Background
Stroke symptoms in the general adult population are common and associated with stroke
risk factors, lower physical and mental functioning, impaired cognitive status, and
future stroke. Our objective was to determine the association of stroke symptoms with
self-reported hospitalization or emergency department (ED) visit.
Methods
Lifetime history of stroke symptoms (sudden weakness, numbness, unilateral or general
loss of vision, loss of ability to communicate or understand) was assessed at baseline
in a national, population-based, longitudinal cohort study of 30,239 blacks and whites
younger than 45 years, enrolled from 2003 to 2007. Self-reported hospitalization or
ED visit and reason were collected during follow-up through March 2013. The symptom–hospitalization
association was assessed by proportional hazards analysis in persons who were stroke/transient
ischemic attack-free at baseline (27,126) with adjustment for sociodemographics and
further adjustment for risk factors.
Results
One or more stroke symptoms were reported by 4758 (17.5%). After adjustment for sociodemographics,
stroke symptoms were most strongly associated with greater risk of hospitalization/ED
for cardiovascular disease (CVD) (hazard ratio [HR] = 1.87, 95% confidence interval
[CI]: 1.78-1.96), stroke (HR = 1.69, 95% CI: 1.55-1.85), and any reason (HR = 1.39,
95% CI: 1.34-1.44). These associations remained significant and only modestly reduced
after risk factor adjustment.
Conclusions
Stroke symptoms are a marker for future hospitalization and ED visit not only for
stroke but also for CVD in general. Findings suggest a role for stroke symptom assessment
as a novel and simple approach for identifying individuals at high risk for CVD including
stroke in whom preventive strategies could be implemented.
Key Words
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References
- Development of a method to identify seniors at high risk for high hospital utilization.Med Care. 2002; 40: 782-793
- Preventable hospitalization among elderly Medicare beneficiaries with type 2 diabetes.Diabetes Care. 2003; 26: 1344-1349
- Long-term trends in the concentration of Medicare spending.Health Aff. 2007; 26: 808-816
- Potentially preventable hospitalizations—United States, 2001-2009.Morb Mortal Wkly Rep Surveill Summ. 2013; 62: 139-143
- Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2011; 42: 517-584
- Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 2160-2236
- Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 1545-1588
- 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).JAMA. 2014; 311: 507-520
- Lowering of blood pressure for recurrent stroke prevention.Stroke. 2014; 45: 2506-2513
- 2013 ACC/AHA Guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation. 2014; 129: S49-S73
- 2013 ACC/AHA Guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation. 2014; 129: S1-S45
- The Joint Commission reports high interest in new certification program for Comprehensive Stroke Centers.ED Manag. 2012; 24: 127-129
- Verifying the stroke-free phenotype by structured telephone interview.Stroke. 2000; 31: 1076-1080
- Reliability of the questionnaire for verifying stroke-free status.Cerebrovasc Dis. 2004; 17: 218-223
- Validating the Questionnaire for Verifying Stroke-Free Status (QVSFS) by neurological history and examination.Stroke. 2001; 32: 2232-2236
- Stenting versus endarterectomy for treatment of carotid-artery stenosis.N Engl J Med. 2010; 363: 11-23
- High prevalence of stroke symptoms among persons without a diagnosis of stroke or transient ischemic attack in a general population: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.Arch Intern Med. 2006; 166: 1952-1958
- Cognitive status, stroke symptom reports, and modifiable risk factors among individuals with no diagnosis of stroke or transient ischemic attack in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study.Stroke. 2007; 38: 1143-1147
- Stroke symptoms in individuals reporting no prior stroke or transient ischemic attack are associated with a decrease in indices of mental and physical functioning.Stroke. 2007; 38: 2446-2452
- Care seeking after stroke symptoms.Ann Neurol. 2008; 63: 466-472
- Self-reported stroke symptoms without a prior diagnosis of stroke or transient ischemic attack: a powerful new risk factor for stroke.Stroke. 2011; 42: 3122-3126
- The Reasons for Geographic and Racial Differences in Stroke study: objectives and design.Neuroepidemiology. 2005; 25: 135-143
- Incident cognitive impairment is elevated in the stroke belt: the REGARDS study.Ann Neurol. 2011; 70: 229-236
- Disparities in stroke incidence contributing to disparities in stroke mortality.Ann Neurol. 2011; 69: 619-627
- Probability of stroke: a risk profile from the Framingham Study.Stroke. 1991; 22: 312-318
- Self-report of stroke, transient ischemic attack, or stroke symptoms and risk of future stroke in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.Stroke. 2013; 44: 55-60
- Association between symptoms reported in a population questionnaire and future ischemic stroke: the ARIC study.Neuroepidemiology. 2004; 23: 33-37
- Covert neurological symptoms associated with silent infarcts from midlife to older age: the Atherosclerosis Risk in Communities study.Stroke. 2012; 43: 1218-1223
- Readmission and death after hospitalization for acute ischemic stroke: 5-year follow-up in the Medicare population.Stroke. 2007; 38: 1899-1904
- Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis.Stroke. 2005; 36: 2748-2755
- Validity of self-reported diagnoses leading to hospitalization: a comparison of self-reports with hospital records in a prospective study of American adults.Am J Epidemiol. 1998; 147: 969-977
- Accuracy of self-reported health services use and patterns of care among urban older adults.Med Care. 1999; 37: 662-670
- Predicting hospitalization and functional decline in older health plan enrollees: are administrative data as accurate as self-report?.J Am Geriatr Soc. 1998; 46: 419-425
- The validity of survey data on utilization of health and social services among the very old.J Gerontol. 1994; 49: S156-S164
Article info
Publication history
Published online: January 08, 2016
Accepted:
November 25,
2015
Received:
September 23,
2015
Footnotes
National Institutes of Health NS041588. The Reasons for Geographic and Racial Differences in Stroke research project was supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.11.040
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
