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  • 1
    Online Resource
    Online Resource
    Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019
    Elsevier BV ; 2020
    In:  Journal of the American College of Cardiology Vol. 76, No. 25 ( 2020-12), p. 2982-3021
    Details
    In: Journal of the American College of Cardiology, Elsevier BV, Vol. 76, No. 25 ( 2020-12), p. 2982-3021
    Type of Medium: Online Resource
    ISSN: 0735-1097
    URL: Article
    DOI: 10.1016/j.jacc.2020.11.010
    RVK:
    XA 17760
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 1468327-1
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  • 2
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    Online Resource
    Risk factors and outcome of subtypes of ischemic stroke. Data from a multicenter multinational hospital-based registry. The European Community Stroke Project
    Elsevier BV ; 2006
    In:  Journal of the Neurological Sciences Vol. 244, No. 1-2 ( 2006-5), p. 143-150
    Details
    In: Journal of the Neurological Sciences, Elsevier BV, Vol. 244, No. 1-2 ( 2006-5), p. 143-150
    Type of Medium: Online Resource
    ISSN: 0022-510X
    URL: Article
    DOI: 10.1016/j.jns.2006.01.016
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2006
    detail.hit.zdb_id: 1500645-1
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  • 3
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    Online Resource
    New-Onset Fecal Incontinence After Stroke : Prevalence, Natural History, Risk Factors, and Impact
    Ovid Technologies (Wolters Kluwer Health) ; 2003
    In:  Stroke Vol. 34, No. 1 ( 2003-01), p. 144-150
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 1 ( 2003-01), p. 144-150
    Abstract: Background and Purpose— Fecal incontinence (FI) is a common complication after stroke, yet epidemiological research into this distressing condition is limited. The purpose of this study was to describe the prevalence, natural history, associations, and impact of new-onset FI after stroke. Methods— Stroke patients in the community-based South London Stroke Register (January 1995 to 2000) without preexisting FI were characterized regarding bowel continence at 7 to 10 days, 3 months, and 1 and 3 years after stroke. FI was defined as any degree of bowel leakage. Results— Prevalence of poststroke FI was 30% (7 to 10 days), 11% (3 months), 11% (1 year), and 15% (3 years). One third of patients with FI at 3 months were continent by 1 year; conversely, 63% incontinent at 1 year had been continent at 3 months. Characteristics of 91 patients with FI and 755 without FI at 3 months were compared using multiple logistic regression. Acute stroke associations of neglect (adjusted odds ratio [OR], 1.9; 95% CI, 1.0 to 3.5) and initial urinary incontinence (OR, 6.2; 95% CI, 3.2 to 11.9) were no longer significant after adjustment for clinical factors at 3 months. Final independent associations were anticholinergic drug use (OR, 3.1; 95% CI, 1.1 to 10.2) and needing help with toilet use (OR, 3.5; 95% CI, 1.4 to 17.3). FI at 3 months increased the risk of long-term placement (28% vs 6%) and death within 1 year (20% vs 8%). Conclusions— New-onset FI in stroke survivors is common but may be transient. Modifiable risk factors for FI 3 months after stroke are constipating drug use and difficulty with toilet access, raising implications for developing treatment and prevention strategies.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000044169.54676.F5
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Natural History and Effects on 2-Year Outcomes of Urinary Incontinence After Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Stroke Vol. 32, No. 1 ( 2001-01), p. 122-127
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. 1 ( 2001-01), p. 122-127
    Abstract: Background and Purpose —We sought to describe the natural history of poststroke incontinence and estimate its effect on survival and 2-year outcomes in stroke survivors. Methods —Two hundred thirty-five incident cases of stroke in 1995 were classified by continence status at 10 days after stroke. Age, sex, ethnicity, diabetes, hypertension, atrial fibrillation, premorbid disability, and Oxfordshire Community Stroke Project classification were recorded. Outcome data collected at 3 months and at 1 and 2 years included disability, case-fatality rates, and institutionalization rates. Disability was classified as severe, moderate, mild, or independent using the Barthel Index (without its “continence” component: 0–9, 10–14, 15–17, and 18, respectively) and Frenchay Activity Index (0–15, 16–30, and 31–45). Results —Of 235 cases, 95 were initially incontinent (group 1); 140 were continent (group 2). At the initial, 3-month, and 1- and 2-year assessments, incontinence was recorded in 95 patients (40%), 34 (19%), 23 (15%), and 12 (10%), respectively. In univariate analyses, the 2 groups were not different in terms of demographic factors and risk factors. Compared with group 2, group 1 patients