Comorbid Psychiatric Disease Is Associated With Lower Rates of Thrombolysis in Ischemic Stroke.
Comorbid Psychiatric Disease Is Associated With Lower Rates of Thrombolysis in Ischemic Stroke.
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DOI：
10.1161/strokeaha.117.020295
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发表时间：
2018-03
期刊：
影响因子：
8.3
通讯作者：
Faigle R
中科院分区：
文献类型：
--
作者：
Bongiorno DM;Daumit GL;Gottesman RF;Faigle R
静脉溶栓（IVT）可改善急性缺血性卒中后的结局，但在某些患者人群中未得到充分利用。精神疾病在美国很普遍，患有精神疾病的患者在一系列疾病的治疗中经历不公平。我们的目的是确定合并精神疾病是否与急性缺血性卒中IVT使用的差异相关。在2007年至2011年期间，在全国住院患者样本中确定了急性缺血性卒中入院。精神疾病由ICD 9-CM代码定义，用于精神分裂症或其他精神病、双相情感障碍、抑郁症或焦虑症的次要诊断。使用逻辑回归，我们测试了IVT和精神疾病之间的关联，控制人口统计学，临床和医院因素。在符合入选标准的325，009例缺血性卒中病例中，12.8%有任何特定的精神病合并症。IVT用于3.6%有精神疾病的患者和4.4%无精神疾病的患者（p < 0.001）。存在任何精神疾病与接受IVT的几率较低相关（调整后OR 0.80，95% CI 0.76-0.85）。当单独分析精神病诊断时，与没有精神病的个体相比，精神分裂症或其他精神病，焦虑和抑郁各自与IVT的几率显著降低相关。合并精神疾病的急性缺血性卒中患者发生IVT的几率显著降低。了解这些患者使用IVT的障碍可能有助于制定干预措施，以增加循证卒中护理的可及性。
Intravenous thrombolysis (IVT) improves outcomes after acute ischemic stroke but is underutilized in certain patient populations. Mental illness is pervasive in the U.S., and patients with comorbid psychiatric disease experience inequities in treatment for a range of conditions. We aimed to determine if comorbid psychiatric disease is associated with differences in IVT use in acute ischemic stroke. Acute ischemic stroke admissions between 2007 and 2011 were identified in the Nationwide Inpatient Sample. Psychiatric disease was defined by ICD9-CM codes for secondary diagnoses of schizophrenia or other psychoses, bipolar disorder, depression, or anxiety. Using logistic regression, we tested the association between IVT and psychiatric disease, controlling for demographic, clinical, and hospital factors. Of the 325,009 ischemic stroke cases meeting inclusion criteria, 12.8% had any of the specified psychiatric comorbidities. IVT was used in 3.6% of those with, and 4.4% of those without, psychiatric disease (p < 0.001). Presence of any psychiatric disease was associated with lower odds of receiving IVT (adjusted OR 0.80, 95% CI 0.76–0.85). When psychiatric diagnoses were analyzed separately, schizophrenia or other psychoses, anxiety, and depression were each associated with significantly lower odds of IVT, compared to individuals without psychiatric disease. Acute ischemic stroke patients with comorbid psychiatric disease have significantly lower odds of IVT. Understanding barriers to IVT use in such patients may help in developing interventions to increase access to evidence-based stroke care.