Atrial fibrillation is a predictor of in-hospital mortality in ischemic stroke patients

Integrating AI-driven wearable devices and biometric data into stroke risk assessment: A review of opportunities and challenges

Stroke is a leading cause of morbidity and mortality worldwide, and early detection of risk factors is critical for prevention and improved outcomes. Traditional stroke risk assessments, relying on sporadic clinical visits, fail to capture dynamic changes in risk factors such as hypertension and atrial fibrillation (AF). Wearable technology (devices), combined with biometric data analysis, offers a transformative approach by enabling continuous monitoring of physiological parameters. This narrative review was conducted using a systematic approach to identify and analyze peer-reviewed articles, reports, and case studies from reputable scientific databases. The search strategy focused on articles published between 2010 till date using pre-determined keywords. Relevant studies were selected based on their focus on wearable devices and AI-driven technologies in stroke prevention, diagnosis, and rehabilitation. The selected literature was categorized thematically to explore applications, opportunities, challenges, and future directions. The review explores the current landscape of wearable devices in stroke risk assessment, focusing on their role in early detection, personalized care, and integration into clinical practice. The review highlights the opportunities presented by continuous monitoring and predictive analytics, where AI-driven algorithms can analyze biometric data to provide tailored interventions. Personalized stroke risk assessments, powered by machine learning, enable dynamic and individualized care plans. Furthermore, the integration of wearable technology with telemedicine facilitates remote patient monitoring and rehabilitation, particularly in underserved areas. Despite these advances, challenges remain. Issues such as data accuracy, privacy concerns, and the integration of wearables into healthcare systems must be addressed to fully realize their potential. As wearable technology evolves, its application in stroke care could revolutionize prevention, diagnosis, and rehabilitation, improving patient outcomes and reducing the global burden of stroke.

Hemorrhagic stroke and atherogenic markers - is there any relation?

Background

The triglyceride/high-density lipoprotein (TG/HDL) ratio emerges as a promising marker for cardiovascular risk. However, the relationship between overall serum lipid levels and hemorrhagic stroke (HS) remains uncertain. Therefore, our study aims to explore the association between this novel index and mortality in HS patients.

Methods

Utilizing a retrospective-prospective framework from January 2020 to August 2023, we scrutinized data from 104 hospitalized patients diagnosed with HS, with particular attention to their medical backgrounds and lipid profiles.

Results

Age (odds ratio [OR], 1.078; 95% confidence interval [CI], 1.032-1.125; P = 0.001), atrial fibrillation (OR, 0.237; 95% CI, 0.074-0.760; P = 0.015), glucose level (OR, 1.121; 95% CI, 1.007-1.247; P = 0.037), and TG/HDL index (OR, 0.368; 95% CI, 0.173-0.863; P = 0.020) emerged as independent predictors for in-hospital mortality, as determined by both univariable and multivariable logistic regression analyses.

Conclusion

Our results add weight to the growing evidence backing the utility of the TG/HDL index in assessing cardiovascular risk among HS patients. They emphasize the necessity of adopting a comprehensive risk assessment and management strategy that incorporates both traditional markers and novel indicators.

Prevalence of atrial fibrillation in ischemic stroke and associated risk factors: A hospital-based study in Indonesia

CONTEXT

The prevalence of ischemic stroke increases each year. One such important factor is the presence of atrial fibrillation (AF), but data regarding this are scarce in Indonesia.

AIMS

This study aimed to understand the prevalence of AF in ischemic stroke and its associated risk factors.

SETTINGS AND DESIGN

A cross-sectional study was conducted from January 2021 to 2023 in Fatima Hospital, through medical records.

SUBJECTS AND METHODS

Subjects were ischemic stroke patients aged ≥18 years. Additional data included demographic characteristics, congestive heart failure (CHF), hypertension, diabetes mellitus, stroke history, vascular disease, AF, dyslipidemia, Glasgow Coma Scale, and anticoagulant usage.

STATISTICAL ANALYSIS USED

Data were analyzed using Chi-square, Fisher, Student's t-test, Mann-Whitney, and logistic regression.

