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Karisik A, Dejakum B, Moelgg K, Komarek S, Toell T, Mayer-Suess L, Pechlaner R, Kostner S, Sollereder S, Kiechl S, Rossi S, Schoenherr G, Lang W, Kiechl S, Knoflach M, Boehme C. Association between dysphagia and symptoms of depression and anxiety after ischemic stroke. Eur J Neurol 2024; 31:e16224. [PMID: 38308469 DOI: 10.1111/ene.16224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND AND PURPOSE Dysphagia is associated with poor outcome, higher mortality, reduced quality of life, and social isolation. We investigate the relationship between swallowing impairment and symptoms of anxiety and depression after ischemic stroke. METHODS Consecutive patients with ischemic stroke participating in the prospective STROKE-CARD Registry study from 2020 to 2022 were assessed for dysphagia on hospital admission (clinical swallowing assessment) and for persistence until discharge and 3-month follow-up (SINGER Independency Index). Anxiety and depression symptoms were recorded using Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS) at 3-month follow-up. RESULTS Of 648 patients, 19.3% had dysphagia on admission, persisting in 14.8% at discharge and 6.8% at 3-month follow-up. With the presence or duration of dysphagia (no dysphagia, dysphagia at baseline, at discharge, at 3 months), score (mean ± SD) increased on the BDI (7.9 ± 6.7, 12.5 ± 8.7, 13.5 ± 9.0, 16.5 ± 10.2), HADS-D (4.4 ± 3.7, 7.1 ± 4.2, 7.7 ± 4.4, 9.8 ± 4.3), and HADS-A (4.4 ± 3.5, 5.4 ± 3.6, 6.0 ± 3.6, 7.0 ± 3.6). In linear regression analysis adjusting for age, sex, diabetes, dementia, and either functional disability or stroke severity, BDI and HADS-D scores were significantly higher in patients with dysphagia across all points in time (admission, discharge, 3-month follow-up). An independent association with HADS-A scores was only evident in patients with persisting dysphagia after 3 months. Patients with dysphagia were more likely to receive antidepressants, antipsychotics, or benzodiazepines at discharge and 3-month follow-up. CONCLUSIONS Dysphagia after stroke is common and severely affects psychosocial functioning of individuals. Our results highlight swallowing impairment as an independent predictor for poststroke depressive and, to a lesser extent, anxiety symptoms.
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Affiliation(s)
- Anel Karisik
- VASCage-Center on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Dejakum
- VASCage-Center on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kurt Moelgg
- VASCage-Center on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Silvia Komarek
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Toell
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefanie Kostner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Sophia Kiechl
- VASCage-Center on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Hochzirl Hospital, Hochzirl, Austria
| | - Sonja Rossi
- ICONE-Innsbruck Cognitive Neuroscience, Department for Hearing, Speech, and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Gudrun Schoenherr
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wilfried Lang
- VASCage-Center on Clinical Stroke Research, Innsbruck, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Stefan Kiechl
- VASCage-Center on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- VASCage-Center on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Komarek S, Dejakum B, Moelgg K, Boehme C, Karisik A, Toell T, Kiechl S, Knoflach M, Pechlaner R, Mayer-Suess L. No association between SARS-CoV-2 vaccination and ischaemic stroke or high-risk transient ischaemic attack. J Neurol Sci 2024; 456:120834. [PMID: 38134562 DOI: 10.1016/j.jns.2023.120834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Initiation of SARS-CoV-2 (Severe acute respiratory syndrome coronavirus type 2) vaccinations aroused scepticism within the general-public about risks including stroke. Our aim was to explore temporal associations between vaccination and cerebrovascular events through an analysis of a prospective large-scale cohort of consecutive stroke and high-risk TIA (transitory ischaemic attack) patients. METHODS We prospectively recruited a cohort of consecutive ischaemic stroke and high-risk TIA (ABCD2-Score ≥ 4) patients treated at the Innsbruck University Hospital (STROKE-CARD Registry Study, NCT04582825) from December 2020 until February 2022. SARS-CoV-2 vaccination status and the time of administration was ascertained by electronic health-data. A Cox model with vaccination status as time-dependent co-variable was employed to examine its association with ischaemic events. RESULTS Data on 572 participants were available with 355 (62.1%) vaccinated against SARS-CoV-2 before suffering cerebral ischaemia. In our cohort, no temporal association between vaccination and cerebrovascular event was detected (HR 1.06 [0.85-1.34; p = 0.60]) and this also applies to TIA (HR [0.82 0.37-1.85; p = 0.64]) or minor stroke (HR 1.18 [0.89-1.56; p = 0.26]) and subgroups defined by sex and age. Neither vector-based (HR 1.11 [0.79-1.56; p = 0.55]) nor mRNA-based (HR 1.06 [0.84-1.34; p = 0.61]) vaccinations were associated with the occurrence of cerebral ischaemia. CONCLUSION Among patients with stroke or high-risk TIA, SARS-CoV-2 vaccination was not associated with cerebral ischaemia.
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Affiliation(s)
- Silvia Komarek
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Benjamin Dejakum
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Kurt Moelgg
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Anel Karisik
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Thomas Toell
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Lukas Mayer-Suess
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
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Boehme C, Domig L, Komarek S, Toell T, Mayer L, Dejakum B, Krebs S, Pechlaner R, Bernegger A, Mueller C, Rumpold G, Griesmacher A, Vigl M, Schoenherr G, Schmidauer C, Ferrari J, Lang W, Knoflach M, Kiechl S. Long-term outcome of a pragmatic trial of multifaceted intervention (STROKE-CARD care) to reduce cardiovascular risk and improve quality-of-life after ischaemic stroke and transient ischaemic attack: study protocol. BMC Cardiovasc Disord 2022; 22:347. [PMID: 35915405 PMCID: PMC9344624 DOI: 10.1186/s12872-022-02785-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background Patients with ischaemic stroke or transient ischaemic attack (TIA) are at high risk of incident cardiovascular events and recurrent stroke. Despite compelling evidence about the efficacy of secondary prevention, a substantial gap exists between risk factor management in real life and that recommended by international guidelines. We conducted the STROKE-CARD trial (NCT02156778), a multifaceted pragmatic disease management program between 2014 and 2018 with follow-up until 2019. This program successfully reduced cardiovascular risk and improved health-related quality of life and functional outcome in patients with acute ischaemic stroke or TIA within 12 months after the index event. To investigate potential long-term effects of STROKE-CARD care compared to standard care, an extension of follow-up is warranted. Methods We aim to include all patients from the STROKE-CARD trial (n = 2149) for long-term follow-up between 2019 and 2021 with the study visit scheduled 3–6 years after the stroke/TIA event. The co-primary endpoint is the composite of major recurrent cardiovascular events (nonfatal stroke, nonfatal myocardial infarction, and vascular death) from hospital discharge until the long-term follow-up visit and health-related quality of life measured with the European Quality of Life-5 Dimensions (EQ-5D-3L) at the final visit. Secondary endpoints include overall mortality, long-term functional outcome, and target-level achievement in risk factor management. Discussion This long-term follow-up will provide evidence on whether the pragmatic post-stroke/TIA intervention program STROKE-CARD is capable of preventing recurrent cardiovascular events and improving quality-of-life in the long run. Trial registration clinicaltrials.gov: NCT04205006 on 19 December 2019.
