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Purpose To evaluate a model for calculating the risk of AF and its relationship with the incidence of ischemic stroke and prevalence of cognitive decline. Materials and Methods It was a multicenter, observational, retrospective, community-based study of a cohort of general population ≥6ct 35 years, between 01/01/2016 and 31/12/2018. Setting: Primary Care. Participants: 46,706 people ≥65 years with an active medical history in any of the primary care teams of the territory, information accessible through shared history and without previous known AF. Interventions: The model to stratify the risk of AF (PI) has been previously published and included the variables sex, age, mean heart rate, mean weight and CHA2DS2VASc score. Main measurements: For each risk group, the incidence density/1000 person/years of AF and stroke, number of cases required to detect a new AF, the prevalence of cognitive decline, Kendall correlation, and ROC curve were calculated. Results The prognostic index was obtained in 37,731 cases (80.8%) from lowest (Q1) to highest risk (Q4). A total of 1244 new AFs and 234 stroke episodes were diagnosed. Q3-4 included 53.8% of all AF and 69.5% of strokes in men; 84.2% of all AF and 85.4% of strokes in women; and 77.4% of cases of cognitive impairment. There was a significant linear correlation between the risk-AF score and the Rankin score (p < 0.001), the Pfeiffer score (p < 0.001), but not NIHSS score (p 0.150). The overall NNS was 1/19. Conclusion Risk stratification allows identifying high-risk individuals in whom to intervene on modifiable risk factors, prioritizing the diagnosis of AF and investigating cognitive status.

Background: A wide variety of factors influence stroke prognosis, including age, stroke severity and comorbid conditions; but most current information about outcomes and safety is derived from patients at 3 - 12 months and mostly coming from the hospital activity. The aim of this study is to evaluate whether treatment strategies have a differential impact on long-survival after acute ischemic stroke among men versus women. Methods: Acute ischemic stroke patients identified from the population-based register between January 1, 2011 and December 31, 2012 were included, and they were classified into: 1) Acute ischemic stroke + intravenous thrombolysis (group I); 2) Acute ischemic stroke + mechanical thrombectomy with or without intravenous thrombolysis (group II); 3) Acute ischemic stroke + medical therapy alone (no reperfusion therapies) (group III). Follow-up went through up until December 2016. The probability of survival was estimated by the Kaplan-Meier method, and the hazard ratio was obtained by using the Cox proportional hazard regression models. Mortality was interpreted as overall mortality. Results: A total of 14,368 cases (men 50.1%), 77.1 ± 11.0 years old were included. There was higher survival among those treated with intravenous thrombolysis (P < 0.001); women treated with thrombectomy (P < 0.001); and women < 80 years old without reperfusion therapy. The most common medications were antiplatelets (52.8%), associated with lower survival (P < 0.001); and statins (46.5%), associated with higher survival. The regression model produced the following independent outcome variables associated to mortality: anticoagulant hazard ratio (HR) 1.53 (95% confidence interval (95% CI): 1.44 - 1.63, P < 0.001), diuretics HR 1.71 (95% CI: 1.63 - 1.79, P < 0.001), antiplatelet HR 1.49 (95% CI: 1.42 - 1.56, P < 0.001), statins HR 0.73 (95% CI: 0.70 - 0.77; P < 0.001), angiotensin II receptor antagonists HR 0.93 (95% CI: 0.89 - 0.98, P = 0.008) and reperfusion therapy HR 0.88 (95% CI: 0.81 - 0.97, P = 0.009). Conclusions: Men and women have different prognoses after revascularization treatment for acute ischemic stroke. Under 80 years old the women appear to have a better outcome than men when treated with thrombolysis therapy and/or catheter-based thrombectomy. The chronic cardiovascular pharmacotherapy must be evaluated whether they should be included as factors in the decision to reperfusion. Cardiol Res. 2019;10(2):89-97 doi: https://doi.org/10.14740/cr839