RESULTS

Out of 148 subjects, AF was detected in 16 (10.8%). Among these, 14 (87.5%) had a CHA2DS2-VASc score of ≥2 and were given anticoagulant therapy. A higher proportion of subjects aged over 75 years was observed in the AF group (31.2% vs. 3.8%; P < 0.001). A similar pattern was seen with CHF and dyslipidemia (CHF: 56.3% vs. 8.3%; P < 0.000; dyslipidemia: 93.7% vs. 58.3%; P < 0.005). CHF and dyslipidemia increased the risk of AF by 27-fold (P = 0.001, odds ratio [OR]: 27.400) and 21-fold (P = 0.013, OR: 21.812), respectively.

CONCLUSIONS

These findings underscore the importance of vigilant screening for AF in ischemic stroke, particularly in patients with CHF and dyslipidemia, to guide appropriate anticoagulation therapy and reduce the risk of recurrent stroke. This study was limited by its single-center design and small sample size. A larger, multicenter study is recommended.

Atrial fibrillation and preexisting cognitive impairment in ischemic stroke patients: Dijon Stroke Registry

BACKGROUND

Atrial Fibrillation (AF) is a common cause of ischemic stroke (IS), and is associated with cognitive impairment in the general population. We aimed to compare the prevalence of preexisting cognitive impairment between IS patients with and without AF, and to assess whether prior brain damage could contribute to the observed differences.

METHODS

Patients with acute IS were prospectively identified from the population-based Dijon Stroke Registry, France. Patients who had a CT-scan as brain imaging modality were included in this analysis to assess the presence of preexisting leukoaraiosis, old vascular brain lesions, and cerebral atrophy. Characteristics of patients including prior-to-stroke cognitive status (normal cognition, mild cognitive impairment (MCI), or dementia) were compared between those with and without AF.

RESULTS

Among 916 IS patients, 288 (31.4 %) had AF, of whom 88 had newly diagnosed AF. AF patients had more frequent prior MCI (17.8 % versus 10.2 %) or dementia (22.4 % versus 13.1 %) (p = 0.001), vascular risk factors, and preexisting brain damage. In unadjusted model, preexisting cognitive impairment was associated with AF (OR=2.24; 95 % CI: 1.49-3.37, p < 0.001 for MCI; OR=2.20; 95 % CI: 1.52-3.18, p < 0.001 for dementia). After adjustment for clinical and imaging variables, preexisting mild cognitive impairment (OR=1.87; 95 % CI: 1.06-3.32, p = 0.032) and dementia (OR=1.98; 95 % CI: 1.15-3.40, p = 0.013) were independently associated with AF.

CONCLUSION

AF is a common condition in IS patients and is associated with preexisting cognitive impairment. Brain lesions visible on imaging did not seem to fully account for this association that may involve other mechanisms yet to be elucidated.

Excessive Supraventricular Ectopic Activity and the Risk of Atrial Fibrillation and Stroke: A Systematic Review and Meta-Analysis

BACKGROUND

Excessive supraventricular ectopic activity (ESVEA) is correlated with the development of atrial fibrillation (AF) and is frequently observed in ischemic stroke patients. This meta-analysis aims to summarize the evidence on the association between ESVEA and the risk of AF and stroke.

METHODS

PubMed and Embase databases were systematically searched to identify all publications providing relevant data from inception to 23 August 2022. Hazard ratio (HR) and 95% confidence interval (CI) were pooled using fixed-effect or random-effect models.

RESULTS

We included 23,272 participants from 20 studies. Pooled results showed that ESVEA was associated with an increased risk of AF in the general population (HR: 2.57; 95% CI 2.16-3.05), increased risk of AF in ischemic stroke patients (HR: 2.91; 95% CI 1.80-4.69), new-onset ischemic stroke (HR: 1.91; 95% CI 1.30-2.79), and all-cause mortality (HR: 1.41; 95% CI 1.24-1.59). Pooled analysis indicated that ESVEA was not associated with recurrent ischemic stroke/transient ischemic attack (TIA) (HR: 1.24; 95% CI 0.91-1.67).

