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Disability & Cognition After MI & Stroke

Disability & Cognition After MI & Stroke
Author Information (click to view)

Deborah A. Levine, MD, MPH

Assistant Professor of Internal Medicine
Division of General Medicine
University of Michigan Stroke Program
University of Michigan Medical School
Researcher
Ann Arbor VA Center for Clinical Management Research

Deborah A. Levine, MD, MPH, has indicated to Physician’s Weekly that she has worked as a consultant on the Study to Prevent Major Vascular Events with Ticagrelor Compared to Aspirin in Patients with Acute Ischemic Stroke or TIA (SOCRATES) trial (AstraZeneca; Johnston SC, PI) as an event adjudicator. She has also served as an event adjudicator on the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) Trial, a randomized, double-blind, multi-center clinical trial (NINDS 1U01S062835-01A1; Johnston SC/Easton JD, Multiple PIs).In addition, she has received grants/research aid from the NIH, the University of Michigan and the Ann Arbor VA Health Services Research and Development Service.

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Deborah A. Levine, MD, MPH (click to view)

Deborah A. Levine, MD, MPH

Assistant Professor of Internal Medicine
Division of General Medicine
University of Michigan Stroke Program
University of Michigan Medical School
Researcher
Ann Arbor VA Center for Clinical Management Research

Deborah A. Levine, MD, MPH, has indicated to Physician’s Weekly that she has worked as a consultant on the Study to Prevent Major Vascular Events with Ticagrelor Compared to Aspirin in Patients with Acute Ischemic Stroke or TIA (SOCRATES) trial (AstraZeneca; Johnston SC, PI) as an event adjudicator. She has also served as an event adjudicator on the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) Trial, a randomized, double-blind, multi-center clinical trial (NINDS 1U01S062835-01A1; Johnston SC/Easton JD, Multiple PIs).In addition, she has received grants/research aid from the NIH, the University of Michigan and the Ann Arbor VA Health Services Research and Development Service.

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“MI and stroke survivors should be screened and monitored for functional disability long after they’re discharged from the hospital.” — Deborah A. Levine, MD, MPH
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Recent estimates show that there are approximately 7.6 million myocardial infarction (MI) survivors and 6.8 million stroke survivors living in the United States. These rates are expected to increase by 25% over the next two decades as treatments continue to advance and as the U.S. population lives longer. “MI and strokes are two of the most common healthcare events that Americans survive, but most studies that look at outcomes for these patients focus on short-term data rather than long-term consequences,” says Deborah A. Levine, MD, MPH.

Assessing Post-Event Outcomes

In a study published in Circulation: Cardiovascular Quality & Outcomes, Dr. Levine and colleagues looked at acute and long-term effects of MI and stroke on post-event functional disability and cognition while controlling for changes in functioning over a period of years before the event. The authors analyzed Medicare records from 1998-2010 and data from the Health and Retirement study, a national survey of older Americans. The study included 391 MI survivors and 370 stroke survivors.

Results of the study showed that MI and stroke survivors experienced a rapid decline in the physical ability to care for themselves over the next 10 years. Many required long-term assistance for daily activities like dressing, bathing, grocery shopping, and managing finances. “Over time, these struggles progressively worsened every year following an MI or stroke,” Dr. Levine adds.

Over a period of 10 years, survivors of MI gained between 1.5 and 3.5 new functional limitations while stroke survivors gained approximately 3.5 to 4.5 new limitations. These limitations contributed to significant increases in depressive symptoms among MI and stroke survivors. The risk of developing severe depressive symptoms were 20% higher for every new functional limitation gained after an MI and 34% higher for every new functional limitation gained after stroke. Stroke hospitalization significantly increased risks for moderate-to-severe cognitive impairment at the time of the event, even after adjusting for premorbid cognition.

Addressing the Issue

“Our findings suggest that MI and stroke survivors should be screened and monitored for functional disability long after they’re discharged from the hospital,” says Dr. Levine. “These patients have different long-term needs and are likely to require additional help with activities of daily living over the years after their event. We also need a better understanding of the causes and risk factors of functional disability after MI and stroke. With the number of survivors of these events expected to increase, it’s imperative that researchers develop cost-effective methods of care to best manage the needs of this growing and vulnerable population.”

 

Readings & Resources (click to view)

Levine DA, Davydow DS, Hough CL, Langa KM, Rogers MAM, Iwashyna TJ. Functional disability and cognitive impairment after hospitalization for myocardial infarction and stroke. Circ Cardiovasc Qual Outcomes. 2014;7:863-871. Available at: http://circoutcomes.ahajournals.org/content/7/6/863.

Saczynski JS, Kiefe CI. Dawning of a new era: understanding the functional outcomes of cardiovascular disease. Circ Cardiovasc Qual Outcomes. 2014;7:812-814.

Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304:1787-1794.

Davydow DS, Hough CL, Levine DA, Langa KM, Iwashyna TJ. Functional disability, cognitive impairment, and depression after hospitalization for pneumonia. Am J Med. 2013;126:615-624.

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