ABSTRACT
Objetivo:identificar o conhecimento de idosos sobre acidente vascular cerebral relacionado à busca pelo atendimento emergencial. Método:revisão integrativa realizada em maio e junho de 2021,na Biblioteca Virtual em Saúde, National Library of Medicine and National Institutes of Health, Scientific Eletronic Library Online, Cumulative Index to Nursing and Allied Health Literature, SCOPUS e Web of Science, empregados Descritores de Ciências da Saúde, Medical Subject Headings e termos alternativos, publicados em 2016 a 2021.Resultados:compuseram 33 artigos o corpus da revisão, categorizados em duas vertentes: os conhecimentos sobre fatores de risco, prevenção e identificação do AVC; e a busca pelo atendimento precoce no serviço de urgência e emergência. Conclusão:idosos geralmente desconhecema doença e a necessidade de busca precoce doatendimento, o que ressalta a importância de ações de promoção à saúde e orientações relacionadas ao AVC, sejam elas por meio das mídias ou de pessoas que compõem a rede de apoio(AU)
Objective: to identify the knowledge of the elderly about stroke related to the search for emergency care. Method: integrative review carried out in May and June 2021 at the Virtual Health Library, National Library of Medicine and National Institutes of Health, Scientific Electronic Library Online, Cumulative Index to Nursing and Allied Health Literature, SCOPUS and Web of Science, employees Health Sciences, Medical Subject Headings and alternative terms, published in the years 2016 to 2021. Results: the review corpus comprised 33 articles, categorized into two aspects: knowledge about risk factors, prevention and identification of stroke; and the search for early care in the urgency and emergency service. Conclusion: the elderly are generally unaware of the disease and the need to seek care early, which highlights the importance of health promotion actions and guidelines related to stroke, whether through the media or people who make up the support network.(AU)
Objetivo: identificar el conocimiento de los ancianos sobre el accidente cerebrovascular relacionado con la búsqueda de atención de emergencia. Método: revisión integradora realizada en mayo y junio de 2021 en la Biblioteca Virtual en Salud, Biblioteca Nacional de Medicina e Institutos Nacionales de Salud, Scientific Electronic Library Online, Cumulative Index to Nursing and Allied Health Literature, SCOPUS y Web of Science, empleados Ciencias de la Salud , Medical Subject Headings y términos alternativos, publicados en los años 2016 a 2021. Resultados: el corpus de revisión comprendió 33 artículos, categorizados en dos aspectos: conocimiento sobre factores de riesgo, prevención e identificación del ictus; y la búsqueda de atención temprana en el servicio de urgencias y emergencias. Conclusión: los ancianos generalmente desconocen la enfermedad y la necesidad de buscar atención temprana, lo que destaca la importancia de las acciones y directrices de promoción de la salud relacionadas con el accidente cerebrovascular, ya sea a través de los medios de comunicación o de las personas que componen la red de apoyo.(AU)
Subject(s)
Humans , Aged , Health Knowledge, Attitudes, Practice , Stroke , Emergencies , Stroke/diagnosis , Stroke/prevention & control , Ambulatory CareABSTRACT
Resumo Fundamento: A fibrilação atrial é um problema de saúde pública associado com um risco cinco vezes maior de acidente vascular cerebral e mortalidade. A análise de custos é importante para a introdução de novas terapias, e deve ser reconsiderada em situações especiais, tais como a pandemia do coronavírus em 2020. Objetivo: Avaliar os custos (em um período de um ano) relacionados à terapia anticoagulante e a qualidade de vida de pacientes com fibrilação atrial tratados em um hospital público universitário. Métodos: Os custos do paciente foram aqueles relacionados à anticoagulação e calculados pela média de custos mensais da varfarina ou de anticoagulantes orais diretos (DOACs). As despesas não médicas, como alimentação e transporte, foram calculadas a partir de dados obtidos de questionários. O questionário brasileiro SF-6D foi usado para medir a qualidade de vida. Valores p<0,05 foram considerados estatisticamente significativos. Resultados: A população do estudo consistiu em 90 pacientes, 45 em cada braço (varfarina vs. DOACs). Os custos foram 20% mais altos no grupo dos DOACs (US$55 532,62 vs. US$46 385,88), e principalmente relacionados ao preço dos medicamentos (US$23 497,16 vs. US$1903,27). Os custos hospitalares foram mais altos no grupo da varfarina (US$31 088,41 vs $24 604,74), e relacionados às visitas ao ambulatório. Ainda, as despesas não médicas foram duas vezes maiores no grupo varfarina ($13 394,20 vs $7 430,72). A equivalência de preço entre os dois medicamentos seria alcançada por uma redução de 39% no preço dos DOACs. Não foram observadas diferenças quanto à qualidade de vida. Conclusões: Os custos totais foram mais altos no grupo de pacientes tratados com DOACs que no grupo da varfarina. No entanto, uma redução de cerca de 40% no preço dos DOACs tornaria viável a incorporação desses medicamentos no sistema de saúde público brasileiro.
