Predicting Stroke Complications in Hospital and Functional Status at Discharge by Clustering of Cardiovascular Diseases a Multi-Centre Registry-Based Study of Acute Stroke

• Published in: Journal of stroke and cerebrovascular diseases 2022-01, Vol.31 (1), p.106162-106162, Article 106162
• Main Authors: Han, Thang S, Fry, Christopher H, Fluck, David, Gulli, Giosue, Affley, Brendan, Robin, Jonathan, Kakar, Puneet, Sharma, Pankaj
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiovascular Diseases - epidemiology; Cluster Analysis; Female; Functional Status; Healthcare economics; Humans; Length of stay; Male; Morbidity; Mortality; Multimorbidity; Nosocomial infections; Patient Discharge; Prospective Studies; Registries; Risk Assessment; Stroke - complications; Stroke - physiopathology
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2021.106162

•Four categories from cardiovascular disease Congestive heart failure, Atrial fibrillation, pre-existing Stroke and Hypertension (CASH).were constructed: CASH-0 (no coexisting CVD); CASH-1 (any one coexisting CVD); CASH-2 (any two coexisting CVD); CASH-3 (any three or all four coexisting CVD).•Compared to CASH-0, individuals with CASH-3 had twice the risk of in-hospital mortality, prolonged length of stay on hyperacute stroke units, and disability at discharge; two and half to three times the risk of nosocomial infections within seven days of admission.•CASH is a novel and simple outcome risk scale which can used to identify patients who are at increased risk of a variety of stroke associated adverse outcomes. Indicators for outcomes following acute stroke are lacking. We have developed novel evidence-based criteria for identifying outcomes of acute stroke using the presence of clusters of coexisting cardiovascular disease (CVD). Analysis of prospectively collected data from the Sentinel Stroke National Audit Programme (SSNAP). A total of 1656 men (mean age ±SD=73.1yrs±13.2) and 1653 women (79.3yrs±13.0) were admitted with acute stroke (83.3% ischaemic, 15.7% intracranial haemorrhagic), 1.0% unspecified) in four major UK hyperacute stroke units (HASU) between 2014 and 2016. Four categories from cardiovascular disease Congestive heart failure, Atrial fibrillation, pre-existing Stroke and Hypertension (CASH).were constructed: CASH-0 (no coexisting CVD); CASH-1 (any one coexisting CVD); CASH-2 (any two coexisting CVD); CASH-3 (any three or all four coexisting CVD). These were tested against outcomes, adjusted for age and sex. Compared to CASH-0, individuals with CASH-3 had greatest risks of in-hospital mortality (11.1% vs 24.5%, OR=1.8, 95%CI=1.3-2.7) and disability (modified Rankin Scale score ≥4) at discharge (24.2% vs 46.2%, OR=1.9, 95%CI=1.4-2.7), urinary tract infection (3.8% vs 14.6%, OR= 3.3, 95%CI= 1.9-5.5), and pneumonia (7.1% vs 20.6%, OR= 2.6, 95%CI= 1.7-4.0); length of stay on HASU >14 days (29.8% vs 39.3%, OR=1.8, 95%CI=1.3-2.6); and joint-care planning (20.9% vs 29.8%, OR=1.4, 95%CI=1.0-2.0). We present a simple tool for estimating the risk of adverse outcomes of acute stroke including death, disability at discharge, nosocomial infections, prolonged length of stay, as well as any joint care planning. CASH-0 indicates a low level and CASH-3 indicates a high level of risk of such complications after stroke.