12836
2013
eng
e75719
9
8
article
1
2016-03-01
--
--
Influence of Acute Complications on Outcome 3 Months after Ischemic Stroke
Background: Early medical complications are potentially modifiable factors influencing in-hospital outcome. We investigated the influence of acute complications on mortality and poor outcome 3 months after ischemic stroke.
Methods: Data were obtained from patients admitted to one of 13 stroke units of the Berlin Stroke Registry (BSR) who participated in a 3-months-follow up between June 2010 and September 2012. We examined the influence of the cumulative number of early in-hospital complications on mortality and poor outcome (death, disability or institutionalization) 3 months after stroke using multivariable logistic regression analyses and calculated attributable fractions to determine the impact of early complications on mortality and poor outcome.
Results: A total of 2349 ischemic stroke patients alive at discharge from acute care were included in the analysis. Older age, stroke severity, pre-stroke dependency and early complications were independent predictors of mortality 3 months after stroke. Poor outcome was independently associated with older age, stroke severity, pre-stroke dependency, previous stroke and early complications. More than 60% of deaths and poor outcomes were attributed to age, pre-stroke dependency and stroke severity and in-hospital complications contributed to 12.3% of deaths and 9.1% of poor outcomes 3 months after stroke.
Conclusion: The majority of deaths and poor outcomes after stroke were attributed to non-modifiable factors. However, early in-hospital complications significantly affect outcome in patients who survived the acute phase after stroke, underlining the need to improve prevention and treatment of complications in hospital.
PLOS ONE
10.1371/journal.pone.0075719
1932-6203
urn:nbn:de:bvb:20-opus-128362
PLoS ONE 8(9): e75719. doi:10.1371/journal.pone.0075719
Maike Miriam Grube
Hans-Christian Koennecke
Georg Walter
Andreas Meisel
Jan Sobesky
Christian Hans Nolte
Ian Wellwood
Peter Ulrich Heuschmann
eng
uncontrolled
hospital medical complications
eng
uncontrolled
quality-of-care
eng
uncontrolled
term mortality
eng
uncontrolled
Barthel-Index
eng
uncontrolled
rankin scale
eng
uncontrolled
risk-factors
eng
uncontrolled
trial
eng
uncontrolled
reliability
eng
uncontrolled
dependency
eng
uncontrolled
predictors
Krankheiten
open_access
Institut für Klinische Epidemiologie und Biometrie
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/12836/073_Grube_Plos_One.pdf
15944
2017
eng
49
17
article
German Stroke Register Study Group (ADSR)
1
2018-03-21
--
--
Stroke unit care in Germany: the German stroke registers study group (ADSR)
Background:
Factors influencing access to stroke unit (SU) care and data on quality of SU care in Germany are scarce. We investigated characteristics of patients directly admitted to a SU as well as patient-related and structural factors influencing adherence to predefined indicators of quality of acute stroke care across hospitals providing SU care.
Methods:
Data were derived from the German Stroke Registers Study Group (ADSR), a voluntary network of 9 regional registers for monitoring quality of acute stroke care in Germany. Multivariable logistic regression analyses were performed to investigate characteristics influencing direct admission to SU. Generalized Linear Mixed Models (GLMM) were used to estimate the influence of structural hospital characteristics (percentage of patients admitted to SU, year of SU-certification, and number of stroke and TIA patients treated per year) on adherence to predefined quality indicators.
Results:
In 2012 180,887 patients were treated in 255 hospitals providing certified SU care participating within the ADSR were included in the analysis; of those 82.4% were directly admitted to a SU. Ischemic stroke patients without disturbances of consciousness (p < .0001), an interval onset to admission time ≤3 h (p < .0001), and weekend admission (p < .0001) were more likely to be directly admitted to a SU. A higher proportion of quality indicators within predefined target ranges were achieved in hospitals with a higher proportion of SU admission (p = 0.0002). Quality of stroke care could be maintained even if certification was several years ago.
Conclusions:
Differences in demographical and clinical characteristics regarding the probability of SU admission were observed. The influence of structural characteristics on adherence to evidence-based quality indicators was low.
