Follow-up of people affected by cerebrovascular disease in a regional amazonic hospital: a WHO STEP Stroke methodology
DOI:
https://doi.org/10.11606/issn.2317-0190.v27i4a174718Keywords:
Stroke, Physical Functional Performance, Epidemiology, BrazilAbstract
The WHO STEP Stroke is a tool developed to monitor cases of cerebrovascular and allow comparison of its incidence throughout the world. Objective: To describe the sociodemographic profile and functionality of stroke inpatients admitted in Coari´s Regional Hospital and followed up one month after admittance. Method: This is a prospective, descriptive observational and follow-up study of cases between October 2010 and October 2011. In this study, we used the first step (Step 1) of the WHO STEP Stroke to assess stroke hospitalization in Coari-AM Twenty-three patients were monitored with a standard questionnaire up to two days after hospitalization, 10 days, and 28 after hospitalization. Results: The studied population had average age of 72.8 (SD= 12.4) years, mostly men (65.7%), brown (65.2%), and hypertensive (95.7%), with a hospital incidence of 30 cases for 100.000 people, and mortality in 10 days of 30.4% and 28 days of 34.8%. The neurological impairment at hospitalization had a median of 28 (IIQ= 15-38) points, with 73.9% classified as severe. There was an impairment in functionality among the survivors. Conclusion: This study showed the profile of hospital admittance for cerebrovascular disease in this city to be mainly composed by older men, brown, with no formal study, low income, and history of systemic arterial hypertension and diabetes. The hospital incidence for stroke was 30 (per 100.000) in Coari-AM, with severe neurological impairment at admission, with high mortality rates, and functional deficits 28 days after the event when compared to other regions in Brazil and in the world.
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References
Katan M, Luft A. Global Burden of Stroke. Semin Neurol. 2018;38(2):208-211. Doi: https://doi.org/10.1055/s-0038-1649503
Bensenor IM, Goulart AC, Szwarcwald CL, Vieira ML, Malta DC, Lotufo PA. Prevalence of stroke and associated disability in Brazil: National Health Survey--2013. Arq Neuropsiquiatr. 2015;73(9):746-50. Doi: https://doi.org/10.1590/0004-282X20150115
WHO. Disability: Report by the secretariat [text on the Internet]. Geneva: WHO; c2013 [cited 2020 Aug 12]. Available from: https://apps.who.int/gb/ebwha/pdf_files/EB132/B132_10-en.pdf
World Health Organization. The WHO STEPwise approach to stroke surveillance. Geneva: WHO; 2005.
Truelsen T, Bonita R, Jamrozik K. Surveillance of stroke: a global perspective. Int J Epidemiol. 2001;30 Suppl 1:S11-6. Doi: https://doi.org/10.1093/ije/30.suppl_1.s11
IBGE. Censo demográgico 2010 [texto na Internet]. Rio de Janeiro: IBGE; c2010 [citado 2020 Ago 12]. Disponível em: https://cidades.ibge.gov.br/brasil/am/coari/panorama
Fernandes TG, Benseñor IM, Goulart AC, Tavares BM, Alencar AP, Santos IS, et al. Stroke in the rain forest: prevalence in a ribeirinha community and an urban population in the Brazilian Amazon. Neuroepidemiology. 2014;42(4):235-42. Doi: https://doi.org/10.1159/000362210
Branco JP, Oliveira S, Sargento-Freitas J, Laíns J, Pinheiro J. Assessing functional recovery in the first six months after acute ischemic stroke: a prospective, observational study. Eur J Phys Rehabil Med. 2019;55(1):1-7. Doi: https://doi.org/10.23736/S1973-9087.18.05161-4
Musa KI, Keegan TJ. The change of Barthel Index scores from the time of discharge until 3-month post-discharge among acute stroke patients in Malaysia: A random intercept model. PLoS One. 2018;13(12):e0208594. Doi: https://doi.org/10.1371/journal.pone.0208594
Kelly-Hayes M, Beiser A, Kase CS, Scaramucci A, D'Agostino RB, Wolf PA. The influence of gender and age on disability following ischemic stroke: the Framingham study. J Stroke Cerebrovasc Dis. 2003;12(3):119-26. Doi: https://doi.org/10.1016/S1052-3057(03)00042-9
