Wechsler Paul M, Mistry Eva A, Sucharew Heidi, Robinson David J, Stanton Robert, de Los Rios La Rosa Felipe, Mackey Jason, Ferioli Simona, Demel Stacie L, Coleman Elisheva R, Jasne Adam, Slavin Sabreena, Walsh Kyle B, Star Michael, Haverbusch Mary, Alwell Kathleen, Woo Daniel, Kleindorfer Dawn O, Kissela Brett M
University of Cincinnati OH USA.
Miami Neuroscience Institute Baptist Health South Florida Miami FL USA.
J Am Heart Assoc. 2025 Jun 3;14(11):e040499. doi: 10.1161/JAHA.124.040499. Epub 2025 May 26.
Limited data exist regarding differences in ischemic stroke care across the care continuum between patients with and without prestroke disability. We investigated differences in in-hospital and postdischarge ischemic stroke cause evaluation and treatment between patients with and without prestroke disability using population-based data in the United States.
We ascertained all adult patients (≥18 years) hospitalized with acute ischemic stroke within the Greater Cincinnati/Northern Kentucky population between January 1, 2015, and December 31, 2015. We used univariate analyses and logistic regression to compare differences in acute ischemic stroke reperfusion therapies, stroke cause evaluation, prescription of secondary stroke prevention treatments, and rehabilitation between patients with prestroke disability (modified Rankin Scale score ≥2) and those without prestroke disability (modified Rankin Scale score 0-1).
Of 2476 ischemic stroke patients, 1326 (53%) had prestroke disability. Prestroke disability was associated with lower odds of receiving thrombolysis (adjusted odds ratio [aOR], 0.43 [95% CI, 0.28-0.68], <0.01) and endovascular thrombectomy (aOR, 0.32 [95% CI, 0.13-0.78], <0.01). Patients with prestroke disability were less likely to receive complete in-hospital stroke cause evaluation (aOR, 0.48 [95% CI, 0.33-0.69], <0.01) and there were small differences in antiplatelet (84% versus 87%) and statin therapy (80% versus 86%) prescribed at discharge. Those with prestroke disability were more likely to receive in-hospital (aOR, 2.6 [95% CI, 2.11-3.21], <0.01) and postdischarge rehabilitative therapies (aOR, 2.27 [95% CI, 1.86-2.77], <0.01).
Further research into factors driving medical decision-making for patients with prestroke disability is needed to optimize the entire spectrum of ischemic stroke care for this population.
关于有卒中前残疾和无卒中前残疾患者在整个护理连续过程中缺血性卒中护理差异的数据有限。我们利用美国基于人群的数据，调查了有卒中前残疾和无卒中前残疾患者在住院期间及出院后缺血性卒中病因评估和治疗方面的差异。
我们确定了2015年1月1日至2015年12月31日期间在大辛辛那提/北肯塔基地区因急性缺血性卒中住院的所有成年患者（≥18岁）。我们使用单因素分析和逻辑回归来比较有卒中前残疾（改良Rankin量表评分≥2）和无卒中前残疾（改良Rankin量表评分0 - 1）患者在急性缺血性卒中再灌注治疗、卒中病因评估、二级卒中预防治疗处方和康复方面的差异。
在2476例缺血性卒中患者中，1326例（53%）有卒中前残疾。卒中前残疾与接受溶栓治疗（调整后的优势比[aOR]，0.43 [95%置信区间，0.28 - 0.68]，<0.01）和血管内血栓切除术（aOR，0.32 [95%置信区间，0.13 - 0.78]，<0.01）的较低几率相关。有卒中前残疾的患者接受完整的住院卒中病因评估的可能性较小（aOR，0.48 [95%置信区间，0.33 - 0.69]，<0.01），出院时抗血小板治疗（84%对87%）和他汀类药物治疗（80%对86%）的差异较小。有卒中前残疾的患者更有可能接受住院（aOR，2.6 [95%置信区间，2.11 - 3.21]，<0.01）和出院后康复治疗（aOR，2.27 [95%置信区间，1.86 - 2.77]，<0.01）。
需要进一步研究影响有卒中前残疾患者医疗决策的因素，以优化该人群缺血性卒中护理的全流程。