CONCLUSIONS

ESVEA is associated with AF, new-onset ischemic stroke, and all-cause mortality.

Predictors of Short- and Long-Term Mortality in Ischemic Stroke: A Community-Based Study in Brno, Czech Republic

BACKGROUND AND OBJECTIVE

Short- and long-term mortality following ischemic stroke (IS) and their predictors have not been defined in the Czech population, and studies on long-term mortality are largely missing for the populations of Central Europe.

METHODS

Using the National Register of Hospitalized Patients and the Czech National Mortality Registry, we analyzed data on 1-month, 1-year, and 3-year all-cause mortality for patients admitted with IS to any of the 4 hospitals with a certified stroke unit in Brno, Czech Republic, in 2011. We reviewed discharge summaries and recorded potential factors impacting mortality after the index stroke event. Using univariate and multivariable analyses, we identified predictors of mortality at all 3 time points.

RESULTS

In our multivariable model, statin use (odds ratio [OR] 0.095, p < 0.0001), age at stroke (OR 1.03, p = 0.0445), and admission National Institutes of Health Stroke Scale (NIHSS) score (OR 1.16, p < 0.0001) predicted 1-month mortality, while statin use (OR 0.43, p = 0.0004), history of cardiac failure (OR 2.17, p = 0.0137), age at stroke (OR 1.07, p < 0.0001), and admission NIHSS score (OR 1.14, p < 0.0001) predicted 1-year mortality. Statin use (OR 0.54, p = 0.0051), history of cardiac failure (OR 2.13, p = 0.0206), age at stroke (OR 1.07, p < 0.0001), and admission NIHSS score (OR 1.11, p < 0.0001) also predicted 3-year mortality.

CONCLUSIONS

Our study is the first to report data on short- and long-term mortality rates and their predictors in patients hospitalized with IS in the Czech population. Our results indicate that mortality rates and predictors of mortality are consistent with those reported in studies from other populations throughout the world.

Influencing factors of hemorrhagic transformation in non-thrombolysis patients with cerebral infarction

OBJECTIVES

Hemorrhagic transformation (HT) is a serious complication of acute cerebral infarction. The aim of study is to investigate the influencing factors of HT in non-thrombolysis patients with acute cerebral infarction, and to explore its clinical significance.

PATIENTS AND METHODS

From June 2016 to March 2017, a total of 346 non-thrombolysis patients with acute cerebral infarction hospitalized in the Department of Neurology of Guangdong Second Provincial General Hospital, were chosen and randomly devided into the non-HT group (control) and HT group. A record of 17 indices including the patients'age, gender, hypertension, diabetes, dyslipidemia, hyperhomocystinemia, atrial fibrillation, drinking or smoking, anticoagulation, antithrombosis, international normalized ratio (INR) and platelet count were measured. Then regression analysis was made to find the independent factors for HT.

RESULTS

It was found that 38 of non-thrombolysis patients with acute cerebral infarction involved in this study were with HT. The indices including dyslipidemia, drinking, atrial fibrillation, antiplatelet aggregation, anticoagulation, INR > 1.7, cholesterin, triglyceride and platelet count showed statistical differences between the HT group and the non-HT group (P < 0.05). According to the binary logistic regression analysis, there was a negative correlation between dyslipidemia and HT (odds ratio (OR)=0.371, 95% confidence interval (CI) 0.186-0.740, P = 0.005), while there was a positive correlation between atrial fibrillation (OR=2.476, 95% CI 1.140-5.377, P=0.022), platelet count (OR=1.006, 95% CI 0.682-1.611, P = 0.007), INR>1.7 (OR=10.889, 95% CI 4.760-24.910, P = 0.000) and HT.

CONCLUSION

There is independent correlation between dyslipidemia, atrial fibrillation, platelet count, INR > 1.7 and HT. Dyslipidemia is the protective factor for HT, and atrial fibrillation, platelet count, INR > 1.7 are the risk factors for HT.

Effects of the blood urea nitrogen to creatinine ratio on haemorrhagic transformation in AIS patients with diabetes mellitus

Background

The effect of the blood urea nitrogen (BUN) to creatinine (Cr) ratio (henceforth BUN/Cr) on haemorrhagic transformation (HT) of acute ischaemic stroke (AIS) patients is unclear.

