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30-year nationwide trends in incidence of atrial fibrillation in Denmark and associated 5-year risk of heart failure, stroke, and death.

https://arctichealth.org/en/permalink/ahliterature286741
Source
Int J Cardiol. 2016 Dec 15;225:30-36
Publication Type
Article
Date
Dec-15-2016
Author
Morten Schmidt
Sinna Pilgaard Ulrichsen
Lars Pedersen
Hans Erik Bøtker
Jens Cosedis Nielsen
Henrik Toft Sørensen
Source
Int J Cardiol. 2016 Dec 15;225:30-36
Date
Dec-15-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Atrial Fibrillation - epidemiology - mortality - therapy
Cohort Studies
Death
Denmark - epidemiology
Female
Follow-Up Studies
Heart Failure - epidemiology - mortality - therapy
Hospitalization - trends
Humans
Incidence
Male
Middle Aged
Population Surveillance - methods
Registries
Risk factors
Stroke - epidemiology - mortality - therapy
Time Factors
Abstract
Long-term nationwide trends in atrial fibrillation (AF) incidence and 5-year outcomes are rare.
We conducted a population-based cohort study using the Danish National Patient Registry covering all Danish hospitals. We computed standardized incidence rates during 1983-2012. We used Cox regression to estimate hazard ratios (HRs) of heart failure, stroke, and death within 5years, comparing 5-year calendar periods with the earliest period (1983-1987) as reference.
We identified 312,420 patients with first-time hospital-diagnosed AF. The incidence rate per 100,000person-years increased from 98 in 1983 to 307 in 2012. The mean annual increase during the 30-year study period was 4%, with a 6% increase annually until 2000 and a 1.4% increase annually thereafter. The incidence trends were most pronounced among men and persons above 70years. Among high-risk subgroups, AF incidence was consistently highest in patients with valvular heart disease or heart failure. The rate of heart failure following AF declined by 50% over the entire study period (HR: 0.49, 95% confidence interval (CI): 0.48-0.51) and the mortality rate declined by 40% (HR: 0.62, 95% CI: 0.61-0.63). Within the last two decades, the rate for ischemic stroke declined by 20% (HR 0.81, 95% CI: 0.78-0.84), but increased almost as much for haemorrhagic stroke (HR: 1.14, 95% CI: 1.01-1.29).
The long-term risk of heart failure, ischemic stroke, and death following onset of AF has decreased remarkably over the last three decades. Still, the threefold increased incidence of hospital-diagnosed AF during the same period is a major public health concern.
PubMed ID
27705839 View in PubMed
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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
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Differences in stroke outcome based on sex.

https://arctichealth.org/en/permalink/ahliterature145139
Source
Neurology. 2010 Mar 2;74(9):767-71
Publication Type
Article
Date
Mar-2-2010
Author
N. Shobha
P N Sylaja
M K Kapral
J. Fang
M D Hill
Author Affiliation
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, T2N 2T9, Canada.
Source
Neurology. 2010 Mar 2;74(9):767-71
Date
Mar-2-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada - epidemiology
Cohort Studies
Female
Follow-Up Studies
Humans
Male
Middle Aged
Registries
Retrospective Studies
Severity of Illness Index
Sex Factors
Stroke - epidemiology - mortality - therapy
Thrombolytic Therapy
Time Factors
Tissue Plasminogen Activator - therapeutic use
Treatment Outcome
Abstract
Stroke thrombolysis may have a differential effect by sex. We sought to examine the relationship between sex and outcome after thrombolysis.
This is a retrospective cohort study of stroke patients from the Registry of Canadian Stroke Network phase 1 (June 2001-February 2002) and phase 2 (June 2002-December 2002). Variables including demographics, history, clinical data, process measures, and outcome were analyzed. The primary outcomes were the Stroke Impact Scale-16 score (SIS-16) and mortality at 6 months. We compared the outcomes of the thrombolyzed and nonthrombolyzed cohorts and examined the data for a tissue plasminogen activator (tPA)-by-sex interaction on the 2 primary outcomes.
The overall proportion of patients who achieved an excellent outcome (SIS-16 >75) was not different by gender. However, the proportion of patients achieving an excellent outcome in the non-tPA cohort was much greater in males, with an absolute risk difference of 11.8%. A multiplicative treatment by sex interaction was evident (p = 0.054). This interaction was not present for stroke case fatality.
Women fared poorly compared to men in the placebo groups, but this negative prognostic sex effect was neutralized by thrombolysis.
Notes
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Erratum In: Neurology. 2010 Mar 23;74(12):1008
PubMed ID
20194917 View in PubMed
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Socioeconomic status and ischemic stroke: The FINMONICA Stroke Register.

