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

Our aim was to assess the social insurance costs of hospital treatments for acute stroke in Hungary between 2003 and 2005. We studied how much burden stroke patients impose on the financer (National Health Insurance Fund Administration) in acute and chronic hospital admissions. We extracted the data of "new" stroke patients (ICD-10: 160-64 diagnosis) hospitalized in May 2003 from the database of the financer. We analyzed active and chronic hospital treatment costs of these patients in the period of 12 months before the stroke and in the following first and second 12 months. Data were collected by sex and age (age groups: 25-44, 45-64, over 65). We studied patients hospitalized in May 2003 with the ICD-10: 160-64 main diagnosis but not being treated with the same diagnosis in the previous 24 months. In the first 12 months of the active care the burden of the disease was (male vs. female) 65+: 254.6 vs. 205.8; 45-64: 341.4 vs. 280.5; 25-44: 370.1 vs. 306.1 thousand HUF per patient. In the second 12 months the costs were 50.6 vs. 36.2; 24.2 vs. 32.6; 27.6 vs. 24.8 thousand HUF respectively. In the first year following the episode the costs of the chronic hospital treatment were (age groups as above) 23.3 vs. 31.3; 28.9 vs. 22.2; 22.8 vs. 22.5 thousand HUF A year later the chronic hospital costs were 9.0 vs. 10.9; 6.7 vs. 12.2; 1.4 vs. 38.1 thousand HUF respectively. Average costs of stroke are higher in the case of males as are in the case of females, 364.8 vs. 303.0 thousand HUF in the first 24 months. The remarkable difference results from active hospital treatment costs (331.5 vs. 262.1 thousand HUF), while the discrepancy is smaller in the chronic hospital care (33.3 vs. 40.9 thousand HUF).
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PMID:[Social insurance costs of hospital treatment of stroke in Hungary, 2003-2005]. 1771 12

The aim of our research was to assess the incidence and the 12- and 24-month mortality of hospitalized stroke in Hungary. We analyzed the rate of mortality after stroke and compared it to the standard mortality rate of the population. To assess the incidence we extracted the data of "new" stroke patients (ICD-10 diagnoses: 160-64) hospitalized in May 2003 from the database of the National Health Insurance Fund Administration. We regarded those as "new" patients who had not been treated with these primary or secondary diagnoses in the previous 24 months. Data were collected by sex and age (age groups: 25-44, 45-64, 65 and over). We analyzed the patients' survival on the basis of their April 2004 and April 2005 data. The incidence of the "new" hospitalized stroke patients was higher in men than in women; the incidence in the age group of 65 and over was 2112/100.000 in males and 1582/100.000 in females, the corresponding values in the 45-64 age group were 623 vs. 366 per 100.000, respectively. In 2003 more than 42 thousand "new" stroke patients were hospitalized in Hungary of whom over 10 thousand died in the first year, followed by a further 2 thousand in the second year. Women's survival is more favourable than men's: in the first year it is 71.47% vs. 69.24% (65+ group), and 88.18% vs. 83.16% (45-64 group); in the second year the corresponding values are 66.95% vs. 61.62% (65+), and 85.45% vs. 80.90% (45-64), respectively. The risk of death in the first year after stroke, compared to the standard population, is 5.17-fold in women and 4.70-fold in men in the total sample, and 10-15-fold in the 45-64 group. There are large differences by gender, particularly in men of the working age groups (25-44, 45-64), whose mortality is twice as high as that of women of the same age.
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PMID:[Mortality of hospitalized stroke patients in Hungary; 2003-2005]. 1771 13

The change in ICD coding from ICD-9 to ICD-10 may produce inconsistencies and discontinuities in cause-specific mortality, thus impacting on effects estimates of air pollution on mortality. The current study was conducted in Wuhan, China. We examined the concordant rates and Kappa statistics using the mortality data from the year 2002 coded with both ICD-9 and ICD-10 codes and compared the estimated effects of air pollution using the Generalized Additive Model in R. We found high concordant rates (>99.3%) and Kappa statistics close to 1.0 (>0.98). Little difference was identified in the estimated effects of air pollution on daily cardiovascular, stroke, cardiac, cardiopulmonary, and respiratory mortality. This study provides evidence that, based on the wide definitions of cause-specific morality typically used in the studies of time-series air pollution mortality, the change in the ICD coding does not significantly affect the estimated effects of air pollution.
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PMID:Exploring uncertainty of the change from ICD-9 to ICD-10 on acute mortality effects of air pollution. 1785 96