Abstract Background: Atrial fibrillation is a public health problem associated with a fivefold increased risk of stroke or death. Analyzing costs is important when introducing new therapies and must be reconsidered in special situations, such as the novel coronavirus pandemic of 2020. Objective: This study aimed to evaluate the costs related to anticoagulant therapy in a one-year period, and the quality of life of atrial fibrillation patients treated in a public university hospital. Methods: Patient costs were those related to the anticoagulation and calculated by the average monthly costs of warfarin or direct oral anticoagulants (DOACs). Patient non-medical costs (eg., food and transportation) were calculated from data obtained by questionnaires. The Brazilian SF-6D was used to measure the quality of life. P-values < 0.05 were considered statistically significant. Results: The study population consisted of 90 patients, 45 in each arm (warfarin vs direct oral anticoagulants). Costs were 20% higher in the DOAC group ($55,532.62 vs $46,385.88), and mainly related to drug price ($23,497.16 vs $1,903.27). Hospital costs were higher in the warfarin group ($31,088.41 vs $24,604.74) and related to outpatient visits. Additionally, non-medical costs were almost twice higher in the warfarin group ($13,394.20 vs $7,430.72). Equivalence of price between the two drugs could be achieved by a 39% reduction in the price of DOACs. There were no significant group differences regarding quality of life. Conclusions: Total costs were higher in the group of patients taking DOACs than those taking warfarin. However, a nearly 40% reduction in the price of DOACs could make it feasible to incorporate these drugs into the Brazilian public health system.
Subject(s)
Humans , Atrial Fibrillation/complications , Stroke/prevention & control , Stroke/drug therapy , COVID-19 , Quality of Life , Administration, Oral , Retrospective Studies , SARS-CoV-2 , AnticoagulantsSubject(s)
Humans , Male , Female , Middle Aged , Aged , Diabetes Mellitus/diagnosis , Atherosclerosis/complications , Atherosclerosis/prevention & control , Dyslipidemias/prevention & control , Dyslipidemias/drug therapy , Heart Disease Risk Factors , Tobacco Use Disorder/prevention & control , Tomography, X-Ray Computed/methods , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Stroke/prevention & control , Hypertension/therapy , Cholesterol, HDL/toxicity , Cholesterol, LDL/toxicityABSTRACT
SUMMARY: Intracranial artery stenosis (ICAS) was one of the main causes of ischemic stroke onset and recurrence. About 30 % of strokes were caused by intracranial artery stenosis. Intracranial artery stenosis had a high incidence in China and faced a high risk of recurrence for a long time. It affected patient safety and quality of life seriously. At the same time, it caused a heavy financial burden for the patient´s family. Therefore, early detection and accuracy of intracranial artery stenosis evaluation were extremely important. High-resolution magnetic resonance imaging (HR-MRI) had been widely used in clinical examinations, making up for the shortcomings of traditional vascular imaging methods that could only show the degree of luminal stenosis, making it possible to perform lumens, tube wall and plaque features of atherosclerotic intracranial arteries at the same time. There were still some controversies about the credibility of this technique in assessing the intracranial artery lumen stenosis. This article reviewed the application efficacy of HR-MRI technology in evaluating the degree of intracranial atherosclerotic stenosis.