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Affiliation(s)
- Christian Boehme
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Lena Domig
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.,VASCage, Research Centre On Vascular Ageing and Stroke, Innsbruck, Austria
| | - Silvia Komarek
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.,VASCage, Research Centre On Vascular Ageing and Stroke, Innsbruck, Austria
| | - Thomas Toell
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Lukas Mayer
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Benjamin Dejakum
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.,VASCage, Research Centre On Vascular Ageing and Stroke, Innsbruck, Austria
| | - Stefan Krebs
- Department of Neurology, Hospital St. John's of God, Vienna, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | | | - Christoph Mueller
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gerhard Rumpold
- Department of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute of Medical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - Marion Vigl
- Department of Neurology, Hospital St. John's of God, Vienna, Austria
| | - Gudrun Schoenherr
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christoph Schmidauer
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Julia Ferrari
- Department of Neurology, Hospital St. John's of God, Vienna, Austria
| | - Wilfried Lang
- Department of Neurology, Hospital St. John's of God, Vienna, Austria.,Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Mayer-Suess L, Geiger M, Dejakum B, Boehme C, Domig LM, Komarek S, Toell T, Kiechl S, Knoflach M. Sex-differences in psychosocial sequelae after spontaneous cervical artery dissection. Sci Rep 2022; 12:611. [PMID: 35022509 PMCID: PMC8755839 DOI: 10.1038/s41598-021-04686-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
Short- to mid-term functional outcome in spontaneous cervical artery dissection is favorable, but the concomitant psychosocial impact is underreported. We aimed to determine these possible sequelae, with a special focus on sex differences, in our cohort of spontaneous cervical artery dissection subjects. During a standardized prospective in-house follow-up visit we, among other values, evaluated functional outcome (modified Rankin Scale [mRS]), psychosocial measures (return to work-, divorce rate) and health-related quality of life (WHO-QoL-BREF and SF-36-questionnaires). 145 patients participated in the long-term prospective follow-up. Median follow-up time was 6.5 years and excellent functional outcome (mRS ≤ 1) was achieved in 89.0% subjects. 87.6% returned to work and 17.6% married patients had a divorce during follow-up. Even though relevant baseline-/discharge characteristics and functional outcome did not differ between the sexes, women were less likely to return to work compared to men (79.7% vs. 93.8%; P = 0.010) and divorce rate was considerably higher in women (30.2% vs. 9.2%; P = 0.022). Health related quality of life did not differ significantly between the sexes, but women consistently reported lower values. Even though functional outcome is beneficial in most patients, measures to prevent poor psychosocial outcome should be considered in the long-term care of patients with spontaneous cervical artery dissection, especially women.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Moritz Geiger
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Benjamin Dejakum
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Lena M Domig
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Silvia Komarek
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Thomas Toell
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
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Abstract
Background Tremendous progress in acute stroke therapy has improved short-term outcome but part of this achievement may be lost in the long run. Concepts for a better long-term management of stroke survivors are needed to address their unmet needs and to reduce the burden of post-stroke complications, residual deficits, and recurrent vascular events. Aims This review summarizes current knowledge on post-hospital care and the scientific evidence supporting individual programs. Summary of review A systematic search of electronic databases according to PRISMA guidelines identified 10,374 articles, 77 of which met the inclusion criteria. One large randomised controlled trial on a multifaceted care program delivered by the multidisciplinary stroke team reduced recurrent vascular events and improved quality of life and functional outcome one year after the event, while a number of studies offer solutions for individual components of post-hospital disease management like patient education, counselling, and self-management or the management of post-stroke complications and residual deficits. A majority of studies, however, was small in size and limited by a short follow-up. Most initiatives with a narrow focus on risk factor control failed to lower the risk of recurrent events. The caregivers’ central role in post-stroke patient management is broadly neglected in research. Conclusions Over the past years, first knowledge on how to best organize post-hospital care of stroke patients has emerged. Comprehensive and pragmatic programs operated by the multidisciplinary stroke team hold promise to reduce the long-term health burden of stroke. There is a clear need for further high-quality studies with both clinical endpoints and patient-reported outcomes to establish sustainable solutions in different settings and regions to improve life after stroke, a key priority of the Stroke Action Plan for Europe 2018–2030.