Longley V, Peters S, Swarbrick C, Rhodes S, Bowen A. Does pre-existing cognitive impairment impact on amount of stroke rehabilitation received? An observational cohort study. Clin Rehabil. 2019;33(9):1492-1502. Doi: https://doi.org/10.1177/0269215519843984
Meyer MJ, Pereira S, McClure A, Teasell R, Thind A, Koval J, et al. A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation. Disabil Rehabil. 2015;37(15):1316-23. Doi: https://doi.org/10.3109/09638288.2014.963706
Goulart AC, Bustos IR, Abe IM, Pereira AC, Fedeli LM, Benseñor IM, et al. A stepwise approach to stroke surveillance in Brazil: the EMMA (Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral) study. Int J Stroke. 2010;5(4):284-9. Doi: https://doi.org/10.1111/j.1747-4949.2010.00441.x
Trevisan CM, Marcon CLV, Cavalheiro BR, Melo LP, Campos TF. Aspectos clínicos relevantes de pacientes com acidente vascular cerebral na emergência hospitalar: implicações para o serviço público de saúde. Rev Ciênc Méd Biol. 2015;14(2):171-6. Doi: http://dx.doi.org/10.9771/cmbio.v14i2.13607
Costa FA, Silva DLA, Rocha VM. Severidade clínica e funcionalidade de pacientes hemiplégicos pós-AVC agudo atendidos nos serviços públicos de fisioterapia de Natal (RN). Cien Saude Colet. 2011;16 (S1):1341-8. Doi: https://doi.org/10.1590/S1413-81232011000700068
Costa FA, Silva DLA, Rocha VM. Estado neurológico e cognição de pacientes pós-acidente vascular cerebral. Rev Esc Enferm USP. 2011 Rev Esc Enferm USP. 2011;45(5):1083-8. Doi: https://doi.org/10.1590/S0080-62342011000500008
Amaral CHD, Amaral AR, Nagel V, Venancio V, Garcia AC, Magalhaes PS, et al. Incidence and functional outcome of atrial fibrillation and non-atrial fibrillation- related cardioembolic stroke in Joinville, Brazil: a population-based study. Arq Neuropsiquiatr. 2017;75(5):288-94. Doi: https://doi.org/10.1590/0004-282X20170039
Hanauer L, Schmidt D, Miranda RE, Borges MK. Comparação da severidade do déficit neurológico de pacientes com acidente vascular cerebral isquêmico agudo submetidos ou não à terapia trombolítica. Fisioter Pesq. 2018;25(2):217-23. Doi: https://doi.org/10.1590/1809-2950/18020425022018
Goulart AC, Bensenor IM, Fernandes TG, Alencar AP, Fedeli LM, Lotufo PA. Early and one-year stroke case fatality in Sao Paulo, Brazil: applying the World Health Organization's stroke STEPS. J Stroke Cerebrovasc Dis. 2012;21(8):832-8. Doi: https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.04.017
Machado JP, Martins ACM, Martins MS. Avaliação da qualidade do cuidado hospitalar no Brasil: uma revisão sistemática. Cad Saude Publica. 2013;29(6):1063-82. Doi: https://doi.org/10.1590/s0102-311x2013000600004
Lange MC, Cabral NL, Moro CH, Longo AL, Gonçalves AR, Zétola VF, Rundek T. Incidence and mortality of ischemic stroke subtypes in Joinville, Brazil: a population-based study. Arq Neuropsiquiatr. 2015;73(8):648-54. Doi: https://doi.org/10.1590/0004-282X20150081
StrokEDGE II Task Force. Final EDGE recommendations [text on the Internet]. Minneapolis: Academy of Neurologic Physical Therapy; c2018 [cited 2020 Aug 19]. Available from: https://www.neuropt.org/practice-resources/neurology-section-outcome-measures-recommendations/stroke
Campos TF, Dantas AATSG, Protásio de Melo L, Carvalho de Oliveira D. Grau neurológico e funcionalidade de pacientes crônicos com acidente vascular cerebral: Implicações para a prática clínica. Arq Ciênc Saúde. 2014;21(1):28-33.
Dantas AATSG, Torres SVS, Farias IMA, Sant’Ana SBCL, Campos TF. Rastreio cognitivo em pacientes com acidente vascular cerebral: um estudo transversal. J Bras Psiquiatr. 2014;63(2):98-103. Doi: https://doi.org/10.1590/0047-2085000000012
Yoshida HM, Lima FO, Fernandes PT. Habilidade motora e hemisfério cerebral em pacientes pós-AVC: existe relação? Rev Bras Neurol Psiquiatr. 2019;23(3):196-205.
