Top

Published in:

01-12-2020 | Stroke | Research article

Increased recurrent risk did not improve cerebrovascular disease survivors’ response to stroke in China: a cross-sectional, community-based study

Authors: Shengde Li, Li-Ying Cui, Craig Anderson, Chunpeng Gao, Chengdong Yu, Guangliang Shan, Longde Wang, Bin Peng, on behalf of the FAST-RIGHT Investigators and Coordinators

Published in: BMC Neurology | Issue 1/2020

Abstract

Background

Cerebrovascular disease (CVD) survivors are at a high risk of recurrent stroke. Although it is thought that survivors with higher risk of stroke respond better to stroke onset, to date, no study has been able to demonstrate that. Thus, we investigated whether the intent to call emergency medical services (EMS) increased with recurrent stroke risk among CVD survivors.

Methods

A cross-sectional community-based survey was conducted from January 2017 to May 2017, including 187,723 adults (age ≥ 40 years) across 69 administrative areas in China. A CVD survivor population of 6290 was analyzed. According to the stroke risk score based on Essen Stroke Risk Score, CVD survivors were divided into three subgroups: low (0), middle (1–3) and high (4–7) recurrent risk groups. Multivariable logistic regression models were used to identify the association between the stroke risk and stroke recognition, as well as stroke risk and EMS calling.

Results

The estimated stroke recognition rate in CVD survivors with low, middle, and high risk was 89.0% (503/565), 85.2% (3841/4509), and 82.5% (1001/1213), respectively, while the rate of calling EMS was 66.7% (377/565), 64.3% (2897/4509), and 69.3% (840/1213), respectively. The CVD survivors’ knowledge of recognizing stroke and intent to call EMS did not improve with recurrent stroke risk, even after adjustment for multiple socio-demographic factors.

Conclusions

Despite being at a higher risk of recurrent stroke, Chinese CVD survivors showed poor knowledge of stroke, and their intent to call EMS did not increase with recurrent stroke risk. Enhanced and stroke risk-orientated education on stroke recognition and proper response is needed for all CVD survivors.

Available only for authorised users

Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet. 2014;383(9913):245–54.CrossRef

Liu M, Wu B, Wang WZ, Lee LM, Zhang SH, Kong LZ. Stroke in China: epidemiology, prevention, and management strategies. Lancet Neurol. 2007;6(5):456–64. https://doi.org/10.1016/S1474-4422(07)70004-2.CrossRefPubMed

Yang G, Wang Y, Zeng Y, Gao GF, Liang X, Zhou M, et al. Rapid health transition in China, 1990-2010: findings from the global burden of disease study 2010. Lancet. 2013;381(9882):1987–2015. https://doi.org/10.1016/S0140-6736(13)61097-1.CrossRefPubMedPubMedCentral

de Graaf JA, van Mierlo ML, Post MWM, Achterberg WP, Kappelle LJ, Visser-Meily JMA. Long-term restrictions in participation in stroke survivors under and over 70 years of age. Disabil Rehabil. 2018;40(6):637–45. https://doi.org/10.1080/09638288.2016.1271466.CrossRefPubMed

Wang Y, Liao X, Zhao X, Wang DZ, Wang C, Nguyen-Huynh MN, et al. Using recombinant tissue plasminogen activator to treat acute ischemic stroke in China: analysis of the results from the Chinese National Stroke Registry (CNSR). Stroke. 2011;42(6):1658–64. https://doi.org/10.1161/STROKEAHA.110.604249.CrossRefPubMed

Jin H, Zhu S, Wei JW, Wang J, Liu M, Wu Y, et al. Factors associated with prehospital delays in the presentation of acute stroke in urban China. Stroke. 2012;43(2):362–70. https://doi.org/10.1161/STROKEAHA.111.623512.CrossRefPubMed

Saver JL, Smith EE, Fonarow GC, Reeves MJ, Zhao X, Olson DM, et al. The “golden hour” and acute brain ischemia: presenting features and lytic therapy in >30,000 patients arriving within 60 minutes of stroke onset. Stroke. 2010;41(7):1431–9. https://doi.org/10.1161/STROKEAHA.110.583815.CrossRefPubMedPubMedCentral

