Stroke; a journal of cerebral circulation
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Multicenter Study
Applying the evidence: do patients with stroke, coronary artery disease, or both achieve similar treatment goals?
The importance of early and aggressive initiation of secondary prevention strategies for patients with both coronary artery disease (CAD) and cerebrovascular disease (CVD) is emphasized by multiple guidelines. However, limited information is available on cardiovascular protection and stroke prevention in an outpatient setting from community-based populations. We sought to evaluate and compare differences in treatment patterns and the attainment of current guideline-recommended targets in unselected high-risk ambulatory patients with CAD, CVD, or both. ⋯ Despite the proven benefits of available antihypertensive and lipid-lowering therapies, current management of hypertension and dyslipidemia continues to be suboptimal. A considerable proportion of patients failed to achieve guideline-recommended targets, and this apparent treatment gap was more pronounced among patients with CVD and women. Quality improvement strategies should target these patient subgroups.
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Comparative Study
Do presenting symptoms explain sex differences in emergency department delays among patients with acute stroke?
Previous studies report that women with stroke may experience longer delays in diagnostic workup than men after arriving at the emergency department. We hypothesized that presenting symptom differences could explain these delays. ⋯ Women with acute stroke experienced greater emergency department delays than men, which were not attributable to differences in presenting symptoms, time of arrival, age, or other confounders.
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Comparative Study
Quality of care in women with ischemic stroke in the GWTG program.
Prior studies have suggested worse poststroke outcomes in women. We sought to examine sex differences in quality of care (QOC) in the Get With The Guidelines-Stroke (GWTG-Stroke) program. ⋯ Quality of care for women with ischemic stroke was lower than that for men, and women were less likely to be discharged home. Further study is warranted to identify the causes and consequences of these sex-based differences in care.
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Comparative Study
Sex differences in incidence, mortality, and survival in individuals with stroke in Scotland, 1986 to 2005.
The aim of this study was to examine the effect of sex across different age groups and over time for stroke incidence, 30-day case-fatality, and mortality. ⋯ We observed lower rates of incidence and mortality in younger women than men. However, higher numbers of older women in the population mean that the absolute burden of stroke is greater in women. Short-term case-fatality is greater in women of all ages and, worryingly, these differences have increased from 1986 to 2005.
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Few studies have focused on long-term changes in the caregiving experience after stroke. This study assessed changes in the psychosocial functioning of spouses (burden, depressive symptoms, harmony in the relationship between patient and spouse, and social relations) during the first 3 years after stroke and identified predictors of the course of spouses' psychosocial functioning based on the characteristics of patients and spouses with special emphasis on coping style. ⋯ Follow-up of spouses of patients with stroke requires not only assessment of burden, but also other aspects of psychosocial functioning like harmony in the relationship, depression, and social relations, because our results show negative long-term consequences of stroke for these aspects of caregiver quality of life.