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Affiliation(s)
- Christian Boehme
- Department of Neurology, 27280Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Toell
- Department of Neurology, 27280Medical University of Innsbruck, Innsbruck, Austria
| | - Wilfried Lang
- Department of Neurology, Hospital St. John's of God, Vienna, Austria
| | - Michael Knoflach
- Department of Neurology, 27280Medical University of Innsbruck, Innsbruck, Austria.,VASCage, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, 27280Medical University of Innsbruck, Innsbruck, Austria.,VASCage, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
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Boehme C, Toell T, Knoflach M, Kiechl S. Author response: The dimension of preventable stroke in a large representative patient cohort. Neurology 2020; 95:558. [DOI: 10.1212/wnl.0000000000010592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mayer L, Pechlaner R, Barallobre-Barreiro J, Boehme C, Toell T, Lynch M, Yin X, Willeit J, Gizewski ER, Perco P, Ratzinger G, Kiechl S, Mayr M, Knoflach M. Extracellular matrix protein signature of recurrent spontaneous cervical artery dissection. Neurology 2020; 95:e2047-e2055. [PMID: 32887783 DOI: 10.1212/wnl.0000000000010710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/27/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To assess whether connective tissue disorder is evident in patients with spontaneous cervical artery dissection and therefore identify patients at risk of recurrence using a cutting-edge quantitative proteomics approach. METHODS In the ReSect study, all patients with spontaneous cervical artery dissection treated at the Innsbruck University Hospital since 1996 were invited to attend a standardized clinical follow-up examination. Protein abundance in skin punch biopsies (n = 50) was evaluated by a cutting-edge quantitative proteomics approach (liquid chromatography-mass spectrometry) that has hitherto not been applied to such patients. RESULTS Patients with 1-time single-vessel (n = 19) or multiple-vessel (n = 13) dissections did not differ between each other or compared to healthy controls (n = 12) in protein composition. Patients with recurrent spontaneous cervical artery dissection (n = 6), however, showed significantly different expression of 25 proteins compared to the other groups combined. Literature review and Gene Ontology term annotation check revealed that 13 of the differently expressed proteins play a major role in the structural integrity of connective tissue or are linked to connective tissue disorders. These proteins showed clustering to a collagen/elastin cluster and one consisting of desmosome related proteins. CONCLUSION This study unravels an extracellular matrix protein signature of recurrent spontaneous cervical artery dissection. In the long run and after large-scale validation, our findings may well assist in identifying patients at risk of recurrent spontaneous cervical artery dissection and thus guide therapy.
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Affiliation(s)
- Lukas Mayer
- From the Departments of Neurology (L.M., R.P., C.B., T.T., J.W., S.K., M.K.), Neuroradiology (E.R.G.), Internal Medicine IV (P.P.), and Dermatology (G.R.), Medical University Innsbruck, Austria; King's British Heart Foundation Centre (J.B.-B., M.L., X.Y., M.M.), King's College London, London, UK; and VASCage (S.K.), Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Raimund Pechlaner
- From the Departments of Neurology (L.M., R.P., C.B., T.T., J.W., S.K., M.K.), Neuroradiology (E.R.G.), Internal Medicine IV (P.P.), and Dermatology (G.R.), Medical University Innsbruck, Austria; King's British Heart Foundation Centre (J.B.-B., M.L., X.Y., M.M.), King's College London, London, UK; and VASCage (S.K.), Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Javier Barallobre-Barreiro
- From the Departments of Neurology (L.M., R.P., C.B., T.T., J.W., S.K., M.K.), Neuroradiology (E.R.G.), Internal Medicine IV (P.P.), and Dermatology (G.R.), Medical University Innsbruck, Austria; King's British Heart Foundation Centre (J.B.-B., M.L., X.Y., M.M.), King's College London, London, UK; and VASCage (S.K.), Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Christian Boehme
- From the Departments of Neurology (L.M., R.P., C.B., T.T., J.W., S.K., M.K.), Neuroradiology (E.R.G.), Internal Medicine IV (P.P.), and Dermatology (G.R.), Medical University Innsbruck, Austria; King's British Heart Foundation Centre (J.B.-B., M.L., X.Y., M.M.), King's College London, London, UK; and VASCage (S.K.), Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Thomas Toell
- From the Departments of Neurology (L.M., R.P., C.B., T.T., J.W., S.K., M.K.), Neuroradiology (E.R.G.), Internal Medicine IV (P.P.), and Dermatology (G.R.), Medical University Innsbruck, Austria; King's British Heart Foundation Centre (J.B.-B., M.L., X.Y., M.M.), King's College London, London, UK; and VASCage (S.K.), Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Marc Lynch
- From the Departments of Neurology (L.M., R.P., C.B., T.T., J.W., S.K., M.K.), Neuroradiology (E.R.G.), Internal Medicine IV (P.P.), and Dermatology (G.R.), Medical University Innsbruck, Austria; King's British Heart Foundation Centre (J.B.-B., M.L., X.Y., M.M.), King's College London, London, UK; and VASCage (S.K.), Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Xiaoke Yin
- From the Departments of Neurology (L.M., R.P., C.B., T.T., J.W., S.K., M.K.), Neuroradiology (E.R.G.), Internal Medicine IV (P.P.), and Dermatology (G.R.), Medical University Innsbruck, Austria; King's British Heart Foundation Centre (J.B.-B., M.L., X.Y., M.M.), King's College London, London, UK; and VASCage (S.K.), Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Johann Willeit
- From the Departments of Neurology (L.M., R.P., C.B., T.T., J.W., S.K., M.K.), Neuroradiology (E.R.G.), Internal Medicine IV (P.P.), and Dermatology (G.R.), Medical University Innsbruck, Austria; King's British Heart Foundation Centre (J.B.-B., M.L., X.Y., M.M.), King's College London, London, UK; and VASCage (S.K.), Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Elke R Gizewski
- From the Departments of Neurology (L.M., R.P., C.B., T.T., J.W., S.K., M.K.), Neuroradiology (E.R.G.), Internal Medicine IV (P.P.), and Dermatology (G.R.), Medical University Innsbruck, Austria; King's British Heart Foundation Centre (J.B.-B., M.L., X.Y., M.M.), King's College London, London, UK; and VASCage (S.K.), Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Paul Perco
- From the Departments of Neurology (L.M., R.P., C.B., T.T., J.W., S.K., M.K.), Neuroradiology (E.R.G.), Internal Medicine IV (P.P.), and Dermatology (G.R.), Medical University Innsbruck, Austria; King's British Heart Foundation Centre (J.B.-B., M.L., X.Y., M.M.), King's College London, London, UK; and VASCage (S.K.), Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Gudrun Ratzinger
- From the Departments of Neurology (L.M., R.P., C.B., T.T., J.W., S.K., M.K.), Neuroradiology (E.R.G.), Internal Medicine IV (P.P.), and Dermatology (G.R.), Medical University Innsbruck, Austria; King's British Heart Foundation Centre (J.B.-B., M.L., X.Y., M.M.), King's College London, London, UK; and VASCage (S.K.), Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Stefan Kiechl
- From the Departments of Neurology (L.M., R.P., C.B., T.T., J.W., S.K., M.K.), Neuroradiology (E.R.G.), Internal Medicine IV (P.P.), and Dermatology (G.R.), Medical University Innsbruck, Austria; King's British Heart Foundation Centre (J.B.-B., M.L., X.Y., M.M.), King's College London, London, UK; and VASCage (S.K.), Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Manuel Mayr
- From the Departments of Neurology (L.M., R.P., C.B., T.T., J.W., S.K., M.K.), Neuroradiology (E.R.G.), Internal Medicine IV (P.P.), and Dermatology (G.R.), Medical University Innsbruck, Austria; King's British Heart Foundation Centre (J.B.-B., M.L., X.Y., M.M.), King's College London, London, UK; and VASCage (S.K.), Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Michael Knoflach
- From the Departments of Neurology (L.M., R.P., C.B., T.T., J.W., S.K., M.K.), Neuroradiology (E.R.G.), Internal Medicine IV (P.P.), and Dermatology (G.R.), Medical University Innsbruck, Austria; King's British Heart Foundation Centre (J.B.-B., M.L., X.Y., M.M.), King's College London, London, UK; and VASCage (S.K.), Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria.
