Welcome to the WSC 2021 Interactive Program

Background and Aims

Initiatives at non-urban hospitals in New Zealand have improved access to reperfusion therapies for patients with stroke. We aimed to investigate if any additional costs are offset by improved outcomes and costs savings after discharge.

Methods

REGIONS Care involved consecutive patients admitted with stroke to all 28 acute stroke hospitals in New Zealand (12 urban) between May and October 2018. Costs from a societal perspective at 12 months after stroke were estimated using standardised data collected on the hospital stay and a follow-up survey. Estimated costs were assigned to the initial hospital patients presented to. Quality adjusted life years (QALYs) were estimated using outcomes at discharge from hospital, vital status and responses to the EuroQol-5D questionnaire at 12 months follow-up. Multiple imputation and multivariable regression analyses were used to assess differences between groups.

Results

There were 946 patients from non-urban and 1419 from urban hospitals. Costs of acute care for patients presenting to urban hospitals were $1786 greater on average than those presenting to non-urban hospitals (p<0.001). Estimated costs until 12 months were no different between groups (urban $26137 vs non-urban $25067, p=0.396). The average QALYs per person was greater in the urban cohort than the non-urban cohort (0.58 vs 0.53, p=0.001).

Conclusions

Despite greater costs of acute care, patients who presented to urban hospitals had similar costs at 12 months compared to non-urban counterparts. Further research is required to investigate if additional funding to non-urban hospitals can reduce downstream costs and improve outcomes.

Background and Aims

Ischemic stroke with large vessel occlusion can be treated with intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). The efficacy of both treatments is highly time dependent. The aim of this study is to identify barriers for timely EVT delivery and to study the effects of hypothetical workflow improvements in the acute stroke pathway.

Methods

Data from 248 patients in the MR CLEAN registry, treated with EVT in the north of the Netherlands between July 2014 and November 2017. Eighty-three patients arrived directly at the comprehensive stroke centre (CSC), and 165 patients were transferred from primary stroke centres (PSCs) to the CSC. Two simulation models for a ‘mothership’- and a ‘drip-and-ship’ set-up were developed and diagnostic steps and time delays were collected for each patient. The main outcome measures were total delay from stroke onset until the start of EVT and functional independence at 90 days (modified Rankin Scale 0-2).

Results

Barriers identified included fast-track emergency department routing, pre-alert for transfer to the CSC, reduced handover time between PSC and ambulance, direct transfer from CSC arrival to angiography suite entry and reducing time to groin puncture. Taken together the hypothetical workflow improvements could reduce onset to groin time by approximately 1 hour. An additional 7.2% (‘drip-and-ship’) and 8.6% (‘mothership’) of patients might regain functional independence after 90 days.

Conclusions

Simulation modelling is a useful tool to assess the potential effects of interventions reducing the onset to EVT time.

Background and Aims

Determining the subtypes and the mechanism of the development of acute ischemic stroke (AIS) is important for choosing the tactics of secondary prevention of stroke in young adults. A research aim was to study the structure of AIS in a group of young adults under 45 years old based on data from the Moscow Hospital Stroke Register (MHSR).

Methods

The MHSR has been held since 2017, it includes all patients with acute cerebrovascular diseases hospitalised in stroke units. This retrospective analysis included data from patients aged 18 to 45 years of the MHSR from 28 stroke units in Moscow for the period from 2017 to 2019. Based on clinical, instrumental and laboratory data, subtypes of AIS were determined according to the TOAST criteria.

Results

A total of 85514 cases of AIS were registered with the proportion of young strokes was 3.8% (3243 cases). After excluding incomplete data, 2878 cases (male 62,3%, median age 38,6) were included in the final analysis. The most frequent subtype of AIS was stroke of undetermined etiology (1398 cases, 48,6%), followed by large-artery atherosclerosis (681 cases, 23,7%), small-vessel occlusion (512 cases, 17,8%), cardioembolism (223 cases, 7,7%). Stroke of other determined etiology accounted for 64 cases, 2,2% (Picture).

Conclusions

In the first large-scale Russian registry study of AIS, we researched the representation of different subtypes of AIS in young adults, to be used in choosing the strategy of secondary stroke prevention.

Background and Aims

Informal stroke caregiving has been shown to place caregivers at a risk of high caregiver strain, however, there is a paucity of such data in Singaporean stroke caregivers. This study aimed to investigate the level of strain, competence and satisfaction of informal stroke caregivers in Singapore.

Methods

A series of questionnaires were conducted online between July 2020 to February 2021. 56 informal stroke caregivers (mean age(SD) 52.3(14.2) years, 37 males) were recruited and completed the study. Measures of strain, competence, and burden were assessed by three instruments: Caregiver Strain Index (CSI), Sense of Competence Questionnaire (SCQ) and Caregiver Reaction Assessment (CRA).

Results

Less than half the stroke caregivers were children (48.2%, n=27) and spouses (32.1%, n=18) of the stroke survivors. Most stroke caregivers were sole (80.4%, n=45), first-time caregivers (89.3%, n=50) and had never received caregiving training (69.9%, n=39). Stroke caregivers reported a mean of 7.6 hours/day and 6.1 days/week over 35.9±16.9 months undertaking caregiving duties. Caregiving satisfaction was high with a mean score of 82.9±16.7 on the SCQ despite high caregiving stress (i.e.>7) with a mean score of 8.2±3.7 on the CSI. Caregiving competence was positively correlated with satisfaction in caregivers (p<0.01, r²=0.64).

Conclusions

This study evidenced that informal stroke caregiving required extensive amounts of time, had a high level of strain, and resulted in high satisfaction. There is a need to improve training and support for informal stroke caregivers in Singapore. Improving caregiving competence of informal stroke caregivers may increase their satisfaction or negate negative aspects of caregiving.

Background and Aims

The 30-day hospital re-admission rate is an outcome of growing attention due to its use as a metric of quality of care as well as its association with increased healthcare expenditures.

Patients with Acute Stroke (AS) are at high risk of hospital re-admission that is often associated with increased mortality rate, greater levels of disability and higher costs as compared with the initial stroke events.

The aim of our study was to assess the validity of a predictive model of unplanned 30-day hospital re-admissions and elaborate a 30-day re-admission risk score for patients with AS.

Methods

We conducted a retrospective study on adult patients with AS who were admitted to Fondazione Policlinico Universitario A. Gemelli and discharged alive between January 1st, 2014 and December 31th, 2019. Data collection included demographic features, clinical and laboratory parameters, diagnostic and invasive procedures as well as discharge and re-admission data.

Results

Of the 7599 screened patients with AS, 4561 patients met the inclusion criteria. Of these patients, 361 patients (7.91%) were readmitted within 30 days from discharge. After the identification of 7 predicting early readmission variables by machine learning model, the risk score was calculated (Figure 1A). Based on this risk score, our patients were stratified in low, medium and high risk groups (Figure 1B).

Conclusions

The identification of risk factors that contribute to early hospital re-admission after AS and the stratification of AS patients at discharge can provide clinicians with a useful tool to plan a personalized follow-up.