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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although the relation between serum total cholesterol and coronary heart disease is well established, the relation with mortality from non-coronary disease is controversial. Inverse relations of serum cholesterol with hemorrhagic stroke and cancer have stimulated the examination of cholesterol-non-coronary mortality associations. The population surveyed is 12,187 men and women aged 40-69 years living in Yao City, a suburb of Osaka, who undertook baseline examinations between 1975 and 1984 and had no history of stroke and coronary heart disease at baseline. The subjects were followed on average 8.9 years until the end of 1988 using systematic mortality surveillance. During the follow-up, there were 343 deaths, comprising 170 cancer deaths (International Classification of Death 9th edition: ICD-9, 140-239), 21 coronary heart disease deaths (ICD-9, 410-414), 67 other cardiovascular deaths (ICD-9, 390-458 excluding 410-414), and 85 non-cardiovascular, non-cancer deaths. There was a significant inverse association of serum cholesterol with total and cancer mortality for men, and no significant association for women. The cholesterol-disease association, although not significant, was positive for coronary heart disease and other cardiovascular disease deaths, and inverse for non-cardiovascular, non-cancer deaths in both sexes. The inverse association of serum cholesterol with total and cancer mortality for men remained significant after controlling for age, job classification, hypertension category, usual alcohol intake, cigarette smoking, and relative weight index.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Serum total cholesterol and mortality in a Japanese population. 773 Sep 12

CABG is associated with many perioperative complications, including supraventricular and ventricular arrhythmias and conduction disturbances. Atrial fibrillation occurs in < or = 40% of patients after CABG and is especially common in older patients. Although it is often benign and self-limited, it can lead to complications such as stroke. Treatment consists primarily of control of the ventricular response rate; in some cases, antiarrhythmic drugs or electrical cardioversion are needed. Anticoagulation should be considered in appropriate cases of persistent (48 to 72 hours) atrial fibrillation after initial treatment. Prophylaxis, especially with beta-blocking agents, seems to be effective and should be considered in appropriate cases. Simple ventricular arrhythmias are common after CABG and do not affect the patient's prognosis; however, sustained VT/VF occur infrequently (< 2% of patients) and carry a high mortality rate. Treatment is aimed at correcting precipitating factors (e.g., myocardial ischemia). Electrophysiologically guided drug therapy and implantation of an ICD should be considered in appropriate cases for patients who survive the initial events. Transient minor conduction disturbances are common after CABG; in some patients persistent AV block and sinus node dysfunction develop and may require treatment with permanent pacemaker.
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PMID:Arrhythmias and conduction disturbances after coronary artery bypass graft surgery: epidemiology, management, and prognosis. 790 Jun 34

This article summarizes various concepts (Binswangers encephalopathy, multiinfarct-dementia, lacunar state, mixed dementia, dementia due to amyloid angiopathy or vasculitis) and classifications (DSM, ICD, ADDTC) on vascular dementia. It reviews historical, clinical, and diagnostic aspects (i.e. neuroradiology, SPECT, PET) as well as therapeutic approaches. The confusing nomenclature on vascular dementia is discussed, considering especially the non-convincing concept of multiinfarct-dementia that often has been misused as a synonym for vascular dementia. Multiinfarct-dementia is now restricted to a syndrome of vascular dementia due to several large vessels strokes. A current definition and classification of vascular dementia as suggested by NINDS-AIREN international workshop is described. It defines criteria consistent with the diagnosis of "possible", "probable" and "definite" vascular dementia based on clinical, radiologic and neuropathologic features. The criteria of "probable" vascular dementia include all the following: 1. the presence of dementia and cerebrovascular disease defined by focal signs on neurologic investigation and evidence of relevant cerebrovascular disease by brain imaging (multiple lacunae, extensive white matter lesions, multiple large-vessels infarcts or a strategically placed infarct) 2. A relationship between dementia and cerebrovascular disease (onset of dementia within 3 months following a recognized stroke; abrupt deterioration, stepwise progression). This classification of vascular dementia emphasises pathogenetic aspects and includes dementia resulting from small- and large-vessels disease as well as hypoperfusion, haemorrhagic dementia and dementia due to still unknown factors. Operational criteria for the frequent Binswangers encephalopathy--a prototype of vascular dementia--are presented. Thereby a basis for further research and discussion in this exciting area should have been formed.
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PMID:[Progress in vascular dementia--an overview of vascular dementia from past to new concepts]. 805 Jul 74

