Dataset Information

Association of prestroke medicine use and health outcomes after ischaemic stroke in Sweden: a registry-based cohort study.

ABSTRACT:

Objective

The objective was to investigate if there is a relationship between preischaemic stroke medicine use and health outcomes after stroke.

Setting

This registry-based study covered Swedish stroke care, both primary and secondary care, including approximately 60% of the Swedish stroke cases from seven Swedish regions.

Participants

The Sveus research database was used, including 35?913 patients (33?943 with full information on confounding factors) with an ischaemic stroke (International Classification of Diseases, 10th Revision (ICD-10) I63*) between 2009 and 2011 registered both in the regions' patient administrative systems and in the Swedish Stroke Register. Patients with haemorrhagic stroke (ICD-10 I61*) were excluded.

Primary outcome

The primary outcome was the association, expressed in ORs, of prestroke medicine use (oral anticoagulants, statins, antihypertensives, antidepressants, non-steroidal anti-inflammatory drugs (NSAIDs) and antidiabetic drugs) and health outcomes 1 and 2 years poststroke (survival, activities of daily living dependency and modified Rankin Scale (mRS) 0-2), adjusted for patient characteristics and stroke severity at stroke onset.

Results

The multivariate analysis indicated that patients on drugs for hypertension, diabetes, oral anticoagulants and antidepressants prestroke had worse odds for health outcomes in both survival (OR 0.65, 95%?CI 0.60 to 0.69; OR 0.77, 95%?CI 0.71 to 0.83; OR 0.72, 95%?CI 0.66 to 0.80; OR 0.91, 95%?CI 0.84 to 0.98, respectively, for survival at 2 years) and functional outcome (OR 0.82, 95%?CI 0.75 to 0.89; OR 0.61, 95%?CI 0.55 to 0.68; OR 0.83, 95%?CI 0.72 to 0.95; OR 0.58, 95%?CI 0.52 to 0.65, respectively, for mRS 0-2 at 1?year), whereas patients on statins and NSAIDS had significantly better odds for survival (OR 1.16, 95%?CI 1.08 to 1.25 and OR 1.12, 95%?CI 1.00 to 1.25 for 1-year survival, respectively), compared with patients without these treatments prior to stroke.

Conclusions

The results indicated that there are differences in health outcomes between patients who had different common prestroke treatments, patients on drugs for hypertension, diabetes, oral anticoagulants and antidepressants had worse health outcomes, whereas patients on statins and NSAIDS had significantly better survival, compared with patients without these treatments prior to stroke.

SUBMITTER: Ingrid L

PROVIDER: S-EPMC7170610 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Publications

Association of prestroke medicine use and health outcomes after ischaemic stroke in Sweden: a registry-based cohort study.

Ingrid Lekander L von Euler Mia M Sunnerhagen Katharina S KS

BMJ open 20200329 3

<h4>Objective</h4>The objective was to investigate if there is a relationship between preischaemic stroke medicine use and health outcomes after stroke.<h4>Setting</h4>This registry-based study covered Swedish stroke care, both primary and secondary care, including approximately 60% of the Swedish stroke cases from seven Swedish regions.<h4>Participants</h4>The Sveus research database was used, including 35 913 patients (33 943 with full information on confounding factors) with an ischaemic stro ...[more]

