RESUMO
The COVID-19 pandemic resulted in limited access of post-stroke patients to their usual medical follow-up and rehabilitation. To continue these activities, we adopted a technology that is free and has universal access. We remotely followed 32 patients after discharge from the stroke unit during the mandatory lock-down. This allowed to continue with medical controls, physical therapy and speech pathology treatments. All patients fully complied with medical treatment and self-monitoring of vascular risk factors. Early discontinuation of rehabilitation therapies was identified and immediately compensated with tele-rehabilitation. All expressed their willingness to continue with this treatment modality. This strategy was successful to effectively continue medical follow-up and rehabilitation supervision with the collaboration of families, is an accessible and low-cost technology that could be replicated and used in health institutions that treat neurovascular diseases.
La pandemia COVID-19 limitó el acceso de los pacientes post accidente cerebro vascular a los controles de seguimiento médico y a la rehabilitación, por lo cual decidimos incorporar herramientas tecnológicas gratuitas y accesibles para su continuación. Realizamos seguimiento remoto a 32 pacientes dados de alta en los primeros tres meses del período de aislamiento social preventivo obligatorio con el objetivo de continuar controles médicos, rehabilitación física y fonoaudiológica. El 100% adhirió al tratamiento médico y al auto-monitoreo de factores de riesgo; detectamos en forma temprana la interrupción de las terapias de rehabilitación y mantuvimos la adherencia por medio de tele-rehabilitación. Los 32 pacientes mostraron disponibilidad para seguir con esta modalidad de atención, permitiendo continuar el seguimiento médico y supervisar la rehabilitación con la colaboración de las familias. Es una metodología accesible y de bajo costo que podría ser replicada y utilizada en instituciones de salud que traten enfermedades neurovasculares.
Assuntos
COVID-19 , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Telemedicina , Controle de Doenças Transmissíveis , Humanos , Pandemias , SARS-CoV-2 , Prevenção Secundária , Acidente Vascular Cerebral/prevenção & controleRESUMO
Resumen La pandemia COVID-19 limitó el acceso de los pacientes post accidente cerebro vascular a los controles de seguimiento médico y a la rehabilitación, por lo cual decidimos incorporar herramientas tecnológicas gratuitas y accesibles para su continuación. Realizamos seguimiento remoto a 32 pacientes dados de alta en los primeros tres meses del período de aislamiento social preventivo obligatorio con el objetivo de continuar controles médicos, rehabilitación física y fonoaudiológica. El 100% adhirió al tratamiento médico y al auto-monitoreo de factores de riesgo; detectamos en forma temprana la interrupción de las terapias de rehabilita ción y mantuvimos la adherencia por medio de tele-rehabilitación. Los 32 pacientes mostraron disponibilidad para seguir con esta modalidad de atención, permitiendo continuar el seguimiento médico y supervisar la rehabilitación con la colaboración de las familias. Es una metodología accesible y de bajo costo que podría ser replicada y utilizada en instituciones de salud que traten enfermedades neurovasculares.
Abstract The COVID-19 pandemic resulted in limited access of post-stroke patients to their usual medical follow-up and rehabilitation. To continue these activities, we adopted a technology that is free and has universal access. We remotely followed 32 patients after discharge from the stroke unit during the mandatory lock-down. This allowed to continue with medical controls, physical therapy and speech pathology treatments. All patients fully complied with medical treatment and self-monitoring of vascular risk factors. Early discontinuation of rehabilitation therapies was identified and immediately compensated with tele-rehabilitation. All expressed their willingness to continue with this treatment modality. This strategy was successful to effectively continue medical follow-up and rehabilitation supervision with the collaboration of families, is an accessible and low-cost technology that could be replicated and used in health institutions that treat neurovascular diseases.
Assuntos
Humanos , Telemedicina , Acidente Vascular Cerebral/prevenção & controle , Reabilitação do Acidente Vascular Cerebral , COVID-19 , Controle de Doenças Transmissíveis , Prevenção Secundária , Pandemias , SARS-CoV-2RESUMO
The conference "Climate change, air pollution and health" was held at the Pontifical Academy of Sciences. The data presented highlighted that air pollution is a major, under-recognized and modifiable risk factor for stroke and heart disease. Air pollution causes 7.6% of all deaths making it the fifth cause of death globally, and this figure is expected to increase by 50% by 2050. Particulate matter causes endothelial dysfunction and induces thrombosis by altering reactive oxygen species, nitric oxide, insulin resistance, and lipid levels. Thirty-three articles published since 2002 were reviewed to assess the relation between air pollution and stroke with age, geographical location, particulate and gaseous matter type, duration of exposure, previous stroke, and comorbidities. It remains to be defined if air pollution has pathophysiological effects that preferentially predispose individuals to ischemic or hemorrhagic stroke. There is ample evidence showing an association between acute and chronic exposure to PM2.5 or gaseous pollutants with stroke. This potentially avoidable scenario and its dramatic consequences are heavily under-recognized by health professionals and the wider public. Preventive measures in people at high vascular risk are warranted. Procrastination in implementing efforts to stop the current worldwide course of worsening air pollution is the seed of a potential global health catastrophe.