https://arctichealth.org/en/permalink/ahliterature194136
Source
Stroke. 2001 Jul;32(7):1492-8
Publication Type
Article
Date
Jul-2001
Author
D. Jakovljevic
C. Sarti
J. Sivenius
J. Torppa
M. Mähönen
P. Immonen-Räihä
E. Kaarsalo
K. Alhainen
K. Kuulasmaa
J. Tuomilehto
P. Puska
V. Salomaa
Author Affiliation
KTL-National Public Health Institute, Department of Epidemiology and Health Promotion, Helsinki, Finland.
Source
Stroke. 2001 Jul;32(7):1492-8
Date
Jul-2001
Language
English
Publication Type
Article
Keywords
Adult
Aged
Brain Ischemia - epidemiology - mortality - therapy
Female
Finland - epidemiology
Humans
Incidence
Male
Middle Aged
Population Surveillance
Prognosis
Proportional Hazards Models
Registries
Social Class
Stroke - epidemiology - mortality - therapy
Survival Rate
Abstract
It has been shown that low socioeconomic status is associated with death from stroke. More-detailed data have, however, remained scanty. The purpose of the present study was to examine the association of socioeconomic status with ischemic stroke. Besides mortality, we analyzed the incidence, case-fatality ratio, and prognosis of ischemic stroke events.
Our population-based study included 6903 first stroke events registered by the FINMONICA Stroke Register in 3 areas of Finland during 1983 to 1992. Indicators of socioeconomic status, such as taxable income and education, were obtained by record linkage of the stroke register data with files of Statistics Finland.
Incidence, case-fatality ratio, and mortality rates for ischemic stroke were all inversely related to income. Furthermore, 28 days after the onset of symptoms, a greater proportion of patients with low income than of those with high income was still in institutionalized care and/or in need of help for their activities of daily living. Population-attributable risk of the incidence of first ischemic stroke due to low socioeconomic status was 36% for both sexes. For the death from first ischemic stroke, it was 56% for both sexes.
Persons with low socioeconomic status have considerable excess rates of morbidity and mortality from ischemic stroke in Finland. A reduction in this excess could markedly decrease the burden of ischemic stroke to the society and thus constitute an important public health improvement.
Notes
Comment In: Stroke. 2001 Nov;32(11):272511692047
PubMed ID
11441191 View in PubMed
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Stroke unit care revisited: who benefits the most? A cohort study of 105,043 patients in Riks-Stroke, the Swedish Stroke Register.

https://arctichealth.org/en/permalink/ahliterature89485
Source
J Neurol Neurosurg Psychiatry. 2009 Aug;80(8):881-7
Publication Type
Article
Date
Aug-2009
Author
Terént A.
Asplund K.
Farahmand B.
Henriksson K M
Norrving B.
Stegmayr B.
Wester P-O
Asberg K H
Asberg S.
Author Affiliation
Department of Medical Sciences, Uppsala University Hospital, SE-75185 Uppsala, Sweden. andreas.terent@medsci.uu.se
Source
J Neurol Neurosurg Psychiatry. 2009 Aug;80(8):881-7
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Aged
Aged, 80 and over
Brain Ischemia - complications
Cerebral Hemorrhage - complications
Cohort Studies
Consciousness
Female
Hospital Departments
Humans
Male
Middle Aged
Mortality
Proportional Hazards Models
Registries
Sex Factors
Stroke - epidemiology - mortality - therapy
Sweden - epidemiology
Treatment Outcome
Young Adult
Abstract
BACKGROUND: Treatment at stroke units is superior to treatment at other types of wards. The objective of the present study is to determine the effect size of stroke unit care in subgroups of patients with stroke. This information might be useful in a formal priority setting. METHODS: All acute strokes reported to the Swedish Stroke Register from 2001 through 2005 were followed until January 2007. The subgroups were age (18-64, 65-74, 75-84, 85+ years and above), sex (male, female), stroke subtype (intracerebral haemorrhage, cerebral infarction and unspecified stroke) and level of consciousness (conscious, reduced, unconscious). Cox proportional hazards and logistic regression analyses were used to estimate the risk for death, institutional living or dependency. RESULTS: 105,043 patients were registered at 86 hospitals. 79,689 patients (76%) were treated in stroke units and 25,354 patients (24%) in other types of wards. Stroke unit care was associated with better long-term survival in all subgroups. The best relative effect was seen among the following subgroups: age 18-64 years (hazard ratio (HR) for death 0.53; 0.49 to 0.58), intracerebral haemorrhage (HR 0.61; 0.58 to 0.65) and unconsciousness (HR 0.70; 0.66 to 0.75). Stroke unit care was also associated with reduced risk for death or institutional living after 3 months. CONCLUSIONS: Stroke unit care was associated with better long-term survival in all subgroups, but younger patients, patients with intracerebral haemorrhage and patients who were unconscious had the best relative effect and may be given the highest priority to this form of care.
PubMed ID
19332423 View in PubMed
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