PMID: 32229526

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Project description:IntroductionPiling evidence suggests that a higher level of prestroke physical activity can decrease stroke severity, and reduce the risk of poststroke mortality. However, prior studies have only included ischaemic stroke cases, or a majority of such. We aim to investigate how premorbid physical activity influences admission stroke severity and poststroke mortality in patients with intracerebral haemorrhage, compared with ischaemic stroke. A prespecified analysis plan counteract some inherent biases in observational studies, and promotes transparency.Methods and analysisThis is a statistical analysis protocol for a matched cohort study, including all adult patients with intracerebral haemorrhage, and matched ischaemic stroke controls, treated at Sahlgrenska University Hospital in Sweden between 1 November 2014 and 30 June 2019. All patients have been identified in the Väststroke register, and the data file has been sent for merging with national registries. The follow-up of time for survival will be approximately 2-7 years. The sample size calculation indicates that a minimum of 628 patients with intracerebral haemorrhage is needed for power of 80% at an alpha level of 0.01. Multiple imputation by chained equations will be used to handle missing data. The entire cohort of patients with intracerebral haemorrhage will be matched with consecutive ischaemic stroke controls (1:3 ratio) using nearest neighbour propensity score matching. The association between prestroke physical activity and admission stroke severity will be evaluated using multivariable ordinal regression models, and risk for all-cause mortality will be analysed using multivariable Cox proportional-hazards models. Potential confounders include age, ethnicity, income, educational level, comorbidity, medical treatments, alcohol-related disorders, drug abuse and smoking.EthicsData collection for the Physical Activity Pre-Stroke In GOThenburg project was approved by the Regional Ethical Board on 4 May 2016. An additional application was approved by the National Ethical Review Authority on 7 July 2021.

Project description:OBJECTIVE:The relationship of anticoagulation therapies with stroke severity and outcomes have been well documented in the literature. However, none of the previous research has reported the relationship of atrial fibrillation (AF)/anticoagulation therapies with urinary tract infection (UTI), pneumonia and length of stay in hyperacute stroke units (HASUs). The present study aimed to evaluate AF and anticoagulation status in relation to early outcomes in 1387 men (median age=75?years, IQR=65-83) and 1371 women (median age=83?years, IQR=74-89) admitted with acute ischaemic stroke to HASUs in Surrey between 2014 and 2016. METHODS:We conducted this registry-based, prospective cohort study using data from the Sentinel Stroke National Audit Programme. Association between AF anticoagulation status with severe stroke on arrival (National Institutes of Health Stroke Scale score ?16), prolonged HASU stay (>3?weeks), UTI and pneumonia within 7?days of admission, severe disability on discharge (modified Rankin Scale score=4?and 5) and inpatient mortality was assessed by logistic regression, adjusted for age, sex, hypertension, congestive heart failure, diabetes and previous stroke. RESULTS:Compared with patients with stroke who are free from AF, those with AF without anticoagulation had an increased adjusted risk of having more severe stroke: 5.8%?versus 14.0%, OR=2.4 (95%?CI 1.6 to 3.6, P<0.001), prolonged HASU stay: 21.5%?versus 32.0%, OR=1.4 (1.0-2.0, P=0.027), pneumonia: 8.2%?versus 19.1%, OR=2.1 (1.4-2.9, P<0.001), more severe disability: 24.2%?versus 40.4%, OR=1.6 (1.2-2.1, P=0.004) and mortality: 9.3%?versus 21.7%, OR=1.9 (1.4-2.8, P<0.001), and AF patients with anticoagulation also had greater risk for having UTI: 8.6%?versus 12.3%, OR=1.9 (1.2-3.0, P=0.004), pneumonia: 8.2%?versus 11.5%, OR=1.6 (1.1-2.4, P=0.025) and mortality: 9.7%?versus 21.7%, OR=1.9 (1.4-2.8, P<0.001). The median HASU stay for stroke patients with AF without anticoagulation was 10.6 days (IQR=2.8-26.4) compared with 5.8 days (IQR=2.3-17.5) for those free from AF (P<0.001). CONCLUSIONS:Patients with AF, particularly those without anticoagulation, are at increased risk of severe stroke, associated with prolonged HASU stay and increased risk of early infection, disability and mortality.

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Dataset Information

Association of prestroke medicine use and health outcomes after ischaemic stroke in Sweden: a registry-based cohort study.

Objective

Setting

Participants

Primary outcome

Results

Conclusions

Publications

Association of prestroke medicine use and health outcomes after ischaemic stroke in Sweden: a registry-based cohort study.

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