The Health Care Financing Administration (HCFA) plans to use the Uniform Clinical Data Set System (UCDSS) to collect data on hospitalized Medicare patients. This study examined the value of UCDSS data for creating severity of illness measures. UCDSS data were obtained from a study hospital and from a national data set for patients with pneumonia (n = 528) and stroke (n = 565). Models to predict length of stay or an adverse event were derived for each condition using HCFA claims data alone, UCDSS data alone, and UCDSS data supplemented with additional information also abstracted from charts. The models were derived from one set of patients and validated on another. The R2 for predicting length of stay in the validation data for the UCDSS model was 0.29 for pneumonia and 0.19 for stroke compared to R2 values from the claims model of 0.09 for stroke and 0.06 for pneumonia. UCDSS models also were better than claims models for predicting adverse events. The best UCDSS models included International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and other information requiring clinical judgment, and were improved by adding more information on patient functional status. Some findings were more strongly associated with outcome for the study hospital than for the national data. These results suggest that UCDSS models will predict outcome much better than the claims based models currently used by HCFA for the analysis of hospitalization-related mortality; more functional status information should be added to UCDSS; and despite an extensive objective database, the most predictive UCDSS models require clinician-assigned diagnostic codes.
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PMID:Severity of illness measures derived from the Uniform Clinical Data Set (UCDSS). 809 42

To measure the burden of comorbid diseases using the MED-ECHO database (Quebec), the so-called Charlson index was adapted to International Classification of Disease (ICD-9) codes. The resulting comorbidity index was applied to the study of inpatient death in a group of 62,456 patients having one of the following conditions: ischemic heart disease, congestive heart failure, stroke, or bacterial pneumonia. Multiple logistic regression was used to relate inpatient death to its predictors, including gender, principal diagnosis, age, and the comorbidity index. Various transformations of the comorbidity score were performed, and their effect on predictive accuracy was assessed. The comorbidity index was constantly and strongly associated with death. When gender, age, comorbidity and the principal diagnoses were taken into account, the area under the receiver-operating curve was 0.83. Therefore, the Charlson Index is a useful approach to risk adjustment in outcomes research from administrative databases.
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PMID:Risk adjustment in outcome assessment: the Charlson comorbidity index. 829 45

Designed for acute care classification, the 9th version of the International Classification of Disease, Clinical Modification (ICD-9-CM) is also used to describe the principal diagnosis in medical rehabilitation. ICD-9-CM (ICD-9) coding practices for all stroke cases found in two nationally representative databases were examined (sample sizes over 17,000 and over 2,000). Of the more than 100 codes selected, four were indicated for 67% and 72% of stroke cases in the two data sets, respectively. Codes 436 and 438 distinguish acute from late stroke effects; whereas code 434.9 identifies stroke, but not its duration. The most frequently used code in the larger database, 342.9, refers to the manifestation of hemiplegia rather than to diagnosis, and thus is not specific to stroke. Other less frequently selected ICD-9 codes are more specific to the underlying pathophysiology (e.g., thrombosis, embolus or hemorrhage). Results emphasize the need for more precise selection of etiologic ICD-9 codes for stroke rehabilitation so that they describe specific pathology.
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PMID:Specificity of ICD-9-CM coding practices for stroke rehabilitation. 839 25

In the evaluation of a hypertension treatment program, the end-point surveillance included incidence of acute myocardial infarction and acute stroke identified from hospital in-patient registers and the national mortality register. To ascertain the validity, in-patient records containing the ICD-codes 410-411 and 430-438 were validated. First event of acute myocardial infarction and acute stroke suggested in the in-patient register could be confirmed in 96% and 94%, respectively. In-patient diagnoses of suspected acute myocardial infarction or other acute or subacute ischemic heart diseases, transient ischemic attack and unspecified heart diseases, transient ischemic attack and unspecified cerebrovascular disease revealed high proportions of what in fact turned out to be definite events (11%, 24% and 53% respectively). It is concluded that disease ascertainment for this cohort study claims validation of register data with hospital records.
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PMID:Validity of register data on acute myocardial infarction and acute stroke: the Skaraborg Hypertension Project. 846 41

