Stroke care in the United Kingdom before, during, and after the COVID-19 lockdowns: A retrospective nationwide cohort study.

Background And Aim: The COVID-19 pandemic imposed significant pressures on healthcare services such as stroke care. This study aimed to assess the quality of stroke care and, outcome before, during and post lockdown.

Methods: Nationwide registry-based cohort study of patients with acute stroke admitted to hospitals in England, Wales, and Northern Ireland were analyzed.

Long-Term Trends in Incidence and Risk Factors for Hemorrhagic Stroke Subtypes Over 24 Years: The South London Stroke Register.

Background: Hemorrhagic stroke (HS), including intracerebral and subarachnoid hemorrhage (ICH and SAH), has high mortality and morbidity. We assessed the 24-year trends in incidence, prestroke risk factors, medications, and demographic patterns in a multiracial and multiethnic population.

Methods: We used 1995 to 2018 data from the South London Stroke Register.

Long-Term Course of Depression After Stroke and Risk Factors for Symptoms With Poor Progression: A Population-Based Study.

Background: Data on the long-term poststroke depression trajectories and their determinants are limited. This study aims to estimate the 5-year course of poststroke depression and identify risk factors for recurrent and persistent depression.

Methods: Data were from the South London Stroke Register (1997-2022).

Long-term outcomes of depression up to 10-years after stroke in the South London Stroke Register: a population-based study.

Background: Current evidence on the long-term outcomes of post-stroke depression (PSD) is limited, with most studies relying on short follow-ups and cross-sectional designs. We aim to examine (1) associations between depression at 3-months and long-term outcomes-including mortality, stroke recurrence, functional ability and quality of life (QoL)- up to 10-years; (2) the impact of depression recovery and timing of onset on these associations.

Methods: Data were from the South London Stroke Register (1-January-1997-20-April-2023).

Global, Regional, and National Burden of Nontraumatic Subarachnoid Hemorrhage: The Global Burden of Disease Study 2021.

Importance: Nontraumatic subarachnoid hemorrhage (SAH) represents the third most common stroke type with unique etiologies, risk factors, diagnostics, and treatments. Nevertheless, epidemiological studies often cluster SAH with other stroke types leaving its distinct burden estimates obscure.

Objective: To estimate the worldwide burden of SAH.

Direct oral anticoagulants versus no anticoagulation for the prevention of stroke in survivors of intracerebral haemorrhage with atrial fibrillation (PRESTIGE-AF): a multicentre, open-label, randomised, phase 3 trial.

Background: Direct oral anticoagulants (DOACs) reduce the rate of thromboembolism in patients with atrial fibrillation but the benefits and risks in survivors of intracerebral haemorrhage are uncertain. We aimed to determine whether DOACs reduce the risk of ischaemic stroke without substantially increasing the risk of recurrent intracerebral haemorrhage.

Methods: PRESTIGE-AF is a multicentre, open-label, randomised, phase 3 trial conducted at 75 hospitals in six European countries.

Trends in Ethnic Disparities in Stroke Care and Long-Term Outcomes.

Importance: Reducing the burden of stroke is a public health priority. While higher stroke incidence among ethnic minority populations (defined in the context of this study as individuals who are not White) is well established, reports on ethnic inequalities in care or outcomes are conflicting and often limited to hospital-admitted patients and short-term outcomes.

Objective: To investigate ethnic differences in stroke care and outcomes up to 5 years after stroke and describe temporal trends and contributory factors.

Major vascular events after first incident stroke: a population-based study.

Background: Recent advances in stroke care have led to improvements in survival and rates of stroke recurrence. However, there is a lack of data on trends of major vascular events, and risk factors associated with non-fatal and fatal outcomes. We aim to identify demographical and clinical factors leading to incidence of subsequent major vascular events after the first-ever stroke.

Genetic-Guided Pharmacotherapy for Coronary Artery Disease: A Systematic and Critical Review of Economic Evaluations.