RESUMEN: La estenosis de arterias intracraneales (ICAS) es una de las principales causas del ictus isquémico, como así también de su recurrencia. Alrededor del 30 % de los ataques cerebrovasculares son causados por estenosis de la arteria intracraneal. La estenosis de arterias intracraneales tiene una alta incidencia en China y enfrenta un alto riesgo de recurrencia, afectando gravemente la seguridad y la calidad de vida de los pacientes. Al mismo tiempo, supone una importante carga financiera para la familia de los pacientes. Por lo tanto, la detección temprana y la precisión de la evaluación de la estenosis de arterias intracraneales es extremadamente importante. La resonancia magnética de alta resolución (HR-MRI, por sus siglas en inglés) es utilizada ampliamente en los exámenes clínicos, compensando las deficiencias de los métodos tradicionales de imágenes vasculares que solo pueden mostrar el grado de estenosis luminal, haciendo posible el estudio de las características del lumen, pared vascular y la placa ateroesclerótica, de las arterias intracraneales afectadas, al mismo tiempo. Aún existen algunas controversias sobre la credibilidad de esta técnica en la evaluación de la estenosis del lumen de arterias intracraneales. En este artículo se revisó la eficacia de la aplicación de la tecnología HR-MRI para evaluar el grado de estenosis aterosclerótica intracraneal.
Subject(s)
Humans , Magnetic Resonance Imaging/methods , Intracranial Arteriosclerosis/diagnostic imaging , Imaging, Three-Dimensional/methods , Constriction, Pathologic/diagnostic imaging , Stroke/prevention & controlABSTRACT
Youth is the core force of social and economic development, once the occurrence of youth stroke will place a heavy burden on society and family. However, the prevention and control of stroke in China is mainly aimed at middle-aged and elderly patients, the part of young stroke is relatively easy to be ignored. This article focuses on the characteristics, research progress, prevention and control status of young stroke, pointing out the importance of centering on the prevention and treatment of young stroke. At the same time, it hopes that the industry can concentrate on the prevention and treatment of young stroke, making precise policies in the future, and developing secondary prevention guidelines for the causes or risk factors of young stroke, so as to improve comprehensive stroke prevention and control system. On this basis, the health level of the whole population will be improved, and the life expectancy of residents will be extended, thus promoting the realization of the strategic goal of "Healthy China 2030".
Subject(s)
Adolescent , Aged , China/epidemiology , Health Status , Humans , Life Expectancy , Middle Aged , Policy , Stroke/prevention & controlABSTRACT
As a serious disease of death and disability, stroke constitutes a serious threat to human health. Because of stroke patients often have high-risk factors of malnutrition such as dysphagia and autonomic eating disorder, the hospitalization time, mortality and disability rate of stroke patients increases. Nutritional therapy can effectively improve the malnutrition of patients, which are of great significance for the treatment and rehabilitation of stroke and the prevention of its complications. Nutrients are important components of nutrition therapy, and different ways of nutrition therapy directly affect the effect of treatment. This article summarizes effects of nutrients and different nutritional treatments on stroke prevention, morbidity and treatment, and provides a theoretical basis and new thinking for further reducing the incidence rate of stroke, improving the quality of life in patients and reducing the financial burden of society and family.
Subject(s)
Enteral Nutrition/adverse effects , Humans , Malnutrition/prevention & control , Nutritional Status , Nutritional Support/adverse effects , Quality of Life , Stroke/prevention & controlSubject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Cardiovascular Diseases/chemically induced , Stroke/chemically induced , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Sodium-Glucose Transporter 2 Inhibitors/adverse effects , Heart Failure , Metformin/adverse effects , Myocardial Infarction/chemically induced , Sodium/therapeutic use , United States , Cardiovascular Diseases/prevention & control , Cardiovascular Diseases/epidemiology , Medicare , Stroke/prevention & control , Stroke/epidemiology , Glucose/therapeutic use , Hypoglycemic Agents/adverse effects , Myocardial Infarction/prevention & control , Myocardial Infarction/epidemiologyABSTRACT
Abstract Background Stroke and acute myocardial infarction (AMI) are cardiovascular diseases commonly characterized by the development of atheromatous plaques associated with major complications and high mortality rates. Objective To identify an epidemiological trend in hospitalizations due to stroke and AMI and to analyze the relationship between health programs applied in Primary Health Care, gender and the Federative Unit. Methods Ecological study with a time series design between 1998 and 2018, collecting data from all federal units in Brazil stratified by, gender and place of residence. There were analyzed Hospitalization Authorizations (AIH) for stroke and MI, consulting the Hospital Admissions System (SIH) of the Informatics Department of the National Health Service with p <0.05. Results From 1998 to 2018, the rate of hospitalization for AMI increased in Brazil approximately 42.58 events per 100 thousand inhabitants annually (p<0.001), while hospitalizations for stroke declined 32.17 cases (p=0.03). This pattern was observed in both sexes in AMI and stroke. There is also evidence of the effect of the Hiperdia (p<0.001) and Mais Médicos (p=0.001) program in reducing stroke and Hiperdia cases in mitigating the evolution of AMI cases (p = 0.0001). Conclusion Although these diseases remain as an important cause of death, stroke hospitalization has reduced significantly in the period evaluated. National programs as the Hiperdia and Mais Médicos showed an impact in the acute cases of strokes and AMI.
