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BACKGROUND Informal caregiving of stroke survivors often begins with intensity compared with the linear caregiving trajectories in progressive conditions. Informal caregivers of stroke survivors are often inadequately prepared for their caregiving role, which can have detrimental effects on their well-being. A greater depth of understanding about caregiving burden is needed to identify caregivers in most need of intervention. The purpose of this study was to examine caregiver burden and associated factors among a cohort of informal caregivers of stroke survivors. METHODS A cross-sectional study of 88 informal caregivers of stroke survivors was completed. Caregiver burden was determined with the Zarit Burden Interview, caregiver depressive symptoms were measured with the Patient Health Questionnaire-9, and stroke survivor functional disability was assessed with the Barthel Index. Ordinal logistic regression was used to identify independent factors associated with caregiver burden. RESULTS Forty-three informal caregivers (49%) reported minimal or no caregiver burden, 30 (34%) reported mild to moderate caregiver burden, and 15 (17%) reported moderate to severe caregiver burden. Stroke survivor functional disability was associated with informal caregiver burden (P = .0387). The odds of having mild to moderate caregiver burden were 3.7 times higher for informal caregivers of stroke survivors with moderate to severe functional disability than for caregivers of stroke survivors with no functional disability. The presence of caregiver depressive symptoms was highly correlated with caregiver burden (P < .001). CONCLUSION Caregivers of stroke survivors with functional disabilities and caregivers experiencing depressive symptoms may have severer caregiver burden. Trials of interventions aimed at decreasing informal caregiver burden should consider the potential impact of stroke survivors' functional disability and the presence of depressive symptoms.

Informal caregiving of stroke survivors often begins with intensity compared with the linear caregiving trajectories in progressive conditions. Informal caregivers of stroke survivors are often inadequately prepared for their caregiving role, which can have detrimental effects on their well-being. A greater depth of understanding about caregiving burden is needed to identify caregivers in most need of intervention. The purpose of this study was to examine caregiver burden and associated factors among a cohort of informal caregivers of stroke survivors.A cross-sectional study of 88 informal caregivers of stroke survivors was completed. Caregiver burden was determined with the Zarit Burden Interview, caregiver depressive symptoms were measured with the Patient Health Questionnaire-9, and stroke survivor functional disability was assessed with the Barthel Index. Ordinal logistic regression was used to identify independent factors associated with caregiver burden.Forty-three informal caregivers (49%) reported minimal or no caregiver burden, 30 (34%) reported mild to moderate caregiver burden, and 15 (17%) reported moderate to severe caregiver burden. Stroke survivor functional disability was associated with informal caregiver burden (P = .0387). The odds of having mild to moderate caregiver burden were 3.7 times higher for informal caregivers of stroke survivors with moderate to severe functional disability than for caregivers of stroke survivors with no functional disability. The presence of caregiver depressive symptoms was highly correlated with caregiver burden (P.001).Caregivers of stroke survivors with functional disabilities and caregivers experiencing depressive symptoms may have severer caregiver burden. Trials of interventions aimed at decreasing informal caregiver burden should consider the potential impact of stroke survivors' functional disability and the presence of depressive symptoms.

Background and Purpose: Caregiver burden is commonly encountered in chronic disease management. Caregiver burden among informal caregivers of stroke survivors has potential to impact patient outcomes. We sought to assess the degree of caregiver burden and related factors among informal caregivers of patients followed in our Stroke Transitions Education and Prevention (STEP) clinic. Methods: We surveyed informal caregivers accompanying stroke patients to our STEP clinic visits within 2 years of ischemic or hemorrhagic stroke occurrence. Assessments included a caregiver demographic questionnaire, Zarit caregiver burden scale, patient health questionnaire-9 (PHQ-9, depression), Barthel index (BI -stroke survivor). Zarit score was dichotomized as no/minimal burden vs mild/moderate/severe burden. Univariate and multivariate analysis were conducted using logistic regression. Results: Among 71 surveys obtained, 69% of informal caregivers were women, despite a similar gender distribution of stroke survivors (54% women). While 49% of caregivers reported some degree of caregiver burden, 34% were classified as moderate-severe or severe. Caregiver burden was strongly associated with stroke survivor physical disability; odds of moderate or worse caregiver burden was 4.5 times higher (95% CI 1.52, 16.1) with BI < 75 compared to = 75. Additionally, odds of moderate-severe depression, as defined by PHQ-9 > 9, were 10 times higher (95% CI 2.06, 48.9). Conclusions: High levels of caregiver burden exist among informal caregivers of stroke survivors, and burden is associated with stroke survivor physical disability. Caregiver burden was associated with significantly greater odds of depression. Findings suggest the need for studies focused on characterization of informal caregiver needs and interventions to address the challenges they face.

