Recurrent Stroke Risk Is Higher Than Cardiac Event Risk After Initial Stroke/Transient Ischemic Attack

Brown, Devin L.; Lisabeth, Lynda D.; Roychoudhury, Canopy; Ye, Yining; Morgenstern, Lewis B.

doi:10.1161/01.str.0000165926.74213.e3

Cited by 55 publications

(53 citation statements)

References 14 publications

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“…Past studies have found a 1-year recurrence rate for stroke of <14%. [44][45][46] The strengths of our study include the use of spatial statistics to identify and monitor county clusters of stroke hospitalization rates, the identification of transitional counties in addition to persistently high-and persistently low-rate clusters, and the inclusion of community-level healthcare profiles and socioeconomic profiles. The use of Medicare data enabled nationwide analysis of geographic patterns in stroke hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

Tracking Stroke Hospitalization Clusters Over Time and Associations With County-Level Socioeconomic and Healthcare Characteristics

Schieb

Mobley

George

et al. 2013

Stroke

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Our study included hospital claims data for fee-for-service Medicare beneficiaries aged ≥65 for 1995, 1996, 2005, and 2006 from the Centers for Medicare and Medicaid Services' Medicare Provider Analysis and Review file, Part A. We defined a stroke hospitalization Background and Purpose-This study evaluated clustering of stroke hospitalization rates, patterns of the clustering over time, and associations with community-level characteristics. Methods-We used Medicare hospital claims data from 1995-1996 to 2005-2006 with a principal discharge diagnosis of stroke to calculate county-level stroke hospitalization rates. We identified statistically significant clusters of highand low-rate counties by using local indicators of spatial association, tracked cluster status over time, and assessed associations between cluster status and county-level socioeconomic and healthcare profiles. Results-Clearly defined clusters of counties with high-and low-stroke hospitalization rates were identified in each time.Approximately 75% of counties maintained their cluster status from 1995-1996 to 2005-2006. In addition, 243 counties transitioned into high-rate clusters, and 148 transitioned out of high-rate clusters. Persistently high-rate clusters were located primarily in the Southeast, whereas persistently low-rate clusters occurred mostly in New England and in the West. In general, persistently low-rate counties had the most favorable socioeconomic and healthcare profiles, followed by counties that transitioned out of or into high-rate clusters. Persistently high-rate counties experienced the least favorable socioeconomic and healthcare profiles. Conclusions-The persistence of clusters of high-and low-stroke hospitalization rates during a 10-year period suggests that the underlying causes of stroke in these areas have also persisted. In this study, we refer to cerebrovascular disease as stroke. Beneficiaries were determined from the Medicare Denominator Files and were excluded if they were members of a health maintenance organization, died before July 1, or were <65 years on July 1 for each of the study years. All stroke hospitalizations and Medicare beneficiaries were assigned to the county of the patient's residence in the Medicare claims files. The study years were combined to create 2 periods: 1995-1996 and 2005-2006. Two-year stroke hospitalization rates were calculated for each period and age-adjusted by using the 2000 US standard population weights.10 Data for independent cities in Virginia were merged with their surrounding counties. Only counties located in the 48 contiguous United States that had at least 1 neighboring county were included (n=3074). Stroke hospitalization rates were calculated by using SAS software (version 9.1.3).11 Maps were created by using ArcMap software (version 10.0). 12 Spatial Clustering AnalysesWe undertook a 2-step process to assess positive spatial autocorrelation, or clustering. All spatial clustering analyses were conducted by using GeoDa software (version 0.9.5-i), 13 and the Empirical-B...

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Section: Discussionmentioning

confidence: 99%

Tracking Stroke Hospitalization Clusters Over Time and Associations With County-Level Socioeconomic and Healthcare Characteristics

Schieb

Mobley

George

et al. 2013

Stroke

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“…8 The observation that ischemic stroke patients have additional costs and resource use for non-stroke-related cardiovascular events, such as MI and coronary heart disease (CHD), in addition to strokerelated events, supports the notion that stroke patients are at high risk of future coronary events as well as recurrent cerebrovascular events. [2][3][4][5][6][7] Therefore, therapeutic strategies aimed at total cardiovascular risk reduction in stroke patients may have the potential to reduce both the morbidity and mortality associated with stroke as well as downstream hospitalizations and health care costs.…”

Section: Discussionmentioning

confidence: 99%

Additional Stroke-Related and Non–Stroke-Related Cardiovascular Costs and Hospitalizations in Managed-Care Patients After Ischemic Stroke

