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Prognosis in acute stroke with special reference to some cardiac factors
Insights
Evaluating cardiac health alongside neurological status is crucial for predicting stroke patient outcomes. Early assessment of heart conditions improves short-term and long-term prognosis in acute cerebrovascular disease.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Acute cerebrovascular disease (stroke) presents a significant mortality risk.
- Prognostic factors in stroke patients require comprehensive evaluation beyond neurological deficits.
Purpose of the Study:
- To investigate the short-term and long-term prognostic factors in patients with acute cerebrovascular disease.
- To determine the role of cardiac assessment in stroke prognosis.
Main Methods:
- Prospective study of 283 consecutive patients with acute cerebrovascular disease.
- Regular neurological assessments and a preplanned investigation program.
- Multivariate analysis to identify significant prognostic factors for mortality.
Main Results:
- Hospital mortality was 18%. Low neurological score and heart failure were key short-term predictors.
- For cerebral infarction patients, ambulatory capacity and bundle branch block improved short-term prognosis.
- Long-term mortality (1-2 years) was 14-18%. Age and ECG ST changes were significant long-term predictors.
- Bundle branch block was the strongest predictor for long-term prognosis in cerebral infarction patients.
Conclusions:
- Neurological findings alone are insufficient for accurate stroke prognostication.
- Cardiac evaluation, particularly for conditions like bundle branch block and ST changes, is vital for predicting both short-term and long-term outcomes.
- Integrating cardiac assessment into stroke care pathways can enhance patient management and prognosis.
Abstract:
Neurological assessments were done regularly during hospitalization in 283 consecutive patients (mean age 73 yr) with acute cerebrovascular disease treated at the Stroke Unit of Serafimerlasarettet. A preplanned investigation program and strict criteria for diagnosis and treatment were followed. Hospital mortality was 18%. Patients with a major cerebral infarction or haemorrhage often died very early during the hospital period and deaths due to complications increased significantly during the second week. Multivariate analysis regarding mortality showed that a low neurological score and heart failure were the most important factors for the short-term prognosis. In those patients with cerebral infarction, ambulatory capacity and ECG-diagnosed bundle branch block added significantly to the prognostic power of the neurological score. Among the 227 patients discharged alive, 1 and 2-yr mortality was 14 and 18% respectively. Here, the most important long-term prognostic factors were age and ST changes on the ECG. Again, considering only patients with cerebral infarction (N = 190), bundle branch block was found to be the single most useful predictive factor. Prognostication in acute ischemic stroke should thus be based not only on neurological findings but on careful evaluation of associated cardiac disease, especially in the long-term perspective.