Subject(s)
Primary Health Care , Stroke/prevention & control , Stroke/epidemiology , Health Consortia , Hospitalization , Myocardial Infarction/prevention & control , Myocardial Infarction/epidemiology , Time Factors , Brazil/epidemiology , Ecological Studies , Plaque, Atherosclerotic , National Health ProgramsABSTRACT
Resumo Fundamento: A fibrilação ou flutter atrial (FFA) é a arritmia cardíaca sustentada mais comum. Existem poucos dados sobre a epidemiologia da FFA na América do Sul. Objetivo: O presente estudo procurou descrever a epidemiologia clínica da FFA e o uso de anticoagulantes na avaliação da linha de base do Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil). Métodos: Foram analisados dados de 13.260 participantes do ELSA-Brasil. A FFA foi definida pelo eletrocardiograma ou por autorrelato. Modelos de regressão logística foram construídos para analisar fatores associados à FFA. Este estudo também analisou se idade e sexo estavam associados ao uso de anticoagulantes para evitar acidente vascular cerebral. O nível de significância foi de 5%. Resultados: A idade mediana foi de 51 anos, e 7.213 (54,4%) participantes eram mulheres. A FFA foi detectada em 333 (2,5%) participantes. O aumento da idade (razão de chances [RC]:1,05; intervalo de confiança de 95% [IC95%]: 1,04-1,07), hipertensão (RC:1,44; IC95%:1,14-1,81) coronariopatia (RC: 5,11; IC95%:3,85-6,79), insuficiência cardíaca (RC:7,37; IC95%:5,00-10,87) e febre reumática (RC:3,38; IC95%:2,28-5,02) foram associadas à FFA. Dos 185 participantes com FFA e pontuação no CHA2DS2-VASc≥2, apenas 20 (10,8%) usavam anticoagulantes (50,0% entre aqueles com FFA no eletrocardiograma de linha de base). O uso de anticoagulantes nesse grupo foi associado a maior idade (1,8% vs 17,7% naqueles com idade ≤ 54 e ≥ 65 anos, respectivamente; p=0,013). Observou-se uma tendência ao menor uso de anticoagulantes em mulheres (7,1% vs. 16,4% em mulheres e homens, respectivamente; p=0,055). Conclusões: No recrutamento do ELSA-Brasil, 2,5% dos participantes tinham FFA. O baixo uso de anticoagulantes era comum, o que representa um desafio para os cuidados de saúde nesse cenário.
Abstract Background: Atrial fibrillation or flutter (AFF) is the most common sustained cardiac arrhythmia. Limited data can be found on AFF epidemiology in South America. Objective: The present study sought to describe the clinical epidemiology of AFF and the use of stroke prevention medication in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment. Methods: This study analyzed data from 13,260 ELSA-Brasil participants. AFF was defined according to ECG recording or by self-report. Logistic regression models were built to analyze factors associated with AFF. This study also analyzed if age and sex were associated with anticoagulant use for stroke prevention. Significance level was set at 5%. Results: Median age was 51 years and 7,213 (54.4%) participants were women. AFF was present in 333 (2.5%) participants. Increasing age (odds ratio [OR]:1.05; 95% confidence interval [95%CI]: 1.04-1.07), hypertension (OR:1.44; 95%CI: 1.14-1.81), coronary heart disease (OR: 5.11; 95%CI: 3.85-6.79), heart failure (OR:7.37; 95%CI: 5.00-10.87), and rheumatic fever (OR:3.38; 95%CI: 2.28-5.02) were associated with AFF. From 185 participants with AFF and a CHA2DS2-VASc score ≥2, only 20 (10.8%) used anticoagulants (50.0% among those with AFF in the baseline ECG). Stroke prevention in this group was associated with a higher age (1.8% vs 17.7% in those aged ≤ 54 and ≥ 65 years, respectively; p=0.013). A trend towards a reduced anticoagulant use was observed in women (7.1% vs. 16.4% in women and men, respectively; p=0.055). Conclusions: At the ELSA-Brasil baseline, 2.5% of the participants had AFF. The lack of stroke prevention was common, which is an especially challenging point for healthcare in this setting.
