Welcome to the WSC 2021 Interactive Program

Background and Aims

It is unclear whether treatment with lipid-lowering medications (LLMs) affects health-related quality of life (HRQoL) after stroke. We evaluated the association between 90-day use and adherence to LLMs after hospital discharge for ischaemic stroke and HRQoL.

Methods

Retrospective cohort study of 90-day survivors of ischaemic stroke admitted to hospitals in Victoria and Queensland participating in the Australian Stroke Clinical Registry (2012-2016). Use and adherence to LLMs were determined through linkage of patient-level data with the Pharmaceutical Benefits Scheme. Adherence to LLMs in the first 90 days post-discharge was calculated as the proportion of days covered (PDC: <80% vs. ≥80% [greater adherence]). The EQ-5D-3L questionnaire was administered to registrants between 90-180 days from hospital admission date to assess self-reported HRQoL overall and across five health domains. Cross-sectional associations between use/adherence and HRQoL outcomes were determined using multivariable regression models.

Results

Of 6,780 eligible registrants (median age 72 years, 42% female), 5,816 (86%) used LLMs in 90 days post-discharge, including 3,838 (66%) with PDC ≥80%. Compared to users, non-users were at significantly greater odds of reporting problems in each health domain: mobility (odds ratio 1.40), self-care (1.81), usual activities (1.26), pain/discomfort (1.19), and anxiety/depression (1.39). Non-use of LLMs was also associated with poorer overall HRQoL (-5.00, 95% CI -7.27, -2.73). Among users, having a PDC <80% was associated with reporting problems in each health domain and poorer overall HRQoL.

Conclusions

Use and greater adherence to LLMs post-discharge for ischaemic stroke is associated with better HRQoL outcomes.

Background and Aims

The EuroQol Group 5-Dimension Self-Reported Questionnaire (EQ-5D) may not cover the full range of deficits relevant to patients with ischemic stroke, such as aphasia, dysarthria, hemianopia and neglect.We aimed to quantify and compare the influence of neurological deficits on the five dimensions of the EQ-5D in patients with ischemic stroke.

Methods

We used data of the Interventional Management of Stroke (IMS) III trial. The association between neurological deficits (NIHSS sum score and individual NIHSS item scores) and each EQ-5D dimension was assessed with univariable ordinal logistic regression. The explained variance of each model was estimated with Nagelkerke’s pseudo R².

Results

In total, 525 surviving patients were included in this study. The association between the NIHSS sum score and each EQ-5D dimension was statistically significant. The NIHSS sum score explained 54.2% of the variation in mobility, 60.0% in self-care, 56.9% in usual activities, 12.6% in pain/discomfort, and 9.2% in anxiety/depression. The explained variance in pain/discomfort was 0.5% for aphasia, 2.9% for dysarthria, 6.8% for sensory loss, 5.5% for hemianopia, and 2.9% for neglect.

Conclusions

In patients with ischemic stroke, the influence of neurological deficits on the EQ-5D dimensions mobility, self-care, and usual activities is substantial, but small on the dimensions pain/discomfort and anxiety/depression. This confirms our hypothesis that it may not be clear that discomfort caused by aphasia and neglect could be included in the dimension pain/discomfort. A small change in the way this dimension is proposed to the patient, might improve health-related quality of life assessment in stroke patients.

Background and Aims

Intravenous thrombolysis substantially improves outcome in patients with acute stroke. Over time the use of rtPA has been increasing. We aim to assess whether there is an associated trend of increasing frequencies of good functional outcome in rtPA-treated patients.

Methods

We analyzed data of rtPA-treated patients during the period of 2006-2019 in the Austrian Stroke Unit Registry. Frequencies of good functional outcome, defined as modified Rankin Scale (mRS) 0-2, were assessed for the overall population and prespecified subgroups; logistic regression analysis was calculated to assess associations of baseline characteristics and outcome.

Results

In 9409 patients who were treated with rtPA between 2006 and 2019, frequencies of good functional outcome increased from 45.9% to 57.0%. Patients >70 years, patients with wake-up stroke/unknown time from symptom onset and patients without atrial fibrillation showed a more pronounced increase. We observed lower numbers of mRS 0-2 in women compared to men during the whole study period. On logistic regression analysis advancing time(OR 1.04, p<0.001) and premorbid independency(OR 6.9, p<0.001) were positively associated with good outcome whereas older age(age 61-70: OR 0.66, p<0.001, age 71-80: OR 0.4, p<0.001, age >80: OR 0.2, p<0.001), moderate-to-severe strokes(OR 0.2, p<0.001), large artery atherosclerosis(OR 0.5, p<0.001) and cardioembolic etiology(OR 0.7, p=0.006), prior stroke(OR 0.8, p=0.024), diabetes mellitus(OR 0.6, p<0.001) and atrial fibrillation(OR 0.7, p<0.001) were negatively associated.

Conclusions

Frequencies of good functional outcome in patients with acute ischemic stroke treated with rtPA have been increasing over time but some subgroups are still less likely to achieve good outcome and deserve particular attention.

Background and Aims

There is scarce clinical information about the frequency, patient profile and stroke mechanisms in patients with acute ischaemic stroke (AIS) with previously undiagnosed major vascular risk factors (UMRF).

Methods

In a retrospective analysis from the ASTRAL-registry from 2003-2018, we analysed demographic, clinical, therapeutic and prognostic variables. Univariate comparisons were performed and results of logistic regression analysis will be presented at the congress.

Results

After excluding 763 (14.9%) patients for lack of consent and 3 for missing information, we analysed 4354 patients [median age 70 years (IQR 15.2), 44.7% female]. In the 1125 (25.8%) UMRF patients, 342 (7.9%) had no UMRF, and 783 (18.0%) had at least one UMRF. The newly detected major risk factors were dyslipidaemia (61.4%), hypertension (23.7%), atrial fibrillation (10.2%), diabetes mellitus (5.2%), ejection fraction <35% (2.0%) and coronary disease (1.0%).

Patients with UMRF had significantly lower age (OR=0.9, 0.9-0.9), lower BMI (OR=0.9, 0.9-0.9), less valvular disease (OR=0.5, 0.4-0.5), renal failure (OR=0.2, 0.1-0.3), sleep apnea (OR=0.9, 0.9-1) and prestroke antiplatelet intake (OR=0.1, 0.1-0.2). They were more often smokers (OR=2.0, 1.8-2.4), contraceptive users (OR=7.7, 5.1-12.1) and more often had PFO (OR=2.6, 2.1-3.3). Regarding stroke mechanism, they had more rare (OR=2.5, 1.8-3.3) and less cardioembolic (OR=0.2, 0.2-0.3) etiologies.

Conclusions

In this large single center AIS cohort, 25.8% of patients with UMRF were newly diagnosed with it, the most common being dyslipidaemia, hypertension and atrial fibrillation. Patients with UMRF were younger and more often had rare stroke mechanisms, PFOs, contraceptive and tobacco use.