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Publications (10 of 13) Show all publications
Appelros, P., Farahmand, B., Terént, A. & Åsberg, S. (2017). To Treat or Not to Treat: Anticoagulants as Secondary Preventives to the Oldest Old With Atrial Fibrillation.. Stroke, 48(6), 1617-1623
Open this publication in new window or tab >>To Treat or Not to Treat: Anticoagulants as Secondary Preventives to the Oldest Old With Atrial Fibrillation.
2017 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 48, no 6, p. 1617-1623Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: Anticoagulant treatment is effective for preventing recurrent ischemic strokes in patients who have atrial fibrillation. This benefit is paid by a small increase of hemorrhages. Anticoagulant-related hemorrhages seem to increase with age, but there are few studies showing whether the benefits of treatment persist in old age.

METHODS: For this observational study, 4 different registers were used, among them Riksstroke, the Swedish Stroke Register. Patients who have had a recent ischemic stroke, were 80 to 100 years of age, and had atrial fibrillation, were included from 2006 through 2013. The patients were stratified into 3 age groups: 80 to 84, 85 to 89, and ≥90 years of age. Information on stroke severity, risk factors, drugs, and comorbidities was gathered from the registers. The patients were followed with respect to ischemic or hemorrhagic stroke, other hemorrhages, or death.

RESULTS: Of all 23 356 patients with atrial fibrillation, 6361 (27%) used anticoagulants after an ischemic stroke. Anticoagulant treatment was associated with less recurrent ischemic stroke in all age groups. Hemorrhages increased most in the ≥90-year age group, but this did not offset the overall beneficial effect of the anticoagulant. Apart from age, no other cardiovascular risk factor or comorbidity was identified that influenced the risk of anticoagulant-associated hemorrhage. Drugs other than anticoagulants did not influence the incidence of major hemorrhage.

CONCLUSIONS: Given the patient characteristics in this study, there is room for more patients to be treated with anticoagulants, without hemorrhages to prevail. In nonagenarians, hemorrhages increased somewhat more, but this did not affect the overall outcome in this age stratum.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2017
Keywords
aged, 80 and over, anticoagulants, atrial fibrillation, comorbidity, stroke
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-60887 (URN)10.1161/STROKEAHA.117.016902 (DOI)000401819300042 ()28487335 (PubMedID)2-s2.0-85019591496 (Scopus ID)
Available from: 2017-09-19 Created: 2017-09-19 Last updated: 2018-08-06Bibliographically approved
Bergh, C., Udumyan, R., Appelros, P., Fall, K. & Montgomery, S. (2016). Determinants in adolescence of stroke-related hospital stay duration in men: a national cohort study. Stroke, 47(9), 2416-2418
Open this publication in new window or tab >>Determinants in adolescence of stroke-related hospital stay duration in men: a national cohort study
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2016 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 47, no 9, p. 2416-2418Article in journal (Refereed) Published
Abstract [en]

Background and purpose: Physical and psychological characteristics in adolescence are associated with subsequent stroke risk. Our aim is to investigate their relevance to length of hospital stay and risk of second stroke.

Methods: Swedish men born between 1952 and 1956 (n=237 879) were followed from 1987 to 2010 using information from population-based national registers. Stress resilience, body mass index, cognitive function, physical fitness, and blood pressure were measured at compulsory military conscription examinations in late adolescence. Joint Cox proportional hazards models estimated the associations of these characteristics with long compared with short duration of stroke-related hospital stay and with second stroke compared with first.

Results: Some 3000 men were diagnosed with nonfatal stroke between ages 31 and 58 years. Low stress resilience, underweight, and higher systolic blood pressure (per 1-mm Hg increase) during adolescence were associated with longer hospital stay (compared with shorter) in ischemic stroke, with adjusted relative hazard ratios (and 95% confidence intervals) of 1.46 (1.08-1.89), 1.41 (1.04-1.91), and 1.01 (1.00-1.02), respectively. Elevated systolic and diastolic blood pressures during adolescence were associated with longer hospital stay in men with intracerebral hemorrhage: 1.01 (1.00-1.03) and 1.02 (1.00-1.04), respectively. Among both stroke types, obesity in adolescence conferred an increased risk of second stroke: 2.06 (1.21-3.45).

Conclusions: Some characteristics relevant to length of stroke-related hospital stay and risk of second stroke are already present in adolescence. Early lifestyle influences are of importance not only to stroke risk by middle age but also to recurrence and use of healthcare resources among stroke survivors.

