Search

Objectives: to identify explanatory factors for the association between depression at 3 months after stroke and physical disability at 3 years. Methods: data from the South London Stroke Register (1998--2013) were used. Patients (n = 3,612) were assessed at stroke onset. Follow-up at 3 months included assessment for depression with the Hospital Anxiety and Depression scale (scores ≥ 7 = depression), physical disability (Barthel index) cognitive function, smoking habit, selective serotonin reuptake inhibitors (SSRIs) use, perception of recovery and social support. Physical disability was reassessed at 3 years. The associations between depression at 3 months and physical disability at 3 years were estimated with multinomial regression adjusting for age, gender, ethnicity, stroke severity and possible explanatory factors for the association (introduced in the models first individually and then sequentially): pre-stroke medical history and physical disability, cognitive function, smoking, SSRIs, perception of recovery and social support at 3 months. Results: one thousand three hundred and seven survivors were assessed at 3 months, of which 418 (32.0%) had depression. Survivors with depression had a higher physical disability rate at 3 years. These associations remained significant after adjustment for individual explanatory factors but were not significant after adjustment for combined explanatory factors. Physical disability at 3 months was a relevant explanatory factor for this association. SSRIs were associated with severe, relative risk: 6.62 (2.92-15.02) P < 0.001, and moderate physical disability, relative risk: 3.45 (1.58-7.52) P = 0.002, at 3 years. Conclusion: the association between depression and physical disability appears to be multifactorial. The use of SSRIs after stroke requires further research. [ABSTRACT FROM AUTHOR]

Background: evidence on the long-term natural history, predictors and outcomes of anxiety after stroke is insufficient to inform effective interventions. This study estimates within 10 years of stroke: (i) the incidence, cumulative incidence, prevalence, and time of onset of anxiety. (ii) Predictors of anxiety and its association with depression. (iii) The association between anxiety 3 months after stroke and mortality, stroke recurrence, disability, cognitive impairment and quality of life (QoL) at follow-up.Methods: data from the South London Stroke Register (1995–2010). Patients were assessed at the time of the stroke, at 3 months, 1 year and then annually for up to 10 years. Baseline data included socio-demographics and stroke severity. Follow-up data included assessments for anxiety and depression (hospital anxiety and depression scale), disability, cognition and QoL. Multivariate regression was used to investigate predictors and associated outcomes of anxiety.Results: incidence of anxiety up to 10 years ranged from 17 to 24%. Cumulative incidence: 57%. Prevalence range: 32–38%. Amongst patients with anxiety, 58% were anxious at 3 months. 57–73% of patients with anxiety had co-morbid depression. Predictors of anxiety included age under 65, female gender, inability to work, depression treatment, smoking and stroke severity. Anxiety at 3 months was associated with lower QoL at follow-up.Conclusions: anxiety is a frequent problem affecting stroke survivors in the long term. Clinicians should pay attention to patients at risk of anxiety since it is associated with lower QoL and depression. [ABSTRACT FROM AUTHOR]

Study objectives: to measure the quality of secondary prevention of stroke provided to patients in England, Wales and Northern Ireland. Design: retrospective case note analysis. Setting: 235 hospitals (95% of all such hospitals), providing care for acute stroke patients in England, Wales and Northern Ireland and primary health care for follow-up data. Patients: 8,200 patients admitted with stroke between 1st April and 30th June 2001. Data on up to 40 consecutive cases submitted by each hospital. Audit tool: Royal College of Physicians Intercollegiate Stroke Working Party Stroke Audit. Results: 24% of patients with previous cerebrovascular disease were not on anti-thrombotic medication at the time of admission. Nine percent of appropriate patients were not taking anti-thrombotic medication at discharge. Patients left with moderate to very severe disability (Barthel scores 14 or less) compared with those independent with mild disability (Barthel score 15-20) were more likely not to have anti-thrombotic treatment (18% versus 8%). Fifty-four percent of patients with known hyperlipidaemia and 21% of those with previous ischaemic heart disease were on lipid lowering therapy on admission. Sixty-four percent of patients had lipids measured during their hospital stay and of those with high total cholesterol or LDL the rate of non-treatment was 36%. Older patients (75+ years) were less likely to be treated (54%) than those <65 years (71%). Seventy-nine percent of known patients with hypertension were on treatment at admission, with 78% being treated by discharge from hospital. At 6 months after stroke a systolic blood pressure of 140mmHg or less, and a diastolic of 85 mmHg or less, was achieved in 41% of known pre-stroke hypertensives on treatment, 31% of previously untreated hypertensives hut on treatment at follow-up and 40% of patients not previously labelled as hypertensive. Conclusions: major deficiencies in... [ABSTRACT FROM AUTHOR]

Objectives: to identify the factors associated with hospital admission and the differences in management and outcome of stroke patients between hospital and home. Design: a prospective community stroke register (1995–8) with multiple notification sources. Setting: an inner city multi-ethnic population of 234 533 in South London, UK. Participants: 975 subjects with first in a lifetime strokes, whether or not they were admitted to hospital. Patients dying suddenly and those already hospitalized at the time of stroke were excluded. Main outcome measures: factors associated with hospital admission; differences in management in the acute phase of stroke; mortality and dependency assessed by the Barthel index 3 months post-stroke. Results: 812 patients were admitted to hospital for stroke; 163 were managed in the community. Factors independently associated with hospital admission included stroke severity, pre-stroke independence, atrial fibrillation, having an intracranial haemorrhage and having a non-lacunar infarction. Computed tomography scan rates were higher in admitted (78%) than non-admitted patients (63%; P =0.001). By 3 months, 285 (35%) of the admitted patients had died compared with 13 (8%) of non-admitted patients ( P <0.001). Of the admitted patients, 241 (47%) had a Barthel index ≥18 compared with 106 (72%) of those who were not admitted ( P <0.001). After adjusting for case-mix variables, the odds ratios for death and dependency (Barthel index<18) in admitted and non-admitted patients were 2.21 (0.96–5.12) and 2.39 (1.35–4.22) respectively. Conclusion: patients with clinical indicators for a more severe stroke were more likely to be admitted to hospital. Hospitalized stroke patients may have poorer survival and disability rates than those who remain at home, even after adjustment for case mix. There may be some aspects of acute hospital care that may be detrimental to outcome in certain groups of stroke patients. This r... [ABSTRACT FROM AUTHOR]

Abstract Case report: a 72-year-old woman presented after a series of falls with a history of malaise, lethargy, cold hands and arm weakness for several months. She had undergone extensive investigation for what remained an unexplained anaemia during this period. Examination revealed cold hands with absent radial pulses. Axillary Doppler studies confirmed grossly diminished systolic pressures. The erythrocyte sedimentation rate was markedly elevated. An arch aortogram showed obliteradve changes selectively affecting the subclavian and axillary arteries. In spite of clinically normal temporal arteries, and the absence of headache, temporal artery biopsy revealed giant cell arteritis. Discussion: aortic arch syndrome is an important but under-appreciated complication of giant cell arteritis and may be the presenting feature. In this case, it resulted in falls consequent upon arm claudication when using a walking frame. [ABSTRACT FROM AUTHOR]