Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Factors associated with in-hospital case fatality following spontaneous intracerebral hemorrhage among young ghanaians: findings from a hospital-based stroke registry","authors":"Priscilla Abrafi Opare-Addo MD, MSCR ,&nbsp;Fred Stephen Sarfo MD, PhD, PhD ,&nbsp;Minas Aikins MD ,&nbsp;Serwaa Asare-Bediako MD ,&nbsp;Adwoa Agyemang Adu-Gyamfi MD ,&nbsp;Nessya Taylor MD ,&nbsp;Emmanuella Naa Ayerki Nartey MD ,&nbsp;Maxwell Nyenaah BSc ,&nbsp;Jessey Mahama Holu BSc ,&nbsp;Samuel Kekeli MPhil ,&nbsp;Christian Obirikorang PhD ,&nbsp;Francis Agyemang-Yeboah PhD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108568","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108568","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of spontaneous Intracerebral Hemorrhage (sICH) in Low-Middle-Income Countries (LMICs) has risen steeply over the past decade, with a relatively earlier age of onset and higher rates of adverse outcomes compared to the rest of the world.</div></div><div><h3>Aim</h3><div>To determine the factors associated with in-hospital case fatality among patients aged ≤ 50 years with spontaneous Intracerebral Hemorrhage, admitted to a Ghanaian tertiary Hospital.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study among individuals aged 18-50 years admitted with Intracerebral Hemorrhage to Komfo Anokye Teaching Hospital over 2 years, from 2022 to 2023. Multivariable Logistic regression was performed to determine the factors associated with ICH-related case fatality during hospital admission. Survival was compared across categories of explanatory variables using the Kaplan-Meier curve. Predictors of time to death were identified using the Cox regression model.</div></div><div><h3>Results</h3><div>46.2% (190 out of 411) of all ICH cases were aged ≤ 50 years, with the majority (63.7%) of those affected in this age group being male. The overall case fatality rate among hospitalized patients in this age group was 27.4% (52 out of 190). The factors independently associated with in-hospital case fatality were the presence of aspiration pneumonia (aOR 6.00 (2.47-15.46), p=0.000), NIHSS score at the time of admission (aOR 1.16 (1.08-1.24), p=0.000), and the presence of neuroimaging features of raised intracranial pressure (aOR 2.66 (1.04-7.00), p=0.044). Independent predictors of time to death included the presence of aspiration pneumonia (aOR 3.51 (1.44-8.55), p=0.004) and NIHSS score (aOR 1.07 (1.01-1.13), p=1.27e-08).</div></div><div><h3>Conclusions</h3><div>Up to 1 in 4 young Ghanaian patients succumb to spontaneous ICH during hospitalization. Prevention, prompt detection, and management of complications, notably aspiration pneumonia during the acute phase of admission, may significantly reduce ICH-related mortality among young individuals in our setting.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108568"},"PeriodicalIF":1.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early insights from a multi-centre national stroke surveillance initiative in Tanzania","authors":"Sarah Shali Matuja ,&nbsp;Azan Nyundo ,&nbsp;Emmanuel Assey ,&nbsp;Joel Bwelemo ,&nbsp;Marieke Dekker ,&nbsp;Sarah Urasa ,&nbsp;Emanuel Makarius ,&nbsp;Peter Kishimbo ,&nbsp;Yudathadei Baltazar ,&nbsp;Baraka Alphonce ,&nbsp;Joshua Ngimbwa ,&nbsp;Philip Adebayo ,&nbsp;Sipora Siha ,&nbsp;Anney Chagula ,&nbsp;Mary Libena ,&nbsp;Theresia Lutufyo ,&nbsp;Mohamed A Mnacho ,&nbsp;Faraja S Chiwanga ,&nbsp;Kigocha Okeng’o ,&nbsp;Brighton Mushengezi ,&nbsp;William Matuja","doi":"10.1016/j.jstrokecerebrovasdis.2026.108571","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108571","url":null,"abstract":"<div><h3>Background</h3><div>Stroke is a leading cause of death and disability globally, with sub-Saharan Africa, bearing the greatest burden. Tanzania has only one active stroke registry, limiting evidence-based care and policy development. We aimed to expand the registry into a multi-centre study across eight major tertiary hospitals to generate baseline data for a national stroke registry.