Background The number of individuals with atrial fibrillation (AF) and cognitive impairment (CI) will increase 150% by 2050. Purpose The main objective of this study is to elucidate the relationship between AF-risk, the ischemic stroke, and the cognitive dysfunction. Methods Multicenter, longitudinal and retrospective community-based study of cohort ≥65 year-old without AF between 1/1/2013–31/12/2017 conducted by 11 Primary Care teams. Variables: sociodemographic; Charlson, CHA2DS2VASc score, Pfeiffer and NIHSS scores from records database (primary care, specialty clinics and hospitalizations). Kaplan-Meier to evaluate mortality. Descriptive analysis Cox regression to create an AF risk score was developed: Q1 (lowest AF-risk)-Q4 (highest AF-risk). Incidence density (ID) rate per 1000/people/years of AF and stroke; and CI prevalence were calculated by risk stratum. Approved by Ethics Committee of IDIAP Jordi Gol PP15/047. Results 46706 (women 49%) cases, aged 78.01±11.9 and average follow-up time 4.9±0.7 years. Q4 risk group (Q4) was characterized by women's (85.2%), highest age, AF, stroke, CI and mortality. 1244 AF were diagnosed (ID 10.5/1000/year's IC95% 9.9–11.2). Q3–4 levels included 53.8% of AF in men vs 84.2% in women. 214 strokes were diagnosed and 78.5% happened in Q3–4, especially among women (88.1%). The stroke and AF were diagnosed simultaneously in 9.8% (ID 5.8/1000/year CI95% 3.4–8.1) and showed higher severity (NIHSS 7.25±8.62 vs 4.55±5.74, p=0.002). The cognitive impairment increased from 2.6% (Q1) up to 16.4% (Q4) significantly higher in women (17.6% vs 12.1%) Conclusions Differences were found according to gender and risk groups. The risk-based screening could improve the effectiveness of AF screening in primary care. Funding Acknowledgement Type of funding source: None

Purpose To evaluate a model for calculating the risk of AF and its relationship with the incidence of ischemic stroke and prevalence of cognitive decline. Materials and Methods It was a multicenter, observational, retrospective, community-based study of a cohort of general population ≥6ct 35 years, between 01/01/2016 and 31/12/2018. Setting: Primary Care. Participants: 46,706 people ≥65 years with an active medical history in any of the primary care teams of the territory, information accessible through shared history and without previous known AF. Interventions: The model to stratify the risk of AF (PI) has been previously published and included the variables sex, age, mean heart rate, mean weight and CHA2DS2VASc score. Main measurements: For each risk group, the incidence density/1000 person/years of AF and stroke, number of cases required to detect a new AF, the prevalence of cognitive decline, Kendall correlation, and ROC curve were calculated. Results The prognostic index was obtained in 37,731 cases (80.8%) from lowest (Q1) to highest risk (Q4). A total of 1244 new AFs and 234 stroke episodes were diagnosed. Q3-4 included 53.8% of all AF and 69.5% of strokes in men; 84.2% of all AF and 85.4% of strokes in women; and 77.4% of cases of cognitive impairment. There was a significant linear correlation between the risk-AF score and the Rankin score (p < 0.001), the Pfeiffer score (p < 0.001), but not NIHSS score (p 0.150). The overall NNS was 1/19. Conclusion Risk stratification allows identifying high-risk individuals in whom to intervene on modifiable risk factors, prioritizing the diagnosis of AF and investigating cognitive status.

Purpose: Compare long-term survival by sex after reperfusion therapies with simultaneous medical therapy of cardiovascular conditions. Methods: AIS patients identified from the population-based register between 01Jan2011 and 31Dec2012 and classified into: 1) AIS + intravenous thrombolysis [group I], 2) AIS + mechanical thrombectomy with or without intravenous thrombolysis [group II], and 3) AIS + medical therapy alone (no reperfusion therapies) [group III]. Follow-up went through up until December 2016. Statistical approaches were employed for analyzing survival outcomes and their relationship with reperfusion therapy.