Roberts

Gorelick

et al. 2009

Stroke

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Background and Purpose-Prior stroke confers an increased risk of future cardiovascular events. Because the incremental economic impact of this added risk is unknown, we assessed the additional cardiovascular costs and hospitalizations associated with ischemic stroke. Methods-Patients hospitalized for ischemic stroke during 2002 to 2005 were identified from a large US managed-care plan and matched to control patients hospitalized for a noncardiovascular acute event. Cumulative stroke-related and non-strokerelated cardiovascular medical costs were determined for each group. Stroke and nonstroke cardiovascular hospitalization rates were calculated with the Kaplan-Meier method; risk of hospitalization was estimated with a Cox regression model. Results-Stroke patients and matched controls (Nϭ11 883) were identified (mean age Ϸ58 years; 47.8% female).Compared with controls, patients hospitalized for ischemic stroke had higher stroke and nonstroke cardiovascular medical costs at 6 months (stroke: $1756 vs $50, PϽ0.01; nonstroke cardiovascular: $1437 vs $658, PϽ0.01) and 12 months (stroke: $2109 vs $68, PϽ0.01; nonstroke cardiovascular: $2203 vs $1167, PϽ0.01) of follow-up. Among stroke patients, cumulative stroke and nonstroke cardiovascular hospitalization rates were 9.06% and 5.63% at 6 months, respectively, and 21.09% and 22.05% at 36 months, respectively. Stroke patients were at significantly increased risk of repeat stroke hospitalization (hazard ratioϭ12.55; 95% CI, 10.50 to 15.01) and nonstroke cardiovascular hospitalization (hazard ratioϭ1.95; 95% CI, 1.77 to 2.14). Conclusions-After ischemic stroke, patients have significantly greater stroke and nonstroke cardiovascular costs and hospitalizations than do matched controls. Attention to total cardiovascular risk reduction in this population could potentially reduce downstream costs.

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“…8 In a study of cardiovascular events among Michigan Medicare patients after stroke or TIA, the 2-year incidence of stroke was 11.8%, whereas the incidence of cardiac events (such as PCI and coronary bypass procedures, as well as MI) was 7.7%. 9 Another study of recurrent events after first ischemic stroke among elderly patients enrolled in the Heart Protection Study (age 65 years or older) found that the 1-year rate of recurrent stroke was nearly twice that of cardiac events (105.4 versus 59.3 per thousand person-years, respectively). 10 Similar patterns of recurrent events have also been described in clinical intervention studies.…”

Section: Differences Between Recurrent Cerebrovascular and Coronary Ementioning

confidence: 99%

Secondary Prevention of Stroke and Transient Ischemic Attack

Liao

2007

Circulation

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Background— Recurrent cerebrovascular events constitute an estimated 200 000 of the 700 000 strokes reported annually in the United States, which makes secondary stroke prevention an important goal in the management of disease among patients who have experienced stroke or transient ischemic attack. Methods and Results— Various pharmacological approaches have been advocated, but the relative efficacy and safety of these regimens has remained the subject of much debate. The results of recent clinical trials on the use of antiplatelet therapy suggest that patients with a history of stroke or transient ischemic attack may constitute a population distinct from patients with coronary or peripheral vascular disease. This may be caused, in part, by the differing etiologies of stroke and the increased vulnerability of cerebral vessels to bleeding. Indeed, dual antiplatelet therapy, which has been found to be beneficial for the treatment of acute coronary syndromes and percutaneous coronary interventions, does not confer secondary stroke protection. The emerging paradigm is that some level of platelet inhibition is required for secondary stroke protection; a level beyond which increased risk of bleeding arises. Conclusion— Because the vast majority of patients with ischemic stroke have recurrent stroke or transient ischemic attack, rather than myocardial infarction, as their next event, antiplatelet therapies for these patients should be administered according to what has been shown to be efficacious for secondary stroke protection rather than for myocardial protection. Combination therapies, which provide optimal platelet inhibition as well as vascular protection, may offer the best strategy for secondary stroke protection.

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Recurrent Stroke Risk Is Higher Than Cardiac Event Risk After Initial Stroke/Transient Ischemic Attack

Cited by 55 publications

References 14 publications

Tracking Stroke Hospitalization Clusters Over Time and Associations With County-Level Socioeconomic and Healthcare Characteristics

Tracking Stroke Hospitalization Clusters Over Time and Associations With County-Level Socioeconomic and Healthcare Characteristics

Additional Stroke-Related and Non–Stroke-Related Cardiovascular Costs and Hospitalizations in Managed-Care Patients After Ischemic Stroke

Secondary Prevention of Stroke and Transient Ischemic Attack

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