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Background: Aphasia negatively impacts quality of life. This is the first Brazilian study that investigates the prevalence of aphasia and its related factors, the results of which may underpin hospital and health service planning for this vulnerable population. Objective: To establish the prevalence of aphasia in patients after first-ever ischemic stroke (FEIS) and associated factors. Methods: This is a retrospective cohort study, based on a database held in Joinville, Brazil. All cases of FEIS admitted to one public hospital in Joinville in 2015 were selected. The diagnosis of aphasia was verified by neurologists through the language item of the National Institute of Health Stroke Scale (NIHSS). Results: Of the 350 patients with FEIS, 79 (22.6%) had aphasia. Patients with aphasia (PWA) were older, with a higher likelihood of dysarthria, more thrombolytic use, and greater stroke severity. PWA had higher mortality than patients without aphasia (24.1% versus 10.7%, p =.004) and longer hospitalization time (21.32 versus 17.46 days, p =.009). Higher NIHSS score was an independent predictor for the occurrence of aphasia on admission (OR 1.24, 95% CI 1.17–1.31, p <.001). Older age (OR 1.06, 95% CI 1.03–1.09, p <.001) and stroke severity by NIHSS (OR 1.19, 95% CI 1.12–1.25, p = <0.001) were independent predictors of death. Conclusions: PWA may need more health care during hospitalization, because of the severity of the stroke, and their frailty. Further studies are needed to assess the direct impact of aphasia on inpatients. [ABSTRACT FROM AUTHOR]

Objectives. We compared the incidence of recurrent or fatal cardiovascular disease in patients using Brazil's government-run Family Health Program (FHP) with those using non-FHP models of care. Methods. From 2005 to 2010, we followed outpatients discharged from city public hospitals after a first ever stroke for stroke recurrence and myocardial infarction, using data from all city hospitals, death certificates, and outpatient monitoring in state-run and private units. Results. In the follow-up period, 103 patients in the FHP units and 138 in the non-FHP units had exclusively state-run care. Stroke or myocardial infarction occurred in 30.1% of patients in the FHP group and 36.2% of patients in non-FHP care (rate ratio [RR] = 0.85; 95% confidence interval [CI] = 0.61, 1.18; P = .39); 37.9% of patients in FHP care and 54.3% in non-FHP care (RR = 0.68; 95% CI = 0.50, 0.92; P = .01) died. FHP use was associated with lower hazard of death from all causes (hazard ratio [HR] = 0.58; P = .005) after adjusting for age and stroke severity. The absolute risk reduction for death by all causes was 16.4%. Conclusions. FHP care is more effective than is non-FHP care at preventing death from secondary stroke and myocardial infarction. [ABSTRACT FROM AUTHOR]