Background: Genetic-guided pharmacotherapy (PGx) is not recommended in clinical guidelines for coronary artery disease (CAD). We aimed to examine the extent and quality of evidence from economic evaluations of PGx in CAD and to identify variables influential in changing conclusions on cost-effectiveness.

Methods And Results: From systematic searches across 6 databases, 2 independent reviewers screened, included, and rated the methodological quality of economic evaluations of PGx testing to guide pharmacotherapy for patients with CAD.

Burden of intracerebral haemorrhage in Europe: forecasting incidence and mortality between 2019 and 2050.

Background: Anticipating the burden of intracerebral haemorrhage is crucial for proactive management and building resilience against future health challenges. Prior forecasts are based on population demography and to a lesser extent epidemiological trends. This study aims to utilise selected modifiable risk factors and socio-demographic indicators to forecast the incidence and mortality of intracerebral haemorrhage in Europe between 2019 and 2050.

Incidence and Long-Term Survival of Spontaneous Intracerebral Hemorrhage Over Time: A Systematic Review and Meta-Analysis.

Background And Purpose: Recent epidemiological data indicate that the absolute number of hemorrhagic stroke cases increased by 47% between 1990 and 2010 and continued to cause high rates of death and disability. The last systematic review and meta-analysis of incidence and long-term survival of intracerebral hemorrhage (ICH) were published 11 and 7 years ago, respectively, and lacked comparison between different income groups, therefore, a more up to date analysis is needed. We aim to investigate the ICH incidence and long-term survival data in countries of different income groups.

Genetic-Guided Pharmacotherapy for Atrial Fibrillation: A Systematic and Critical Review of Economic Evaluations.

Objectives: This study aimed to examine the extent and quality of evidence from economic evaluations (EEs) of genetic-guided pharmacotherapy (PGx) for atrial fibrillation (AF) and to identify variables influential in changing base-case conclusions.

Methods: From systematic searches, we included EEs of existing PGx testing to guide pharmacotherapy for AF, without restrictions on population characteristics or language. Articles excluded were genetic tests used to guide device-based therapy or focused on animals.

Diabetes As an Independent Risk Factor for Stroke Recurrence in Ischemic Stroke Patients: An Updated Meta-Analysis.

Introduction: Stroke and its recurrence and diabetes will increase in incidence as the population ages globally. This study explores the relationship between diabetes and stroke recurrence to understand if diabetes is an independent predictor for stroke recurrence in ischemic stroke (IS) patients.

Methods: We conducted a systematic review and meta-analysis of studies on the effect of diabetes on stroke recurrence among patients with IS.

Impacts of COVID-19 on clinical research in the UK: A multi-method qualitative case study.

Background: Clinical research has been central to the global response to COVID-19, and the United Kingdom (UK), with its research system embedded within the National Health Service (NHS), has been singled out globally for the scale and speed of its COVID-19 research response. This paper explores the impacts of COVID-19 on clinical research in an NHS Trust and how the embedded research system was adapted and repurposed to support the COVID-19 response.

Methods And Findings: Using a multi-method qualitative case study of a research-intensive NHS Trust in London UK, we collected data through a questionnaire (n = 170) and semi-structured interviews (n = 24) with research staff working in four areas: research governance; research leadership; research delivery; and patient and public involvement.

Genetic-guided pharmacotherapy for venous thromboembolism: a systematic and critical review of economic evaluations.

Despite the known contributions of genes, genetic-guided pharmacotherapy has not been routinely implemented for venous thromboembolism (VTE). To examine evidence on cost-effectiveness of genetic-guided pharmacotherapy for VTE, we searched six databases, websites of four HTA agencies and citations, with independent double-reviewers in screening, data extraction, and quality rating. The ten eligible studies, all model-based, examined heterogeneous interventions and comparators.

Risk Prediction of Cognitive Decline after Stroke.