Jiang B, Ru X, Sun H, Liu H, Sun D, Liu Y, et al. Pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China. Sci Rep. 2016;6:29795. https://doi.org/10.1038/srep29795.CrossRefPubMedPubMedCentral

Yin X, Yang T, Gong Y, Zhou Y, Li W, Song X, et al. Determinants of emergency medical services utilization among acute ischemic stroke patients in Hubei Province in China. Stroke. 2016;47(3):891–4. https://doi.org/10.1161/STROKEAHA.115.011877.CrossRefPubMed

10.

Amarenco P, Lavallee PC, Monteiro Tavares L, Labreuche J, Albers GW, Abboud H, et al. Five-year risk of stroke after TIA or minor ischemic stroke. N Engl J Med. 2018;378(23):2182–90. https://doi.org/10.1056/NEJMoa1802712.CrossRefPubMed

11.

Hankey GJ. Secondary stroke prevention. Lancet Neurol. 2014;13(2):178–94. https://doi.org/10.1016/S1474-4422(13)70255-2.CrossRefPubMed

12.

Luengo-Fernandez R, Gray AM, Rothwell PM, Oxford VS. A population-based study of hospital care costs during 5 years after transient ischemic attack and stroke. Stroke. 2012;43(12):3343–51. https://doi.org/10.1161/STROKEAHA.112.667204.CrossRefPubMedPubMedCentral

13.

Wang YL, Pan YS, Zhao XQ, Wang D, Johnston SC, Liu LP, et al. Recurrent stroke was associated with poor quality of life in patients with transient ischemic attack or minor stroke: finding from the CHANCE trial. CNS Neurosci Ther. 2014;20(12):1029–35. https://doi.org/10.1111/cns.12329.CrossRefPubMedPubMedCentral

14.

Pan L, Yang Z, Wu Y, Yin RX, Liao Y, Wang J, et al. The prevalence, awareness, treatment and control of dyslipidemia among adults in China. Atherosclerosis. 2016;248:2–9. https://doi.org/10.1016/j.atherosclerosis.2016.02.006.CrossRefPubMed

15.

Lu J, Lu Y, Wang X, Li X, Linderman GC, Wu C, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1.7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet. 2017;390(10112):2549–58. https://doi.org/10.1016/S0140-6736(17)32478-9.CrossRefPubMed

16.

Qin Y, Wang R, Ma X, Zhao Y, Lu J, Wu C, et al. Prevalence, awareness, treatment and control of diabetes mellitus-a population based study in Shanghai, China. Int J Environ Res Public Health. 2016;13:5. https://doi.org/10.3390/ijerph13050512.CrossRef

17.

Wang MD, Wang Y, Mao L, Xia YP, He QW, Lu ZX, et al. Acute stroke patients’ knowledge of stroke at discharge in China: a cross-sectional study. Tropical Med Int Health. 2018;23(11):1200–6. https://doi.org/10.1111/tmi.13148.CrossRef

18.

Li S, Cui LY, Anderson C, Zhu S, Xu P, Wei T, et al. Public awareness of stroke and the appropriate responses in China: a cross-sectional community-based study (FAST-RIGHT). Stroke. 2019;50:455–62. https://doi.org/10.1161/ST%20ROKEAHA.118.023317.CrossRefPubMed

19.

Longde W, Ling Y, Yang H, Yi Z, Yongjun W, Xunming J, et al. Fixed-dose combination treatment after stroke for secondary prevention in China: a national community-based study. Stroke. 2015;46(5):1295–300. https://doi.org/10.1161/STROKEAHA.114.007384.CrossRefPubMed

20.

National Center for Stroke Control and Prevention, National Health Commission. The China National Stroke Screening Survey Guidelines [online, in Chinese]. 2016, http://cnstroke.com/WebManage/InterveneProject/Index. (Accessed 28 May 2019).

21.

Harbison J, Hossain O, Jenkinson D, Davis J, Louw SJ, Ford GA. Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test. Stroke. 2003;34(1):71–6.CrossRef

22.