Place, publisher, year, edition, pages
Philadelphia, USA: Lippincott Williams & Wilkins, 2016
Keywords
Adolescent, blood pressure, length of stay, psychological stress, risk factors
National Category
Cardiac and Cardiovascular Systems Neurology
Identifiers
urn:nbn:se:oru:diva-51591 (URN)10.1161/STROKEAHA.116.014265 (DOI)000383559300052 ()27491740 (PubMedID)2-s2.0-84982813061 (Scopus ID)
Note

Funding Agencies:

UK Economic and Social Research Council RES-596-28-0001  ES/JO19119/1

Stiftelsen Olle Engqvist Byggmästare

Folksam

Örebro University

Available from: 2016-08-08 Created: 2016-08-08 Last updated: 2018-07-20Bibliographically approved
Tavosian, A., Ström, J. O. & Appelros, P. (2016). Incidence of Transient ischemic Attacks in Sweden. Neuroepidemiology, 47(1), 20-25
Open this publication in new window or tab >>Incidence of Transient ischemic Attacks in Sweden
2016 (English)In: Neuroepidemiology, ISSN 0251-5350, E-ISSN 1423-0208, Vol. 47, no 1, p. 20-25Article in journal (Refereed) Published
Abstract [en]

Background and Purpose: Stroke incidence may be on the decline in high-income countries. There may have been a shift from severe forms of cerebrovascular disease to less severe forms. No study regarding transient ischemic attack (TIA) incidence has been performed in Sweden since the 1980s.

Methods: We used 2011 and 2012 data from the Swedish stroke register. A large proportion of Sweden's 72 hospitals took part in the TIA register, meaning that 63 (2011) and 66 (2012) percent of the entire population were studied.

Results: The number of TIA-cases was 13,880. The number of first ever TIA cases was 9098, 4,675 in men, and 4,423 in women, comprising 66% of all TIAs. The crude overall IR for first ever TIA was 74 per 100,000. The age- and sex-standardized IRs were 73 per 100,000 when standardized to the European population of 2013, and 47 per 100,000 when standardized to the European population 1976.

Conclusions: The TIA incidence in Sweden is high, and no decline is seen when compared with previous studies. Better prevention may have caused a shift from severe forms of cerebrovascular disease to less severe forms. Fordemographic reasons, the health services will most likely face an increasing number of TIA patients in the coming years.

Place, publisher, year, edition, pages
Basel: S. Karger, 2016
Keywords
Transient ischemic attack, Incidence, Epidemiology
National Category
Public Health, Global Health, Social Medicine and Epidemiology Neurology
Identifiers
urn:nbn:se:oru:diva-53021 (URN)10.1159/000447240 (DOI)000383315100004 ()27322728 (PubMedID)2-s2.0-84976272252 (Scopus ID)
Available from: 2016-10-18 Created: 2016-10-18 Last updated: 2018-07-17Bibliographically approved
Appelros, P. & Terent, A. (2015). Thrombolysis in acute stroke [Letter to the editor]. The Lancet, 385(9976), 1394-1394
Open this publication in new window or tab >>Thrombolysis in acute stroke
2015 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 385, no 9976, p. 1394-1394Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2015
National Category
General Practice
Research subject
Family Medicine
Identifiers
urn:nbn:se:oru:diva-44541 (URN)10.1016/S0140-6736(15)60715-2 (DOI)000352719800021 ()25890417 (PubMedID)
Available from: 2015-05-06 Created: 2015-05-06 Last updated: 2018-06-29Bibliographically approved
Bergh, C., Udumyan, R., Fall, K., Nilsagård, Y., Appelros, P. & Montgomery, S. (2014). Stress resilience in male adolescents and subsequent stroke risk: cohort study. Journal of Neurology, Neurosurgery and Psychiatry, 85(12), 1331-1336
Open this publication in new window or tab >>Stress resilience in male adolescents and subsequent stroke risk: cohort study
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2014 (English)In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 85, no 12, p. 1331-1336Article in journal (Refereed) Published
Abstract [en]

Objective Exposure to psychosocial stress has been identified as a possible stroke risk, but the role of stress resilience which may be relevant to chronic exposure is uncertain. We investigated the association of stress resilience in adolescence with subsequent stroke risk.

Methods Register-based cohort study. Some 237 879 males born between 1952 and 1956 were followed from 1987 to 2010 using information from Swedish registers. Cox regression estimated the association of stress resilience with stroke, after adjustment for established stroke risk factors.

