The Kentucky Appalachian Stroke Registry (KApSR)

Kitzman, Patrick H.; Wolfe, Marc; Elkins, Kelley; Fraser, Justin F.; Grupke, Stephen; Dobbs, Michael

doi:10.1016/j.jstrokecerebrovasdis.2017.10.031

Cited by 3 publications

(6 citation statements)

References 10 publications

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“…The data were gathered through KApSR, a data warehouse built from stroke-related data extracted from the University of Kentucky Health System, generating a "snapshot" dataset. KApSR is further described in a previous article [6]. Inclusion criteria were patients who presented from January 1, 2012, to December 31, 2016, and ICD-9 or ICD-10 codes for moyamoya.…”

Section: Methodsmentioning

confidence: 99%

“…However, a recent analysis of moyamoya within Appalachia has suggested that its prevalence may significantly exceed prior US estimates [5]. To further evaluate this, we performed a retrospective review utilizing the Kentucky Appalachian Stroke Registry (KApSR) [6], to characterize its incidence as a cause of stroke and to characterize the patient population within our region.…”

Section: Introductionmentioning

confidence: 99%

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High Prevalence of Moyamoya Syndrome in Appalachia

Nisiewicz

Roberts

Dobbs³

et al. 2020

Cerebrovasc Dis

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Introduction: Moyamoya is a chronic cerebrovascular condition of unclear etiology characterized by progressive occlusion of 1 or both internal carotid arteries with neovascular collateral formation. With both an idiopathic form (moyamoya disease) and congenital condition-associated form (moyamoya syndrome), it can cause ischemic and hemorrhagic stroke. Recent findings in Kentucky have challenged traditional estimates of its incidence in US populations. Using the Kentucky Appalachian Stroke Registry (KApSR), our aim was to further characterize its incidence as a cause of stroke and to understand the patient population in Appalachia. Methods: A retrospective review of moyamoya patients was performed using the KApSR database. Data collected included demographics, county location, risk factors, comorbidities, and health-care encounters from January 1, 2012, to December 31, 2016. Results: Sixty-seven patients were identified; 36 (53.7%) resided in Appalachian counties. The cohort accounted for 125 of 6,305 stroke admissions, representing an incidence of 1,983 per 100,000 stroke admissions. Patients presented with ischemic strokes rather than hemorrhagic strokes (odds ratio 5.50, 95% CI: 2.74–11.04, p < 0.01). Eleven patients (16.4%) exhibited autoimmune disorders. Compared to the general population with autoimmune disorder prevalence of 4.5%, the presence of autoimmunity within the cohort was significantly higher (p < 0.01). Compared to non-Appalachian patients, Appalachian patients tended to present with lower frequencies of tobacco use (p = 0.08), diabetes mellitus (p = 0.13), and hypertension (p = 0.16). Conclusions: Moyamoya accounts for a substantial number of stroke admissions in Kentucky; these patients were more likely to develop an ischemic stroke rather than a hemorrhagic stroke. Autoimmune disorders were more prevalent in moyamoya patients than in the general population. The reduced frequency of traditional stroke risk factors within the Appalachian group suggests an etiology distinct to the population.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High Prevalence of Moyamoya Syndrome in Appalachia

Nisiewicz

Roberts

Dobbs³

et al. 2020

Cerebrovasc Dis

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“…Kentucky Appalachian Stroke Registry (KApSR) is a database of demographic and clinical data from patients that live in Appalachia Kentucky (13), a distinct region with increased health disparities and stroke severity. A crosssectional analysis of inpatients with cardiovascular disease (CVD) containing a principle diagnosis of hemorrhagic stroke were evaluated for DM and/or AD in the KApSR database from 2010-2018.…”

Section: Study Samplementioning

confidence: 99%

“…A crosssectional analysis of inpatients with cardiovascular disease (CVD) containing a principle diagnosis of hemorrhagic stroke were evaluated for DM and/or AD in the KApSR database from 2010-2018. Hemorrhagic stroke patients were identified in KApSR as presenting with intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH), methods previously described (13). Briefly, demographics, comorbidities (defined by International Classification of Disease (ICD) codes), glycated hemoglobin A1 (hbA1c) values, previous diagnosis of AD, and outcome measures were collected from electronic health records (EHR) for inpatients, >18 years old, with an ICH or SAH, ICD9 codes: 431 and 430; ICD10 codes of 161 and 160, respectively.…”

Section: Study Samplementioning

confidence: 99%

“…The Kentucky Appalachian Stroke Registry (KApSR) is a database of demographic and clinical data from patients in the rural Kentucky and West Virgina regions with stroke (13). In this study, we used KApSR to retrospectively analyze the contributions of diabetes and AD to outcomes following hemorrhagic stroke such as length of stay, discharge destination, change in National Institute of Health Stroke (NIHSS), and 30-day readmission rates.…”

Section: Introductionmentioning

confidence: 99%

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Hemorrhagic stroke outcomes of KApSR patients with co-morbid diabetes and Alzheimer’s disease

Trout¹,

McLouth²,

Kitzman³

et al. 2021

Ann Transl Med

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Background: Vascular risk factors, such as diabetes mellitus (DM), are associated with poorer outcomes following many neurodegenerative diseases, including hemorrhagic stroke and Alzheimer's disease (AD).Combined AD and DM co-morbidities are associated with an increased risk of hemorrhagic stroke and increased Medicare costs. Therefore, we hypothesized that patients with DM in combination with AD, termed DM/AD, would have increased hemorrhagic stroke severity.Methods: Kentucky Appalachian Stroke Registry (KApSR) is a database of demographic and clinical data from patients that live in Appalachia, a distinct region with increased health disparities and stroke severity.Inpatients with a primary indication of hemorrhagic stroke were selected from KApSR for retrospective analysis and were separated into four groups: DM only, AD only, neither, or both.Results: Hemorrhagic stroke patients (2,071 total) presented with either intracerebral hemorrhage (ICH), n=1,448, or subarachnoid hemorrhage (SAH), n=623. When examining all four groups, subjects with AD were significantly older (AD+, 80.9±6.6 yrs) (DM+/AD+, 77.4±10.0 yrs) than non AD subjects (DM-/AD-, 61.3±16.5 yrs) and (DM+, 66.0±12.5 yrs). A higher percentage of females were among the AD+ group and a higher percentage of males among the DM+/AD+ group. Interestingly, after adjusting for multiple comparison, DM+/AD+ subjects were ten times as likely to suffer a moderate to severe stroke based on a National Institute of Health Stroke (NIHSS) upon admission [odds ratio (95% CI

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