Abstract Details

Title Functional Status at 30 and 90 Days After Mild Ischemic Stroke

Topic Neuroepidemiology

Presentation(s) S12 - Neuroepidemiology (1:36 PM-1:48 PM)

Poster/Presentation
Number 004

Background

The final disability status after an ischemic stroke has typically been assessed at 90 days in trials, but it has been shown that the functional status at 30 days post-stroke is a reliable predictor of functional status at 90 days.

Objective

This study compares the global disability status of mild ischemic stroke patients at 30 and 90 days post-stroke, as measured by the modified Rankin Scale (mRS), and identifies predictors of disability change between 30-90 days.

Design/Methods The population included 1339 ischemic stroke patients in the Mild and Rapidly Improving Stroke Study with NIH stroke score 0-5 and mRS measurements at 30 and 90 days. Improvement was defined as having mRS>1 at 30 days and mRS=0-1 at 90 days OR mRS>2 at 30 days and mRS=0-2 at 90 days. Worsening was defined as an increase of ≥2 points or a worsening from mRS of 1 at 30 days to 2 at 90 days. Demographic and clinical characteristics at hospital arrival were abstracted from medical records, and regression models were used to identify predictors of functional improvement and decline from 30-90 days.

Results

Fifty-seven percent of participants had the same mRS at 30 and 90 days. There was moderate agreement in mRS between the two time points (weighted kappa=0.59, 95% CI=0.56-0.62). However, worsening on the mRS was observed in 7.54% of participants from 30-90 days, and 17.33% improved. Participants of older age (per year OR=1.02, 95% CI=1.00-1.03), greater stroke severity (per NIHSS point OR=1.17, 95% CI=1.03-1.34), history of atrial fibrillation (OR=1.72, 95% CI=1.04-2.86), and those without alteplase treatment (OR=1.72, 95% CI=1.10-2.67) were more likely to show functional decline after mutual adjustment.

Conclusions

A quarter of mild ischemic stroke participants exhibited functional changes between 30-90 days, suggesting that the 30-day outcome may insufficiently represent long-term recovery in mild stroke and longer follow-up may be clinically necessary.

Authors/Disclosures
Hannah Gardener, ScD (University of Miami) PRESENTER	Ms. Gardener has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Intersocietal Accreditation Commission. Ms. Gardener has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ellipse Analytics. Ms. Gardener has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Baum Hedlund. Ms. Gardener has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant with A Green Slate Consulting.
	No disclosure on file
Eric E. Smith, MD (University of Calgary)	Dr. Smith has received personal compensation in the range of $0-$499 for serving as a Consultant for Alnylam Pharmaceuticals. Dr. Smith has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Smith has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. Dr. Smith has received publishing royalties from a publication relating to health care.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Ralph L. Sacco, MD, MS, FAHA	Dr. Sacco has received personal compensation in the range of $100,000-$499,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Sacco has received research support from NIH, NINDS, NCATS, NIMHD. The institution of Dr. Sacco has received research support from FL Department of Health. Dr. Sacco has received research support from University of Washington, Seattle. Dr. Sacco has received publishing royalties from a publication relating to health care.
Pooja Khatri, MD, FAAN (Univ of Cincinnati/Dept of Neuro)	The institution of Dr. Khatri has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lumosa. Dr. Khatri has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bayer. The institution of Dr. Khatri has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Diamedica. Dr. Khatri has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Basking Biosciences. Dr. Khatri has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Khatri has received research support from Cerenovus. Dr. Khatri has received publishing royalties from a publication relating to health care.
	No disclosure on file
Brian Mac Grory, MBChB (Duke University School of Medicine)	An immediate family member of Dr. Mac Grory has received personal compensation for serving as an employee of Sanofi. Dr. Mac Grory has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke. The institution of Dr. Mac Grory has received research support from National Institutes of Health. The institution of Dr. Mac Grory has received research support from American Heart Association.
Deepak Gulati, MD (The Ohio State University)	Dr. Gulati has nothing to disclose.
Navdeep Sangha, MD (Kaiser Permanente)	Dr. Sangha has nothing to disclose.
Karin E. Olds, MD (SLMBNI)	Dr. Olds has nothing to disclose.
Curtis G. Benesch, MD, MPH (Strong Mem Hosp/Dept Neurology)	Dr. Benesch has nothing to disclose.
Adam Kelly, MD, FAAN (University of Rochester)	Dr. Kelly has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Grand Rounds/Included Health. Dr. Kelly has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology. Dr. Kelly has received personal compensation in the range of $500-$4,999 for serving as a Question writer for various educational offerings with American Academy of Neurology.
	No disclosure on file
Amit Kansara, MD (Providence Stroke Center)	Dr. Kansara has nothing to disclose.
Lee H. Schwamm, MD, FAAN (Yale New Haven Health System)	Dr. Schwamm has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Prime Education. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for lifeimage. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for mediasphere. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for medscape/WebMD. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Penumbra. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. The institution of Dr. Schwamm has received research support from NINDS. The institution of Dr. Schwamm has received research support from PCORI. Dr. Schwamm has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Schwamm has received publishing royalties from a publication relating to health care. Dr. Schwamm has a non-compensated relationship as a Board of directors with American heart association that is relevant to AAN interests or activities.
Jose G. Romano, MD, FAAN (University of Miami, Miller School of Medicine)	Dr. Romano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Romano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vycor. Dr. Romano has stock in Vycor Medical/NovaVision. The institution of Dr. Romano has received research support from NIH/NINDS. The institution of Dr. Romano has received research support from NIH/NIMHHD.