Do older patients receive adequate stroke care? An experience of a neurovascular clinic

Kee, Y.-Y. K.; Brooks, Wendy; Bhalla, Ajay

doi:10.1136/pgmj.2008.070607

Cited by 11 publications

(8 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A study in a neurovascular clinic for people with TIAs or mild strokes compared patients over and under 75 years and found no differences in appointment times, preventative treatments offered, or in rates of receiving CT scans [35]. However younger people were more often given life-style advice about diet and weight, they were CT scanned sooner, and more of them received MRI scans and carotid Doppler investigations (but older people received carotid endarterectomy more rapidly).…”

Section: Young Stroke Survivors' Experiences Of Servicesmentioning

confidence: 99%

The Psychology of Stroke in Young Adults: The Roles of Service Provision and Return to Work

Morris

2011

Stroke Research and Treatment

View full text Add to dashboard Cite

Literature about the psychological consequences of stroke in those under 65 is reviewed focussing on services and work. Despite similarities, young and old survivors have different experiences and needs. These are attributable to the effects of stroke on age-normative roles and activities, self-image, and the young person's stage in the life-cycle, especially family and work. “Hidden” cognitive impairments, a disrupted sense of self, and the incongruity of suffering an “older person's” disease are salient. Young survivors benefit from services, but experience lack of congruence between their needs and service philosophy, methods, and aims, and consequently have unmet needs. Employment is psychologically salient, and the evidence about return rates, factors that affect return, and the adequacy of employment-related service provision is reviewed. Specific and general recommendations are made for increasing congruence between young survivors' needs and service provision and also for facilitating their return to work.

show abstract

Section: Young Stroke Survivors' Experiences Of Servicesmentioning

confidence: 99%

The Psychology of Stroke in Young Adults: The Roles of Service Provision and Return to Work

Morris

2011

Stroke Research and Treatment

View full text Add to dashboard Cite

show abstract

“…18 Even with optimal anticoagulation, patients with AF with previous stroke have an 8% to 10% risk for recurrent stroke as reported in several major studies. 6,19,20 Furthermore, some patients with AF may elect a single interventional procedure to avoid the risks of lifelong anticoagulation therapy. 21 The left atrial appendage is the major source of emboli in AF, and in this study, the AtriClip (AtriCure Inc, Westchester, OH USA), a dacron-covered nitinol clip, was placed epicardially to close the appendage at the same time pulmonary vein isolation was performed to restore NSR.…”

Section: Discussionmentioning

confidence: 99%

“…5 More importantly, patients with AF with previous stroke have a 10% risk of recurrence even with optimal anticoagulation strategies. 6 Minimally invasive thoracoscopic pulmonary vein isolation and appendage ligation (TPVIAL) has been shown to have great procedural success (990%) in the elimination of AF and prevention of thromboembolic events. [7][8][9] This minimally invasive surgical approach includes ligation of the atrial appendage, the predominant site of thrombus formation and the site thought to be most important in the genesis of AF-related stroke.…”

mentioning

confidence: 99%

Thoracoscopic Ablation with Appendage Ligation versus Medical Therapy for Stroke Prevention a Proof-of-Concept Randomized Trial

et al. 2016

View full text Add to dashboard Cite

Objective: Atrial fibrillation (AF) has a demonstrable effect on quality of life (QOL). Recurrent stroke occurs in 10% of patients with AF. The objective of this study was to demonstrate proof of concept that thoracoscopic pulmonary vein isolation and atrial appendage ligation (TPVIAL) could prevent recurrent stroke and could potentially improve QOL in patients with AF with a previous stroke. Methods: The study was a National Institutes of HealthYfunded single-center proof-of-concept design that randomized 23 patients with AF-related stroke to TPVIAL (n = 12) or to medical management (n = 11). Quality of life was the primary outcome variable; secondary end points included restoration of rhythm, recurrent stroke, and surgical morbidity. Results: Quality-of-life subscores at 3 and 6 months revealed improvements in energy and decreases in fatigue in the TPVIAL arm [baseline, 33 (19.8); 3 months, 49.5 (20.6), P = 0.01; 6 months, 55.5 (14.4), P = 0.03]. At 12-month follow-up, there were no recurrent strokes in the TPVIAL group. In the medically treated arm, two patients at 6 months (P = 0.22) and three total patients at 12 months (P = 0.09) had recurrent ischemic stroke. There was one death in the medical management arm.

show abstract

“…Use of cardiovascular rehabilitation has been found to be higher among men than women (Beswick et al 2004, Raine et al 2004, Harrison & Wardle 2005. Older patients are also found to have lower rates of access to/use of revascularisation (Shaw et al 2004, Quaas et al 2004, Collinson et al, 2005Harries et al, 2007;, West et al 2011, Gale et al 2012, Zaman et al 2014, Hall et al 2016; cardiovascular rehabilitation (Beswick et al 2004, Harrison & Wardle 2005; and stroke care (Rudd et al 2007, Kee et al 2009, Addo et al 2011Lazzarino et al, 2011).…”

Section: Specialist Management Of Cardiovascular Diseasementioning

confidence: 99%

Inequity in cardiovascular care in the English National Health Service (NHS): a scoping review of the literature

Asthana

Moon

Gibson

et al. 2016

Health Soc Care Community

View full text Add to dashboard Cite

There is a general understanding that socioeconomically disadvantaged people are also disadvantaged with respect to their access to NHS care. Insofar as considerable NHS funding has been targeted at deprived areas, it is important to better understand whether and why socioeconomic variations in access and utilisation exist. Exploring this question with reference to cardiovascular care, our aims were to synthesise and evaluate evidence relating to access to and/or use of English NHS services around (i) different points on the care pathway (i.e. presentation, primary management and specialist management) and (ii) different dimensions of inequality (socioeconomic, age- and gender-related, ethnic or geographical). Restricting our search period from 2004 to 2016, we were concerned to examine whether, compared to earlier research, there has been a change in the focus of research examining inequalities in cardiac care and whether the pro-rich bias reported in the late 1990s and early 2000s still applies today. We conducted a scoping study drawing on Arksey & O'Malley's framework. A total of 174 studies were included in the review and appraised for methodological quality. Although, in the past decade, there has been a shift in research focus away from gender and age inequalities in access/use and towards socioeconomic status and ethnicity, evidence that deprived people are less likely to access and use cardiovascular care is very contradictory. Patterns of use appear to vary by ethnicity; South Asian populations enjoying higher access, black populations lower. By contrast, female gender and older age are consistently associated with inequity in cardiovascular care. The degree of geographical variation in access/use is also striking. Finally, evidence of inequality increases with stage on the care pathway, which may indicate that barriers to access arise from the way in which health professionals are adjudicating health needs rather than a failure to seek help in the first place.

show abstract

Do older patients receive adequate stroke care? An experience of a neurovascular clinic

Abstract: Older patients were less likely to receive diagnostic investigations and lifestyle modification advice than younger patients. Guidelines need to be adopted to ensure prompt evidence-based stroke care in the outpatient setting.

Cited by 11 publications

References 15 publications

The Psychology of Stroke in Young Adults: The Roles of Service Provision and Return to Work

The Psychology of Stroke in Young Adults: The Roles of Service Provision and Return to Work

Thoracoscopic Ablation with Appendage Ligation versus Medical Therapy for Stroke Prevention a Proof-of-Concept Randomized Trial

Inequity in cardiovascular care in the English National Health Service (NHS): a scoping review of the literature

Contact Info

Product

Resources

About