</div></div><div><h3>Methods</h3><div>From January to August 2024, we analysed de-identified data from adults (≥18 years) admitted with a World Health Organisation defined stroke. Data collected included demographics, risk factors, imaging, and in-hospital mortality. Logistic regression identified predictors of mortality.</div></div><div><h3>Results</h3><div>A total of 1000 patients were registered with a mean age 60.2±15 years and 56.2% (562/1000) were females. Most strokes occurred in those aged 50-69 years 46.3% (463/1000). Hypertension was the most common risk factor 90.1% (901/1000), followed by diabetes 13.1% (131/1000), prior stroke 10.6% (106/1000) and HIV infection 3.5% (35/1000). Haemorrhagic and ischaemic strokes accounted for 57.9% (579/1000) and 38.3% (383/1000) of cases, respectively; and 5% (19/383) of ischaemic strokes presented within 4.5 h from symptom onset. In-hospital mortality was 31.5% (315/1000), highest among patients aged 50–59 years (23.2%). Independent predictors of mortality included previous cardiac disease (aOR 2.15; 95% CI: 1.18–3.94) and haemorrhagic stroke (aOR 1.38; 95% CI: 1.12–2.02).</div></div><div><h3>Conclusions</h3><div>Stroke imposes a high burden in Tanzania, with substantial mortality and delayed presentation. Strengthening hypertension control, early stroke recognition, and organized stroke unit care are critical priorities. These findings provide foundational data for the national stroke surveillance initiative and support evidence-based planning for stroke prevention, acute care, and system readiness across Tanzania.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108571"},"PeriodicalIF":1.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of health outcomes of stroke survivors in Africa: A systematic review and meta-analysis","authors":"Marufat Odetunde PhD ,&nbsp;Tadesse Gebrye MSc, MPH ,&nbsp;Chidozie Mbada PhD ,&nbsp;Faatihah Niyi-Odumosu PhD ,&nbsp;Francis Fatoye PhD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108569","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108569","url":null,"abstract":"<div><h3>Background</h3><div>Understanding the determinants of stroke prognosis and outcomes is crucial for guiding treatment decisions and recovery expectations. This systematic review aimed to synthesise the key determinants of health outcomes for stroke survivors (SSVs) in low- and middle-income countries (LMICs), with a particular focus on Africa.</div></div><div><h3>Methods</h3><div>This review adhered to the PRISMA guidelines and was registered on PROSPERO (CRD42025629244). Literature search was conducted using EBSCOhost, Scopus, and Web of Science databases for studies published from inception to April 14, 2025. Original researches on SSVs in Africa were included. Methodological quality was assessed using the Newcastle–Ottawa Scale. Data was analysed using a narrative synthesis and summarised in tables and texts. A random-effects meta-analysis was conducted to quantitatively synthesise the findings from the included reviews.</div></div><div><h3>Results</h3><div>The literature search identified 979 articles published between October 1987 and April 2025. Of these, 52 studies conducted in seven African countries met the inclusion criteria. Clinical determinants were reported in 40 studies, while 12 studies assessed psychosocial factors. Risks of bias were classified as low in 47 of the studies and moderate in the remaining five. The key clinical determinants of health outcomes were stroke severity/neurological status (<em>n</em> = 19), biomarkers and blood parameters (<em>n</em> = 18), and abnormal radiological/imaging findings (<em>n</em> = 10). The psychosocial determinants were mental health and emotional well-being, especially from social support (<em>n</em> = 6) and quality-of-life domains (<em>n</em> = 5). The overall pooled estimates of clinical risk factors among SSVs indicated a statistically significant association, with an odds ratio (OR) of 1.446 (95% CI: 1.202-1.739, <em>P</em> &lt; 0.001) based on 11 studies.</div></div><div><h3>Conclusion</h3><div>The determinants of health outcomes among SSVs in Africa are multifactorial. The significance of these findings highlights the critical importance of comprehensive management approaches that target key factors to enhance health outcomes and reduce the burden of stroke in Africa.