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Willeit P, Toell T, Boehme C, Krebs S, Mayer L, Lang C, Seekircher L, Tschiderer L, Willeit K, Rumpold G, Schoenherr G, Griesmacher A, Ferrari J, Knoflach M, Lang W, Kiechl S, Willeit J. STROKE-CARD care to prevent cardiovascular events and improve quality of life after acute ischaemic stroke or TIA: A randomised clinical trial. EClinicalMedicine 2020; 25:100476. [PMID: 32954239 PMCID: PMC7486330 DOI: 10.1016/j.eclinm.2020.100476] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients with ischaemic stroke or transient ischaemic attack (TIA) are at high risk of recurrent stroke and other cardiovascular diseases and commonly suffer from reduced quality of life. We aimed to determine whether the disease management programme STROKE-CARD can prevent cardiovascular diseases and improve quality of life in these patients. METHODS In this pragmatic open-label two-centre randomised controlled trial with blinded outcome assessment, we randomly assigned patients with acute ischaemic stroke or TIA (ABCD2 score ≥3) in a 2:1 ratio to receive STROKE-CARD care or standard care. STROKE-CARD care is a disease management programme by a multidisciplinary stroke team that comprises a standardised 3-month visit and access to a web-based patient portal targeting risk factor management, post-stroke complications, comorbidities and cardiovascular warning signs, rehabilitation demands, and patient education, counselling, and self-empowerment. Co-primary outcomes were analysed on an intention-to-treat basis and were: (i) major cardiovascular disease events defined as nonfatal ischaemic or haemorrhagic stroke, nonfatal myocardial infarction, or vascular death occurring between hospital discharge and 12 months; and (ii) health-related quality of life at 12 months quantified with the EuroQol-5-Dimensions-3-Levels (EQ-5D-3L) overall utility score. This trial is registered with ClinicalTrials.gov, number NCT02156778. FINDINGS Of 2149 patients enrolled between January 2014 and December 2017 (mean age 69 years, 41% female, 83% with ischaemic stroke, 17% with TIA), 1438 were assigned to STROKE-CARD care and 711 to standard care. Major cardiovascular disease events occurred in 78 patients in the STROKE-CARD care group (5.4%) and in 59 patients in the standard care group (8.3%) (hazard ratio, 0.63; 95% confidence interval: 0.45-0.88; P=0.007). STROKE-CARD care also led to a better EQ-5D-3L overall utility score at 12 months (P<0.001). Among pre-specified secondary outcomes, STROKE-CARD care improved all individual EQ-5D-3L dimensions and functional outcome on the modified Rankin Scale at 12 months. Post hoc explanatory analyses identified considerable demands for additional rehabilitation and refinement of preventive therapy regimes at the 3-month visit and high proportions of post-stroke complications and warning signs of imminent cardiovascular diseases within the first three months. INTERPRETATION The pragmatic and easily implementable STROKE-CARD care programme reduced cardiovascular risk and improved health-related quality of life and functional outcome in patients with acute ischaemic stroke or TIA. FUNDING Tirol Kliniken, Tyrolean Health Insurance Company, Tyrol Health Care Funds, Boehringer Ingelheim, Nstim Services, Sanofi, Bayer Healthcare.
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Affiliation(s)
- Peter Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Corresponding author at: Department of Neurology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria.
| | - Thomas Toell
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Krebs
- Department of Neurology, St. John's of God Hospital, Vienna, Austria
| | - Lukas Mayer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Clemens Lang
- Department of Neurology, St. John's of God Hospital, Vienna, Austria
| | - Lisa Seekircher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lena Tschiderer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Karin Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gerhard Rumpold
- Department of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gudrun Schoenherr
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute of Medical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - Julia Ferrari
- Department of Neurology, St. John's of God Hospital, Vienna, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wilfried Lang
- Department of Neurology, St. John's of God Hospital, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Corresponding author at: Department of Neurology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria.
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Gothe H, Matteucci Gothe R, Arvandi M, Hintringer K, Toell T, Oberaigner W, Rajsic S, Kugler J, Kiechl S, Willeit J, Siebert U. Linkage von klinischen Primärdaten und Krankenkassenabrechnungsdaten in der Evaluation der Schlaganfallversorgung – SeDaStro: Erfahrungen aus dem Tiroler StrokeCard-Programm. Gesundheitswesen 2020; 82:S122-S130. [DOI: 10.1055/a-1101-8949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Zusammenfassung
Hintergrund Und Zielsetzung Datenlinkage-Verfahren sind von erheblicher Bedeutung für die Evaluation von Therapieregimes chronischer Erkrankungen, bei denen Patient/inn/en zwischen verschiedenen Versorgungssektoren navigieren. Ein umfassendes Bild langfristiger Effekte und der Kosten-Effektivität der Behandlung kann nur gezeichnet werden, wenn Daten verschiedener Provenienz miteinander verknüpft werden.
Methodische Probleme und Herausforderungen Am Beispiel der post-akuten Versorgung des Schlaganfalls veranschaulicht die vorliegende Studie, wie per exaktem deterministischem Datenlinkage klinische Patient/inn/endaten (Primärdaten) mit Routineabrechnungsdaten (Sekundärdaten) der Tiroler Gebietskrankenkasse (TGKK) verknüpft werden können. Die von Datenlinkage-Projekten bekannten Herausforderungen traten auch beim StrokeCard-Projekt der Medizinischen Universität Innsbruck auf, insgesamt jedoch begünstigten die Spezifika des österreichischen Gesundheitssystems (ein Großteil der Population ist in der Gebietskrankenkasse des jeweiligen Bundeslandes pflichtversichert) das Datenlinkage-Vorhaben.
