Characteristics, Treatment and Outcome of Ischemic Stroke with Atrial Fibrillation in a Chinese Hospital-Based Stroke Study

Lin, Sen; Wu, Bo; Zeng, Hao; Kong, Fanyi; Tao, Wendan; Wang, Deren; He, Sha; Liu, Ming

doi:10.1159/000323221

Cited by 69 publications

(82 citation statements)

References 47 publications

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“…18 Variation across hospitals in the Netherlands (29%-78%) was similar to our study. At a patient level, reports of functional dependence at 3 months poststroke hospital discharge in our study were similar to cohort studies from China, 19,20 Spain, 21 and Japan. 22 Importantly, these findings of dependence post-stroke in the United States and abroad demonstrate the high level of stroke morbidity and the need for continued efforts targeting functional recovery.…”

Section: Discussionsupporting

confidence: 87%

Hospital Variation in Functional Recovery After Stroke

Bettger

Thomas

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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Background-Functional status is a key patient-centric outcome, but there are little data on whether functional recovery post-stroke varies among hospitals. This study examined the distribution of functional status 3 months after stroke, determined whether these outcomes vary among hospitals, and identified hospital characteristics associated with better (or worse) functional outcomes. Methods and Results-Observational analysis of the AVAIL study (Adherence Evaluation After Ischemic StrokeLongitudinal) included 2083 ischemic stroke patients enrolled from 82 US hospitals participating in Get With The Guidelines-Stroke and AVAIL. The primary outcome was dependence or death at 3 months (modified Rankin Scale [mRS] score of 3-6). Secondary outcomes included functional dependence (mRS score of 3-5), disabled (mRS score of 2-5), and mRS evaluated as a continuous score. By 3 months post-discharge, 36.5% of patients were functionally dependent or dead. Rates of dependence or death varied widely by discharging hospitals (range: 0%-67%). After risk adjustment, patients had lower rates of 3-month dependence or death when treated at teaching hospitals (odds ratio, 0.72; 95% confidence interval, 0.54-0.96) and certified primary stroke centers (odds ratio, 0.69; 95% confidence interval, 0.53-0.91). In contrast, a composite measure of hospital-level adherence to acute stroke care performance metrics, stroke volume, and bed size was not associated with downstream patient functional status. Findings were robust across mRS end points and sensitivity analyses. Conclusions-One third of acute ischemic stroke patients were functionally dependent or dead 3 months postacute stroke; functional recovery rates varied considerably among hospitals, supporting the need to better determine which care processes can maximize functional outcomes. (Circ Cardiovasc Qual Outcomes.

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Section: Discussionsupporting

confidence: 87%

Hospital Variation in Functional Recovery After Stroke

Bettger

Thomas

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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“…13,17,18 The previous population-based investigation for prevalence of RHD in China supported our results, which found 6 of 15 cases were underdiagnosed. 8 One possible explanation is that improvement in health care resulted in these subjects having their rheumatic fever treated earlier, which could have resulted in silent and/or less severe symptoms during the chronic phase 8 and, moreover, these patients were reluctant to receive echocardiography because of poverty.…”

Section: Discussionsupporting

confidence: 88%

“…12 Atrial fibrillation (AF) was defined as a history of persistent AF or paroxysmal AF, supported by past ECG or diagnosed by the attending physicians based on ECG and/or 24-hour ECG monitoring during admission. 13 Other vascular risk factors surveyed in this study included hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease, previous transient ischemic attacks, history of stroke, and current smoking and alcohol consumption, which have been described in previous reports. 10,11 Stroke severity on admission was measured using the National Institutes of Health Stroke scale (NIHSS).…”

Section: Definition Of Collected Data and Outcomementioning

confidence: 87%

Features of Acute Ischemic Stroke With Rheumatic Heart Disease in a Hospitalized Chinese Population

