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Trends in ischemic stroke outcomes in a rural population in the United States

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dc.contributor.authorChaudhary, Durgeshen
dc.contributor.authorKhan, Ayeshaen
dc.contributor.authorShahjouei, Shimaen
dc.contributor.authorGupta, Muditen
dc.contributor.authorLambert, Clareen
dc.contributor.authorAvula, Venkateshen
dc.contributor.authorSchirmer, Clemens M.en
dc.contributor.authorHolland, Neil R.en
dc.contributor.authorGriessenauer, Christoph J.en
dc.contributor.authorAzarpazhooh, Mahmoud Rezaen
dc.contributor.authorLi, Jiangen
dc.contributor.authorAbedi, Vidaen
dc.contributor.authorZand, Raminen
dc.contributor.departmentFralin Life Sciences Instituteen
dc.date.accessioned2021-04-22T12:22:46Zen
dc.date.available2021-04-22T12:22:46Zen
dc.date.issued2021-03-15en
dc.description.abstractIntroduction: 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.en
dc.description.notesRZ and VA had funding support from the Geisinger Health Plan Quality Fund as well as the National Institutes of Health R56HL116832 (subaward) during the study period. The funders had no role in study design, data collection, and interpretation, or the decision to submit the work for publication.en
dc.description.sponsorshipGeisinger Health Plan Quality Fund; National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R56HL116832]en
dc.format.mimetypeapplication/pdfen
dc.identifier.doihttps://doi.org/10.1016/j.jns.2021.117339en
dc.identifier.eissn1878-5883en
dc.identifier.issn0022-510Xen
dc.identifier.other117339en
dc.identifier.pmid33592506en
dc.identifier.urihttp://hdl.handle.net/10919/103077en
dc.identifier.volume422en
dc.language.isoenen
dc.rightsCreative Commons Attribution 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectTrendsen
dc.subjectIschemic strokeen
dc.subjectOutcomesen
dc.subjectRecurrent strokeen
dc.subjectAll-cause mortalityen
dc.titleTrends in ischemic stroke outcomes in a rural population in the United Statesen
dc.title.serialJournal of the Neurological Sciencesen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten
dc.type.dcmitypeStillImageen

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