Ergebnisse Im Rekrutierungszeitraum 01/2014–12/2015 konnten n=540 Pat. identifiziert und dem operativen Datensatz zugespielt werden. Davon waren n=367 Teil der StrokeCard-Gruppe (d. h. der Interventionsgruppe), n=173 gehörten der Standardversorgungsgruppe an (d. h. der Kontrollgruppe); n=11 Pat. haben das 1-Jahres-Follow-up nicht beendet (n=7 Pat. der Interventionsgruppe vs. n=4 Pat. der Kontrollgruppe); n=7 Pat. verstarben während der Studie (n=5 Pat. der Interventionsgruppe vs. n=2 Pat. der Kontrollgruppe). Für alle 540 Pat. waren TGKK-Routinedaten für 1 Jahr vor Rekrutierung bis 1 Jahr nach Entlassung aus der Klinik verfügbar. Alle Daten konnten für die gesundheitsökonomische Evaluation verwendet werden.
Schlussfolgerungen Mit diesem Projekt wurde die Machbarkeit der Verknüpfung von Primär- und Sekundärdaten unterschiedlicher Herkunft untersucht. Trotz günstiger Rahmenbedingungen hat die österreichische Versorgungsforschung nur begrenzte Erfahrungen auf diesem Gebiet. Die Ergebnisse zeigen, dass ein unter Datenschutzkautelen betriebenes Linkage gelingen kann und aufgrund der Verfügbarkeit relevanter Informationen aus Abrechnungsdaten eine empirische Bereicherung insbesondere für gesundheitsökonomische Analysen darstellt. Dies sollte als Anregung verstanden werden, in Evaluationsstudien Datenlinkage-Prozeduren in Zukunft in verstärktem Maße einzusetzen.
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Affiliation(s)
- Holger Gothe
- Department für Public Health, Versorgungsforschung und Health Technology Assessment, UMIT, Hall in Tirol, Austria
- Lehrstuhl Gesundheitswissenschaften/Public Health, Medizinische Fakultät, TU Dresden, Dresden
- IGES Institut GmbH, Berlin
| | - Raffaella Matteucci Gothe
- Department für Public Health, Versorgungsforschung und Health Technology Assessment, UMIT, Hall in Tirol, Austria
| | - Marjan Arvandi
- Department für Public Health, Versorgungsforschung und Health Technology Assessment, UMIT, Hall in Tirol, Austria
| | - Katharina Hintringer
- Gesundheitsökonomie, Landesstelle Tirol, Österreichische Gesundheitskasse, Innsbruck, Austria
| | - Thomas Toell
- Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Willi Oberaigner
- Institut für klinische Epidemiologie, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Sasa Rajsic
- Department für Public Health, Versorgungsforschung und Health Technology Assessment, UMIT, Hall in Tirol, Austria
| | - Joachim Kugler
- Lehrstuhl Gesundheitswissenschaften/Public Health, Medizinische Fakultät, TU Dresden, Dresden
| | - Stefan Kiechl
- Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Johann Willeit
- Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Uwe Siebert
- Department für Public Health, Versorgungsforschung und Health Technology Assessment, UMIT, Hall in Tirol, Austria
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Boehme C, Toell T, Mayer L, Domig L, Pechlaner R, Willeit K, Tschiderer L, Seekircher L, Willeit P, Griesmacher A, Knoflach M, Willeit J, Kiechl S. The dimension of preventable stroke in a large representative patient cohort. Neurology 2019; 93:e2121-e2132. [DOI: 10.1212/wnl.0000000000008573] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 07/22/2019] [Indexed: 01/03/2023] Open
Abstract
ObjectiveTo analyze the frequency of inadequately treated risk factors in a large representative cohort of patients with acute ischemic stroke or TIA and to estimate the proportion of events potentially avertable by guideline-compliant preventive therapy compared to the status quo.MethodsA total of 1,730 patients from the Poststroke Disease Management STROKE-CARD trial (NCT02156778) were recruited between 2014 and 2017. We focused on 8 risk conditions amenable to drug therapy and 3 lifestyle risk behaviors and assessed pre-event risk factor control in retrospect.ResultsThe proportion of patients with at least 1 inadequately treated risk condition was 79.5% (95% confidence interval [CI] 77.6%–81.4%) and increased to 95.1% (95% CI 94.1%–96.1%) upon consideration of the lifestyle risk behaviors. Risk factor control was worse in patients with recurrent vs first-ever events (p < 0.001), men vs women (p = 0.003), and patients ≤75 vs >75 years of age (p < 0.001). The estimated degree of stroke preventability ranged from 0.4% (95% CI 0.2%–0.6%) to 13.7% (95% CI 12.2%–15.2%) for the individual risk factors. Adequate control of the 5 most relevant risk factors combined (hypertension, hypercholesterolemia, atrial fibrillation, smoking, and overweight) would have averted ≈1 of 2 events or 1 in 4 with a highly conservative computation approach.ConclusionsOur study confirms the existence of a considerable gap between risk factor control recommended by guidelines and real-world stroke prevention. Our study intends to increase awareness among physicians about stroke preventability and provides a quantitative basis for the emerging discussion on how to best tackle this challenge.