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108569"},"PeriodicalIF":1.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor - Effectiveness of perception–interaction-enhanced rehabilitation in post-stroke recovery: A real-world propensity-matched cohort study","authors":"Tamanna Sharma BPT, MPT,&nbsp;Mandeep Kumar Jangra BPT, MPT, PhD,&nbsp;Akanksha Saxena BPT, MPT, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108566","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108566","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108566"},"PeriodicalIF":1.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial and spatiotemporal pattern of stroke relative risk in Ghana using Bayesian modelling approach","authors":"Abdul-Karim Iddrisu ,&nbsp;Sampson Appiah Takyi ,&nbsp;Joyseline Owusu Afriyie ,&nbsp;Abubakar Siddick","doi":"10.1016/j.jstrokecerebrovasdis.2026.108567","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108567","url":null,"abstract":"<div><h3>Introduction</h3><div>Stroke ranks as the second-leading cause of death and third in combined death and disability globally. In Ghana, there is a significant incidence of stroke, yet systematic reviews highlight a lack of comprehensive data on stroke in Sub-Saharan Africa, including Ghana. Additionally, information on the spatial and spatiotemporal distribution of stroke risk across Ghana's 16 regions remains limited. The objective of this study was to study the spatial and spatiotemporal distribution of stroke relative risk, identify regions with high-risk regions and associated predictors.</div></div><div><h3>Material and Methods</h3><div>Stroke risk for each region was estimated using Bayesian spatial and spatiotemporal models, and these risks were mapped to visualize areas with elevated stroke relative risk. The Random Forest and Gradient Boosting models, nonparametric ensemble machine learning algorithms, were used to investigate the effects of potential predictors on stroke risk. The study utilized annual stroke data from 2018 to 2022 obtained from the Ghana Health Service (GHS) via the District Health Information Management System version 2 (DHIMS2) and utilized parameter estimates within the Integrated Nested Laplace Approximation via R software version 4.3.2.</div></div><div><h3>Results</h3><div>Stroke relative risk decreases significantly over the study period. Some regions exhibited elevated risk, where the spatial model identified Volta, Central, Eastern, Bono, Upper East, Bono East, and Oti as high-risk regions, while the spatiotemporal model pinpointed Eastern, Ahafo, Bono East, Upper West, Savannah, Bono, and Western as high-risk regions. Clustering and variability in stroke risk were observed among regions. The study highlighted that gross national income significantly decreases the risk of stroke occurrence. While temperature and diabetes prevalence showed increased stroke risk, they were not statistically significant.</div></div><div><h3>Conclusion</h3><div>This study offers valuable insights that can inform resource allocation to regions experiencing elevated stroke risk. Identified high-risk regions can inform targeted screening strategies, referral pathway strengthening, and resource prioritization. Diagnostic capacity (including CT/MRI access), health-facility reporting quality, and surveillance system upgrades needed to reduce measurement bias and improve case ascertainment. Furthermore, we situate the findings within Ghana’s existing noncommunicable disease (NCD) policy frameworks and describe how routine updates of the model using new DHIMS2 data can support ongoing decision-making.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108567"},"PeriodicalIF":1.