Background and Purpose -With the changes in management of atrial fibrillation (AF) over time, it is possible that the time trends of post-AF stroke incidenc e and mortality have changed. We sought to determine whether...Background and Purpose -With the changes in management of atrial fibrillation (AF) over time, it is possible that the time trends of post-AF stroke incidenc e and mortality have changed. We sought to determine whether the incidence and survival of ischemic stroke after AF diagnosis have improved. Methods -We identified the Olmsted County, Minn, residents who developed first AF from 1980 to 2000 and followed them in medical records to 2004. The outcomes were first ischemic stroke and death. Results -Of the 4117 subjects diagnosed with first AF and without previous stroke, 446 (11%) sustained a first ischemic stroke during a mea n follow-up time of 5.5±5.0 years. The age-and sex-adjusted incidence of str oke decreased, on average, by 3.4%per year (P=0.0001), concurrent with an increase in warfarin and aspirin use (both P < 0.0001) and reduction of systolic blood pressure (P < 0.001). The age-adjusted ischemic stroke incidence was higher in women (P=0.039), but not after adjusting for systolic blood pressure (P=0.41). Compared with the general Minnesota white population, the relative mortality hazard ratio was 1.88 for men and 1.84 for women without stroke and 3.03 for men and 3.80 for women (P < 0.05)with stroke. The relative mortality hazard did not vary by age or calendar year of AF diagnosis. Conclusions -Post-AF ischemic stroke incidence decreased significantly from 1980 to 2000, during which time a substantial increase in the use of antithrombotic therapy and reduction of systolic blood pressure was evident. The relative mortality risk of stroke, however, had not improved over time.展开更多
2017年美国心脏病学会/美国心脏协会成年人高血压指南将高血压重新定义为收缩压≥130和/或舒张压≥80mm Hg(1mm Hg=0.133kPa)。然而,在不同体质量指数(body mass index,BMI)人群中,可使脑卒中发病率降低的最佳血压尚不确定。方法:该前...2017年美国心脏病学会/美国心脏协会成年人高血压指南将高血压重新定义为收缩压≥130和/或舒张压≥80mm Hg(1mm Hg=0.133kPa)。然而,在不同体质量指数(body mass index,BMI)人群中,可使脑卒中发病率降低的最佳血压尚不确定。方法:该前瞻性队列研究进行四次检查:基线检查(2004-2006年),2008,2010和2017年随访。本实验纳入36352人,旨在确定能降低两种BMI类别水平脑卒中发生率的理想血压范围.展开更多
目的系统评价出院准备服务对脑卒中患者干预效果。方法计算机检索中国知网、万方、维普、中国生物文献数据库、PubMed、Embase、Web of Science、Cochrane Library数据库中关于出院准备服务对脑卒中患者干预效果的随机对照试验。探索时...目的系统评价出院准备服务对脑卒中患者干预效果。方法计算机检索中国知网、万方、维普、中国生物文献数据库、PubMed、Embase、Web of Science、Cochrane Library数据库中关于出院准备服务对脑卒中患者干预效果的随机对照试验。探索时限从建库至2022年2月。采用RevMan 5.3进行meta分析。结果共纳入12篇原始文献,共有1244例研究对象。meta分析结果示,出院准备服务能够提高脑卒中患者日常生活活动能力[MD=7.86,95%CI(6.48,9.23),P<0.00001]、提高自我效能感[MD=3.85,95%CI(0.28,7.42),P=0.03]、提高出院准备度[MD=35.30,95%CI(4.43,66.17),P=0.03]以及降低二次脑卒中发生率[MD=0.27,95%CI(0.16,0.45),P<0.00001]。结论出院服务准备能够提高脑卒中患者日常生活活动能力,提高自我效能感和出院准备度以及降低二次脑卒中发生率。展开更多
Background and Purpose -Patients with atrial fibrillation have a high risk of stroke and other vascular events even if anticoagulated. The primary objective here is to determine whether routine blood pressure-lowering...Background and Purpose -Patients with atrial fibrillation have a high risk of stroke and other vascular events even if anticoagulated. The primary objective here is to determine whether routine blood pressure-lowering provides additional protection for this high-risk patient group. Methods -This study was a subsidiary analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS)-a randomized, placebocontrolled trial that established the beneficial effects of blood pressure-lowering in a heterogeneous group of patients with cerebrovascular disease. A total of 6105 patients were randomly assigned to either active treatment (2 to 4 mg perindopril for all participants plus 2.0 to 2.5 mg i ndapamide for those without an indication for or a contraindication to a diuretic) or matching placebo(s). Outcomes are total major vascular events, causespecific vascular outcomes, and death from any cause. Results -There were 476 patient s with atrial fibrillation at baseline, of whom 51%were taking anticoagulants. In these patients, active treatment lowered mean blood pressure by 7.3/3.4 mm Hg and was associated with a 38%(95%confidence interval [CI], 6 to 59) reduction in major vascular eve nt s and 34%(95%CI, -13 to 61) reduction in stroke. The benefits of blood pressu re-lowering in patients with atrial fibrillation were achieved irrespective of the use of anticoagulant therapy (P homogeneity=0.8) or the presence of hyperten sion (P homogeneity=0.4). Conclusions -For most patients with atrial fibrillati on, routine blood pressurelowering is likely to provide protection against major vascular events additional to that conferred by anticoagulation.展开更多