Meng X, Wang Y, Zhao X, Wang C, Li H, Liu L, et al. Validation of the Essen stroke risk score and the stroke prognosis instrument II in Chinese patients. Stroke. 2011;42(12):3619–20. https://doi.org/10.1161/STROKEAHA.111.624148.CrossRefPubMed

23.

Weimar C, Diener HC, Alberts MJ, Steg PG, Bhatt DL, Wilson PW, et al. The Essen stroke risk score predicts recurrent cardiovascular events: a validation within the REduction of Atherothrombosis for continued health (REACH) registry. Stroke. 2009;40(2):350–4. https://doi.org/10.1161/STROKEAHA.108.521419.CrossRefPubMed

24.

Yang J, Zheng M, Cheng S, Ou S, Zhang J, Wang N, et al. Knowledge of stroke symptoms and treatment among community residents in Western urban China. J Stroke Cerebrovasc Dis. 2014;23(5):1216–24. https://doi.org/10.1016/j.jstrokecere%20brovasdis.2013.10.019.CrossRefPubMed

25.

Fussman C, Rafferty AP, Lyon-Callo S, Morgenstern LB, Reeves MJ. Lack of association between stroke symptom knowledge and intent to call 911: a population-based survey. Stroke. 2010;41(7):1501–7. https://doi.org/10.1161/STROKEAHA.110.578195.CrossRefPubMed

26.

Miyamatsu N, Okamura T, Nakayama H, Toyoda K, Suzuki K, Toyota A, et al. Public awareness of early symptoms of stroke and information sources about stroke among the general Japanese population: the Acquisition of Stroke Knowledge Study. Cerebrovasc Dis. 2013;35(3):241–9. https://doi.org/10.1159/000347066.CrossRefPubMed

27.

Gu HQ, Rao ZZ, Yang X, Wang CJ, Zhao XQ, Wang YL, et al. Use of emergency medical services and timely treatment among ischemic stroke. Stroke. 2019;50(4):1013–6. https://doi.org/10.1161/STROKEAHA.118.024232.CrossRefPubMed

28.

O'Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016;388(10046):761–75. https://doi.org/10.1016/S0140-6736(16)30506-2.CrossRefPubMed

29.

Wei Y, Xu J, Wu H, Zhou G, Chen S, Wang C, et al. Survey of Antithrombotic Treatment in Rural Patients (>60 years) with Atrial Fibrillation in East China. Sci Rep. 2018;8(1):6830. https://doi.org/10.1038/s41598-018-24878-y.CrossRefPubMedPubMedCentral

30.

Yang F, Qian D, Chen J, Hu D, Hou M, Chen S, et al. Prevalence, awareness, treatment and control of diabetes mellitus in rural China: results from Shandong Province. Diabet Med. 2016;33(4):454–8. https://doi.org/10.1111/dme.12842.CrossRefPubMed

31.

Zhao Y, Yan H, Marshall RJ, Dang S, Yang R, Li Q, et al. Trends in population blood pressure and prevalence, awareness, treatment, and control of hypertension among middle-aged and older adults in a rural area of Northwest China from 1982 to 2010. PLoS One. 2013;8(4):e61779. https://doi.org/10.1371/journal.pone.0061779.CrossRefPubMedPubMedCentral

32.

Chen Z, Peto R, Zhou M, Iona A, Smith M, Yang L, et al. Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet. 2015;386(10002):1447–56. https://doi.org/10.1016/S0140-6736(15)00340-2.CrossRefPubMedPubMedCentral

33.

Fonarow GC, Smith EE, Saver JL, Reeves MJ, Bhatt DL, Grau-Sepulveda MV, et al. Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke: patient characteristics, hospital factors, and outcomes associated with door-to-needle times within 60 minutes. Circulation. 2011;123(7):750–8. https://doi.org/10.1161/CIRCULATIONAHA.110.974675.CrossRefPubMed

34.

Das K, Mondal GP, Dutta AK, Mukherjee B, Mukherjee BB. Awareness of warning symptoms and risk factors of stroke in the general population and in survivors stroke. J Clin Neurosci. 2007;14(1):12–6. https://doi.org/10.1016/j.jocn.2005.12.049.CrossRefPubMed

35.