Results Some 3411 diagnoses of first stroke were identified. Lowest stress resilience (21.8%) compared with the highest (23.7%) was associated with increased stroke risk, producing unadjusted HR (with 95% CIs) of 1.54 (1.40 to 1.70). The association attenuated slightly to 1.48 (1.34 to 1.63) after adjustment for markers of socioeconomic circumstances in childhood; and after further adjustment for markers of development and disease in adolescence (blood pressure, cognitive function and pre-existing cardiovascular disease) to 1.30 (1.18 to 1.45). The greatest reduction followed further adjustment for markers of physical fitness (BMI and physical working capacity) in adolescence to 1.16 (1.04 to 1.29). The results were consistent when stroke was subdivided into fatal, ischaemic and haemorrhagic, with higher magnitude associations for fatal rather than non-fatal, and for haemorrhagic rather than ischaemic stroke.

Conclusions Stress susceptibility and, therefore, psychosocial stress may be implicated in the aetiology of stroke. This association may be explained, in part, by poorer physical fitness. Effective prevention might focus on behaviour/lifestyle and psychosocial stress.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2014
Keywords
stroke
National Category
Neurology Psychiatry Surgery
Identifiers
urn:nbn:se:oru:diva-35058 (URN)10.1136/jnnp-2013-307485 (DOI)000345276400010 ()2-s2.0-84896691316 (Scopus ID)
Note

Funding Agency:

UK Economic and Social Research Council (ESRC) RES-596-28-0001 ES/J019119/1

Stiftelsen Olle Engqvist Byggmästare 

Örebro University 

Available from: 2014-05-15 Created: 2014-05-15 Last updated: 2018-08-29Bibliographically approved
Andersson, Å. G., Seiger, Å. & Appelros, P. (2013). Hip fractures in persons with stroke. Stroke Research and Treatment, 2013, Article ID 954279.
Open this publication in new window or tab >>Hip fractures in persons with stroke
2013 (English)In: Stroke Research and Treatment, ISSN 2090-8105, E-ISSN 2042-0056, Vol. 2013, article id 954279Article in journal (Refereed) Published
Abstract [en]

Background. Our aim was to determine the incidence of hip fractures within two years after stroke, to identify associated factors, to evaluate which test instruments that best could identify people at risk, and to describe the circumstances that prevailed when they sustained their hip fractures. Method. A total of 377 persons with first-ever stroke were followed up for a 24-month period. Stroke severity, cognition, and associated medical conditions were registered. The following test instruments were used: National Institutes of Health Stroke Scale, Mini-Mental State Examination, Berg Balance Scale, Timed Up & Go, and Stops Walking When Talking. Result. Sixteen of the persons fractured their hip within the study period, which corresponds to an incidence of 32 hip fractures per 1000 person-years. Persons with fractures more often had impaired vision and cognitive impairment and more had had previous fractures. Of the investigated test instruments, Timed Up & Go was the best test to predict fractures. Conclusion. The incidence of hip fractures in persons with stroke was high in this study. Persons with previous fractures, and visual and cognitive defects are at the greatest risk. Certain test instruments could be used in order to find people at risk, which should be targeted for fall preventive measures.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2013
National Category
Geriatrics Neurology
Identifiers
urn:nbn:se:oru:diva-56416 (URN)10.1155/2013/954279 (DOI)23691433 (PubMedID)
Available from: 2017-03-16 Created: 2017-03-16 Last updated: 2018-04-16Bibliographically approved
Andersson, Å. G., Kamwendo, K. & Appelros, P. (2008). Fear of falling in stroke patients: relationship with previous falls and functional characteristics. International Journal of Rehabilitation Research, 31(3), 261-264
Open this publication in new window or tab >>Fear of falling in stroke patients: relationship with previous falls and functional characteristics
2008 (English)In: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 31, no 3, p. 261-264Article in journal (Refereed) Published
Abstract [en]

The objectives of this study were to determine the relationship between fear of falling and functional characteristics of patients after stroke as well as to determine what characterizes fallers who score high fall-related self-efficacy, and nonfallers who score low fall-related self-efficacy. Patients (n=140) treated in a stroke unit during a 12-month period were included. On follow-up, fallers were identified and patients answered the questions in the Falls Efficacy Scale, Swedish version (FES-S). Assessments of motor capacity, functional mobility and balance were also made. In univariate analysis, low fall-related self-efficacy was significantly associated with increased age, female sex, earlier falls, visual and cognitive impairment, low mood and impaired physical function. In multivariate analysis, only earlier falls and physical function remained significant. Twenty percent of the patients scored low fall-related self-efficacy without having experienced a fall, and 11% who experienced a fall scored high fall-related self-efficacy. Impaired physical function was significantly associated with scoring low fall-related self-efficacy, for both fallers and nonfallers. Fear of falling is significantly associated with poor physical function and earlier falls. Falls Efficacy Scale, Swedish version could add useful information to a fall risk analysis. Patients scoring low fall-related self-efficacy should be offered fall prevention measures whether they have fallen or not.