Subject(s)
Humans , Male , Female , Adult , Aged , Atrial Fibrillation/diagnosis , Atrial Fibrillation/epidemiology , Stroke/diagnosis , Stroke/prevention & control , Stroke/epidemiology , Cross-Sectional Studies , Risk Factors , Longitudinal Studies , Risk Assessment , Electrocardiography , Self Report , Middle Aged , Anticoagulants/therapeutic useABSTRACT
Resumen La pandemia COVID-19 limitó el acceso de los pacientes post accidente cerebro vascular a los controles de seguimiento médico y a la rehabilitación, por lo cual decidimos incorporar herramientas tecnológicas gratuitas y accesibles para su continuación. Realizamos seguimiento remoto a 32 pacientes dados de alta en los primeros tres meses del período de aislamiento social preventivo obligatorio con el objetivo de continuar controles médicos, rehabilitación física y fonoaudiológica. El 100% adhirió al tratamiento médico y al auto-monitoreo de factores de riesgo; detectamos en forma temprana la interrupción de las terapias de rehabilita ción y mantuvimos la adherencia por medio de tele-rehabilitación. Los 32 pacientes mostraron disponibilidad para seguir con esta modalidad de atención, permitiendo continuar el seguimiento médico y supervisar la rehabilitación con la colaboración de las familias. Es una metodología accesible y de bajo costo que podría ser replicada y utilizada en instituciones de salud que traten enfermedades neurovasculares.
Abstract The COVID-19 pandemic resulted in limited access of post-stroke patients to their usual medical follow-up and rehabilitation. To continue these activities, we adopted a technology that is free and has universal access. We remotely followed 32 patients after discharge from the stroke unit during the mandatory lock-down. This allowed to continue with medical controls, physical therapy and speech pathology treatments. All patients fully complied with medical treatment and self-monitoring of vascular risk factors. Early discontinuation of rehabilitation therapies was identified and immediately compensated with tele-rehabilitation. All expressed their willingness to continue with this treatment modality. This strategy was successful to effectively continue medical follow-up and rehabilitation supervision with the collaboration of families, is an accessible and low-cost technology that could be replicated and used in health institutions that treat neurovascular diseases.
Subject(s)
Humans , Telemedicine , Stroke/prevention & control , Stroke Rehabilitation , COVID-19 , Communicable Disease Control , Secondary Prevention , Pandemics , SARS-CoV-2ABSTRACT
Abstract Coronary artery bypass grafting (CABG) has consolidated its role as the most effective procedure for treating patients with advanced atherosclerotic coronary artery disease, reducing the long-term risk of myocardial infarction and death compared to other therapies and relieving angina. Despite the recognized benefits afforded by surgical myocardial revascularization, a subset of higher-risk patients bears a more elevated risk of perioperative stroke. Stroke remains the drawback of conventional CABG and has been strongly linked to aortic manipulation (cannulation, cross‐clamping, and side-biting clamping for the performance of proximal aortic anastomoses) and the use of cardiopulmonary bypass. Adoption of off-pump CABG (OPCAB) is demonstrated to lower the risk of perioperative stroke, as well as reducing the risk of short-term mortality, renal failure, atrial fibrillation, bleeding, and length of intensive care unit stay. However, increased risk persists owing to the need for the tangential ascending aorta clamping to construct the proximal anastomosis. The concept of anaortic (aorta no-touch) OPCAB (anOPCAB) stems from eliminating ascending aorta manipulation, virtually abolishing the risk of embolism caused by aortic wall debris into the brain circulation. The adoption of anOPCAB has been shown to further decrease the risk of postoperative stroke, especially in higher-risk patients, entailing a step forward and a refinement of outcomes provided by the primeval OPCAB technique. Therefore, anOPCAB has been the recommended technique in patients with cerebrovascular disease and/or calcification or atheromatous plaque in the ascending aorta and should be preferred in patients with high-risk factors for neurological damage and stroke.