Assuntos
Poluição do Ar , Acidente Vascular Cerebral/epidemiologia , Congressos como Assunto , Exposição Ambiental/efeitos adversos , Humanos , Material Particulado/efeitos adversos , Fatores de Risco , Cidade do VaticanoRESUMO
AIMS: Left atrium (LA) dilation is associated with adverse cardiovascular (CV) outcomes. Blood stasis, thrombus formation and atrial fibrillation may occur, especially in heart failure (HF) patients. It is not known whether preventive antithrombotic treatment may decrease the incidence of CV events in HF patients with LA enlargement. We investigated the relationship between LA enlargement and CV outcomes in HF patients and the effect of different antithrombotic treatments. METHODS AND RESULTS: Two-dimensional echocardiography with LA volume index (LAVi) measurement was performed in 1148 patients with systolic HF from the Warfarin versus Aspirin in Reduced Ejection Fraction (WARCEF) trial. Patients were randomized to warfarin or aspirin and followed for 3.4 ± 1.7 years. While the primary aim of the trial was a composite of ischaemic stroke, death, and intracerebral haemorrhage, the present report focuses on the individual CV events, whose incidence was compared across different LAVi and treatment subgroups. After adjustment for demographics and clinical covariates, moderate or severe LA enlargement was significantly associated with total death (hazard ratio 1.6 and 2.7, respectively), CV death (HR 1.7 and 3.3), and HF hospitalization (HR 2.3 and 2.6) but not myocardial infarction (HR 1.0 and 1.4) or ischaemic stroke (1.1 and 1.5). The increased risk was observed in both patients treated with warfarin or aspirin. In warfarin-treated patients, a time in therapeutic range >60% was associated with lower event rates, and an interaction between LAVi and time in therapeutic range was observed for death (P = 0.034). CONCLUSIONS: In patients with systolic HF, moderate or severe LA enlargement is associated with death and HF hospitalization despite treatment with antithrombotic medications. The possibility that achieving a more consistent therapeutic level of anticoagulation may decrease the risk of death requires further investigation.
Assuntos
Aspirina/administração & dosagem , Volume Cardíaco/fisiologia , Átrios do Coração/diagnóstico por imagem , Insuficiência Cardíaca Sistólica/fisiopatologia , Volume Sistólico/efeitos dos fármacos , Tromboembolia/prevenção & controle , Varfarina/administração & dosagem , Anticoagulantes/administração & dosagem , Argentina/epidemiologia , Canadá/epidemiologia , Relação Dose-Resposta a Droga , Ecocardiografia , Feminino , Átrios do Coração/fisiopatologia , Insuficiência Cardíaca Sistólica/complicações , Insuficiência Cardíaca Sistólica/tratamento farmacológico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/administração & dosagem , Taxa de Sobrevida/tendências , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: High blood pressure (BP) is commonly not diagnosed, and patients do not achieve target values when treated. Among 20,000 patients encompassing most races-ethnicities, we evaluated BP measurements and treatment response in a stroke prevention trial. Our goal was to identify BP measurement differences between clinical trial and patient determinations and among the racial-ethnic groups. MATERIALS AND METHODS: A total of 20,332 patients with ischemic stroke were randomized to receive antiplatelet treatment and 80 mg of telmisartan versus placebo. BP measurements were obtained at the first clinic visit and then 1 and 3 months later and every 6 months thereafter. One week after the first clinic visit, patients were requested to report a BP measurement obtained elsewhere. Measurements at the trial clinics were obtained with the same electronic device. Statistical analysis was used to detect significant differences. RESULTS: The mean patient age was 66 years; 36% were women, and race-ethnicity comprised 58% Whites, 33% Asian, 4.9% Hispanic, and 4% Black. Overall, 74% of patients were hypertensive. BP varied between the race-ethnicity groups, being highest in Hispanics (145/85) and lowest in Blacks (144/82). BP at visits clinic 1, nonclinic 1A, and clinic 2 were, respectively, 144/84, 137/80, and 139/81 mmHg, with the difference between visits 1-2 and visit 1A being significant. BPs were normal in 42% of the cases at visit 1A, and of these, only 44% were normal at visit 1 and 57.6% were normal on visit 2. Similar findings were noted for all race-ethnicity groups. CONCLUSION: BP values varied among race-ethnicities and showed differences between clinic and patient measurements. This finding questions the reliability of self-reported BP and has implications for BP management in daily clinical practice.