Methods

AIS patients in the West China Hospital, Sichuan University, Chengdu, China, admitted within seven days from stroke onset (2012–2016) were included in the study. Baseline data, including BUN and Cr levels, were collected. The outcome was defined as HT during hospitalization.

Results

In this study, 1738 participants with an average age of 62.7 ± 14.0 years were included. After adjusting potential confounders (age, blood platelet, albumin, stroke severity, triglycerides and low-density lipoprotein [LDL]), multivariate logistic regression analyses indicated that BUN/Cr is independently associated with HT. The nonlinear relation between BUN/Cr and HT was explored in a dose-dependent manner, with an apparent inflection point of 30.71. On the left and right sides of the inflection point, the odds ratio (OR) and 95% confidence interval (CI) were 1.05 (1.02–1.08) and 0.96 (0.88–1.05), respectively. Interaction between BUN/Cr and diabetes mellitus (DM) and HT (P for interaction = 0.0395) was noted. BUN/Cr showed positive correlation with HT in DM patients (OR = 1.07; 95% CI: [1.02, 1.12]) but no significant relationship with HT in patients without DM.

Conclusion

BUN/Cr is significantly associated with HT in AIS patients in a linear fashion, with an apparent cut point demarcating the HT difference. When the patients have DM, BUN/Cr is positively correlated with HT. These results support a revision in how we anticipate the prognosis for AIS patients.

Electronic supplementary material

The online version of this article (10.1186/s12883-019-1290-x) contains supplementary material, which is available to authorized users.

Sex-related differences in the risk factors for in-hospital mortality and outcomes of ischemic stroke patients in rural areas of Taiwan

Background and purpose

Sex-related differences in the clinical presentation and outcomes of stroke patients are issues that have attracted increased interest from the scientific community. The present study aimed to investigate sex-related differences in the risk factors for in-hospital mortality and outcome in ischemic stroke patients.

Methods

A total of 4278 acute ischemic stroke patients admitted to a stroke unit between January 1, 2007 and December 31, 2014 were included in the study. We considered demographic characteristics, clinical characteristics, co-morbidities, and complications, among others, as factors that may affect clinical presentation and in-hospital mortality. Good and poor outcomes were defined as modified Ranking Score (mRS)≦2 and mRS>2. Neurological deterioration (ND) was defined as an increase of National Institutes of Health Stroke Score (NIHSS) ≥ 4 points. Hemorrhagic transformation (HT) was defined as signs of hemorrhage in cranial CT or MRI scans. Transtentorial herniation was defined by brain edema, as seen in cranial CT or MRI scans, associated with the onset of acute unilateral or bilateral papillary dilation, loss of reactivity to light, and decline of ≥ 2 points in the Glasgow coma scale score.

Results

Of 4278 ischemic stroke patients (women 1757, 41.1%), 269 (6.3%) received thrombolytic therapy. The in hospital mortality rate was 3.35% (139/4278) [4.45% (80/1757) for women and 2.34% (59/2521) for men, p < 0.01]. At discharge, 41.2% (1761/4278) of the patients showed good outcomes [35.4% (622/1757) for women and 45.2% (1139/2521) for men]. Six months after stroke, 56.1% (1813/3231) showed good outcomes [47.4% (629/1328) for women and 62.2% (1184/1903) for men, p < 0.01]. Atrial fibrillation (AF), diabetes mellitus, stroke history, and old age were factors contributing to poor outcomes in men and women. Hypertension was associated with poor outcomes in women but not in men in comparison with patients without hypertension. Stroke severity and increased intracranial pressure were associated with increased in-hospital mortality in men and women. AF was associated with increased in-hospital mortality in women but not in men compared with patients without AF.

Conclusion

The in-hospital mortality rate was not significantly different between women and men. Functional outcomes at discharge and six months after stroke were poorer in women than in men. Hypertension is an independent factor causing poorer outcomes in women than in men. AF is an independent factor affecting sex differences in hospital mortality in women.