文摘Background and Purpose -With the changes in management of atrial fibrillation (AF) over time, it is possible that the time trends of post-AF stroke incidenc e and mortality have changed. We sought to determine whether the incidence and survival of ischemic stroke after AF diagnosis have improved. Methods -We identified the Olmsted County, Minn, residents who developed first AF from 1980 to 2000 and followed them in medical records to 2004. The outcomes were first ischemic stroke and death. Results -Of the 4117 subjects diagnosed with first AF and without previous stroke, 446 (11%) sustained a first ischemic stroke during a mea n follow-up time of 5.5±5.0 years. The age-and sex-adjusted incidence of str oke decreased, on average, by 3.4%per year (P=0.0001), concurrent with an increase in warfarin and aspirin use (both P < 0.0001) and reduction of systolic blood pressure (P < 0.001). The age-adjusted ischemic stroke incidence was higher in women (P=0.039), but not after adjusting for systolic blood pressure (P=0.41). Compared with the general Minnesota white population, the relative mortality hazard ratio was 1.88 for men and 1.84 for women without stroke and 3.03 for men and 3.80 for women (P < 0.05)with stroke. The relative mortality hazard did not vary by age or calendar year of AF diagnosis. Conclusions -Post-AF ischemic stroke incidence decreased significantly from 1980 to 2000, during which time a substantial increase in the use of antithrombotic therapy and reduction of systolic blood pressure was evident. The relative mortality risk of stroke, however, had not improved over time.
文摘2017年美国心脏病学会/美国心脏协会成年人高血压指南将高血压重新定义为收缩压≥130和/或舒张压≥80mm Hg(1mm Hg=0.133kPa)。然而,在不同体质量指数(body mass index,BMI)人群中,可使脑卒中发病率降低的最佳血压尚不确定。方法:该前瞻性队列研究进行四次检查:基线检查(2004-2006年),2008,2010和2017年随访。本实验纳入36352人,旨在确定能降低两种BMI类别水平脑卒中发生率的理想血压范围.
文摘目的系统评价出院准备服务对脑卒中患者干预效果。方法计算机检索中国知网、万方、维普、中国生物文献数据库、PubMed、Embase、Web of Science、Cochrane Library数据库中关于出院准备服务对脑卒中患者干预效果的随机对照试验。探索时限从建库至2022年2月。采用RevMan 5.3进行meta分析。结果共纳入12篇原始文献,共有1244例研究对象。meta分析结果示,出院准备服务能够提高脑卒中患者日常生活活动能力[MD=7.86,95%CI(6.48,9.23),P<0.00001]、提高自我效能感[MD=3.85,95%CI(0.28,7.42),P=0.03]、提高出院准备度[MD=35.30,95%CI(4.43,66.17),P=0.03]以及降低二次脑卒中发生率[MD=0.27,95%CI(0.16,0.45),P<0.00001]。结论出院服务准备能够提高脑卒中患者日常生活活动能力,提高自我效能感和出院准备度以及降低二次脑卒中发生率。
文摘Background and Purpose -Patients with atrial fibrillation have a high risk of stroke and other vascular events even if anticoagulated. The primary objective here is to determine whether routine blood pressure-lowering provides additional protection for this high-risk patient group. Methods -This study was a subsidiary analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS)-a randomized, placebocontrolled trial that established the beneficial effects of blood pressure-lowering in a heterogeneous group of patients with cerebrovascular disease. A total of 6105 patients were randomly assigned to either active treatment (2 to 4 mg perindopril for all participants plus 2.0 to 2.5 mg i ndapamide for those without an indication for or a contraindication to a diuretic) or matching placebo(s). Outcomes are total major vascular events, causespecific vascular outcomes, and death from any cause. Results -There were 476 patient s with atrial fibrillation at baseline, of whom 51%were taking anticoagulants. In these patients, active treatment lowered mean blood pressure by 7.3/3.4 mm Hg and was associated with a 38%(95%confidence interval [CI], 6 to 59) reduction in major vascular eve nt s and 34%(95%CI, -13 to 61) reduction in stroke. The benefits of blood pressu re-lowering in patients with atrial fibrillation were achieved irrespective of the use of anticoagulant therapy (P homogeneity=0.8) or the presence of hyperten sion (P homogeneity=0.4). Conclusions -For most patients with atrial fibrillati on, routine blood pressurelowering is likely to provide protection against major vascular events additional to that conferred by anticoagulation.