Background And Purpose: Cognitive decline is one of the major outcomes after stroke. We have developed and evaluated a risk predictive tool of post-stroke cognitive decline and assessed its clinical utility.

Methods: In this population-based cohort, 4,783 patients with first-ever stroke from the South London Stroke Register (1995-2010) were included in developing the model.

Stroke Care in the United Kingdom During the COVID-19 Pandemic.

Background And Purpose: The coronavirus disease 2019 (COVID-19) pandemic has potentially caused indirect harm to patients with other conditions via reduced access to health care services. We aimed to describe the impact of the initial wave of the pandemic on admissions, care quality, and outcomes in patients with acute stroke in the United Kingdom.

Methods: Registry-based cohort study of patients with acute stroke admitted to hospital in England, Wales, and Northern Ireland between October 1, 2019, and April 30, 2020, and equivalent periods in the 3 prior years.

Inverse problem approach to regularized regression models with application to predicting recovery after stroke.

Regression modelling is a powerful statistical tool often used in biomedical and clinical research. It could be formulated as an inverse problem that measures the discrepancy between the target outcome and the data produced by representation of the modelled predictors. This approach could simultaneously perform variable selection and coefficient estimation.

Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register.

Background: Acute stroke impairments often result in poor long-term outcome for stroke survivors. The aim of this study was to estimate the trends over time in the prevalence of these acute stroke impairments.

Methods And Findings: All first-ever stroke patients recorded in the South London Stroke Register (SLSR) between 2001 and 2018 were included in this cohort study.

Risk and Secondary Prevention of Stroke Recurrence: A Population-Base Cohort Study.

Background And Purpose: With recent advances in secondary prevention management, stroke recurrence rates may have changed substantially. We aim to estimate risks and trends of stroke recurrence over the past 2 decades in a population-based cohort of patients with stroke.

Methods: Patients with a first-ever stroke between 1995 and 2018 in South London, United Kingdom (n=6052) were collected and analyzed.

Burden of Stroke in Europe: Thirty-Year Projections of Incidence, Prevalence, Deaths, and Disability-Adjusted Life Years.

Background And Purpose: Prediction of stroke impact provides essential information for healthcare planning and priority setting. We aim to estimate 30-year projections of stroke epidemiology in the European Union using multiple modeling approaches.

Methods: Data on stroke incidence, prevalence, deaths, and disability-adjusted life years in the European Union between 1990 and 2017 were obtained from the global burden of disease study.

Long-Term Outcomes in Stroke Patients with Cognitive Impairment: A Population-Based Study.

This study assesses five year outcomes of patients with cognitive deficits within the first three months after stroke. Population-based data from the South London Stroke Register between 1995 and 2018 were studied. Cognitive function was assessed using the Abbreviated-Mental-Test or Mini-Mental-State-Examination.

Global, Regional, and National Burden of Calcific Aortic Valve and Degenerative Mitral Valve Diseases, 1990-2017.

Background: Nonrheumatic valvular diseases are common; however, no studies have estimated their global or national burden. As part of the Global Burden of Disease Study 2017, mortality, prevalence, and disability-adjusted life-years (DALYs) for calcific aortic valve disease (CAVD), degenerative mitral valve disease, and other nonrheumatic valvular diseases were estimated for 195 countries and territories from 1990 to 2017.

Methods: Vital registration data, epidemiologic survey data, and administrative hospital data were used to estimate disease burden using the Global Burden of Disease Study modeling framework, which ensures comparability across locations.

Long-term trends in death and dependence after ischaemic strokes: A retrospective cohort study using the South London Stroke Register (SLSR).

Background: There have been reductions in stroke mortality over recent decades, but estimates by aetiological subtypes are limited. This study estimates time trends in mortality and functional dependence by ischaemic stroke (IS) aetiological subtype over a 16-year period.

Methods And Findings: The study population was 357,308 in 2011; 50.