Tseng MC, Chang KC. Stroke severity and early recovery after first-ever ischemic stroke: results of a hospital-based study in Taiwan. Health Policy. 2006;79(1):73-8. Doi: https://doi.org/10.1016/j.healthpol.2005.12.003
Dalal PM, Malik S, Bhattacharjee M, Trivedi ND, Vairale J, Bhat P, et al. Population-based stroke survey in Mumbai, India: incidence and 28-day case fatality. Neuroepidemiology. 2008;31(4):254-61. Doi: https://doi.org/10.1159/000165364
Cheng B, Forkert ND, Zavaglia M, Hilgetag CC, Golsari A, Siemonsen S, et al. Influence of stroke infarct location on functional outcome measured by the modified rankin scale. Stroke. 2014;45(6):1695-702. Doi: https://doi.org/10.1161/STROKEAHA.114.005152
Hedna VS, Bodhit AN, Ansari S, Falchook AD, Stead L, Heilman KM, et al. Hemispheric differences in ischemic stroke: is left-hemisphere stroke more common? J Clin Neurol. 2013;9(2):97-102. Doi: https://doi.org/10.3988/jcn.2013.9.2.97
Pedroso VSP, Brunoni AR, Vieira ÉLM, Jorge RE, Lauterbach EC, Teixeira AL. Early psychiatric morbidity in a Brazilian sample of acute ischemic stroke patients. Clinics (Sao Paulo). 2018;73:e55. Doi: https://doi.org/10.6061/clinics/2018/e055
Carod-Artal FJ, Medeiros MS, Horan TA, Braga LW. Predictive factors of functional gain in long-term stroke survivors admitted to a rehabilitation programme. Brain Inj. 2005;19(9):667-73. Doi: https://doi.org/10.1080/02699050400013626
Caro CC, Cruz DMC. Correlação entre independência funcional e cognição em homens com AVC. Rev Ter Ocup Univ São Paulo. 2017;28(2):173. Doi: https://doi.org/10.11606/issn.2238-6149.v28i2p173-180
Minelli C, Fen LF, Minelli DPC. Stroke incidence, prognosis, 30-day, and 1-year case fatality rates in Matão, Brazil: A population-based prospective study. Stroke. 2007;38(11):2906-11. Doi: https://doi.org/10.1161/STROKEAHA.107.484139
Cabral NL, Gonçalves AR, Longo AL, Moro CH, Costa G, Amaral CH, et al. Incidence of stroke subtypes, prognosis and prevalence of risk factors in Joinville, Brazil: a 2 year community based study. J Neurol Neurosurg Psychiatry. 2009;80(7):755-61. Doi: https://doi.org/10.1136/jnnp.2009.172098
Martins Jr AN, Figueiredo MM, Rocha OD, Fernandes MA, Jeronimo SM, Dourado Jr ME. Frequency of stroke types at an emergency hospital in Natal, Brazil. Arq Neuropsiquiatr. 2007;65(4B):1139-43. Doi: https://doi.org/10.1590/s0004-282x2007000700009
Carvalho JJ, Alves MB, Viana GÁ, Machado CB, Santos BF, Kanamura AH, et al. Stroke epidemiology, patterns of management, and outcomes in Fortaleza, Brazil: a hospital-based multicenter prospective study. Stroke. 2011;42(12):3341-6. Doi: https://doi.org/10.1161/STROKEAHA.111.626523
Fernandes TG, Goulart AC, Campos TF, Lucena NM, Freitas KL, Trevisan CM, et al. Early stroke case-fatality rates in three hospital registries in the Northeast and Southeast of Brazil. Arq Neuropsiquiatr. 2012;70(11):869-73. Doi: https://doi.org/10.1590/s0004-282x2012001100009
Macciocchi SN, Diamond PT, Alves WM, Mertz T. Ischemic stroke: relation of age, lesion location, and initial neurologic deficit to functional outcome. Arch Phys Med Rehabil. 1998;79(10):1255-7. Doi: https://doi.org/10.1016/s0003-9993(98)90271-4
Saposnik G, Hill MD, O'Donnell M, Fang J, Hachinski V, Kapral MK. Variables associated with 7-day, 30-day, and 1-year fatality after ischemic stroke. Stroke. 2008;39(8):2318-24. Doi: https://doi.org/10.1161/STROKEAHA.107.510362
Ogbu UC, Slobbe LC, Arah OA, Bruin A, Stronks K, Westert GP. Hospital stroke volume and case-fatality revisited. Med Care. 2010;48(2):149-56. Doi: https://doi.org/10.1097/MLR.0b013e3181bd4df1
Rolim CLRC, Martins M. Qualidade do cuidado ao acidente vascular cerebral isquêmico no SUS. Cad Saude Publica. 2011;27(11):2106-2116. Doi: https://doi.org/10.1590/s0102-311x2011001100004
Seenan P, Long M, Langhorne P. Stroke units in their natural habitat: systematic review of observational studies. Stroke. 2007;38(6):1886-92. Doi: https://doi.org/10.1161/STROKEAHA.106.480871
Meretoja A, Roine RO, Kaste M, Linna M, Roine S, Juntunen M, et al. Effectiveness of primary and comprehensive stroke centers: PERFECT stroke: a nationwide observational study from Finland. Stroke. 2010;41(6):1102-7. Doi: https://doi.org/10.1161/STROKEAHA.109.577718
Kurtz P, Bastos LS, Aguilar S, Hamacher S, Bozza FA. Effect of seasonal and temperature variation on hospitalizations for stroke over a 10-year period in Brazil. Int J Stroke. 2020:1747493020947333. Doi: https://doi.org/10.1177/1747493020947333
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Conselho Nacional de Desenvolvimento Científico e Tecnológico
Grant numbers Edital MCT/CNPq N º 14/2009 – Universal, processo nº 475439/2009-0