Subject(s)
Humans , Coronary Artery Disease/surgery , Stroke/etiology , Stroke/prevention & control , Coronary Artery Bypass, Off-Pump , Mammary Arteries , Coronary Artery BypassABSTRACT
Abstract Background Stroke management require rapid identification, assessment, and transport of patients to qualified health care centers. However, there is little description in the literature on the multiple challenges associated with the pre-hospital transport of suspected stroke patients. Objective To characterize the pre-hospital care provided to suspected stroke patients by the Brazilian Emergency Medical Service (SAMU in Portuguese), by means of a descriptive case study. Methods This is a descriptive study of a series of cases. Data from the SAMU regarding the responses to emergency calls from suspected stroke patients were collected. Independent reviewers confirmed the diagnostic hypothesis and all discordances were assessed using kappa statistics. Clinical data and transport times were described as frequency and proportion or central tendency and dispersion measures. Normality of continuous variable distribution was assessed using the Kolmogorov-Smirnov test. The Mann-Whitney U test was used for comparison of medians, with a 5% significance level. Results During the studied period, 556 suspected stroke patients were treated. The kappa index was 0.82 (95% CI 0.737 to 0.919) CI. In 74.7% of the cases, the symptom onset time was not recorded. The median time elapsed between the call for emergency services and the ambulance arrival was 18 minutes, and the median transport time was 38 minutes. A total of 34% of the patients were taken to referral hospitals for stroke. Conclusion This study revealed a low level of knowledge regarding the need to determine the exact time of symptom onset of suspected stroke patients. Also, the study showed the low rate of patients taken to referral hospitals. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Stroke/therapy , Emergency Medical Services/methods , Epidemiology, Descriptive , Ambulances/supply & distribution , Transportation of Patients/methods , Stroke/diagnosis , Stroke/prevention & control , Prehospital Care , Health PromotionABSTRACT
Background: Vitamin K antagonists such as acenocoumarol and warfarin are usually indicated for the treatment of Atrial Fibrillation (AF). The Therapeutic Range Time (TRT) is a quality of treatment indicator. Values greater than 65% are associated with significantly lower stroke and bleeding rates. Proper pharmaceutical care improves TRT. Aim: To evaluate the impact of pharmaceutical care in patients with AF treated with acenocoumarol. Material and Methods: We studied 41 patients using acenocoumarol for AF aged 71 ± 11 years (43% women). They received pharmaceutical counseling during 12 weeks. TRT was calculated retrospectively for the year before counseling and prospectively during the intervention period. Results: After receiving pharmaceutical counseling TRT improved from 29% at baseline to 46% at the end of the intervention (p < 0.01). After pharmaceutical care, the adherence of patients to drug treatment improved from 27% at baseline to 85% at the end of the study. The user satisfaction survey of the pharmaceutical care received showed a high degree of patient satisfaction. Conclusions: Pharmaceutical care in patients with oral anticoagulant treatment improves TRT of anticoagulation. It is accepted and positively evaluated by patients.
Subject(s)
Humans , Male , Female , Atrial Fibrillation/complications , Atrial Fibrillation/drug therapy , Pharmaceutical Preparations , Stroke/prevention & control , Stroke/drug therapy , Administration, Oral , Retrospective Studies , Counseling , Anticoagulants/therapeutic useABSTRACT
ABSTRACT BACKGROUND: Stroke is the second leading cause of death in Brazil and the main cause of disability. Inability to identify alarm signals causes delays in seeking emergency services, thereby leading to a worse prognosis. OBJECTIVES: To assess the population's knowledge of how to recognize and prevent stroke. DESIGN AND SETTING: Prospective cross-sectional study on data derived from a questionnaire that was administered during the 2016 World Stroke Campaign, launched in the city of São Paulo, Brazil. METHODS: Data on 806 interviewees were evaluated using descriptive statistics and univariate and multivariate analyses. RESULTS: Among all the interviewees, 52.1% knew how to conceptualize stroke; 70.07% knew someone who had suffered a stroke; and 29.03% listed three or more risk factors. Only 27.5% mentioned controlling high blood pressure as a preventive measure. In the event of witnessing a stroke, 57.8% would call the emergency service and 2.9% would check the timing. Less educated individuals were 5.6 times more likely (95% confidence interval, CI 3.45-9.02) to have poor knowledge of stroke, compared with the more educated group. Knowing someone who had had a stroke reduced the chances of not knowing the terms relating to the disease (odds ratio, OR = 0.56; 95% CI 0.4-0.78). CONCLUSIONS: Despite the severity and prevalence of stroke, the population still has little information on this disease. In this context, the importance of mounting campaigns to improve prevention and treatment and to contribute to healthcare policies becomes evident.
