Recurrent stroke in midlife is associated with not having a primary care physician
Recurrent stroke in midlife is associated with not having a primary care physician
复制标题
DOI：
10.1212/wnl.0000000000006878
复制
发表时间：
2019-02-05
期刊：
影响因子：
9.9
通讯作者：
Morgenstern, Lewis B.
中科院分区：
文献类型：
--
作者：
Lank, Rebecca J.;Lisabeth, Lynda D.;Morgenstern, Lewis B.
目的通过一项以人群为基础的研究，确定首次卒中时有初级保健医生(PCP)的中年卒中患者是否比没有初级保健医师的患者具有更低的卒中复发风险和死亡率。方法通过2000年至2013年德克萨斯州克里斯蒂语料库(BASIC)脑发作监测(BASIC)项目，确诊首次发病的缺血性卒中患者，发病年龄45~。COX比例风险模型被用来在不同的模型中检验没有PCP与卒中复发或全因死亡率之间的关联。对这些病例进行了长达5年的随访，或直到2013年12月31日，以先到者为准。如果病例在经历复发事件之前死亡，则会对其进行复发审查。我们对可能与PCP和复发或死亡率相关的临床风险因素进行了调整。结果663例患者为首发缺血性卒中。在这些人中，77%有PCP，43%是女性，平均年龄为55.6岁。5年复发风险为14.6%，死亡风险为19.2%。没有PCP与较高的复发风险相关(调整后的危险比为1.75，95%可信区间为1.02-3.02)。五氯苯酚与死亡率无关。敏感度分析表明，结果对不同的慢性病调整方式是稳健的。结论本研究发现首次卒中时有PCP的患者卒中复发率较低。未来的研究可能会确定在卒中住院出院前建立PCP对二级卒中预防的价值。
Objective To determine using a population-based study whether midlife stroke patients having a primary care physician (PCP) at the time of first stroke have a lower risk of stroke recurrence and mortality than those who do not have a PCP. Methods First-ever ischemic stroke patients 45 to 64 years of age at stroke onset were ascertained through the Brain Attack Surveillance in Corpus Christi (BASIC) project from 2000 to 2013 in Texas. Cox proportional hazards models were used to examine the association between not having a PCP and stroke recurrence or all-cause mortality in separate models. Cases were followed up for up to 5 years or until December 31, 2013, whichever came first. Cases were censored for recurrence if they died before experiencing a recurrent event. We adjusted for clinical risk factors that could be associated with having a PCP and recurrence or mortality. Results There were 663 first-occurrence ischemic stroke cases. Of these, 77% had a PCP, 43% were female, and average age was 55.6 years. Five-year recurrence risk was 14.6%, and mortality risk was 19.2%. Not having a PCP was associated with higher recurrence risk (adjusted hazard ratio 1.75, 95% confidence interval 1.02-3.02). Having a PCP was not associated with mortality. Sensitivity analyses showed that results were robust to different ways to adjust for chronic conditions. Conclusion This study found lower rates of stroke recurrence among those with a PCP at the time of first stroke. Future studies could determine the value of establishing a PCP before stroke hospital discharge for secondary stroke prevention.