BMC Neurology
10.1186/s12883-017-0819-0
urn:nbn:de:bvb:20-opus-159447
BMC Neurology (2017) 17:49. DOI: 10.1186/s12883-017-0819-0
223153
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Steffi Hillmann
Silke Wiedmann
Viktoria Rücker
Klaus Berger
Darius Nabavi
Ingo Bruder
Hans-Christian Koennecke
Günter Seidel
Björn Misselwitz
Alfred Janssen
Christoph Burmeister
Christine Matthis
Otto Busse
Peter Hermanek
Peter Ulrich Heuschmann
eng
uncontrolled
stroke register
eng
uncontrolled
stroke unit care
eng
uncontrolled
quality of health care
eng
uncontrolled
quality indicators
Krankheiten
open_access
Institut für Klinische Epidemiologie und Biometrie
OpenAIRE
Förderzeitraum 2017
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/15944/Hillmann_BMC_Neurology.pdf
26696
2022
eng
470–480
1
269
article
1
--
--
--
Off-label-dosing of non-vitamin K-dependent oral antagonists in AF patients before and after stroke: results of the prospective multicenter Berlin Atrial Fibrillation Registry
Aims
We aimed to analyze prevalence and predictors of NOAC off-label under-dosing in AF patients before and after the index stroke.
Methods
The post hoc analysis included 1080 patients of the investigator-initiated, multicenter prospective Berlin Atrial Fibrillation Registry, designed to analyze medical stroke prevention in AF patients after acute ischemic stroke.
Results
At stroke onset, an off-label daily dose was prescribed in 61 (25.5%) of 239 NOAC patients with known AF and CHA2DS2-VASc score ≥ 1, of which 52 (21.8%) patients were under-dosed. Under-dosing was associated with age ≥ 80 years in patients on rivaroxaban [OR 2.90, 95% CI 1.05-7.9, P = 0.04; n = 29] or apixaban [OR 3.24, 95% CI 1.04-10.1, P = 0.04; n = 22]. At hospital discharge after the index stroke, NOAC off-label dose on admission was continued in 30 (49.2%) of 61 patients. Overall, 79 (13.7%) of 708 patients prescribed a NOAC at hospital discharge received an off-label dose, of whom 75 (10.6%) patients were under-dosed. Rivaroxaban under-dosing at discharge was associated with age ≥ 80 years [OR 3.49, 95% CI 1.24-9.84, P = 0.02; n = 19]; apixaban under-dosing with body weight ≤ 60 kg [OR 0.06, 95% CI 0.01-0.47, P < 0.01; n = 56], CHA2DS2-VASc score [OR per point 1.47, 95% CI 1.08-2.00, P = 0.01], and HAS-BLED score [OR per point 1.91, 95% CI 1.28-2.84, P < 0.01].
Conclusion
At stroke onset, off-label dosing was present in one out of four, and under-dosing in one out of five NOAC patients. Under-dosing of rivaroxaban or apixaban was related to old age. In-hospital treatment after stroke reduced off-label NOAC dosing, but one out of ten NOAC patients was under-dosed at discharge.
Journal of Neurology
1432-1459
10.1007/s00415-021-10866-2
34718884
urn:nbn:de:bvb:20-opus-266969
publish
Journal of Neurology 2022, 269(1):470–480. DOI: 10.1007/s00415-021-10866-2
false
true
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Serdar Tütüncü
Manuel Olma
Claudia Kunze
Joanna Dietzel
Johannes Schurig
Cornelia Fiessler
Carolin Malsch
Tobias Eberhard Haas
Boris Dimitrijeski
Wolfram Doehner
Georg Hagemann
Frank Hamilton
Martin Honermann
Gerhard Jan Jungehulsing
Andreas Kauert
Hans-Christian Koennecke
Bruno-Marcel Mackert
Darius Nabavi
Christian H. Nolte
Joschua Mirko Reis
Ingo Schmehl
Paul Sparenberg
Robert Stingele
Enrico Völzke
Carolin Waldschmidt
Daniel Zeise-Wehry
Peter U. Heuschmann
Matthias Endress
Karl Georg Haeusler
eng
uncontrolled
NOAC
eng
uncontrolled
ischemic stroke
eng
uncontrolled
atrial fibrillation
eng
uncontrolled
under-dosing
Medizin und Gesundheit
open_access
Neurologische Klinik und Poliklinik
Institut für Klinische Epidemiologie und Biometrie
Deutsches Zentrum für Herzinsuffizienz (DZHI)
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/26696/Tuetuencue_Neurology.pdf