Abstract WMP54: Detection of Late Complications After Stroke in Younger versus Older Adults With Ischemic Stroke Using Active Surveillance versus Usual Care: A Retrospective Cohort Study
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Titel:
Abstract WMP54: Detection of Late Complications After Stroke in Younger versus Older Adults With Ischemic Stroke Using Active Surveillance versus Usual Care: A Retrospective Cohort Study
Beschreibung:
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<jats:bold>Introduction:</jats:bold>
Late complications after stroke (LCAS) impede return to pre-stroke responsibilities and worsen quality of life, yet they can be readily treated. We previously demonstrated that an active surveillance approach could improve LCAS detection in young adults. However, it is not known if a similar strategy would be useful for older adults. We assessed differences in LCAS detection and resultant clinical practice changes (CPC) among young and older stroke survivors using both active surveillance and usual care approaches.
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<jats:bold>Methods:</jats:bold>
We retrospectively collected data from the EHR at Tufts Medical Center for patients age ≥ 18 with acute ischemic stroke (AIS) and Stroke Clinic evaluations including demographics, comorbidities, presence of LCAS (including central pain, cognitive impairment, dystonia, headache, insomnia, lethargy, mood disorders, orthostasis, seizures, and spasticity), and evidence of CPC (diagnostic test, prescription, or referral). Differences in LCAS detection and in clinical practice change between age groups were compared during three-time intervals (0-3 months, 3-12 months, 0-12 months), and stratified by surveillance strategy. Descriptive statistics and multivariable logistic regression were used to identify predictors of LCAS detection and CPC.
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<jats:bold>Results:</jats:bold>
Three hundred eleven AIS survivors (16% young, 44% female, 42% non-white) were included, with 43% undergoing active surveillance. Older adults were more likely to have a non-English preferred language. While LCAS were detected more frequently in young adults (86% vs 65%, p=0.003), the overall proportion was high in both age groups. Motor LCAS were detected at similar proportions (20% vs 12%, p=0.15), but nonmotor LCAS were detected more in young adults (91% vs 71%, p=0.003). Among all AIS survivors, active surveillance was associated with higher proportion of LCAS detection for nonmotor symptoms but not for motor symptoms. In analyses adjusted for surveillance method and age, active surveillance was strongly associated with any LCAS detection and with CPC for any LCAS and nonmotor LCAS.
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<jats:bold>Conclusions:</jats:bold>
Active surveillance increases LCAS detection in both young and older AIS survivors compared to usual care, and it is a major determinant of CPC for nonmotor LCAS.
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