To date, there have been no population-based data published regarding the influence of the patient's demographic factors on rt-PA use. We present preliminary data regarding the effect of race and gender on patterns of rt-PA use in the pre-FDA approval era, in a population with demographic and socioeconomic characteristics similar to the United States. All ischemic strokes within a biracial population of 1.3 million were identified by review of all primary and secondary hospital ICD-9-CM codes 430-438 from July 1993 to June 1994 at all hospitals in the region. The number of patients treated with rt-PA or placebo as part of the blinded NINDS rt-PA trial, as well as demographic characteristics, were recorded and analyzed. There were a total of 1973 hospitalized ischemic strokes that occurred at a hospital participating in the NINDS rt-PA trial. Patients that received rt-PA were significantly younger than those that did not (mean age 67 v 72, respectively, P = .01). Of the 413 strokes that occurred in African Americans, 2.2% were treated with rt-PA vs. 2.6% of the 1560 non-African Americans. Women (2.0%) and men (3.0%) were equally likely to receive rt-PA. The single academic center was as likely to give rt-PA as the community medical centers. In the Greater Cincinnati/Northern Kentucky population, patterns of rt-PA use in 1993-94 did not appear to vary according to race or gender, or type of medical center. These findings may be in part because of the regionally-based method of stroke care delivery in the area.
J Stroke Cerebrovasc Dis
PMID:The effect of race and gender on patterns of rt-PA use within a population. 1790 30

Studies that accurately identify myocardial infarction (MI) and stroke within populations would provide valuable epidemiological information as well as data on vascular disease prevention. We performed a pilot study to assess the feasibility of adding MI surveillance to an ongoing population-based stroke surveillance study, the Brain Attack Surveillance in Corpus Christi (BASIC) Project. We also tested two screening methods for MI ascertainment: discharge International Classification of Diseases, Ninth Revision (ICD-9) codes and cardiac biomarker screening. This pilot study suggests that the addition of MI surveillance to community-based stroke surveillance studies is feasible. Screening for abnormal cardiac biomarkers to identify potential MI cases may be more accurate and efficient than using ICD-9 codes.
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PMID:Screening for myocardial infarction and ischemic stroke: a population-based study. 1792 1

The objective of this study was to determine if elevations in blood glucose, in a range classified as impaired fasting glucose, are associated with a greater incidence of cerebrovascular disease in nondiabetic patients. Morning blood glucose determinations were evaluated with respect to subsequent stroke using records from 28 477 nondiabetic patients. Strokes and transient ischemic attacks (TIA) were identified from ICD-9 coding for a new event more than a year after baseline glucose determinations. Of the patients studied, 593 suffered stroke or TIA over a total risk analysis time of 100 982 years. Higher baseline morning glucose (100 to 126 mg/dL vs under 100 mg/dL) was associated with 31% more diagnoses (2.4% vs 1.8%, P < .001). Incidence rate was 5.3 per 1000 patient-years for those patients with glucose over 100 mg/dL and 3.9 per 1000 patient-years for those with glucose under 100 mg/dL (P <.001). Kaplan-Meier analysis showed that elevated baseline glucose was associated with a progressive, increased risk with time. A Cox proportional hazards model with adjustment for age, body mass index, sex, creatinine, lipids, smoking, and medications showed that elevated fasting glucose was associated with an increased hazard for a new event (hazard ratio 1.24, 95% CI 1.05-1.46, glucose over 100 mg/dL vs under 100 mg/dL). Thus, patients with higher baseline blood glucose levels in the absence of diabetes and after adjustment for covariants have a significantly greater risk for development of cerebrovascular disease.
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PMID:Blood glucose and cerebrovascular disease in nondiabetic patients. 1802 49

Comorbidities may affect the decision to treat chronic hepatitis C virus (HCV) infection. We undertook this study to determine the prevalence of these conditions in the HCV-infected persons compared with HCV-uninfected controls. Demographic and comorbidity data were retrieved for HCV-infected and -uninfected subjects from the VA National Patient Care Database using ICD-9 codes. Logistic regression was used to determine the odds of comorbid conditions in the HCV-infected subjects. HCV-uninfected controls were identified matched on age, race/ethnicity and sex. We identified 126 926 HCV-infected subjects and 126 926 controls. The HCV-infected subjects had a higher prevalence of diabetes, anaemia, hypertension, chronic obstructive pulmonary disease (COPD)/asthma, cirrhosis, hepatitis B and cancer, but had a lower prevalence of coronary artery disease and stroke. The prevalence of all psychiatric comorbidities and substance abuse was higher in the HCV-infected subjects. In the HCV-infected persons, the odds of being diagnosed with congestive heart failure, diabetes, anaemia, hypertension, COPD/asthma, cirrhosis, hepatitis B and cancer were higher, but lower for coronary artery disease and stroke. After adjusting for alcohol and drug abuse and dependence, the odds of psychiatric illness were not higher in the HCV-infected persons. The prevalence and patterns of comorbidities in HCV-infected veterans are different from those in HCV-uninfected controls. The association between HCV and psychiatric diagnoses is at least partly attributable to alcohol and drug abuse and dependence. These factors should be taken into account when evaluating patients for treatment and designing new intervention strategies.
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PMID:Co-morbid medical and psychiatric illness and substance abuse in HCV-infected and uninfected veterans. 1807 Feb 93