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Willeit K, Pechlaner R, Willeit P, Skroblin P, Paulweber B, Schernthaner C, Toell T, Egger G, Weger S, Oberhollenzer M, Kedenko L, Iglseder B, Bonora E, Schett G, Mayr M, Willeit J, Kiechl S. Association Between Vascular Cell Adhesion Molecule 1 and Atrial Fibrillation. JAMA Cardiol 2019; 2:516-523. [PMID: 28355442 DOI: 10.1001/jamacardio.2017.0064] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance Accumulating evidence links inflammation and atrial fibrillation (AF). Objective To assess whether markers of systemic and atrial inflammation are associated with incident AF in the general population. Design, Setting, and Participants The Bruneck Study is a prospective, population-based cohort study with a 20-year follow-up (n = 909). The population included a random sample of the general community aged 40 to 79 years. Levels of 13 inflammation markers were measured at baseline in 1990. Findings were replicated in a case-control sample nested within the prospective Salzburg Atherosclerosis Prevention Program in Subjects at High Individual Risk (SAPHIR) study (n = 1770). Data analysis was performed from February to May 2016. Exposures Levels of 13 inflammation markers. Main Outcomes and Measures Incident AF over a 20-year follow-up period in the Bruneck Study. Results Of the 909 participants included in the Bruneck Study, mean [SD] age was 58.8 (11.4) years and 448 (49.3%) were women. Among the 880 participants free of prevalent AF (n = 29) at baseline, 117 developed AF during the 20-year follow-up period (incidence rate, 8.2; 95% CI, 6.8-9.6 per 1000 person-years). The levels of soluble vascular cell adhesion molecule 1 (VCAM-1) and osteoprotegerin were significantly associated with incident AF (hazard ratio [HR], 1.49; 95% CI, 1.26-1.78; and 1.46; 95% CI, 1.25-1.69, respectively; P < .001 with Bonferroni correction for both), but osteoprotegerin lost significance after age and sex adjustment (HR, 1.05; 95% CI, 0.87-1.27; P > .99 with Bonferroni correction). Matrix metalloproteinase 9, metalloproteinase inhibitor 1, monocyte chemoattractant protein-1, P-selectin, fibrinogen, receptor activator of nuclear factor-κB ligand, high-sensitivity C-reactive protein, adiponectin, leptin, soluble intercellular adhesion molecule 1, and E-selectin all fell short of significance (after Bonferroni correction in unadjusted and age- and sex-adjusted analyses). The HR for a 1-SD higher soluble VCAM-1 level was 1.34 (95% CI, 1.11-1.62; Bonferroni-corrected P = .03) in a multivariable model. The association was of a dose-response type, at least as strong as that obtained for N-terminal pro-B-type natriuretic peptide (multivariable HR for a 1-SD higher N-terminal pro-B-type natriuretic peptide level, 1.15; 95% CI, 1.04-1.26), internally consistent in various subgroups, and successfully replicated in the SAPHIR Study (age- and sex-adjusted, and multivariable odds ratios for a 1-SD higher soluble VCAM-1 level, 1.91; 95% CI, 1.24-2.96, P = .003; and 2.59; 95% CI, 1.45-4.60; P = .001). Conclusions and Relevance Levels of soluble VCAM-1, but not other inflammation markers, are significantly associated with new-onset AF in the general community. Future studies should address whether soluble VCAM-1 is capable of improving AF risk classification beyond the information provided by standard risk scores.
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Affiliation(s)
- Karin Willeit
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Willeit
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria2Department of Public Health and Primary Care, University of Cambridge, Cambridge, England3Cardiovascular Division, King's British Heart Foundation Centre, King's College London, London, England
| | - Philipp Skroblin
- Cardiovascular Division, King's British Heart Foundation Centre, King's College London, London, England
| | - Bernhard Paulweber
- First Department of Internal Medicine, Paracelsus Medical University/Salzburger Landeskliniken, Salzburg, Austria
| | - Christiana Schernthaner
- Department of Cardiology, Paracelsus Medical University/Salzburger Landeskliniken, Salzburg, Austria
| | - Thomas Toell
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Egger
- Department of Internal Medicine, Bruneck Hospital, Bruneck, Italy
| | - Siegfried Weger
- Department of Internal Medicine, Bruneck Hospital, Bruneck, Italy
| | | | - Ludmilla Kedenko
- First Department of Internal Medicine, Paracelsus Medical University/Salzburger Landeskliniken, Salzburg, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Paracelsus Medical University/Salzburger Landeskliniken, Salzburg, Austria
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolic Diseases, University and Hospital Trust of Verona, Verona, Italy
| | - Georg Schett
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Manuel Mayr
- Cardiovascular Division, King's British Heart Foundation Centre, King's College London, London, England
| | - Johann Willeit
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Rajsic S, Gothe H, Borba HH, Sroczynski G, Vujicic J, Toell T, Siebert U. Economic burden of stroke: a systematic review on post-stroke care. Eur J Health Econ 2019; 20:107-134. [PMID: 29909569 DOI: 10.1007/s10198-018-0984-0] [Citation(s) in RCA: 247] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 05/03/2018] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Stroke is a leading cause for disability and morbidity associated with increased economic burden due to treatment and post-stroke care (PSC). The aim of our study is to provide information on resource consumption for PSC, to identify relevant cost drivers, and to discuss potential information gaps. METHODS A systematic literature review on economic studies reporting PSC-associated data was performed in PubMed/MEDLINE, Scopus/Elsevier and Cochrane databases, Google Scholar and gray literature ranging from January 2000 to August 2016. Results for post-stroke interventions (treatment and care) were systematically extracted and summarized in evidence tables reporting study characteristics and economic outcomes. Economic results were converted to 2015 US Dollars, and the total cost of PSC per patient month (PM) was calculated. RESULTS We included 42 studies. Overall PSC costs (inpatient/outpatient) were highest in the USA ($4850/PM) and lowest in Australia ($752/PM). Studies assessing only outpatient care reported the highest cost in the United Kingdom ($883/PM), and the lowest in Malaysia ($192/PM). Fifteen different segments of specific services utilization were described, in which rehabilitation and nursing care were identified as the major contributors. CONCLUSION The highest PSC costs were observed in the USA, with rehabilitation services being the main cost driver. Due to diversity in reporting, it was not possible to conduct a detailed cost analysis addressing different segments of services. Further approaches should benefit from the advantages of administrative and claims data, focusing on inpatient/outpatient PSC cost and its predictors, assuring appropriate resource allocation.
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Affiliation(s)
- S Rajsic
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - H Gothe
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
- Department of Health Sciences/Public Health, Dresden Medical School "Carl Gustav Carus", Technical University Dresden, Dresden, Germany
| | - H H Borba
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
- Department of Pharmacy, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil
| | - G Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - J Vujicic
- Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - T Toell
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria.
- Department of Health Policy and Management, Center for Health Decision Science, Harvard Chan School of Public Health, Boston, MA, USA.
- Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Mayer L, Boehme C, Toell T, Dejakum B, Willeit J, Schmidauer C, Berek K, Siedentopf C, Gizewski ER, Ratzinger G, Kiechl S, Knoflach M. Local Signs and Symptoms in Spontaneous Cervical Artery Dissection: A Single Centre Cohort Study. J Stroke 2019; 21:112-115. [PMID: 30732447 PMCID: PMC6372896 DOI: 10.5853/jos.2018.03055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/26/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Lukas Mayer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Toell
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Benjamin Dejakum
- Department of Neurology, Unfallklinik Murnau, Murnau am Staffelsee, Germany
| | - Johann Willeit
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Klaus Berek
- Department of Neurology, Bezirkskrankenhaus Kufstein, Kufstein, Austria
| | | | - Elke Ruth Gizewski
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Gudrun Ratzinger
- Department of Dermatology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Toell T, Boehme C, Mayer L, Krebs S, Lang C, Willeit K, Prantl B, Knoflach M, Rumpold G, Schoenherr G, Griesmacher A, Willeit P, Ferrari J, Lang W, Kiechl S, Willeit J. Pragmatic trial of multifaceted intervention (STROKE-CARD care) to reduce cardiovascular risk and improve quality-of-life after ischaemic stroke and transient ischaemic attack -study protocol. BMC Neurol 2018; 18:187. [PMID: 30400876 PMCID: PMC6219064 DOI: 10.1186/s12883-018-1185-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/21/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Patients with ischaemic stroke or transient ischaemic attack (TIA) are at high risk of future cardiovascular events. Despite compelling evidence about the efficacy of secondary prevention, a substantial gap exists between risk factor management in real life and that recommended by international guidelines. Moreover, stroke is a leading cause of disability and morbidity which partly emerges from post-stroke complications. METHODS/DESIGN We designed a block-randomised (2:1 ratio) open pragmatic trial [NCT02156778] with blinded outcome assessment comparing STROKE-CARD to usual post-stroke-patient care. STROKE-CARD is a multifaceted post-stroke disease management program with the objective of reducing recurrent cardiovascular events and improving quality of life in ischaemic stroke and TIA-patients. It combines intensified multi-domain secondary prevention, systematic detection and treatment of post-stroke complications, and patient self-empowerment. Enrolment of 2160 patients with acute ischaemic stroke or TIA (ABCD2-Score ≥ 3) is planned at two study centres in Austria. The co-primary efficacy endpoints are (i) the composite of major recurrent cardiovascular events (nonfatal stroke, nonfatal myocardial infarction, and vascular death) occurring within 12 months after the index event and (ii) one-year health-related quality-of-life measured with the European Quality of Life-5 Dimensions (EQ-5D-3 L) questionaire. Secondary endpoints include all-cause mortality, functional outcome, and target-level achievement in risk factor management. DISCUSSION This trial will provide evidence on whether the pragmatic post-stroke intervention program STROKE-CARD can help prevent cardiovascular events and improve quality-of-life within the setting of a high-quality acute stroke care system. In case of success, STROKE-CARD may be implemented in daily clinical routine and serve as a model for other disease management initiatives. TRIAL REGISTRATION ClinicalTrials.gov: NCT02156778 . (June 5, 2014, retrospectively registered).
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Affiliation(s)
- Thomas Toell
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Lukas Mayer
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Stefan Krebs
- Department of Neurology, Hospital St. John of God, Johannes von Gott Platz 1, A-1020 Vienna, Austria
| | - Clemens Lang
- Department of Neurology, Hospital St. John of God, Johannes von Gott Platz 1, A-1020 Vienna, Austria
| | - Karin Willeit
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
- Department of Neurology, Inselspital Bern, University Hospital, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Barbara Prantl
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Gerhard Rumpold
- Department of Medical Psychology, Medical University of Innsbruck, Schöpfstraße 23a, A-6020 Innsbruck, Austria
| | - Gudrun Schoenherr
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute of Medical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Peter Willeit
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Julia Ferrari
- Department of Neurology, Hospital St. John of God, Johannes von Gott Platz 1, A-1020 Vienna, Austria
| | - Wilfried Lang
- Department of Neurology, Hospital St. John of God, Johannes von Gott Platz 1, A-1020 Vienna, Austria
- Sigmund Freud Private University, Medical Faculty, Campus Prater Freudplatz 1, A-1020 Vienna, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
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15
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Mayer L, Ferrari J, Krebs S, Boehme C, Toell T, Matosevic B, Tinchon A, Brainin M, Gattringer T, Sommer P, Thun P, Willeit J, Lang W, Kiechl S, Knoflach M. ABCD3-I score and the risk of early or 3-month stroke recurrence in tissue- and time-based definitions of TIA and minor stroke. J Neurol 2018; 265:530-534. [PMID: 29327286 PMCID: PMC5834555 DOI: 10.1007/s00415-017-8720-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 11/26/2022]
Abstract
Changing definition of TIA from time to a tissue basis questions the validity of the well-established ABCD3-I risk score for recurrent ischemic cerebrovascular events. We analyzed patients with ischemic stroke with mild neurological symptoms arriving < 24 h after symptom onset in a phase where it is unclear, if the event turns out to be a TIA or minor stroke, in the prospective multi-center Austrian Stroke Unit Registry. Patients were retrospectively categorized according to a time-based (symptom duration below/above 24 h) and tissue-based (without/with corresponding brain lesion on CT or MRI) definition of TIA or minor stroke. Outcome parameters were early stroke during stroke unit stay and 3-month ischemic stroke. Of the 5237 TIA and minor stroke patients with prospectively documented ABCD3-I score, 2755 (52.6%) had a TIA by the time-based and 2183 (41.7%) by the tissue-based definition. Of the 2457 (46.9%) patients with complete 3-month followup, corresponding numbers were 1195 (48.3%) for the time- and 971 (39.5%) for the tissue-based definition of TIA. Early and 3-month ischemic stroke occurred in 1.1 and 2.5% of time-based TIA, 3.8 and 5.9% of time-based minor stroke, 1.2 and 2.3% of tissue-based TIA as well as in 3.1 and 5.5% of tissue-based minor stroke patients. Irrespective of the definition of TIA and minor stroke, the risk of early and 3-month ischemic stroke steadily increased with increasing ABCD3-I score points. The ABCD3-I score performs equally in TIA patients in tissue- as well as time-based definition and the same is true for minor stroke patients.
