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Prestroke dementia is associated with poor outcomes after reperfusion therapy among elderly stroke patients
Busl KM, Nogueira RG, Yoo AJ, Hirsch JA, Schwamm LH, Rost NS.. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2011-12-17
Topic: Risk, prevention and care in population studies
Background In elderly acute stroke patients, reperfusion therapy is often withheld. We sought to determine whether prestroke dementia contributed to poor outcomes after reperfusion therapy in these patients. Methods All consecutive patients ≥ 80 years of age who received intravenous (IV) or intra-arterial reperfusion therapy (IAT) were identified in our Get With the Guidelines Stroke (GWTG-S) database. Vascular risk factors, presence of dementia, and outcomes were abstracted from the medical record. Dementia was recorded when listed in the medical history or when under medical treatment. Primary outcome was in-hospital mortality. Secondary outcome was discharge destination, "favorable" (home or rehabilitation facility) versus "unfavorable" (skilled nursing facility, hospice, or death). Multivariate logistic regression models were used to assess outcomes. Results Of 153 patients, 72% received IV tissue plasminogen activator (tPA), 35% IAT, and 7% both. The mean age was 85.8 ± 4.6 years; 13.6% had prestroke dementia. The in-hospital mortality rate was 35%. The likelihood of death increased with National Institutes of Health Stroke Scale (NIHSS; odds ratio [OR] 1.14; 95% confidence interval [CI] 1.07-1.21), IAT (OR 3.43; 95% CI 1.70-6.92), and dementia (OR 3.61; 95% CI 1.39-9.37), and decreased with IV tPA (OR 0.34; 95% CI 0.17-0.71). Increasing NIHSS (OR 0.90; 95% CI 0.85-0.95), symptomatic intracranial hemorrhage (OR 0.08; 95% CI 0.01-0.67), IAT (OR 0.43; 95% CI 0.22-0.84), and dementia (OR 0.37; 95% CI 0.14-0.97) decreased the likelihood of favorable discharge. In multivariate analysis, only NIHSS (OR 1.13; 95% CI 1.06-1.22) and dementia (OR 5.64; 95% CI 1.88-16.89) independently predicted death and unfavorable discharge destination. Conclusions Among the elderly, prestroke dementia is a powerful independent predictor of in-hospital mortality after acute reperfusion therapy for stroke. Future investigations of thrombolysis outcomes in the elderly are warranted.
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APA 7th
Busl, K. M., Nogueira, R. G., Yoo, A. J., Hirsch, J. A., Schwamm, L. H., & Rost, N. S. (2013). Prestroke dementia is associated with poor outcomes after reperfusion therapy among elderly stroke patients. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.11.005
Vancouver
Busl KM, Nogueira RG, Yoo AJ, Hirsch JA, Schwamm LH, Rost NS. Prestroke dementia is associated with poor outcomes after reperfusion therapy among elderly stroke patients. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2013. doi:10.1016/j.jstrokecerebrovasdis.2011.11.005. PMID: 22182760.
BibTeX
@article{busl2013-22182760,
author = {Busl, K. M. and Nogueira, R. G. and Yoo, A. J. and Hirsch, J. A. and Schwamm, L. H. and Rost, N. S.},
title = {{Prestroke dementia is associated with poor outcomes after reperfusion therapy among elderly stroke patients}},
journal = {Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association},
year = {2013},
doi = {10.1016/j.jstrokecerebrovasdis.2011.11.005},
pmid = {22182760},
url = {https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.11.005}
}
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Key findings
- Secondary outcome was discharge destination, "favorable" (home or rehabilitation facility) versus "unfavorable" (skilled nursing facility, hospice, or death).
- Results Of 153 patients, 72% received IV tissue plasminogen activator (tPA), 35% IAT, and 7% both.
Study details
- Participants153
- Effect size13.6%; OR 3.43; OR 3.61
- Evidence strengthLow
How this study scored 50/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 29 of the 58 points we could judge it on, which is 50 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2013 — within 20 year(s) of the newest study here |
| Sample size | 2 / 4 | 153 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 22182760) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 29 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 29 of the 58 points we could judge it on is 50 out of 100. |
| Total | 50 / 100 | — |
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