We estimated the hospital costs for patients with different cerebrovascular events and applied patient and administrative variables to explain the variance of the cost estimates with particular attention to the relationship between patient age and cost. The study sample was drawn from an administrative data set of all hospital discharges from five academic medical centers for the 1992 calendar year. Using International Classification of Diseases (ICD-9-CM) primary diagnosis codes, cases were classified into cerebrovascular subgroups: subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), ischemic cerebral infarction (ICI), and transient ischemic attack (TIA). The ICD-9-driven data file was supplemented with billing data containing inpatient charges reported in UB-82 format. Costs were imputed by applying Medicare charge-to-cost ratios and regional wage adjustments to the billing data. We estimated relationships between inpatient costs and a number of demographic and administrative variables. A statistically significant difference was found between cerebrovascular subgroups for both the mean cost per discharge (p<0.01) and the mean cost of an inpatient day (p<0.01). The mean cost per discharge for each subgroup was as follows: SAH, $39,994 (n=218); ICH, $21,535 (n=258); ICI, $9,882 (n=908); TIA, $4,653 (n=303). Likewise, the mean cost per inpatient day was as follows: SAH, $2,215; ICH, $1,396; ICI, $1,036; TIA, $1,117. Length of stay as a measure of resource use was strongly predictive of inpatient cost, explaining 72 to 82% of the variation in cost. Demographic variables (i.e., age, gender, race, insurance status), however, revealed virtually no predictive power, accounting for less than 10% of the variance in each of the four subgroups. There are substantial differences in the patient-level cost of hospital services for stroke-related events. After controlling for the type of cerebrovascular event, basic demographic variables and insurance status (including Medicare) contribute little to the total cost of inpatient care. More important factor include stroke severity, social factors, and clinical practice variations.
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PMID:Inpatient costs of specific cerebrovascular events at five academic medical centers. 861 53

The purpose of this study was to define the relationship between the surgeon's operative experience and specialty and the postoperative morbidity and mortality of carotid endarterectomy. All patients undergoing carotid endarterectomy (code ICD-9CM 38.12) in Connecticut between October 1985 and September 1991 were retrospectively identified. A total of 3997 carotid endarterectomies were performed by 226 surgeons in four specialties: general, cardiac, vascular, and neurosurgery. Individual surgeon volume ranged from fewer than one per year to 27.5 per year (mean 2.9 carotid endarterectomies per year). Outcome was measured as a combined stroke and/or death percentage. The average combined stroke and/or death rate for the entire group was 4.9%. The combined stroke and/or death percentage was influenced significantly by the surgeon's annual volume. Surgeons who performed one or fewer carotid endarterectomies (43% of total surgeons) were 2.5 times more likely (p < 0.002) to have a poor postoperative outcome than those who performed 10 or more per year (9.3% of total surgeons). Overall there was a statistically significant correlation between a surgeon's annual volume and outcome, particularly for general surgeons.
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PMID:Outcome analysis of carotid endarterectomy in Connecticut: the impact of volume and specialty. 868 92

To define the causal relationship of ischemic cerebral infarction to automobile accidents in hospitalized patients a computerized hospital record search with ICD-9 diagnostic codes 433 and 434 for occlusive cerebrovascular disease, and E810 and E819 for motor vehicle traffic accidents was conducted over a three-year period. Inclusion criteria required patients be identified as the driver of the vehicle and demonstrate computed tomographic (CT) evidence of an evolving cerebral infarction on serial scans. Of 2,844 ischemic cerebral infarctions admitted to the hospital during the study period, four met the selection criteria. In three, stroke was the cause and in one, the result of the accident. When stroke preceded the accident, visual field defect impaired consciousness, and/or loss of motor control were major contributing factors. Head CT, detailed accident scene history, and vascular disease risk factors were most important in determining a cause-and-effect relationship of stroke to the accident.
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PMID:Stroke and automobile accidents. 877 36


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