were more likely to have atrial fibrillation (28% versus 16%; P =0.02). Multivariate analyses showed that age 〉 75 years (OR 15.9; CI 2.2 to 116.2), dysphagia (OR 4.03; CI 1.85 to 8.73), motor weakness (OR 5.41; CI 1.38 to 21.1) and visual field defects (OR 4.78; CI 1.78 to 12.9) were all significantly associated with incontinence. Incontinence was less common in lacunar infarctions (OR 0.12; CI 0.02 to 0.62). At 2 years, compared with group 2, group 1 had higher case-fatality rates (67% versus 20%; P 〈 0.001), higher institutionalization rates (39% versus 16%; P =0.007), and greater disability (Barthel [0–9]: 39% versus 5%; P 〈 0.001; Frenchay [0–15]: 75% versus 37%; P =0.001). Death or disability at 2 years was worse in subjects with initial incontinence(OR 4.43; CI 1.76 to 11.2). Conclusions —Incontinence remains a prevalent condition 2 years after stroke. Initial incontinence was associated with age 〉 75 years, dysphagia, visual field defect, and motor weakness. Poststroke incontinence adversely affected 2-year stroke survival, disability, and institutionalization rates.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.32.1.122
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
    detail.hit.zdb_id: 1467823-8
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  • 5
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    Online Resource
    Point-of-Care Cluster Randomized Trial in Stroke Secondary Prevention Using Electronic Health Records
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 7 ( 2014-07), p. 2066-2071
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 7 ( 2014-07), p. 2066-2071
    Abstract: The aim of this study was to evaluate whether the remote introduction of electronic decision support tools into family practices improves risk factor control after first stroke. This study also aimed to develop methods to implement cluster randomized trials in stroke using electronic health records. Methods— Family practices were recruited from the UK Clinical Practice Research Datalink and allocated to intervention and control trial arms by minimization. Remotely installed, electronic decision support tools promoted intensified secondary prevention for 12 months with last measure of systolic blood pressure as the primary outcome. Outcome data from electronic health records were analyzed using marginal models. Results— There were 106 Clinical Practice Research Datalink family practices allocated (intervention, 53; control, 53), with 11 391 (control, 5516; intervention, 5875) participants with acute stroke ever diagnosed. Participants at trial practices had similar characteristics as 47 887 patients with stroke at nontrial practices. During the intervention period, blood pressure values were recorded in the electronic health records for 90% and cholesterol values for 84% of participants. After intervention, the latest mean systolic blood pressure was 131.7 (SD, 16.8) mm Hg in the control trial arm and 131.4 (16.7) mm Hg in the intervention trial arm, and adjusted mean difference was −0.56 mm Hg (95% confidence interval, −1.38 to 0.26; P =0.183). The financial cost of the trial was approximately US $22 per participant, or US $2400 per family practice allocated. Conclusions— Large pragmatic intervention studies may be implemented at low cost by using electronic health records. The intervention used in this trial was not found to be effective, and further research is needed to develop more effective intervention strategies. Clinical Trial Registration— URL: http://www.controlled-trials.com . Current Controlled Trials identifier: ISRCTN35701810.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.114.005713
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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  • 6
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    Online Resource
    Ethnic Differences in Risk Factors for Ischemic Stroke : A European Case–Control Study
    Ovid Technologies (Wolters Kluwer Health) ; 2004
    In:  Stroke Vol. 35, No. 7 ( 2004-07), p. 1562-1567
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 7 ( 2004-07), p. 1562-1567
    Abstract: Background and Purpose— The aim is to estimate the relative risk and population attributable risk (PAR) of risk factors for ischemic stroke by ethnic group. Methods— In this case–control study, cases of first ischemic stroke were taken from the South London Stroke Register and controls from a cross-sectional prevalence survey covering the same area. PAR was determined for each risk factor by ethnic group. Multivariable analysis was used to examine the association between risk factors and ischemic stroke across all ethnic groups. Results— 664 cases and 716 controls aged 45 to 74 years were included, with ethnicity of white 78%:42%, black Caribbean 16%:43%, and black African 6%:15%, respectively. For the white group, high PAR was found for ischemic heart disease (IHD) on ECG (56% [95% CI, 49% to 62%]), obesity (49% [95% CI, 40% to 