Risikofaktoren des isch�mischen Schlaganfalls

Vascular risk factor awareness before and pharmacological treatment before and after stroke and TIA

BACKGROUND AND PURPOSE

Educating the public to screen for vascular risk factors and have them treated is a major public health issue. We assessed the vascular risk factor awareness and frequency of treatment in a cohort of patients with cerebral ischaemia.

METHODS

Data on awareness and pharmacological treatment of vascular risk factors before hospital admission of patients with confirmed ischaemic stroke/transient ischaemic attack (TIA) were analyzed. A follow-up questionnaire assessed the frequency of treatment 1 year after discharge and assessed non-adherence to antithrombotic medication.

RESULTS

At time of stroke/TIA, individual awareness regarding existing hypertension, diabetes, hyperlipidemia and atrial fibrillation (AF) was 83%, 87%, 73% and 69% respectively (n = 558). Pharmacological treatment for hypertension, diabetes, hyperlipidemia and AF was being administered in 80%, 77%, 37% and 62% of patients aware of their conditions. The follow-up was completed by 383 patients (80% recall rate): of the patients with hypertension, diabetes, hyperlipidemia and AF, 89%, 78%, 45% and 86% were receiving risk factor targeted medication. This represents a significant increase concerning AF and hyperlipidemia. Non-adherence to recommended antithrombotics (15%) was higher in patients who had had a TIA.

CONCLUSIONS

All risk factors leave room for improvement in screening and treatment efforts. Adherence to treatment is higher for hypertension and diabetes than for hyperlipidemia. Education efforts should bear in mind less well recognized risk factors.

The impact of atrial fibrillation on the cost of stroke: the berlin acute stroke study

OBJECTIVES

Atrial fibrillation (AF) is an important risk factor for stroke. The primary purpose of this study was to determine the resource use for patients admitted to hospital with acute stroke and to calculate stroke-related direct costs, stratifying the results according to the presence of AF as a risk factor.

METHODS

Data from 558 consecutive patients hospitalized with confirmed acute stroke between August 2000 and July 2001 were analyzed as part of the Berlin Acute Stroke Study. Sociodemographic variables were assessed by direct interview, while hospital data were derived from patient medical records. Patients or their carers completed a follow-up questionnaire about resource utilization and absenteeism from work during the 12-month period after hospital admission.

RESULTS

Out of the 367 patients with follow-up data and ECG findings, 71 (19%) had AF. Patients with AF were generally older, more likely to be female, and had more severe strokes compared with those without AF. Mean direct costs per patient were significantly higher in those with AF-related strokes (EURO 11,799 vs EURO 8817 for non-AF-related strokes; P < 0.001). After adjustment for confounding factors, direct costs were comparable in the two groups, except for acute hospitalization costs, which remained significantly higher in the group with AF (P < 0.05).

CONCLUSION

Medical care for stroke patients with AF is associated with higher costs compared with those without AF; this is explained mainly by confounding factors and driven essentially by a significant difference in acute hospitalization costs.

Symptome, Risikofaktoren und Ätiologie von transitorisch ischämischer Attacke und Schlaganfall

BACKGROUND

It is unclear whether clinical signs and symptoms differ in the presentation of transient ischemic attack (TIA) and stroke, apart from temporal dynamics.

METHODS

Signs and symptoms of patients diagnosed with TIA or stroke were prospectively collected and compared by means of an age-adjusted logistic regression analysis. Risk factors, prehospital medication, and diagnostic workup were obtained from the charts.

RESULTS

Four hundred five patients diagnosed with stroke (68+/-12 years old, 45% female) and 143 diagnosed with TIA (64+/-14 years old, 48% female) were included. Signs and symptoms of patients with TIA were less often "classic" such as paresis (48% vs 71%, P<0.001) or sensory loss (38% vs 48%, P=0.03). The etiology of TIA was more often classified as "undetermined" (57% vs 46%, P<0.05).

CONCLUSIONS

Transient ischemic attack needs special attention and intensive diagnostic workup, because it bears a considerable risk of death and disability but presents less often with classic signs and symptoms and its etiology often remains undetermined.