Wang

Liu

Zeng

et al. 2012

Stroke

Self Cite

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Background and Purpose-Rheumatic heart disease (RHD) is an important risk factor for ischemic stroke in developing countries. Observational data on its characteristics and influence on outcome or recurrence of ischemic stroke are scarce. We aimed to investigate proportions, characteristics, functional outcome, and recurrence of acute ischemic stroke patients with RHD in a hospitalized Chinese population. Methods-We prospectively enrolled consecutive patients with acute ischemic stroke who were admitted within 1 month of stroke onset from January 2003 to February 2007, into the analysis. Clinical characteristics such as age, gender, risk factors, and National Institutes of Health Stroke Scale on admission were investigated. Basic characteristics, functional outcomes, and recurrence were compared between RHD group and non-RHD group. Results-Of the 1638 cases included, RHD was present in 130 patients (7.9%). RHD patients, compared with those without RHD, were younger, more frequently female, and more often had experienced atrial fibrillation and higher National Institutes of Health Stroke Scale score on admission (all P≤0.006). After adjustment for age, sex, and National Institutes of Health Stroke Scale on admission, the death risk in patients with RHD was 2.0-fold higher at 3 months, 6 months, and 1 year compared with patients without RHD (all P≤0.013). Compared with patients without RHD, those with RHD showed a significantly higher cumulative recurrence rate (13.6% vs 6.0%; P=0.001, log rank test) by 1-year cumulative recurrent curves. Conclusions-Stroke attributable to RHD is still common in the Chinese population. RHD was associated with 2-fold increased risk of death and 1-fold increased risk of recurrence in stroke patients. (Stroke. 2012;43:2853-2857.)

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“…Older patients, heavy alcohol drinkers, and patients with higher National Institutes of Health Stroke Scale score on admission were independently associated with less frequent use of warfarin, whereas patients with history of heart failure and an INR between 2.0 and 3.0 during hospitalization were significantly associated with warfarin use at discharge. When compared with the previous studies from China that launched before 2010 8,21 (in which anticoagulants use in hospitalized AF patients were 11% and 14.2%, respectively), the rate of warfarin use was not increased substantially. In contrast, anticoagulation use among eligible AF patients improved from 88.4% to 95.2% during 7 years in the Get With The Guidelines-Stroke in the United States.…”

Section: Strokementioning

confidence: 62%

Use of Warfarin at Discharge Among Acute Ischemic Stroke Patients With Nonvalvular Atrial Fibrillation in China

Yang

Wang

et al. 2016

Stroke

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Background and Purpose— Guidelines recommend oral anticoagulation for ischemic stroke patients with atrial fibrillation, and previous studies have shown the underuse of anticoagulation for these patients in China. We sought to explore the underlying reasons and factors that currently affect the use of warfarin in China. Methods— From June 2012 to January 2013, 19 604 patients with acute ischemic stroke were admitted to 219 urban hospitals voluntarily participating in the China National Stroke Registry II. Multivariable logistic regression models using the generalized estimating equation method were used to identify patient/hospital factors independently associated with warfarin use at discharge. Results— Among the 952 acute ischemic stroke patients with nonvalvular atrial fibrillation, 19.4% were discharged on warfarin. The risk of bleeding (52.8%) and patient refusal (31.9%) were the main reasons for not prescribing anticoagulation. Larger/teaching hospitals were more likely to prescribe warfarin. Older patients, heavy drinkers, patients with higher National Institutes of Health Stroke Scale score on admission were less likely to be given warfarin, whereas patients with history of heart failure and an international normalized ratio between 2.0 and 3.0 during hospitalization were significantly associated with warfarin use at discharge. Conclusions— The rate of warfarin use remains low among patients with ischemic stroke and known nonvalvular atrial fibrillation in China. Hospital size and academic status together with patient age, heart failure, heavy alcohol drinking, international normalized ratio in hospital, and stroke severity on admission were each independently associated with the use of warfarin at discharge. There is much room for improvement for secondary stroke prevention in nonvalvular atrial fibrillation patients in China.

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Characteristics, Treatment and Outcome of Ischemic Stroke with Atrial Fibrillation in a Chinese Hospital-Based Stroke Study

Cited by 69 publications

References 47 publications

Hospital Variation in Functional Recovery After Stroke

Hospital Variation in Functional Recovery After Stroke

Features of Acute Ischemic Stroke With Rheumatic Heart Disease in a Hospitalized Chinese Population

Use of Warfarin at Discharge Among Acute Ischemic Stroke Patients With Nonvalvular Atrial Fibrillation in China

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