Over recent years there has been growing evidence of increased risk of mortality associated with hemorrhagic stroke among older patients. The main objective of this study is to propose and validate a prognostic life table for complex chronic patients after an intracerebral hemorrhage (ICH) episode in primary care settings. This was a multicenter and retrospective study (April 1, 2006–December 31, 2016) of a cohort from the general population presenting an episode of ICH from which a predictive model of mortality was obtained using a Cox proportional hazards regression model. In addition, Kaplan–Meier survival curves, the log-rank test, receiver operating characteristic (ROC) curves, and area under the ROC curve (AUC) were used to evaluate the ability to stratify patients according to vital prognosis. We proceeded to external validation of the model through prospective monitoring (January 1, 2013–December 31, 2017) of the population of complex chronic patients with an episode of ICH. A total of 3594 people aged ≥ 65 years were identified as complex chronic patients (women 55.9%; mean age, 86.1 ± 8.4 years) of whom 161 suffered hemorrhagic stroke during the study period (January 1, 2013–December 31, 2017). The primary outcome was death from any cause within 5 years of follow-up after an ICH episode. The independent prognostic factors of mortality were age > 80 years (HR 1.048, 95% CI 1.021–1.076, p

Background: A number of large trials have confirmed the benefits of thrombolysis in acute stroke, but there are gender differences. We sought to examine the relationship between sex and outcome after thrombolysis. Methods: This was a prospective cohort study including 1,272 incident ischemic strokes (597 in women) from April 1, 2006 to December 31, 2014. Statistical approaches were used for analyzing survival outcomes and their relationship with thrombolysis therapy. Results: The death rates were lower (p = 0.003) in the thrombolysis therapy group with an incidence ratio of 0.57 (95% CI 0.39-0.83). 113 (8.8%) patients (53 women) received thrombolysis. They were significantly younger (69.2 ± 12.7 vs. 73.9 ± 12.5 years; p < 0.001), had higher NIHSS score (12.7 ± 6.3 vs. 7.3 ± 7.0; p < 0.001), spent more days in hospital (10.4 ± 8.3 vs. 8.3 ± 7.9; p < 0.001), and had a higher average Barthel score at discharge (85.5 ± 24.4 vs. 79.2 ± 28.6; p = 0.023). The male/female incidence ratio showed a significant decrease (p = 0.01) in the incidence of mortality in women and a better Barthel score. The thrombolysis improved the survival in the overall group with thrombolysis versus without thrombolysis (p = 0.028), in women versus in men with thrombolysis (p = 0.023), and in women with thrombolysis versus in those without thrombolysis (p < 0.001) but not in men with thrombolysis versus in those without thrombolysis (p = 0.743). The protective factors as regards mortality were thrombolysis therapy (95% CI 0.37-0.80; p = 0.002), Barthel score ≥60 (95% CI 0.81-0.94; p = 0.002), and cardiovascular secondary prevention 1 year after stroke (0.13, 95% CI 0.06-0.28). Conclusions: The stroke death rates were lower in women after thrombolysis treatment and suggest significant benefit for women in this setting. The overall benefit on survival of the patients treated with thrombolysis might be explained by the beneficial effect of the thrombolysis on the women.

ResumenObjetivoInvestigar la relación entre género y supervivencia después de un episodio de ictus tratado con fibrinólisis.DiseñoEstudio de cohortes.EmplazamientoAtención primaria.ParticipantesLos casos tratados con fibrinólisis por un ictus agudo desde el 1 de abril de 2006 al 13 de septiembre de 2013.IntervencionesSeguimiento del estado vital.Mediciones principalesRiesgos vasculares: escala Framingham, REGICOR, CHA2DS2-VASc, Essen, NIHSS, índice Barthel; densidad de incidencia; análisis de supervivencia por Kaplan-Meier; bivariado entre supervivientes y fallecidos; y multivariante de Cox.ResultadosNoventa y un pacientes con edad media 68,02±11,9 años. Los hombres tienen mayor riesgo cardiovascular basal. El tiempo medio de seguimiento fue de 2,95±2,33 años. La razón de tasa de incidencias mostró un mayor riesgo en los hombres respecto a las mujeres IR=3,2 (IC 95%: 1,2-8,0). Los fallecidos en relación con los supervivientes son mayores (p=0,032); mayor riesgo cardiovascular basal (p=0,040) y de recidiva de ictus (p

