Pre-stroke dementia and in-hospital outcomes in the Chinese Stroke Center Alliance
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Published on: December 16, 2022
Chelsea Liu1, Hong-Qiu Gu2,3, Xin Yang2,3
1Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Insights
Patients with pre-stroke dementia face worse in-hospital outcomes, including higher mortality and complications, after an initial stroke. This highlights a need for tailored care pathways for this vulnerable population.
Area of Science:
- Neurology
- Geriatrics
- Public Health
Background:
- Prevalent dementia significantly impacts in-hospital outcomes for patients experiencing their first stroke.
- Understanding these outcomes is crucial for improving care in China.
- The Chinese Stroke Center Alliance (CSCA) database provides valuable insights.
Purpose of the Study:
- To determine the prevalence of pre-stroke dementia in incident stroke patients in China.
- To assess if pre-stroke dementia is associated with adverse in-hospital outcomes compared to non-demented patients.
Main Methods:
- Utilized multivariable logistic regression on data from 559,070 ischemic stroke patients.
- Analyzed associations between pre-stroke dementia and ambulation, mortality, complications, and discharge destination.
- Controlled for demographics, comorbidities, stroke severity (NIHSS), and treatments (IV tPA, DVT prophylaxis).
Main Results:
- Pre-stroke dementia was present in 0.3% (1,511) of patients, who were older and more likely female.
- Patients with pre-stroke dementia had lower odds of ambulating by day 2 (OR=0.69) and being discharged home (OR=0.71).
- They faced higher odds of in-hospital mortality (OR=2.01) and complications (OR=2.17) despite similar treatments.
Conclusions:
- Pre-stroke dementia is linked to significantly worse in-hospital outcomes after an initial stroke.
- Cognitive impairment may hinder patients' ability to communicate care needs.
- Further research should explore specialized care pathways for stroke patients with pre-existing dementia.
Background:
Little is known about the impact of prevalent dementia on in-hospital outcomes of patients with incident stroke in China. Using data from the Chinese Stroke Center Alliance (CSCA), we aim to quantify the prevalence of pre-stroke dementia and whether this group is at higher risk of adverse in-hospital outcomes compared to those without pre-stroke dementia.
Methods:
We used multivariable logistic regression models to assess the associations between pre-stroke dementia and ambulation by day 2, in-hospital mortality, in-hospital complications, and being discharged home. Covariates included age, sex, comorbidities [dyslipidemia, atrial fibrillation, peripheral vascular disease (PVD), smoking, and alcohol use], medication history (antiplatelet drugs or lipid-lowering drugs), stroke severity [measured by the National Institute of Health Stroke Scale (NIHSS)], administration of intravenous tissue plasminogen activator (IV tPA) within 4.5 hours of stroke onset, and receipt of deep vein thrombosis (DVT) prophylaxis if indicated.
Results:
In the final analytic sample of 559,070 ischemic stroke patients with no prior stroke history enrolled across 1,476 hospitals, those with pre-stroke dementia (n=1,511; 0.3%) were older and more likely to be female. Despite having received similar treatment, patients with pre-stroke dementia had lower odds of ambulating by day 2 [odds ratio (OR) =0.69; 95% confidence interval (CI): 0.62-0.78], higher odds of in-hospital mortality (OR =2.01; 95% CI: 1.35-2.99) or complications (OR =2.17; 95% CI: 1.93-2.44), and lower odds of being discharged home compared to those without pre-stroke dementia (OR =0.71; 95% CI: 0.62-0.83).
Conclusions:
Worse in-hospital outcomes among patients with pre-stroke dementia may be explained by pre-existing cognitive impairment that limited their ability to advocate for care needs. Further research is needed to determine whether a different care pathway or additional attention from clinicians is necessary for patients with pre-stroke dementia.
