Long-term impact of urgent secondary prevention after transient ischemic attack and minor stroke: ten-year follow-up of the EXPRESS study
| العنوان: | Long-term impact of urgent secondary prevention after transient ischemic attack and minor stroke: ten-year follow-up of the EXPRESS study |
|---|---|
| المؤلفون: | Nicola C. Beddows, Peter M. Rothwell, Louise E. Silver, Ramon Luengo-Fernandez, Linxin Li, Sergei A. Gutnikov |
| المصدر: | Stroke |
| بيانات النشر: | AHA Journals, 2022. |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | Adult, Male, medicine.medical_specialty, Cost-Benefit Analysis, Original Contributions, Population, population, costs and cost analysis, maintenance, Stroke risk, Disability Evaluation, Clinical and Population Sciences, Quality of life, Recurrence, Secondary Prevention, Humans, Medicine, Transient (computer programming), Prospective Studies, education, Aged, Aged, 80 and over, Advanced and Specialized Nursing, Secondary prevention, education.field_of_study, business.industry, Minor stroke, Middle Aged, Term (time), Stroke, quality of life, Ischemic Attack, Transient, Emergency medicine, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, life expectancy, Life expectancy, Female, Quality-Adjusted Life Years, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Follow-Up Studies |
| الوصف: | Supplemental Digital Content is available in the text. Background and Purpose: Urgent assessment aimed at reducing stroke risk after transient ischemic attack or minor stroke is cost-effective over the short-term. However, it is unclear if the short-term impact is lost on long-term follow-up, with recurrent events being delayed rather than prevented. By 10-year follow-up of the EXPRESS study (Early Use of Existing Preventive Strategies for Stroke), previously showing urgent assessment reduced 90-day stroke risk by 80%, we determined whether that early benefit was still evident long-term for stroke risk, disability, and costs. Methods: EXPRESS was a prospective population-based before (phase 1: April 2002–September 2004; n=310) versus after (phase 2: October 2004–March 2007; n=281) study of the effect of early assessment and treatment of transient ischemic attack/minor stroke on early recurrent stroke risk, with an external control. This report assesses the effect on 10-year recurrent stroke risk, functional outcomes, quality-of-life, and costs. Results: A reduction in stroke risk in phase 2 was still evident at 10 years (55/23.3% versus 82/31.6%; hazard ratio=0.68 [95% CI, 0.48–0.95]; P=0.024), as was the impact on risk of disabling or fatal stroke (17/7.7% versus 32/13.1%; hazard ratio=0.54 [0.30–0.97]; P=0.036). These effects were due to maintenance of the early reduction in stroke risk, with neither additional benefit nor rebound catch-up after 90 days (post-90 days hazard ratio=0.88 [0.65–1.44], P=0.88; and hazard ratio=0.83 [0.42–1.65], P=0.59, respectively). Disability-free life expectancy was 0.59 (0.03–1.15; P=0.043) years higher in patients in phase 2, as was quality-adjusted life expectancy (0.49 [0.03–0.95]; P=0.036). Overall, 10-year costs were nonsignificantly higher in patients attending the phase 2 clinic ($1022 [-3865–5907]; P=0.66). The additional cost per quality-adjusted life year gained in phase 2 versus phase 1 was $2103, well below current cost-effectiveness thresholds. Conclusions: Urgent assessment and treatment of patients with transient ischemic attack or minor stroke resulted in a long-term reduction in recurrent strokes and improved outcomes, with little atrophy of the early benefit over time, representing good value for money even with a 10-year time horizon. Our results suggest that other effective acute treatments in transient ischemic attack/minor stroke in the short-term will also have the potential to have long-term benefit. |
| اللغة: | English |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c0229e67f200b2a16398a4266a2ec8ff https://ora.ox.ac.uk/objects/uuid:6a82b7bd-58da-44c6-b56b-777df7074c9d |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....c0229e67f200b2a16398a4266a2ec8ff |
| قاعدة البيانات: | OpenAIRE |
| الوصف غير متاح. |