected control conditions (asthma, appendicitis, head trauma). Vascular events were more likely to occur on birthday (242 vs 191; odds ratio [OR] = 1.27). No significant differences were observed during the birthday week for any of the conditions. Multivariate logistic regression showed that birthday vascular events were more likely to occur in patients with a history of hypertension (OR = 1.88; 95% CI 1.09 to 3.24). Sensitivity analyses with alternative definitions of birthday week did not alter the results.
Stress associated with birthdays may trigger vascular events in patients with predisposing conditions.
Notes
Comment In: Neurology. 2006 Jul 25;67(2):E3-416864804
PubMed ID
16728650 View in PubMed
Less detail

Effect of socioeconomic status on inpatient mortality and use of postacute care after subarachnoid hemorrhage.

https://arctichealth.org/en/permalink/ahliterature108360
Source
Stroke. 2013 Oct;44(10):2842-7
Publication Type
Article
Date
Oct-2013
Author
Blessing N R Jaja
Gustavo Saposnik
Rosane Nisenbaum
Tom A Schweizer
Deven Reddy
Kelvin E Thorpe
R Loch Macdonald
Author Affiliation
From the Keenan Research Centre, Li Ka Shing Knowledge Institute (B.N.R.J., G.S., R.N., T.A.S., K.E.T., R.L.M.), Division of Neurology (G.S.), Division of Neurosurgery (B.N.R.J., T.A.S., R.L.M.), St. Michael's Hospital, Toronto, ON, Canada; Institute of Medical Science (B.N.R.J., G.S., T.A.S., R.L.M.), Dalla Lana School of Public Health (R.N., K.E.T.), University of Toronto, Toronto, ON, Canada; and Division of Neurosurgery (D.R.), McMaster University, Hamilton, ON, Canada.
Source
Stroke. 2013 Oct;44(10):2842-7
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada - epidemiology
Databases, Factual
Female
Humans
Inpatients
Male
Middle Aged
Risk factors
Socioeconomic Factors
Subarachnoid Hemorrhage - mortality - therapy
United States - epidemiology
Abstract
Studies in the United States and Canada have demonstrated socioeconomic gradients in outcomes of acute life-threatening cardiovascular and cerebrovascular diseases. The extent to which these findings are applicable to subarachnoid hemorrhage is uncertain. This study investigated socioeconomic status-related differences in risk of inpatient mortality and use of institutional postacute care after subarachnoid hemorrhage in the United States and Canada.
Subarachnoid hemorrhage patient records in the US Nationwide Inpatient Sample database (2005-2010) and the Canadian Discharge Abstract Database (2004-2010) were analyzed separately, and summative results were compared. Both databases are nationally representative and contain relevant sociodemographic, diagnostic, procedural, and administrative information. We determined socioeconomic status on the basis of estimated median household income of residents for patient's ZIP or postal code. Multinomial logistic regression models were fitted with adjustment for relevant confounding covariates.
The cohort consisted of 31,631 US patients and 16,531 Canadian patients. Mean age (58 years) and crude inpatient mortality rates (22%) were similar in both countries. A significant income-mortality association was observed among US patients (odds ratio, 0.77; 95% CI, 0.65-0.93), which was absent among Canadian patients (odds ratio, 0.97; 95% CI, 0.85-1.12). Neighborhood income status was not significantly associated with use of postacute care in the 2 countries.
Socioeconomic status is associated with subarachnoid hemorrhage inpatient mortality risk in the United States, but not in Canada, although it does not influence the pattern of use of institutional care among survivors in both countries.
PubMed ID
23899917 View in PubMed
Less detail

34 records – page 1 of 4.