National Category
Social Sciences Interdisciplinary Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-3400 (URN)10.1097/MRR.0b013e3282fba390 (DOI)18708851 (PubMedID)
Available from: 2008-12-04 Created: 2008-12-04 Last updated: 2018-04-16Bibliographically approved
Appelros, P., Stegmayr, B. & Terént, A. (2008). Riks-Stroke och hur fallgropar vid tolkning av resultaten undviks: rapport. Läkartidningen, 105(8), 529-533
Open this publication in new window or tab >>Riks-Stroke och hur fallgropar vid tolkning av resultaten undviks: rapport
2008 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 8, p. 529-533Article in journal (Other academic) Published
Abstract [en]

Riks-Stroke, the Swedish quality register for stroke care, has been in service for twelve years. The register gives a unique opportunity to compare treatment, care, and rehabilitation of stroke patients. The protocol has now been launched in its eighth version. The most important changes include that the register now also includes cases that are treated as outpatients. Also, a more robust measure of stroke severity, the National Institutes of Health Stroke Scale (NIHSS) has been included. All quality registers are sensitive for selection bias. Therefore, it is important to aim at as complete case ascertainment as possible, both at baseline and at the 3-month follow-up. To analyze the comparability of quality parameters between different time points, or between different hospitals, we suggest the use of certain “base factors”, for example age, stroke severity, and number of patients included at baseline and at follow-up.From 2007, with a more robust measure of stroke severity, we are offered an instrument that facilitates comparisons. By registering outpatients, selection bias from this cause is avoided. We will also learn if outpatients have a worse long time outcome. A possible future direction is that the quality of medical follow-up is evaluated within the frames of Riks-Stroke, for example life style factors and treatment of hypertension.

Keywords
Activities of Daily Living, Aged, Follow-Up Studies, Humans, Quality Assurance; Health Care, Registries, Severity of Illness Index, Stroke/diagnosis/mortality/rehabilitation, Sweden/epidemiology
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-3401 (URN)18363293 (PubMedID)
Available from: 2008-12-04 Created: 2008-12-04 Last updated: 2017-12-14Bibliographically approved
Appelros, P. & Andersson, A. G. (2006). Changes in mini mental state examination score after stroke: lacunar infarction predicts cognitive decline. European Journal of Neurology, 13(5), 491-495
Open this publication in new window or tab >>Changes in mini mental state examination score after stroke: lacunar infarction predicts cognitive decline
2006 (English)In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 13, no 5, p. 491-495Article in journal (Refereed) Published
Abstract [en]

Stroke and cognitive impairment are inter-related. The purpose of this study was to show the natural evolution of cognitive performance during the first year after a stroke, and to show which factors that predict cognitive decline. Subjects were patients with a first-ever stroke who were treated in a stroke unit. A total of 160 patients were included. At baseline patients were evaluated with regard to stroke type, stroke severity, pre-stroke dementia and other risk factors. Mini Mental State Examinations (MMSE) were performed after 1 week and after 1 year. Patients had a median increase of 1 point (range -8 to +9) on the MMSE. Thirty-two pre cent of the patients deteriorated, 13% were unchanged, and 55% improved. Lacunar infarction (LI) and left-sided stroke were associated with a failure to exhibit improvement. Patients with LI had an average decline of 1.7 points, whilst patients with other stroke types had an average increase of 1.8 points. Most stroke survivors improve cognitively during the first year after the event. The outcome for LI patients is worse, which suggests that LI may serve as a marker for concomitant processes that cause cognitive decline.

National Category
Medical and Health Sciences Geriatrics Neurology
Research subject
Geriatrics; Neurology
Identifiers
urn:nbn:se:oru:diva-11101 (URN)10.1111/j.1468-1331.2006.01299.x (DOI)16722974 (PubMedID)
Available from: 2010-06-16 Created: 2010-06-16 Last updated: 2017-12-12Bibliographically approved
Appelros, P. (2006). Heart failure and stroke. Stroke, 37(7), 1637-1637
Open this publication in new window or tab >>Heart failure and stroke
2006 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 37, no 7, p. 1637-1637Article in journal (Refereed) Published
National Category
Medical and Health Sciences Neurology Geriatrics
Research subject
Neurology; Geriatrics
Identifiers
urn:nbn:se:oru:diva-11097 (URN)10.1161/01.STR.0000227197.16951.2b (DOI)16741171 (PubMedID)
Available from: 2010-06-16 Created: 2010-06-16 Last updated: 2017-12-12Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-6504-9049

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