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning architectures for modeling and forecasting stroke cases in Ghana","authors":"Abdul-Karim Iddrisu ,&nbsp;Morongwa Gabanakgosi ,&nbsp;Abubakar Hudu Siddick","doi":"10.1016/j.jstrokecerebrovasdis.2026.108570","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108570","url":null,"abstract":"<div><h3>Introduction</h3><div>Stroke remains a leading cause of global morbidity and mortality, ranking second in deaths and third in disability-adjusted life years (DALYs). Its burden is particularly severe in low- and middle-income countries such as Ghana, where stroke is currently the leading cause of death. However, local data and predictive modeling remain limited, hindering effective health planning and intervention. This study aimed to model and forecast stroke incidence in Ghana using advanced deep learning techniques to support data-driven public health strategies.</div></div><div><h3>Material and Methods</h3><div>Monthly stroke case data from 2018 to 2023 were obtained from Ghana Health Service. Four deep learning models; Long Short-Term Memory (LSTM), Bayesian LSTM (BLSTM), Convolutional LSTM (ConvLSTM), and Bayesian ConvLSTM (BConvLSTM), were employed to capture spatiotemporal patterns in stroke incidence. Diabetes prevalence was included as a covariate. Model performance was evaluated using mean absolute error (MAE), mean square error (MSE), root mean square error (RMSE), and mean absolute percentage error (MAPE). Data analyses were carried out using python version 3.13.7 and R version software.</div></div><div><h3>Results</h3><div>LSTM and BLSTM models showed strong forecasting performance, with LSTM yielding the lowest errors. ConvLSTM and BConvLSTM models underperformed significantly. Forecasts from 2024 to 2028 reveal initial variability in 2024, with monthly cases between 1,694 and 2,007, followed by gradual stabilization through 2028, where values converge between 1,774 and 1,781.</div></div><div><h3>Conclusion</h3><div>The study highlights a persistently high but stabilizing stroke burden in Ghana. It underscores the urgent need for targeted interventions addressing modifiable risk factors, particularly diabetes, and supports LSTM as the most effective model for forecasting in this context.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108570"},"PeriodicalIF":1.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of diabetes and hyperglycemia on acute stroke outcomes in a semi urban setting in Cameroon: Results of the Buea Stroke Study, Cameroon","authors":"Clovis Nkoke MD ,&nbsp;Cyrille Nkouonlack MD ,&nbsp;Ahmadou Musa Jingi MD ,&nbsp;Jean Jacques Noubiap MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108565","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108565","url":null,"abstract":"<div><h3>Background</h3><div>Data on the impact of diabetes mellitus and hyperglycemia on acute stroke outcomes are inconsistent. This study aimed to assess the prognostic impact of diabetes mellitus and admission hyperglycemia on in-hospital stroke outcomes in a semi-urban setting in Cameroon.</div></div><div><h3>Methods</h3><div>We included patients aged ≥18 years hospitalized for acute stroke at the Buea Regional Hospital, Southwest Region of Cameroon, from January 2021 to August 2023. Multivariable logistic regression analysis was used to assess the impact of known diabetes mellitus and admission hyperglycemia on in-hospital functional outcome, infections, length of hospital stay, and mortality. Risk estimates are presented as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). A p value of &lt;0.05 was considered significant.</div></div><div><h3>Results</h3><div>Out of the 369 patients recruited, 99 (26.8%) had diabetes. Of the 267 patients with blood glucose on admission, 81 (30.3%) had hyperglycemia. Patients with diabetes mellitus were significantly older (65.1 vs 61.1 years; p=0.03), had a higher prevalence of hypertension (84.9% vs 66.7%; p=0.001) and more commonly had ischemic stroke (85.9% vs 68.2%; p=0.001). In multivariable logistic regression analysis, diabetes mellitus was significantly associated with prolonged hospital stay (aOR= 2.20; 95% CI1.19-4.06; p=0.01) and infections (aOR= 2.36, 95% CI1.14-4.87; p=0.02) but not with in-hospital mortality and functional outcome. Admission hyperglycemia was not associated with any of the outcomes.