Presenter of 3 Presentations
EFFECT OF THE AMOUNT OF REHABILITATION TREATMENT ON THE LONG-TERM MORTALITY OF STROKE PATIENTS WITH MILD TO MODERATE DISABILITIES: KOREAN NATIONAL HEALTH INSURANCE DATABASE STUDY
POTENTIAL ROLE OF BOLUS-TRACKING DATA OF CAROTID CT ANGIOGRAPHY FOR ATRIAL FIBRILLATION SCREENING
Abstract
Background and Aims
Atrial fibrillation (AF), a significant cause of ischemic stroke, often goes undetected because of its asymptomatic nature. This study investigated whether the total bolus-tracking time (TTT) and average slope (AS) of a bolus-tracking graph could be used to screen patients with AF.
Methods
This single-center retrospective study included patients who underwent carotid computed tomography angiography (CTA) and a 24-h Holter test. TTT and the average degree of enhancement during bolus-tracking derived from carotid CTA were defined as variables of interest. All patients underwent transthoracic echocardiography. Left ventricular diastolic dysfunction and elevated left atrial pressure (LAP) were identified according to the guidelines of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging.
Results
The final cohort comprised 716 patients, 80 of whom presented with AF. TTT of the AF group was significantly longer (23.8 ± 5.2 s) than that of the non-AF group (18.7 ± 2.8 s); P <0.001. The AS of the bolus-tracking graph of the AF group was 0.80 ± 0.24, which was significantly lower than that of the non-AF group 1.38 ± 0.21 (P <0.001). TTT was associated with a significantly higher risk of AF (odds ratio [OR]: 1.36; P <0.001) and elevated LAP (OR: 1.46; P <0.001). In contrast, the AS of the bolus-tracking graph was not significantly associated with either AF or an elevated LAP.
Conclusions
TTT derived from bolus-tracking carotid CTA is an effective adjuvant tool for screening AF related to left ventricular diastolic dysfunction and elevated LAP confirmed using echocardiography.
EFFECT OF THE AMOUNT OF REHABILITATION TREATMENT ON THE LONG-TERM MORTALITY OF STROKE PATIENTS WITH MILD TO MODERATE DISABILITIES: KOREAN NATIONAL HEALTH INSURANCE DATABASE STUDY
Abstract
Background and Aims
As stroke-related social costs have continually risen, research on survival and functional prognosis after stroke continues to be in demand. We investigated the relationship between the frequency of rehabilitation treatment and the long-term mortality of stroke patients with mild to moderate disabilities.
Methods
This is a retrospective cohort study. Our final cohort included 733 patients with first-ever stroke who were eligible for the national disability registration grades 4–6. The number of special rehabilitation treatment claim codes was a proxy for the frequency of rehabilitation treatments. We categorized the rehabilitation frequencies within 24 months from stroke onset as 1 to 50, 51 to 200, 201 to 400, and over 400 treatments. We applied the landmark method for the time-varying feature of variables. All-cause mortality was a dependent variable and was evaluated 24 to 84 months after stroke onset.
Results
A more severe disability was associated with a lower long-term mortality rate in the chronic phase (p <0.001). In the Cox regression analysis, a more severe disability, older age, male gender, and chronic kidney disease were independent risk factors for long-term mortality in stroke patients with mild to moderate disabilities. The number of acute/subacute phase rehabilitation treatments did not significantly improve long-term mortality.
Conclusions
For patients with stroke accompanied by mild to moderate disabilities, a greater amount of rehabilitation treatment was not necessarily associated with a decreased chronic phase mortality. Our results should be referred to in terms of the efficient distribution of medical resources for stroke patients.