Evaluation of the Possible Impact of a Care Network for Stroke and Transient Ischemic Attack on Rates of Recurrence

Abstract

We aimed to demonstrate that a stroke network is able to reduce the proportion of recurrent cerebrovascular events. In 2003, we set up a care network with the aim to reduce the proportion of stroke recurrence. For the statistical analysis, recurrent cerebrovascular events observed from 1985 to 2002 within the population of Dijon made it possible to model trends using Poisson logistic regression. From 1985 to 2002, we recorded 172 recurrent cerebrovascular events which were used to model trends before the creation of the care network. Within the period 2003–2007, we observed 162 recurrent cerebrovascular events compared with 196.7 expected cerebrovascular events with a significant standardized incidence rate of 0.82 (0.70–0.96; p = 0.01). After eliminating the role of some environmental factors, the possible hypothesis for the fall in recurrent stokes is probably the positive effect of the stroke care network.

Early and One-Year Outcomes of Acute Stroke in the Industrial Region of Poland During the Decade 2006–2015: The Silesian Stroke Registry

“…Similarly lower rates were reported in Nationwide Swedish Study 2001–2012, where the estimated cumulative incidence of stroke recurrence was 5.3% at 1 year, and 14.3% at 5 years, with decreasing risk of stroke recurrence during the study period [56]. The observed decrease in stroke recurrence during last decades might be due to increased antiplatelet and antithrombotic drugs use, blood pressure control and implementation of a stroke care networks [57, 58]. In a 23-year longitudinal population-based study conducted in Dijon, France, the authors show that the implementation of a stroke care network in a defined area was associated with a decrease in the number of recurrent strokes, with standardized reduction of incidence rate of 0.82 (0.70–0.96; p  = 0.01) [58].…”

“…The observed decrease in stroke recurrence during last decades might be due to increased antiplatelet and antithrombotic drugs use, blood pressure control and implementation of a stroke care networks [57, 58]. In a 23-year longitudinal population-based study conducted in Dijon, France, the authors show that the implementation of a stroke care network in a defined area was associated with a decrease in the number of recurrent strokes, with standardized reduction of incidence rate of 0.82 (0.70–0.96; p  = 0.01) [58]. In our cohort, a significant reduction of 1-year risk of recurrent ischaemic stroke (from 10–11 to 8% after ischaemic stroke and from 4–5 to 3% after haemorrhagic stroke) could be attributed to improvement in both AS care (stroke units, rtPA therapy) and secondary prevention; this supports our previous observations.…”

Functional independence measure scores predict level of long-term care required by patients after stroke: a multicenter retrospective cohort study

“…Our findings show that early prediction of the need for long-term care allows careful preparation for discharge, and efficient healthcare planning and financial management, to facilitate early discharge with sufficient care to allow patients to maintain and improve their ADL and functional abilities. The need for a coordinated and organized approach is underpinned by evidence that patients within the LTCI system are less likely to require increased levels of care after discharge [21], and that programs to improve understanding of stroke rehabilitation by patients and their families [22], and social support provided by stroke care networks can reduce the risk of further stroke [23][24][25]. Within the LTCI scheme, patients can request additional care services after consultation with healthcare managers, including community-based services such as home help, visiting rehabilitation, and respite admissions to or longer-term placements in nursing homes.…”

Si j’avais un accident vasculaire cérébral aigu en 2015

“…Si le cardiologue découvrait à l'échographie transoesophagienne un foramen ovale perméable (FOP) avec anévrisme du septum inter-auriculaire, j'accepterais d'être inclus dans l'essai théra-peutique CLOSE qui teste trois bras thérapeutiques : anti-agré-gant, anti-coagulant et fermeture percutanée du FOP. Enfin, de retour à mon domicile, je souhaiterais être suivi dans un réseau de soins de ville-hôpital dédié aux AVC [22] La réadaptation : pour faciliter la réinsertion familiale et professionnelle La prise en charge en urgence au sein de l'UNV par un réédu-cateur, un kinésithérapeute puis en neuro-rééducation à la sortie du service de neurologie, suivie d'une prise en charge à domicile par un kinésithérapeute et un orthophoniste si nécessaire faciliteront ma réintégration socio-professionnelle.…”