</div></div><div><h3>Conclusion</h3><div>In this cohort of patients in a resource limited setting, diabetes mellitus was associated with longer hospital stay and more frequent infections but not mortality nor poor functional outcome after an acute stroke. Admission hyperglycemia was not associated with poor outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108565"},"PeriodicalIF":1.8,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synergistic impacts of physical activity and sleep on risk of dementia and all-cause mortality in chinese older stroke survivors","authors":"Jiawen Wei,&nbsp;Yan Shen","doi":"10.1016/j.jstrokecerebrovasdis.2026.108547","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108547","url":null,"abstract":"<div><h3>Background</h3><div>Physical activity (PA) and sleep reduce the risk of dementia and mortality, but evidence among older stroke survivors in China is limited.</div></div><div><h3>Objective</h3><div>To investigate the impact of PA on dementia and all-cause mortality risks in this population and analyze its joint effect with sleep.</div></div><div><h3>Methods</h3><div>Utilizing data from the CLHLS, we analyzed the correlation of PA with dementia and mortality in elderly stroke survivors and explored the mediating role of dementia in the PA–mortality relationship. Joint variables of PA and sleep were constructed to assess their combined effects on dementia and mortality.</div></div><div><h3>Results</h3><div>Older stroke survivors engaging in regular PA had a 38% reduced risk of dementia (OR=0.62, 95% CI: 0.56-0.69, <em>P</em>&lt;0.001) and a 44% lower risk of mortality (HR=0.56, 95% CI: 0.52-0.59, <em>P</em>&lt;0.001). Additional protective factors against dementia included pet ownership, social activity, and reading, whereas television viewing and radio listening were linked to an increased risk of dementia. Raising domestic animals/pets, participating in outdoor activities, and performing housework were associated with a lower mortality risk (<em>P</em>&lt;0.05). Dementia mediated 5.9% of PA–mortality risk relationship. The joint analysis highlighted that coupling regular PA with sleep exceeding 9 h was associated with a 42% decrease in dementia risk, whereas pairing it with 9 h or less of sleep yielded a 60% decrease in mortality risk.</div></div><div><h3>Conclusion</h3><div>For elderly stroke survivors, PA confers protective effects against both dementia and all-cause mortality. This association is partially mediated by the reduced risk of dementia. Furthermore, the beneficial impact of regular PA on these outcomes is moderated by sleep duration, underscoring the necessity of a joint consideration of both factors in prognostic assessments.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108547"},"PeriodicalIF":1.8,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aspirin-ticagrelor use after mild acute ischemic stroke: Findings from the get with the guidelines-stroke registry","authors":"Ava L. Liberman MD ,&nbsp;Cenai Zhang BS ,&nbsp;Sara K. Rostanski MD ,&nbsp;Hooman Kamel MD MS ,&nbsp;Babak B. Navi MD MS ,&nbsp;Natalie T. Cheng MD ,&nbsp;Radhika Sundararajan MD PhD ,&nbsp;Steven R. Messe MD ,&nbsp;Gregg C. Fonarow MD ,&nbsp;Shyam Prabhakaran MD MS ,&nbsp;Ying Xian MD PhD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108564","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108564","url":null,"abstract":"<div><h3>Background</h3><div>Recent guidelines suggest that aspirin-ticagrelor may be considered for stroke prevention after mild acute ischemic stroke. However, it is unclear how commonly this dual antiplatelet therapy (DAPT) regimen is used in practice.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional analysis of the Get With The Guidelines-Stroke registry 2017-2023. Patients with a non-cardioembolic mild ischemic stroke (defined as NIHSS &lt;6) who presented within 24 hours of last known well without a contraindication to DAPT were included. The primary study outcome was the proportion of patients prescribed aspirin-ticagrelor at hospital discharge; temporal patterns of prescribing aspirin-ticagrelor and aspirin-clopidogrel over time are also described. In addition to standard tests of comparison, we used multiple logistic regression to evaluate associations between patient and facility factors and aspirin-ticagrelor use reported as odds ratios (OR) with 95% confidence intervals (CI).