XVII. European Stroke Conference
Nice, France
XVII. European Stroke Conference
Nice, France
Poster Session: Very old age (>80 years) and
stroke
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
CLINICAL ISCHAEMIC STROKE PATIENTS AGED >/= 80
I. Soares
P. Abecassis
A. Mello e Silva
J.M.Ferro
Serviço de Medicina I, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental (CHLO)
PORTUGAL
Background - Knowledge of age-specific aspects of stroke is important to establish therapeutic and prevention programs. The aims of this study were to compare vascular risk factors, clinical features and outcome of elderly patients with first-ever acute ischemic stroke, stratified in two age groups (70-79 and ≥ 80 years). Methods - Data from 142 patients, aged 70 years old or more, with first-ever acute ischemic stroke, consecutively admitted to a general ward, were prospectively collected at stroke onset and 6 months after the event. Patients were evaluated for demographics, risk factors, clinical presentation and 6-month outcome. Stroke severity on admission was assessed by the National Institute of Health Stroke Scale (NIHSS). Clinical subtypes of ischemic stroke were rated according to the Oxfordshire Community Stroke Project (OCSP) criteria. Poststroke disability was measured by the modified Rankin Scale. Results – 75 patients (52,8%) were 80 years or older. The mean age of the two groups of patients was 74,2±2,8 and 84,3±3,6 years. At baseline, patients>/=;80 were more often women (77,3% versus 61,2%; p=0,037), had more often atrial fibrillation (48,6% versus 28,8%; p=0,016), heart failure (49,3% versus 28,4%; p=0,011), more severe strokes (NIHSS score >/=7 in 65,3% versus 34,3%; p<0,001), TACI and PACI subtypes (18,7% versus 6,0%, for TACI, and 48,0% versus 28,4%, for PACI; p=0,001) and strokes related to small-vessel disease (22,4% versus 2,7%; p<0,001). Smoking and alcohol consumption were significantly less frequent in patients >/=80 (20,0% versus 35,8%, p=0,035; and 6,7% versus 22,4%, p=0,007, respectively) . Six months after stroke, patients aged >/=80 had a higher case fatality rate (33,3% versus 10,4%; p=0,001) and, among the survivors, a higher proportion of patients with Rankin score > 2 (56,0% versus 35,0%; p=0,027). Discussion – Elderly patients aged <80>/= with acute ischemic stroke have different risk factor profiles, clinical characteristics, stroke subtypes. Patients aged >/=80 have a poorer outcome.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
A QUALITATIVE STUDY OF OLDER PEOPLE’S EXPERIENCES OF STROKE AND STROKE CARE IN A UK TEACHING HOSPITAL
M.M.CHAUHAN
S.L.GILES
A. BOUGHELLAM
S.K.MUNSHI
Nottingham University Hospitals
UNITED KINGDOM
Introduction: Stroke is predominantly a disease of older people and the number of older stroke patients is due to escalate in coming years. It is therefore vital to acknowledge their opinions and experiences. We evaluated patient satisfaction and highlighted aspects of care deemed most important to older stroke patients through exploration of their experiences, perceptions and concerns regarding stroke and stroke care. Method: Eighty patients diagnosed with stroke, and admitted to two tertiary NHS stroke units completed a qualitative, validated, written questionnaire and semi-structured interview. 42(53%) were female and the mean age was 71.3 years. Patient satisfaction was assessed using a combination of the Likert and binary scales. Results: Although older stroke patients are often satisfied with the overall care they receive, particular themes were identified as being most important to them and ultimately in need of improvement. Patients emphasised their need for privacy, adequate rest periods, and importance of detailed information and clear communication from all members of the specialist stroke team. Their primary fears included loss of previous independence, potential strain on close relationships, several kinds of emotional problems, concerns about future care and the risk of a further stroke. Conclusions: A greater understanding of the personal experiences, fears and concerns of older stroke patients is relevant to a wide host of individuals involved in stroke care, and is essential in producing patient-centred health care with the greatest patient satisfaction. It is vital for those involved in the care of stroke patients, and within government agencies instigating policy, to take notice of the deeper fears and concerns of older stroke patients.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
Prevalence of cardiovascular risk factors among elderly Brazilians with ischemic stroke
A. Pieri
M. Spitz
T.O.Lopes
C.G.Barros
M.W.Faulhaber
A.A.Gabbai
M.C.Neto
Albert Einstein Hospital
BRAZIL
Introduction: There has been an increasing number of reports of elderly over eighty with ischemic stroke in the past few years. The knowledge about cardiovascular risk factors in such population is important for the definition of specific policies of prevention. Objective: To evaluate the prevalence of cardiovascular risk factors in patients with age equal to or above 80 in a hospital population with ischemic stoke. Methods: Retrospective study of consecutive patients diagnosed with ischemic stroke admitted to a tertiary health facility. Results: From September 2004 to March 2006, 215 patients were studied. There was a female preponderance in the over eighty patients group (p<0,01). Among patients over eighty, 72% had hypertension and atrial fibrillation was more common among the oldest old (p<0,01). Conclusions: The high prevalence of atrial fibrillation supports the idea that oral anticoagulants should be considered more often in these patients.
Session:
Poster Session II
Date:
Thursday 15 May 2008
Time:
12:30 - 14:00
Room:
Agora 3
PREDICTION OF OUTCOME OF ISCHAEMIC STROKE IN THE ELDERLY
I. Soares
P. Abecassis
A. Mello e Silva
J.M.Ferro
Serviço de Medicina I, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental (CHLO)
PORTUGAL
Background – Few studies attempted to identify independent predictors of stroke outcome in the elderly. The aims of this study were to evaluate the outcome and to develop prognostic models for functional dependence or death, after six months, in acute ischemic stroke patients aged ≥70. Methods – Data from 115 patients, aged >/=70 years old, with first-ever acute ischemic stroke, and nondisabled prior to the event, consecutively admitted to a general ward, were prospectively collected at stroke onset. Outcome was assessed at 6 months. Clinical and radiological findings (infarct size), including the National Institute of Health Stroke Scale (NIHSS) score and the Charlson Comorbidity Index (CCI) score, were recorded. Favorable outcome was defined as modified Rankin scale (mRS) score </=2, unfavorable as mRS > 2. Predictors of outcome at 6 months were analyzed by multiple logistic regression. Results – The mean age of the patients was 78,6+/-5,7 years and 66,1% were female. The 6 month case fatality rate was 19,1%, and, among the survivors, 34,5% became disabled. The prognostic factors for functional dependence or death, identified by the regression model were female gender (OR 2,667; 95% CI 0,865-8,217), initial systolic blood pressure >/=140 mmHg (OR 3,94; 95% CI 1,141-13,618) and NIHSS score on admission (OR 1,509; 95% CI 1,281-1,777). This model has a AUC of 0,893 and correctly classified 85,2% of the patients. Discussion – In the nondisabled elderly, neurologic stroke severity is the strongest predictor of functional dependence and mortality. The NIHSS score was the most powerful predictor of outcome, eliminating the contribution of several others potential prognostic predictors, including the CCI score. This suggests that comorbidity may influence the outcome by increasing the severity of the stroke.