Metias MM, Eisenberg N, Clemente MD, Wooster EM, Dueck AD, Wooster DL, et al. Public health campaigns and their effect on stroke knowledge in a high-risk urban population: a five-year study. Vascular. 2017;25(5):497–503. https://doi.org/10.1177/1708538117691879.CrossRefPubMed

36.

Fassbender K, Balucani C, Walter S, Levine SR, Haass A, Grotta J. Streamlining of prehospital stroke management: the golden hour. Lancet Neurol. 2013;12(6):585–96. https://doi.org/10.1016/S1474-4422(13)70100-5.CrossRefPubMed

37.

Wang W, Jiang B, Sun H, Ru X, Sun D, Wang L, et al. Prevalence, incidence, and mortality of stroke in China: results from a Nationwide population-based survey of 480 687 adults. Circulation. 2017;135(8):759–71. https://doi.org/10.1161/CIRCULATIONAHA.116.025250.CrossRefPubMed

38.

Liu Y, Jiang Y, Tang S, Qiu J, Zhong X, Wang Y. Analysis of the equity of emergency medical services: a cross-sectional survey in Chongqing city. Int J Equity Health. 2015;14:150. https://doi.org/10.1186/s12939-015-0282-8.CrossRefPubMedPubMedCentral

39.

Yan K, Jiang Y, Qiu J, Zhong X, Wang Y, Deng J, et al. The equity of China's emergency medical services from 2010–2014. Int J Equity Health. 2017;16(1):10. https://doi.org/10.1186/s12939-016-0507-5.CrossRefPubMedPubMedCentral

40.

Pan Y, Song T, Chen R, Li H, Zhao X, Liu L, et al. Socioeconomic deprivation and mortality in people after ischemic stroke: the China National Stroke Registry. Int J Stroke. 2016;11(5):557–64. https://doi.org/10.1177/1747493016641121.CrossRefPubMed

41.

Cha JK, Lim JH, Kim DH, Nah HW, Park HS, Choi JH, et al. Prognostic factors for long-term poor outcomes after acute ischemic stroke in very old age (>80 years) patients: Total cholesterol level might differently influence long-term outcomes after acute ischemic stroke at ages above 80 years. Geriatr Gerontol Int. 2015;15(11):1227–33. https://doi.org/10.1111/ggi.12419.CrossRefPubMed

42.

Kim YS, Park SS, Bae HJ, Heo JH, Kwon SU, Lee BC, et al. Public awareness of stroke in Korea: a population-based national survey. Stroke. 2012;43(4):1146–9. https://doi.org/10.1161/STROKEAHA.111.638460.CrossRefPubMed

43.

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early Management of Patients with Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–e110. https://doi.org/10.1161/STR.0000000000000158.CrossRefPubMed

Title: Increased recurrent risk did not improve cerebrovascular disease survivors’ response to stroke in China: a cross-sectional, community-based study
Authors: Shengde Li
Li-Ying Cui
Craig Anderson
Chunpeng Gao
Chengdong Yu
Guangliang Shan
Longde Wang
Bin Peng
on behalf of the FAST-RIGHT Investigators and Coordinators
Publication date: 01-12-2020
Publisher: BioMed Central
Keyword: Stroke
Published in: BMC Neurology / Issue 1/2020
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-020-01724-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Increased recurrent risk did not improve cerebrovascular disease survivors’ response to stroke in China: a cross-sectional, community-based study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

Early prediction of cerebral-cardiac syndrome after ischemic stroke: the PANSCAN scale

Extrastriatal 123I-FP-CIT SPECT impairment in Parkinson’s disease – the PPMI cohort

Daily acute intermittent hypoxia to improve walking function in persons with subacute spinal cord injury: a randomized clinical trial study protocol

Disseminated inflammation of the central nervous system associated with acute hepatitis E: a case report

Traumatic brain injury—the effects of patient age on treatment intensity and mortality

Autoimmune glial fibrillary acidic protein astrocytopathy manifesting as subacute meningoencephalitis with descending myelitis: a case report