Background: There is a paucity of literature on EOL management in patients with catastrophic stroke (CS). CS is unique due to the acuity of the injury and the unresponsive state of the patient. In CS, the families are the decision makers and it is imperative to have the communication skills necessary to begin a difficult conversation with families regarding prognosis and treatment planning. We performed a needs assessment to determine how our Neuroscience staff viewed our current EOL management process and areas for potential improvement. Methods: A multidisciplinary team created a survey with 3 main categories: Process of EOL management, Comfort Level with EOL communication, and roles and responsibility for EOL treatment and decision making. We administered the survey to neuroscience faculty, fellows and advance practice providers (APP), residents, nurses, case managers and social workers. Qualtrics Program pooled the responses of the EOL questionnaire for counts and proportions. Results: The survey was distributed to 419 people with 102 respondents (39.6% MDs, 52.5% RNs, 8.0% others). We found that only 48% of our employees felt comfortable beginning a conversation regarding EOL topics; 67% do not feel trained to address EOL topics and the overwhelming majority felt EOL communication should be part of educational training (Figure). Conclusion: We found that our Neuroscience staff does not have formal training in EOL communication, does not feel comfortable initiating EOL conversations and desires more training in EOL management. Future work should prioritize a patient/family centered approach to EOL care and training for healthcare professions so we are better prepared to handle the needs of our families and patients with CS.

Introduction: Uncontrolled blood pressure (BP) is a major risk factor for recurrent stroke; however, up to 50% of stroke survivors have uncontrolled BP 6 months after stroke. Characterization of factors associated with uncontrolled BP early after stroke discharge (DC) may help to identify patients for BP interventions. Hypothesis: We sought to identify factors associated with uncontrolled BP in the first month after stroke discharge. We hypothesized that African American (AA) race, insurance status, medication complexity, and hospital BP prior to discharge would be associated with uncontrolled BP. Methods: We identified hypertensive patients with ischemic or hemorrhagic stroke or transient ischemic attack scheduled to follow-up in the stroke clinic 2 to 4 weeks after hospital DC. Office BP was obtained using BpTRU, an automated machine that averages five unattended BP measures. Uncontrolled BP was defined using 2017 American College of Cardiology Guidelines as BP ≥ 130/80 mmHg. We used univariate logistic regression to assess relationships between uncontrolled BP and selected variables. Variables with statistically significant associations in the univariate models and variables associated with uncontrolled BP in the literature were included in the multiple logistic regression model. Results: Of the 230 patients identified, 55.7% had uncontrolled BP at clinic follow-up. In univariate and multivariable analyses, AA race, young stroke (age < 50), and systolic BP (SBP) 24-hours prior to DC were significantly associated with uncontrolled BP early after stroke DC. BP medication complexity was not associated with uncontrolled BP in this study. Conclusions: AA race, young age, and elevate SBP in the 24 hours prior to of stroke DC were associated with uncontrolled BP early after stroke. These variables can be used to identify patients who may benefit from early interventions aimed at reducing the risk of uncontrolled BP after stroke and stroke recurrence.

Background Blood pressure (BP) control is important for secondary stroke prevention and there are racial differences in BP control after stroke. BP is often treated based on in-clinic BP measurement; however, casual BP obtained in clinic may be inaccurate. We sought to determine whether race was associated with BP control misclassification in stroke survivors. Methods We followed ischemic/hemorrhagic stroke and transient ischemic attack patients in clinic within 30 days of hospital discharge. Sitting BP was obtained using a standard office automated machine (casual BP). BP was also measured with an automated office BP machine (AOBP), which measures 6 unattended BPs and averages the last 5. OABP has been used to approximate the gold standard 24-hour ambulatory BP (office BP 140/90 = AOBP 135/85). We defined the following categories: concordant control (AOBP Results Among 216 patients, mean age was 59.5 (SD 12.9); 50.5% African American, 21.3% Hispanic (HIS), and 25.5% Non-Hispanic White (NHW). BP control was misclassified in 32.1% of African Americans (17% pseudo-resistant and 16.5% masked uncontrolled); 26.1% of HIS (8.7% and 17.4%); and 20% of NHW (18.2% and 1.8%). In the univariate analysis, there was a trend toward an association between race and BP category (p = 0.06). Race was significantly associated with misclassification in the regression analysis. The odds ratio for masked uncontrolled compared to concordant controlled BP was 12.2 (95% CI 1.5, 99.2) for AA compared to NHW and 9.9 (95% CI 1.1, 87.4) for HIS compared to NHW. Conclusion These findings highlight the challenges in classifying control of BP and thus appropriately treating hypertension after stroke. Accurate tools for BP measurement including AOBP, home BP, and ambulatory BP monitoring should be utilized to optimize BP treatment after stroke.