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Browsing by Author "Gupta, Mudit"

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    Obesity and mortality after the first ischemic stroke: Is obesity paradox real?
    Chaudhary, Durgesh; Khan, Ayesha; Gupta, Mudit; Hu, Yirui; Li, Jiang; Abedi, Vida; Zand, Ramin (2021-02-10)
    Background and purpose Obesity is an established risk factor for ischemic stroke but the association of increased body mass index (BMI) with survival after ischemic stroke remains controversial. Many studies have shown that increased BMI has a "protective" effect on survival after stroke while other studies have debunked the "obesity paradox". This study aimed at examining the relationship between BMI and all-cause mortality at one year in first-time ischemic stroke patients using a large dataset extracted from different resources including electronic health records. Methods This was a retrospective cohort study of consecutive ischemic stroke patients captured in our Geisinger NeuroScience Ischemic Stroke (GNSIS) database. Survival in first-time ischemic stroke patients in different BMI categories was analyzed using Kaplan Meier survival curves. The predictors of mortality at one-year were assessed using a stratified Cox proportional hazards model. Results Among 6,703 first-time ischemic stroke patients, overweight and obese patients were found to have statistically decreased hazard ratio (HR) compared to the non-overweight patients (overweight patients- HR = 0.61 [95% CI, 0.52-0.72]; obese patients- HR = 0.56 [95% CI, 0.48-0.67]). Predictors with a significant increase in the hazard ratio for one-year mortality were age at the ischemic stroke event, history of neoplasm, atrial fibrillation/flutter, diabetes, myocardial infarction and heart failure. Conclusion Our study results support the obesity paradox in ischemic stroke patients as shown by a significantly decreased hazard ratio for one-year mortality among overweight and obese patients in comparison to non-overweight patients.
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    Trends in ischemic stroke outcomes in a rural population in the United States
    Chaudhary, Durgesh; Khan, Ayesha; Shahjouei, Shima; Gupta, Mudit; Lambert, Clare; Avula, Venkatesh; Schirmer, Clemens M.; Holland, Neil R.; Griessenauer, Christoph J.; Azarpazhooh, Mahmoud Reza; Li, Jiang; Abedi, Vida; Zand, Ramin (2021-03-15)
    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.