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Disability Trajectories Before and After Stroke, MI

JAMA Neurol; ePub 2017 Oct 23; Dhamoon, et al

In a recent large, population-based study, a trajectory of increasing disability became significantly steeper after stroke but not after myocardial infarction (MI). In the population-based, prospective cohort Cardiovascular Health Study (1989-2013), longitudinal follow-up was conducted for a mean (SD) of 13 (6.2) years. Participants included 5,888 Medicare-eligible individuals aged ≥65 years who were not institutionalized, expected to reside in the area for ≥3 years, and able to provide informed consent. Exclusions were needing a wheelchair, receiving hospice care, and undergoing radiotherapy or chemotherapy. Researchers found:

  • During follow-up, 382 (6.5%) participants had ischemic stroke and 395 (6.7%) had MI with ≥1 disability assessment after the event.
  • There was a mean of 3.7 (2.4) visits before stroke and 3.7 (2.3) visits after stroke; there was a mean of 3.8 (2.5) visits before MI and 3.8 (2.4) visits after MI.
  • The increase in disability near the time of the event was greater for stroke than MI.
  • The annual increase in disability before stroke more than tripled after stroke.
  • The annual increase in disability before MI did not change significantly after MI.
Citation:

Dhamoon MS, Longstreth Jr. WT, Bartz TM, Kaplan RC, Elkind MSV. Disability trajectories before and after stroke and myocardial infarction. The Cardiovascular Health Study. [Published online ahead of print October 23, 2017]. JAMA Neurol. doi:10.1001/jamaneurol.2017.2802.

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