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Affiliation(s)
- Lukas Mayer
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Julia Ferrari
- Department of Neurology, Hospital Barmherzige Brueder, Vienna, Austria
| | - Stefan Krebs
- Department of Neurology, Hospital Barmherzige Brueder, Vienna, Austria
| | - Christian Boehme
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Thomas Toell
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Benjamin Matosevic
- Department of Neurology, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Alexander Tinchon
- Department of Neurology, University Clinic St. Pölten, Sankt Pölten, Austria
| | - Michael Brainin
- Department of Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems an der Donau, Austria
| | | | - Peter Sommer
- Department of Neurology, Hospital Rudolfstiftung Wien, Vienna, Austria
| | - Peter Thun
- Department of Neurology, Hospital Wilhelminenspital Wien, Vienna, Austria
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Wilfried Lang
- Department of Neurology, Hospital Barmherzige Brueder, Vienna, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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16
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Toell T, Mayer L, Pechlaner R, Krebs S, Willeit K, Lang C, Boehme C, Prantl B, Knoflach M, Ferrari J, Fuchs P, Prokop W, Griesmacher A, Lang W, Kiechl S, Willeit J. Familial hypercholesterolaemia in patients with ischaemic stroke or transient ischaemic attack. Eur J Neurol 2017; 25:260-267. [PMID: 29053901 DOI: 10.1111/ene.13485] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Identification of patients with familial hypercholesterolaemia (FH) is a prerequisite for the appropriate management of their excess cardiovascular risk. It is currently unknown how many patients with acute ischaemic stroke or transient ischaemic attack (TIA) are affected by FH and whether systematic screening for FH is warranted in these patients. METHODS The prevalence of a clinical diagnosis of FH was estimated in a large representative series of patients with acute ischaemic stroke or TIA (ABCD2 score ≥ 3) using the Dutch Lipid Clinic Network Algorithm (DLCNA; possible FH ≥3, probable/definite FH ≥6). RESULTS Out of 1054 patients included in the present analysis, 14 had probable/definite FH (1.3%; 95% confidence interval 0.6-2.0) and 107 possible FH (10.2%; 8.4-12.0) corresponding to an overall prevalence of potential FH of 11.5%. Prevalences were even higher in patients with stroke/TIA manifestation before age 55 in men or 60 in women (3.1%, 0.6-5.6; and 13.1%, 8.3-17.9) and those with a prior history of cardiovascular disease (2.6%, 0.9-4.3; and 15.1%, 11.3-18.9). Of note, in two-thirds of our patients with probable/definite and possible FH, stroke or TIA was the initial clinical disease manifestation. CONCLUSIONS The frequency of potential FH, based on clinical criteria, in patients with acute ischaemic stroke or TIA was 11.5% and that of probable/definite FH (1.3%) was similar to recently reported counts for patients with acute coronary syndrome (1.6%). FH screening using the DLCNA is feasible in clinical routine and should be considered as part of the usual diagnostic work-up.
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Affiliation(s)
- T Toell
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - L Mayer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - R Pechlaner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - S Krebs
- Department of Neurology, Hospital Barmherzige Brueder, Vienna, Austria
| | - K Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - C Lang
- Department of Neurology, Hospital Barmherzige Brueder, Vienna, Austria
| | - C Boehme
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - B Prantl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Ferrari
- Department of Neurology, Hospital Barmherzige Brueder, Vienna, Austria
| | - P Fuchs
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - W Prokop
- Central Institute of Medical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - A Griesmacher
- Central Institute of Medical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria
| | - W Lang
- Department of Neurology, Hospital Barmherzige Brueder, Vienna, Austria
| | - S Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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17
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Lang C, Seyfang L, Ferrari J, Gattringer T, Greisenegger S, Willeit K, Toell T, Krebs S, Brainin M, Kiechl S, Willeit J, Lang W, Knoflach M. Do Women With Atrial Fibrillation Experience More Severe Strokes? Stroke 2017; 48:778-780. [DOI: 10.1161/strokeaha.116.015900] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/02/2016] [Accepted: 12/09/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Ischemic strokes associated with atrial fibrillation (AF) are more severe than those of other cause. We aim to study potential sex effects in this context.
Methods—
In this cross-sectional study, 74 425 adults with acute ischemic stroke from the Austrian Stroke Unit Registry were included between March 2003 and January 2016. In 63 563 patients, data on the National Institutes of Health Stroke Scale on admission to the stroke unit, presence of AF, vascular risk factors, and comorbidities were complete. Analysis was done by a multivariate regression model.
Results—
Stroke severity in general increased with age. AF-related strokes were more severe than strokes of other causes. Sex-related differences in stroke severity were only seen in stroke patients with AF. Median (Q
25
,
75
) National Institutes of Health Stroke Scale score points were 9 (4,17) in women and 6 (3,13) in men (
P
<0.001). The interaction between AF and sex on stroke severity was independent of age, previous functional status, vascular risk factors, and vascular comorbidities and remained significant in various subgroups.
Conclusions—
Women with AF do not only have an increased risk of stroke when compared with men but also experience more severe strokes.
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Affiliation(s)
- Clemens Lang
- From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria
| | - Leonhard Seyfang
- From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria
| | - Julia Ferrari
- From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria
| | - Thomas Gattringer
- From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria
| | - Stefan Greisenegger
- From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria
| | - Karin Willeit
- From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria
| | - Thomas Toell
- From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria
| | - Stefan Krebs
- From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria
| | - Michael Brainin
- From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria
| | - Stefan Kiechl
- From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria
| | - Johann Willeit
- From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria
| | - Wilfried Lang
- From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria
| | - Michael Knoflach
- From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria
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18
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Willeit J, Geley T, Schöch J, Rinner H, Tür A, Kreuzer H, Thiemann N, Knoflach M, Toell T, Pechlaner R, Willeit K, Klingler N, Praxmarer S, Baubin M, Beck G, Berek K, Dengg C, Engelhardt K, Erlacher T, Fluckinger T, Grander W, Grossmann J, Kathrein H, Kaiser N, Matosevic B, Matzak H, Mayr M, Perfler R, Poewe W, Rauter A, Schoenherr G, Schoenherr HR, Schinnerl A, Spiss H, Thurner T, Vergeiner G, Werner P, Wöll E, Willeit P, Kiechl S. Thrombolysis and clinical outcome in patients with stroke after implementation of the Tyrol Stroke Pathway: a retrospective observational study. Lancet Neurol 2015; 14:48-56. [DOI: 10.1016/s1474-4422(14)70286-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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