Subject(s)
Humans , Stroke/prevention & control , Stroke/epidemiology , Brazil/epidemiology , Cross-Sectional Studies , Prospective Studies , Risk FactorsABSTRACT
La tecnología digital móvil (mSalud), recurso aún subutilizado, tiene el potencial para transformarse en un auxiliar imprescindible en la práctica clínica, en particular en Cardiología. La fibrilación auricular es la arritmia más frecuente, cuya prevalencia aumenta con la edad y tiene como complicación más temida el accidente cerebrovascular. Su prevención depende de un diagnóstico oportuno, una adecuada estratificación de riesgo y el uso de anticoagulantes orales. Sin embargo, es con frecuencia paroxística y asintomática, lo que dificulta su diagnóstico. El aporte de la tecnología mediante el desarrollo de aplicaciones para celulares, relojes, dispositivos portátiles o implantables que registran el ritmo cardíaco y permiten el monitoreo prolongado, ambulatorio y a distancia facilitan su detección. Se repasan las principales evidencias que justifican la aplicación de estas estrategias de tamizaje, cuando está indicado realizarlo, cómo y a quiénes hacerlo. Por último, se plantea también la utilidad de estas estrategias de monitoreo prolongado en el manejo y la prevención de la fibrilación auricular.
The mobile digital technology (mHealth), a tool still underutilized, has the potential to become an essential aid in clinical practice, particularly in Cardiology. Atrial fibrillation is the most frequent arrhythmia whose prevalence increases with age and its most feared complication is cerebrovascular accident. Its prevention depends on a timely diagnosis, an adequate risk stratification and the use of oral anticoagulants. However, it is frequently paroxysmal and asymptomatic, which makes its diagnosis difficult. The contribution of technology through the development of applications for cell phones, watches, portable or implantable devices that record the heart rhythm and allow prolonged, outpatient and remote monitoring, facilitate its detection. The main evidences that justify the application of these screening strategies are reviewed, when it is indicated to perform it, how and to whom to do it. Finally, the usefulness of these prolonged monitoring strategies in the management and prevention of atrial fibrillation is also considered.
A utilização da tecnologia digital móvel (m-Saúde), ainda pouco utilizada, tem potencial para se tornar um auxílio essencial na prática clínica, principalmente na Cardiologia. A fibrilação atrial é a arritmia mais frequente, cuja prevalência aumenta com a idade e sua complicação mais temida é o acidente vascular cerebral. Sua prevenção depende de um diagnóstico oportuno, de uma estratificação de risco adequada e do uso de anticoagulantes orais. Porém, freqüentemente é paroxística e assintomática, o que dificulta seu diagnóstico. A contribuição da tecnologia por meio do desenvolvimento de aplicativos para telefones celulares, relógios, dispositivos portáteis ou implantáveis ââque registram o ritmo cardíaco e permitem monitoramento prolongado, ambulatorial e remoto, facilitam sua detecção. São revisadas as principais evidências que justificam a aplicação dessas estratégias de rastreamento, quando é indicado fazê-lo, como e para quem fazê-lo. Finalmente, a utilidade dessas estratégias de monitoramento prolongado no manejo e prevenção da fibrilação atrial também é considerada.
Subject(s)
Humans , Atrial Fibrillation/diagnosis , Mass Screening/instrumentation , Telemedicine/instrumentation , Atrial Fibrillation/prevention & control , Telemedicine/statistics & numerical data , Stroke/prevention & control , eHealth StrategiesABSTRACT
Resumen La pandemia por COVID-19 y el aislamiento social preventivo y obligatorio (ASPO) han generado cambios en la organización y utilización del sistema de salud en todo el mundo. Analizamos el impacto de la situación sanitaria en el número de consultas ambulatorias, internaciones y acceso a terapias de revascularización por enfermedad cerebrovascular. Se analizó el período desde el 1 marzo al 31 de julio de 2020. Se comparó con el mismo período de 2019. Se evaluaron total de consultas ambulatorias e internaciones, escala NIHSS (National Institute of Health Stroke Scale) al ingreso, tipo de enfermedad cerebrovascular y uso de terapias de revascularización. Ingresaron 197 pacientes con eventos cerebrovasculares agudos en 2019 y 150 pacientes en 2020. Hubo un descenso significativo en el número de internaciones por eventos isquémicos totales y accidentes isquémico transitorios en el comparativo de los 5 meses. Se vio además un aumento en trombosis venosas cerebrales y hemorragias cerebrales. El acceso a fibrinolisis intravenosa y trombectomía mecánica se mantuvo estable, pero con prolongación del tiempo puerta-aguja. Las consultas ambulatorias descendieron 67%, siendo mayor el descenso en abril y más marcado en consultas de seguimiento. El número de internaciones y de consultas ambulatorias durante el ASPO descendió sustancialmente. Esto pareciera obedecer al cumplimiento estricto de la cuarentena y no a mecanismos fisiopatológicos relacionados con el COVID-19. Debe educarse a la población sobre la necesidad del control de enfermedades crónicas y de eventos agudos y se deben garantizar medidas de seguridad en los centros de salud.
