Age in relation to comorbidity and outcome in patients with high-risk TIA or minor ischemic stroke: A Swedish national observational study

Abstract

Introduction Recent trials report positive results for preventing vascular events with dual antiplatelet therapy (DAPT) in patients with high-risk TIA or minor ischemic stroke. We aimed to investigate this population regarding influence of age on vascular risk factors, hospital stay and mortality. Patients and methods Data on patients aged 40–100 years with TIA or ischemic stroke in the Swedish Stroke Register during 2012–13 were linked with national registers. To identify patients with high-risk TIA (ABCD2 ≥6) or minor ischemic stroke (NIHSS ≤5) eligible for DAPT, we excluded patients with atrial fibrillation, anticoagulant use, prior major bleeding, or unknown stroke severity. Findings We identified 10,053 potential DAPT-candidates (mean age 72.6 years, 45.2% female, 16.4% with TIA). With advancing age, most vascular risk factors increased. Antiplatelet treatment increased from 31.9% before the event to 95.5% after discharge. Within 1 year following index event, the proportion of patients with ≥1 re-admission increased with age (29.2% in 40–64 year-olds; 47.2% in 85–100 year-olds). All-cause death per 100 person-years was 6.9 (95% CI 6.4–7.4) within 1 year, and highest in the first 30 days (15.2; 95% CI 12.8–18.2). For each year of increased age, the risk of death increased with 3.5% (p = 0.128) in patients 40–64 years and with 11.8% (p < 0.001) in those ≥85 years. Conclusions While in theory representing a subset of patients with mild injury, our observational study highlights substantial use of health-care resources and high mortality rates among patients with high-risk TIA or minor ischemic stroke assumed eligible for DAPT.

Cost-effectiveness of ticagrelor plus aspirin versus aspirin in acute ischaemic stroke or transient ischaemic attack: an economic evaluation of the THALES trial

“…Ticagrelor plus aspirin was dominant in the majority of scenario analyses tested (online supplemental table 7). 18 19 26 28 Ticagrelor plus aspirin remained dominant over 1-year and 10-year time frames, at variable discount rates, and from a payer perspective.…”

“…Time-dependent transition probabilities were then facilitated using tunnel states (months 0–1, 1–2, 2–3, 3–4 and 4+) for the NDS and DS health states, that is, when a patient enters either the NDS or DS health state, they move along these tunnel health states over time. In the early time points of the tunnel states (ie, months 0–1), patients have greater risk of another stroke, lower utilities and higher costs 18. Patients in the NDS state could move to the DS state or remain in the NDS state, but once a patient was in the DS state, they remained in that state, irrespective of whether the subsequent stroke was an NDS or DS (see online supplemental table 1).…”

“…In the early time points of the tunnel states (ie, months 0–1), patients have greater risk of another stroke, lower utilities and higher costs. 18 Patients in the NDS state could move to the DS state or remain in the NDS state, but once a patient was in the DS state, they remained in that state, irrespective of whether the subsequent stroke was an NDS or DS (see online supplemental table 1 ).…”