Mortality and Stroke Recurrence in a Rehabilitation Cohort of Patients with Cerebral Infarcts and Chagas Disease

Abstract

Background: Chagas disease is related to ischemic stroke (IS), although few epidemiological studies have evaluated the associated mortality and recurrence. Our objective is to determine factors associated with mortality and recurrence of IS in patients with IS and Chagas disease. Methods: We retrospectively studied data obtained from electronic medical records of patients admitted at SARAH Hospitals across Brazil between 2009 and 2013. Using Cox regression analysis for mortality and logistic regression for recurrence, we assessed primary population characteristics and statistical associations between risk factors and outcomes. Results: We analyzed 279 patients who were followed up until 2016. The mean age at stroke onset was 61 with a 10% frequency of death. Multivariate analysis assessing mortality demonstrated that the associated factors were age at stroke (hazard ratio [HR] 1.04), initial modified Rankin Scale (mRS; HR 20.91), bladder dysfunction (HR 2.51), diabetes mellitus (DM; HR 3.64), and alcoholism (HR 3.37). Multivariate analysis assessing recurrence demonstrated that the associated factors were age at ictus (OR 0.96), cognitive deficit (OR 0.44), initial mRS (OR 1.84), cardioembolic etiology (OR 2.47), and female sex (OR 2.73). Conclusions: Cardiac conditions did not correlate with mortality or recurrence. Age was a protective factor against recurrence, probably due to cumulative risk of IS over time, while initial mRS was associated with both outcomes. Treating diseases such as DM and bladder dysfunction, and early treatment to reduce the initial mRS could potentially prevent both outcomes; also, establishing a correct etiological diagnosis is important.

Chagas Disease-Related Mortality in Spain, 1997 to 2018

“…Our multivariable analysis showed that neoplasms were associated with mortality in people with CD, while cardiopathy was not. These results are different from other series in endemic countries [ 32 , 33 , 34 , 35 ]. It can be a different treatment of cardiopathy available in our country as transplantation or use of Internal atrial defibrillation.…”

“…In contrast, just a third of the deaths in our study were considered to be directly related to CD. Of those associated with other diseases, the main cause of death was neoplasms (including lymphoma/leukemia), which is consistent with the main cause of non-CD death among people with CD in epidemiological studies in endemic countries [ 35 ]. Our multivariable analysis showed that neoplasms were associated with mortality in people with CD, while cardiopathy was not.…”

“…CD is also associated with ischemic stroke [ 8 , 34 ] and mortality from this cause. Again in Brazil, Montanero et al [ 35 ] found that 10% of people with CD and ischemic stroke died. In our study, 5% of patients had a secondary diagnosis of cerebrovascular disease, while one in five had a diagnosis for CD with involvement of an organ other than the heart.…”

Intervention Effect of Rapid Rehabilitation Nursing Combined with Continuous Nursing after Discharge on Patients with Cerebral Infarction in Recovery Period and the Changes in Motor Function, Mental State, and Quality of Life

“…e recovery period of CI, as a transitional stage from acute stage to sequela stage, is closely related to the recovery of neurological function and prognosis of patients. Some scholars have reported that active management after CI patients are stable can reduce the risk of recurrence of CI by 90% [4]. erefore, it is of great significance to give patients with CI scientific rehabilitation nursing during their recovery period.…”

Stroke Care Services in Brazil

“…14 Some additional challenges for secondary stroke prevention in Brazil are income inequality, aging of the population, higher rates of cardiovascular risk factors in the young and CD, known to be related to higher mortality and recurrence risks. [15][16][17][18] In efforts to improve this reality, the "Line of Care for People with Stroke" published in 2012 also included recommendations of implementation of evidence-based protocols, rehabilitation, outpatient care, and social reintegration. 19 An essential aspect of this regulation was the inclusion of key performance indicators for monitoring disease management in all stroke centers, including: (a) hospital discharge on antithrombotic therapy, (b) hospital discharge on anticoagulation therapy in patients with atrial fibrillation or flutter, (c) hospital discharge on statin therapy in patients with atherothrombotic mechanisms, (d) secondary prevention therapy, and (e) rehabilitation on hospital discharge.…”