56%] ), hypertension (HT) (38% [95% CI, 29% to 46%]), smoking (31% [95% CI, 19% to 41%] ), transient ischemic attack (TIA) (23% [95% CI, 19% to 27%]), and atrial fibrillation (AF) (16% [95% CI, 10% to 21%] ). In the black Caribbean compared with the white group, PAR was higher for HT (46% [95% CI, 21% to 63%]) and diabetes mellitus (DM) (29% [95% CI, 14% to 42%] ), and lower for current smoking (18% [95% CI, 1% to 32%]) and AF (10% [95% CI, 0% to 18%] ). In the black African group HT had a higher PAR (59% [95% CI, 91% to 82%]) than the other groups. PAR for AF (11% [95% CI, −11% to 29%] ), obesity (30% [95% CI, −20% to 60%]), and DM (4% [95% CI, −25% to 26%] ) was low compared with the other groups. In multivariable analysis, risk factors associated with ischemic stroke included TIA, AF, IHD on ECG, smoking, excess alcohol, obesity, HT, and DM. Conclusion— In the first European case-control study examining risk factors for ischemic stroke in black Caribbean and African populations, some differences were demonstrated in the impact of risk factors between these groups. It may be important to address such differences when developing stroke preventative strategies.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000131903.04708.b8
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2004
    detail.hit.zdb_id: 1467823-8
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  • 7
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    Online Resource
    Differences in Risk Factors Between Black Caribbean Patients With Stroke in Barbados and South London
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  Stroke Vol. 40, No. 2 ( 2009-02), p. 640-643
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 2 ( 2009-02), p. 640-643
    Abstract: Background and Purpose— Risk of stroke is higher in black Caribbeans in the United Kingdom compared with black Caribbeans in their country of origin. We investigated if these differences were caused by variations in prior-to-stroke risk factors. Summary of Report— Data were collected from the South London Stroke Register (SLSR) and the Barbados Register of Strokes (BROS). Differences in prevalence and management of stroke risk factors were adjusted for age, sex, living conditions prestroke, stroke subtype, and socioeconomic status by multivariable logistic regression. Patients in BROS were on average older (mean difference 4 years) and more likely to have a nonmanual occupation. They were less likely to have a prestroke diagnosis of myocardial infarction (OR, 0.39; 95% CI, 0.19 to 0.77) or diabetes (OR, 0.65; 95% CI, 0.46 to 0.92) and were less likely to report smoking (OR, 0.31; 95% CI, 0.19 to 0.49). They were also more likely to receive appropriate prestroke antihypertensive (OR, 1.88; 95% CI, 1.21 to 2.92) and antidiabetic treatment (OR, 3.33; 95% CI, 1.44 to 7.70) and less likely to receive cholesterol-lowering drugs (OR, 0.19; 95% CI, 0.05 to 0.71). Conclusions— The higher risk of stroke in black Caribbeans in the United Kingdom might be caused by a higher prevalence of major prior-to-stroke risk factors, differences in treatment patterns for comorbid conditions, and less healthy lifestyle practices compared with indigenous black Caribbean populations.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.108.518852
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
    detail.hit.zdb_id: 1467823-8
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  • 8
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    Online Resource
    Risk and Cumulative Risk of Stroke Recurrence : A Systematic Review and Meta-Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Stroke Vol. 42, No. 5 ( 2011-05), p. 1489-1494
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 5 ( 2011-05), p. 1489-1494
    Abstract: Estimates of risk of stroke recurrence are widely variable and focused on the short- term. A systematic review and meta-analysis was conducted to estimate the pooled cumulative risk of stroke recurrence. Methods— Studies reporting cumulative risk of recurrence after first-ever stroke were identified using electronic databases and by manually searching relevant journals and conference abstracts. Overall cumulative risks of stroke recurrence at 30 days and 1, 5, and 10 years after first stroke were calculated, and analyses for heterogeneity were conducted. A Weibull model was fitted to the risk of stroke recurrence of the individual studies and pooled estimates were calculated with 95% CI. Results— Sixteen studies were identified, of which 13 studies reported cumulative risk of stroke recurrence in 9115 survivors. The pooled cumulative risk was 3.1% (95% CI, 1.7–4.4) at 30 days, 11.1% (95% CI, 9.0–13.3) at 1 year, 26.4% (95% CI, 20.1–32.8) at 5 years, and 39.2% (95% CI, 27.2–51.2) at 10 years after initial stroke. Substantial heterogeneity was found at all time points. This study also demonstrates a temporal reduction in 5-year risk of stroke recurrence from 32% to 16.2% across the studies. Conclusions— The cumulative risk of recurrence varies greatly up to 10 years. This may be explained by differences in case mix and changes in secondary prevention over time However, methodological differences are likely to play an important role and consensus on definitions would improve future comparability of estimates and characterization of groups of stroke survivors at increased risk of recurrence.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.110.602615