Abstract The COVID-19 pandemic and preventive and compulsory social isolation (PCSI) have generated changes in the organization and use of the health system around the world. We analyze the impact of the health situation on the number of outpatient visits, hospitalizations and access to revascularization therapy for cerebrovascular disease. The period from March 1 to July 31, 2020 was analyzed. It was compared with the same period in 2019. Total outpatient and hospital visits were evaluated, NIHSS scale (National Institute of Health Stroke Scale) upon admission, type of cerebrovascular disease and use of revascularization therapies; 197 patients with acute cerebrovascular events were admitted in 2019 and 150 patients in 2020. There was a significant decrease in the number of hospitalizations for total ischemic events and transient ischemic attacks in the comparison of 5 months. An increase in cerebral venous thrombosis and cerebral hemorrhages was also seen. Access to intravenous fibrinolysis and mechanical thrombectomy remained stable, but with prolonged door-to-needle time. Outpatient visits fell 67%, the decrease being greater in April and more marked in follow-up visits. The number of hospitalizations and outpatient visits during the PCSI dropped substantially. This seems to be due to strict compliance with quarantine and not to pathophysiological mechanisms related to COVID-19. The population should be educated about the need to control chronic diseases and acute events and safety measures should be guaranteed in health centers.
Subject(s)
Humans , Stroke/prevention & control , Stroke/epidemiology , COVID-19 , Outpatients , Argentina/epidemiology , Social Isolation , Pandemics , SARS-CoV-2 , HospitalizationABSTRACT
Resumo Baixas doses de edoxabana e enoxaparina sódica foram objeto de uma comparação retrospectiva implementada com a técnica do escore de propensão a fim de mitigar os efeitos das diferenças nas características clínicas basais de duas coortes e minimizar o risco de viés. Posteriormente, usando um modelo de riscos proporcionais de Cox, avaliou-se a associação de cada tipo de terapia com o risco do composto de morte por todas as causas, acidente vascular cerebral/ataque isquêmico transitório, hospitalizações e ocorrência de sangramentos maiores. Para essa análise, um valor de p < 0,05 foi considerado estatisticamente significante. A terapia com enoxaparina e cirrose hepática como causadora de trombocitopenia estiveram associadas ao aumento do risco do endpoint composto (enoxaparina: hazard ratio (HR): 3,31; IC 95%: 1,54 a 7,13; p = 0,0023; cirrose hepática, HR: 1,04; 95% CI: 1,002 a 1,089; p = 0,0410). Por outro lado, a terapia com edoxabana mostrou-se significativamente associada à diminuição do risco do endpoint composto (HR: 0,071; 95% CI: 0,013 a 0,373; p = 0,0019). Com base nessa análise retrospectiva, o edoxaban em doses baixas seria uma ferramenta farmacológica segura e eficaz para a profilaxia de eventos cardioembólicos em pacientes com FA e trombocitopenia.
Abstract Low-dose edoxaban and enoxaparin sodium have been the subject of a retrospective comparison implemented with the propensity score technique in order to mitigate the effects of the differences in the basal clinical features of two cohorts and minimize the risk of bias. Subsequently, using a Cox proportional-hazards model, the association of each type of therapy with the risk of the composite of all-cause death, stroke/transient ischemic attack, hospitalizations and major bleeding events was assessed. For this analysis, a p-value < 0.05 was considered statistically significant. Therapy with enoxaparin and liver cirrhosis as causing thrombocytopenia were associated with increased risk of the composite endpoint (enoxaparin: hazard ratio (HR): 3.31; 95% CI: 1.54 to 7.13; p = 0.0023; liver cirrhosis, HR: 1.04; 95% CI: 1.002 to 1.089; p = 0.0410). Conversely, edoxaban therapy was significantly associated with decreased risk of the composite endpoint (HR: 0.071; 95% CI: 0.013 to 0.373; p = 0.0019). Based on this retrospective analysis, edoxaban at low doses would appear as an effective and safe pharmacological tool for the prophylaxis of cardioembolic events in patients with AF and thrombocytopenia.