</div></div><div><h3>Results</h3><div>Among 1,018,736 patients meeting study criteria, 478,049 (46.9%) were female and median age was 68 (IQR: 59, 78) years. A total of 12,845 (1.3%) patients were discharged on aspirin-ticagrelor whereas 448,348 (44.0%) were discharged on aspirin-clopidogrel. Prescriptions for aspirin-ticagrelor and for aspirin-clopidogrel significantly increased over the study time-period. In regression analysis, coronary artery disease/prior myocardial infarction (OR: 2.6 [95% CI: 2.5-2.7]), Asian race (OR: 2.1 [95% CI: 1.9-2.2]), aspirin-clopidogrel prescription upon admission (OR: 2.0 [95% CI:1.9-2.1]), and history of stroke/TIA (OR: 1.98 [95% CI: (1.9-2.1)]), were substantially associated with aspirin-ticagrelor use whereas lacking insurance/self-pay (OR: 0.7 [95% CI: 0.6-0.8]), rural setting (OR: 0.8 [95% 0.7-0.9]), and primary stroke centers (OR: 0.3 [95% CI: 0.3-0.4]) were inversely associated with aspirin-ticagrelor. In the subgroup of 176,897 (17.4%) patients with NIHSS 4-5, 74,912 (50.8%) were discharged on aspirin-clopidogrel and 2,394 (1.4%) on aspirin-ticagrelor.</div></div><div><h3>Conclusion</h3><div>Unlike aspirin-clopidogrel, aspirin-ticagrelor is infrequently administered after mild acute ischemic stroke (NIHSS &lt;6) despite current guidelines, though the use of both DAPT regimens increased over time.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108564"},"PeriodicalIF":1.8,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protective association of higher frequency physical exercise with all-cause mortality risk in stroke patients: evidence from the health and retirement study","authors":"Jingtao Du ,&nbsp;Xiaofeng Jiang ,&nbsp;Binghua Shao ,&nbsp;Liu Zhenshun ,&nbsp;Liu Tianyu ,&nbsp;Jianwei Wu","doi":"10.1016/j.jstrokecerebrovasdis.2026.108563","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108563","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the association between the different exercise frequency in daily life and all-cause mortality risk of the patients after stroke, and to analyze their dose-response relationship.</div></div><div><h3>Methods</h3><div>1,639 participants with stroke were selected from Health and Retirement Study (HRS) database. Based on physical exercise frequency questionnaires, participants were categorized into five groups: sedentary (n=152), low (n=276), moderate (n=212), high (n=205), and vigorous (n=794). Multivariate Cox proportional hazards regression models and survival analyses were applied to examine the associations between exercise frequency and all-cause mortality risk in stroke patients.</div></div><div><h3>Results</h3><div>Median follow-up time revealed that both median survival time and interquartile range increased progressively with higher exercise frequency. Multivariate Cox regression analysis demonstrated a significant dose-response relationship: Compared to the sedentary group, moderate, high, and vigorous exercise groups exhibited significantly reduced death risks of 28%, 35%, and 42%, respectively. Exercise score showed a significant negative correlation with mortality rate (r=-0.855). Kaplan-Meier survival analysis revealed significant divergence in survival curves among different exercise frequency groups (log-rank P&lt;0.001), with the vigorous exercise group demonstrating the highest cumulative survival rate. Age-stratified analysis indicated that patients aged ≤65 years had the most favorable survival prognosis, while survival rates significantly decreased with advancing age (log-rank P&lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Higher frequency physical exercise manifested a protective association with reduced all-cause mortality risk in stroke patients, with a clear dose-response relationship. These findings support incorporating regular moderate-to-high-frequency exercise into daily life to reduce the hazards of stroke and improve long-term prognosis.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108563"},"PeriodicalIF":1.8,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}