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 1467823-8
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  • 9
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    Online Resource
    Cross-National Key Performance Measures of the Quality of Acute Stroke Care in Western Europe
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. 10 ( 2015-10), p. 2891-2895
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. 10 ( 2015-10), p. 2891-2895
    Abstract: There are no agreed measures of stroke care quality that enable the standardized comparison of stroke care between countries. We aimed to develop a set of measures of quality of acute stroke care involving stroke quality registers in Western Europe. Methods— A multinational working group identified 6 regional or national stroke quality registers in Europe and reviewed their data sets, performance measures, and the method by which these had been developed. Measures used in the registers were presented for discussion to a consensus group of representatives from the quality registers identified, as well as other stroke experts, and the final set of common performance measures was agreed through majority consensus. Results— Thirty final performance measures were agreed by the European consensus group, encompassing the domains of coordination of care (stroke unit–based care), diagnosis (brain imaging, vascular imaging, cardiac arrhythmia detection, and therapy assessment), preservation of neural tissue (thrombolytic therapy and door-to-needle time), prevention of complications (dysphagia screening), initiation of secondary prevention (antiplatelet, anticoagulation, lipid lowering, blood pressure lowering, carotid surgery, time from vascular imaging to carotid surgery, and smoking cessation), survival (90-day poststroke mortality), and functional outcomes (90-day modified Rankin Scale). Conclusions— On the basis of experience of quality registers in Europe, we have proposed a common set of performance measures that will facilitate the international comparison of acute stroke care quality.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.115.008811
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1467823-8
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  • 10
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    Online Resource
    Incidence and Associations of Poststroke Epilepsy : The Prospective South London Stroke Register
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. 3 ( 2013-03), p. 605-611
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 3 ( 2013-03), p. 605-611
    Abstract: To describe the epidemiology and associations of poststroke epilepsy (PSE) because there is limited evidence to inform clinicians and guide future research. Methods— Data were collected from the population-based South London Stroke Register of first strokes in a multiethnic inner-city population with a maximum follow-up of 12 years. Self-completed forms and interviews notified study organizers of epilepsy diagnosis. Kaplan–Meier methods and Cox models were used to assess associations with sociodemographic factors, clinical features, stroke subtype, and severity markers. Results— Three thousand three-hundred ten patients with no history of epilepsy presented with first stroke between 1995 and 2007, with a mean follow-up of 3.8 years. Two-hundred thirteen subjects (6.4%) had development of PSE. PSE incidence at 3 months and 1, 5, and 10 years were estimated at 1.5%, 3.5%, 9.0%, and 12.4%, respectively. Sex, ethnicity, and socioeconomic status were not associations, but markers of cortical location, including dysphasia, visual neglect, and field defect, along with stroke severity indices at presentation, including low Glasgow Coma Scale, incontinence, or poor function on Barthel Index, were associated with PSE on univariate analysis. Young age was independently associated with PSE, affecting 10.7% of patients aged 〈 65 years and 1.6% 〉 85 years ( P ≤0.001) on 10-year estimates. Independent predictors of PSE also included visual neglect, dysphasia, and stroke subtype, particularly total anterior circulation infarcts. Dysarthria was associated with reduced incidence. Conclusions— PSE is common, with risk continuing to increase outside the acute phase. Young age, cortical location, larger lesions, and hemorrhagic lesions are independent predictors.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.111.000220
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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