Recurrent stroke in midlife is associated with not having a primary care physician

Abstract

ObjectiveTo determine using a population-based study whether midlife stroke patients having a primary care physician (PCP) at the time of first stroke have a lower risk of stroke recurrence and mortality than those who do not have a PCP.MethodsFirst-ever ischemic stroke patients 45 to 64 years of age at stroke onset were ascertained through the Brain Attack Surveillance in Corpus Christi (BASIC) project from 2000 to 2013 in Texas. Cox proportional hazards models were used to examine the association between not having a PCP and stroke recurrence or all-cause mortality in separate models. Cases were followed up for up to 5 years or until December 31, 2013, whichever came first. Cases were censored for recurrence if they died before experiencing a recurrent event. We adjusted for clinical risk factors that could be associated with having a PCP and recurrence or mortality.ResultsThere were 663 first-occurrence ischemic stroke cases. Of these, 77% had a PCP, 43% were female, and average age was 55.6 years. Five-year recurrence risk was 14.6%, and mortality risk was 19.2%. Not having a PCP was associated with higher recurrence risk (adjusted hazard ratio 1.75, 95% confidence interval 1.02–3.02). Having a PCP was not associated with mortality. Sensitivity analyses showed that results were robust to different ways to adjust for chronic conditions.ConclusionThis study found lower rates of stroke recurrence among those with a PCP at the time of first stroke. Future studies could determine the value of establishing a PCP before stroke hospital discharge for secondary stroke prevention.

The healthcare needs and general practice utilization of people with acquired neurological disability and complex needs: A scoping review

“…One study reported on participants with a mean age of 20 years. Of the studies included, 20 reported solely the perspective of people with disability 35–37,39,40,42–45,47–50,57–59,61–64 . Four reported on the perspective of the person with a disability, as well as the GPs' perspective 38,46,55,56 and one paper reported on the perspective of the person with disabilities, alongside administrative data 54 .…”

Long term clinical outcomes of patients with ischemic stroke in primary care – a 9-year retrospective study

“…A local study [ 14 ] including 705 acute ischemic stroke patients reported that 199 (28%) suffered further cerebrovascular cardiac events and 117 patients died (17%) during a follow-up period of 42 months. A US population-based study [ 15 ] including 663 first-ever ischemic stroke patients aged 45–64 years found the 5-year recurrent rate was 14.6% and mortality rate was 19.2%, respectively. We observed a lower recurrent stroke rate because of the following reasons: 1) patients had good control of blood pressure and DM at baseline; 2) the risk of recurrent stroke was highest in the first year [ 3 – 7 , 14 , 15 ] after the index stroke, and our cohort mainly consisted of patients with chronic stroke; 3) certain subgroup of stroke patients i.e., those with cardioembolic stroke, was not well presented in our study.…”

“…A US population-based study [ 15 ] including 663 first-ever ischemic stroke patients aged 45–64 years found the 5-year recurrent rate was 14.6% and mortality rate was 19.2%, respectively. We observed a lower recurrent stroke rate because of the following reasons: 1) patients had good control of blood pressure and DM at baseline; 2) the risk of recurrent stroke was highest in the first year [ 3 – 7 , 14 , 15 ] after the index stroke, and our cohort mainly consisted of patients with chronic stroke; 3) certain subgroup of stroke patients i.e., those with cardioembolic stroke, was not well presented in our study. It is known that cardioembolic stroke survivors carries a higher risk for recurrent cardiovascular events [ 4 , 16 ].…”

Investigation of Risk Factors in Recurrent Stroke

“…Tekrarlayan inme, ilk inme ile karşılaştırıldığında daha büyük mortalite, özürlülük ve maliyet oranına sahiptir. 13 İnme geçirmiş hastalarda, son yıllarda tekrarlama riski gittikçe artmaktadır. İnme geçiren hastalardaki risk faktörlerinin araştırılması, tekrarlayan inmelerin önlenmesi ve tedavisinde çok önemlidir.…”