Question: Around 3-5% of people can be identified as chronic complex patients(CCP) and are increasingly at risk of hemorrhagic stroke.The main objective was to explore differences in risk factors and the association with outcome factors on mortality. Materials and Methods: Multicenter and prospective cohort study from January 1 2013 to September 30 2016 among patients registered as chronic complex outpatients. To predict hazard ratios, mean survival time, and survival probabilities, multivariate Cox regression was used. Results: 932 CCP were included (52.3% women). Average age was 82.5 years (95% CI 81.8-83.2). During a mean follow-up period of 2.8 years, 65 (6.98%) stroke episodes happened (37 (56.9%) ischemic; 28 (43.1%) hemorrhagic). The percentage of ICH almost doubled (21.0% to 43.1) after CCP diagnosis; 26.1% had polypharmacy (≥ 10), 57.6% VKA-treated patientsshowed TTR

Background : Atrial fibrillation (AF) is the most common cardiac tachyarrhythmia encountered in clinical practice affecting up to 10% of the population over 60 years old and its prevalence rises with age. The main goals were to characterize the AF patient population after the initial diagnosis of AF and to determine overall survival. Methods : It is a real-life observational study of 269 subjects with an AF diagnosis over 60 years old randomly selected. The collected variables were: sociodemographic, cardiovascular complications/comorbidities (CVCs) included in the CHA 2 DS 2 -VASc and HAS_BLED scores, drug assigned as clinical treatment, mean range INR and CVCs and death dates (all-cause mortality). The survival curve and the risk of death were assessed using Kaplan-Meier survival curve and comparisons with log-rank. Results : The average following time was 6.2 ± 3.7 years (0.2-20.4). Eleven point five percent died. Sixty-five point four percent had some CVCs. There were no differences in the overall incidence of CVCs by gender. The survival probability was 0.86 ± DE 0.03 among men and 0.90 ± DE 0.04 among women without differences. Thirty-six point eight percent (95% CI: 30.8 - 42.7) were diagnosed vascular complications before AF diagnosis, being ischemic cardiopathy (24.2%) and ischemic stroke (23.2%) the most frequent. The mortality is higher (P < 0.036) among those who suffered ≥ 3 vascular complications and significantly lower among those treated with statins ( P = 0.032). After AF diagnosis, the most frequent was the cardiac heart failure (46.7%), significantly higher among women (P = 0.037). The mortality is significantly lower in those treated with OAC (P = 0. 003). Conclusions : AF is associated with ischemic heart disease, ischemic stroke and congestive heart failure, but the average mortality age is not different from the global population in Spain and Catalonia. Cardiol Res. 2014;5(1):12-22 doi: http://dx.doi.org/ 10.14740/ cr324e

Aims/Introduction. Determining the prevalence of diabetes and its cardiovascular complications and all-cause mortality in older chronic complex patients. Materials and Methods. We carried out a multicenter retrospective study and included a randomized sample of 932 CCP people. We assessed the prevalence of diabetes according to World Health Organization criteria. Data included demographics and functional, comorbidity, cognitive, and social assessment. Results. The prevalence of diabetes was 53% and average age 81.16±8.93 years. There were no significant differences in the survival of CCP patients with or without DM, with or without ischaemic cardiopathy, and with or without peripheral vascular disease. The prognostic factors of all-cause mortality in patients with DM were age ≥ 80 years [HR 1.47, 95% CI 1.02–2.13, p 0.038], presence of heart failure [HR 1.73, 95% CI 1.25–2.38, p 0.001], Charlson score [HR 1.20, 95% CI 1.06–1.36, p 0.003], presence of cognitive impairment [HR 1.73, 95% CI 1.24–2.40, p 0.001], and no treatment with statins [HR 1.49, 95% CI 1.08–2.04, p 0.038]. Conclusions. We found high prevalence of DM among CCP patients and the relative importance of traditional risk factors seemed to wane with advancing age. Recommendations may include relaxing treatment goals, providing family/patient education, and enhanced communication strategies.