The 5-year incidence of cardiovascular disease (CVD) and its determinants, in a sample of men and women from Greece, was evaluated. From May 2001 to December 2002, 1514 men and 1528 women (>18 years old) without any clinical evidence of CVD, living in the Attica area, Greece, were enrolled in the ATTICA study. In 2006, a group of experts performed the 5-year follow-up (941 of the 3042 (31%) participants were lost to follow-up). Development of CVD (coronary heart disease, acute coronary syndromes, stroke, or other CVD) during the follow-up period was defined according to WHO-ICD-10 criteria. The 5-year incidence of CVD was 11.0% in men and 6.1% in women (p<0.001); the case fatality rate was 1.6%. Multi-adjusted logistic regression analysis revealed that increased age (odds ratio per year=1.09, p=0.04), waist-to-hip ratio (odds ratio=5.07, p=0.02), hypertension (odds ratio=4.53, p=0.001), diabetes (odds ratio=4.53, p=0.001) and C-reactive protein levels (odds ratio per 1 mg/dl=1.31, p=0.02) were the most significant baseline bio-clinical predictors of CVD. Furthermore, an increased education level and greater adherence to the Mediterranean diet (among 35-65-year-old individuals) were associated with a lower CVD incidence (odds ratio per 3 years of school difference=0.83, p<0.001 and odds ratio per 1/55 units in diet score=0.94, p<0.001), irrespective of various potential confounders. In conclusion, aging, central fat, hypertension and diabetes, inflammation process, low social status and abstinence from a Mediterranean diet seem to predict CVD events within a 5-year period.
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PMID:Five-year incidence of cardiovascular disease and its predictors in Greece: the ATTICA study. 1859

In the past few years, the prediction of CVD risk has received special attention; however, some investigators assert that risk models have so far not been very successful. Thus, we examined whether the inclusion of dietary evaluation in a risk prediction model that already contained the classical CVD risk factors increases the accuracy and reduces the bias in estimating future CVD events. The database of the ATTICA study (which included information from 1,514 men and 1,528 women) was used. At baseline, the HellenicSCORE values (based on age, gender, smoking, systolic blood pressure, and total cholesterol) were calculated, while overall assessment of dietary habits was based on the Mediterranean diet score (MDS) that evaluates adherence to this traditional diet. In 2006, a five-year follow-up was performed in 2,101 participants and development of CVD (coronary heart disease, acute coronary syndromes, stroke, or other CVD) was defined according to WHO-ICD-10 criteria. The MDS and the HellenicSCORE were significant predictors of CVD events, even after adjusting for various potential confounders (p < 0.05). However, estimating bias (i.e., misclassification of cases) of the model that included HellenicSCORE and other potential confounders was 8.7%. The MDS was associated with the estimating bias of the outcome (p < 0.001) and explained 5.5% of this bias. Other baseline factors associated with bias were increased body mass index, low education status, and increased energy intake/BMR ratio. The inclusion of dietary evaluation, as well as other Sociodemographic and anthropometric characteristics, increases the accuracy and reduces estimating bias of CVD risk prediction models.
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PMID:Inclusion of dietary evaluation in cardiovascular disease risk prediction models increases accuracy and reduces bias of the estimations. 1900 82

Recently, the Surgical Trial in IntraCerebral Haemorrhage (STICH) was unable to show an overall benefit from 'early surgery' compared with a policy of 'initial conservative treatment'. Here, we evaluated the impact of the STICH results on the management of spontaneous supratentorial intracerebral haemorrhage (ICH) in the Newcastle upon Tyne Hospitals. The STICH results were released to the Neurosurgery Department at Newcastle General Hospital in November 2003; using ICD-10 data, we analysed ICH admissions before (2002) and after (2004, 2006, 2007) this. We assessed numbers of Neurosurgery and Stroke Unit admissions, numbers of clot evacuation procedures, and 30-day mortality rate (Neurosurgery vs. Stroke Unit admissions). Subarachnoid haemorrhage (SAH) admissions data were also collected to corroborate our findings. There were 478 spontaneous supratentorial ICH admissions in total; 156 in 2002, 120 in 2004, 106 in 2006 and 96 in 2007. SAH admissions remained remarkably constant over this period. Neurosurgery admissions decreased significantly across the four time periods, from 71% of total ICH admissions (n = 156) in 2002 to 55% (n = 96) in 2007, and Stroke Unit admissions increased significantly from 8% (n = 156) in 2002 to 30% (n = 96) in 2007 (chi(2) = 20.968, p < 0.001, df = 3). Clot evacuation procedures also decreased significantly from 32% (n = 111) of Neurosurgery admissions in 2002 to 17% (n = 53) in 2007 (chi(2) = 11.919, p = 0.008, df = 3). 30-day mortality increased in Neurosurgery from 14% of Neurosurgery admissions (n = 111) in 2002 to 26% (n = 53) in 2007, and decreased in the Stroke Unit, from 42% of Stroke Unit admissions (n = 12) in 2002 to 17% (n = 29) in 2007. The STICH results have significantly impacted ICH management in Newcastle, with a trend towards fewer Neurosurgery admissions and clot evacuations, and increased Stroke Unit admissions. The role of surgery for ICH remains controversial, and randomization continues in STICH II for patients with superficial lobar ICH.
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PMID:The effect of the results of the STICH trial on the management of spontaneous supratentorial intracerebral haemorrhage in Newcastle. 1908 56


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