Durgesh Chaudhary1, Ayesha Khan1, Shima Shahjouei1, Mudit Gupta2, Clare Lambert3, Venkatesh Avula4, Clemens M Schirmer5, Neil Holland6, Christoph J Griessenauer5, M Reza Azarpazhooh7, Jiang Li8, Vida Abedi9, Ramin Zand10. 1. Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States. 2. Phenomic Analytics and Clinical Data Core, Geisinger Health System, Danville, PA, United States. 3. Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States; Royal College of Surgeons in Ireland, Dublin, Ireland. 4. Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States; Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA, United States. 5. Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria. 6. Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States; Geisinger Commonwealth School of Medicine, Scranton, PA, United States. 7. Stroke Prevention and Atherosclerosis Research Center, Department of Clinical Neurological Sciences, Western University, London, ON, Canada. 8. Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA, United States. 9. Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA, United States; Biocomplexity Institute, Virginia Tech, Blacksburg, VA, United States. 10. Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States. Electronic address: ramin.zand@gmail.com.
Abstract
INTRODUCTION: The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018. METHODS: This was a retrospective cohort study based on electronic health records (EHR) data. A comprehensive stroke database called "Geisinger NeuroScience Ischemic Stroke (GNSIS)" was built for this study. Clinical data were extracted from multiple sources, including EHR and quality data. RESULTS: The cohort included in the study comprised of 8561 consecutive ischemic stroke patients (mean age: 70.1 ± 13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The one-year recurrence and all-cause mortality rates were 6.3% and 16.1%, respectively. Although the one-year stroke recurrence increased during the study period, the one-year stroke mortality rate decreased significantly. Age > 65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Cause-specific hazard model, diabetes, chronic kidney disease and age < 65 years were found to be associated with one-year ischemic stroke recurrence. CONCLUSION: Although all-cause mortality after stroke has decreased, stroke recurrence has significantly increased in stroke patients from rural population between 2004 and 2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes, chronic kidney disease and age less than 65 years were predictors of ischemic stroke recurrence.
INTRODUCTION: The strokemortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic strokepatients from a rural population in the United States between 2004 and 2018. METHODS: This was a retrospective cohort study based on electronic health records (EHR) data. A comprehensive stroke database called "Geisinger NeuroScience Ischemic Stroke (GNSIS)" was built for this study. Clinical data were extracted from multiple sources, including EHR and quality data. RESULTS: The cohort included in the study comprised of 8561 consecutive ischemic strokepatients (mean age: 70.1 ± 13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The one-year recurrence and all-cause mortality rates were 6.3% and 16.1%, respectively. Although the one-year stroke recurrence increased during the study period, the one-year strokemortality rate decreased significantly. Age > 65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Cause-specific hazard model, diabetes, chronic kidney disease and age < 65 years were found to be associated with one-year ischemic stroke recurrence. CONCLUSION: Although all-cause mortality after stroke has decreased, stroke recurrence has significantly increased in strokepatients from rural population between 2004 and 2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes, chronic kidney disease and age less than 65 years were predictors of ischemic stroke recurrence.