kevin agostino nosm medical student dr. saleem malik associate professor nosm

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Kevin Agostino NOSM Medical Student Dr. Saleem Malik Associate Professor NOSM. Analysis of the Presentation of Aboriginal Patients to the Regional Stroke Program in Northern Ontario. What is a Stroke (CVA)?. Sudden loss of blood circulation to an area of the brain - PowerPoint PPT Presentation

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  • Kevin Agostino NOSM Medical Student

    Dr. Saleem Malik Associate Professor NOSM

  • What is a Stroke (CVA)?Sudden loss of blood circulation to an area of the brain

    May/may not result in a loss of neurologic function

    Classified into:HemorrhagicIschemic

  • Classification of Stroke (CVA)HemorrhagicIntracerebral HemorrhageSubarachnoid Hemorrhage

    IschemicTransient Ischemic AttackThrombotic StrokeEmbolic StrokeSystemic Hypoperfusion

  • Traditional Risk FactorsDiabetes

    Hyperlipidemia

    Hypertension

    Atrial Fibrillation

    Smoking

    Genetics

  • RationaleFew studies exist

    Risks associated with cerebrovascular disease higher in the Aboriginal population

  • GoalsThe goals of this study were to:

    Assess the demographics

    Understand roles of underlying conditions and risk factors

    Explore presentation of cerebrovascular disease

    Assess mortality rate

    Compared to non-Aboriginal population

  • MethodsThree Northern Ontario Stroke hospitals

    Registry of the Canadian Stroke Network (RCSN) was analyzed to determine:

    DemographicsRisk factors Presentation Roles of underlying conditionsRankin score upon discharge Seven-day mortality

  • Subjects2,721 stroke subjects from Northern Ontario inputted into the RCSN database

    The community consultation process was undertaken

    Three Aboriginal liaisons

  • ResultsEthnicity of Patient Population with Stroke:

    70% Aboriginal1% Asian2% Caribbean19% Caucasian1% East Indian2% Hispanic1% Pacific Islander4% other

  • ResultsMean age of stroke:

    Aboriginal males: 62.45 yrs Males in other population: 70.31 yrs

    Aboriginal females: 57.07 yrsFemales in other population: 73.75 yrs

    Mean age of stroke in both males and females:

    Aboriginal population: 60.31 yrs Other population: 71.92 yrs

  • ResultsDiabetes:Aboriginal population: 56.3%Other population: 24.9%

    Valvular Heart Disease:Other population: 5.2% Aboriginal population: 0%

    Atrial Fibrillation or Flutter:Other population: 14.2% Aboriginal population: 6.8%

  • ResultsHypertension:Aboriginal population: 65.0% Other population: 61.3%

    Hyperlipidemia:Aboriginal population: 33.0% Other population: 27.3%

    Chronic congestive heart failure/pulmonary edema:Aboriginal population: 6.8% Other population: 5.8%

  • ResultsDeep vein thrombosis/pulmonary embolus:Other population: 2.3% Aboriginal population: 0%

    Coronary artery disease/angina pectoris:Other population: 20.6% Aboriginal population: 19.4%

    Previous stroke:Other population: 20.6% Aboriginal population: 18.4%

    Peripheral vascular disease, carotid endarterectomy or stenting, and previous TIA:little clinical significance

  • ResultsCurrent smokers:Aboriginal population: 31.1% Other population: 18.4%

    Lifelong non-smokers:Aboriginal population: 53.4% Other population: 62.8%

    The Aboriginal population reported alcohol use:more rarely (68.9% vs 58.0%)< 2 drinks/day (5.8% vs 9.9%)2+ drinks/day (8.7% vs 5.7%)

  • ResultsIschemic stroke:Aboriginal population: 64.1% Other population: 60.4%

    Hemorrhagic stroke:Aboriginal population: 11.6% Other population: 9.5%

    TIA:Aboriginal population: 22.3% Other population: 29.8%

  • ConclusionsMean age of stroke for both Aboriginal males and females combined was lower

    Mean age of stroke in Aboriginal females was significantly lower

    Most prevalent risk factors:SmokingBinge Drinking

  • ConclusionsSignificant contributors to stroke:DiabetesHypertensionHyperlipidemia

    Most prevalent stroke type:Ischemic Stroke

  • AcknowledgementsThe Registry of the Canadian Stroke Network (RCSN)Northwestern Ontario Regional Stroke NetworkDr. David Howse, Neurology, Medical Director of the Regional Stroke ProgramCheryl Bain, Coordinator RCSNDiane Hiscox, Coordinator of the Regional Stroke Program

    *Characterized by the sudden loss of blood circulation to an area of the brain

    May or may not result in a corresponding loss of neurologic function

    Classified into two categories:HemorrhagicIschemic

    *Hemorrhagic:Bleeding in intracerebral hemorrhage (ICH) is usually derived from arterioles or small arteries. The bleeding is directly into the brain, forming a localized collection of blood known as a hematoma which spreads along the brain matter (white matter pathways). This accumulation of blood occurs over minutes or hours

    In subarachnoid hemorrhage (SAH), rupture of arterial aneurysms is the major cause of bleeding. Aneurysm rupture releases blood directly into the cerebrospinal fluid (CSF) under arterial pressure. The blood spreads quickly within the CSF, rapidly increasing intracranial pressure

    Ischemic:Transient ischemic attack (TIA) is a brief episode of neurologic dysfunction resulting from focal temporary interruption of the cerebral blood supply (called ischemia) and is not associated with cerebral infarction

    Thrombotic strokes are those in which the pathologic process giving rise to thrombus (or clot) formation in an artery produces a stroke by reduced blood flow distally

    Embolism in embolic stroke refers to particles of debris originating elsewhere in the body that block arterial access to a particular brain region

    Systemic hypoperfusion is a more general circulatory problem, manifesting itself in the brain and perhaps other organs. Reduced perfusion can be due to cardiac pump failure*Traditional Risk Factors of Stroke Include:Diabetes, HTN, Hyperlipidemia, Atrial Fibrillation, Smoking, and Genetics

    In Regards to Genetics:Your risk of stroke is increased if close family members parents, siblings or children had a stroke before age 65.

    *The Rationale for this study include the following:

    Few studies have looked specifically at the incidence, presentation and fate of aboriginal patients with cerebrovascular disease in Canada

    Ample evidence states risks that are traditionally associated with cerebrovascular disease are higher in the Aboriginal population

    Limited data exists surrounding the demographics, presentation, and role of underlying conditions in Aboriginal patients that present with cerebrovascular disease*The goals of this study were to:assess the demographics of Aboriginal patients with cerebrovascular disease in Northern Ontario

    understand the role of underlying conditions and risk factors in this population

    discover how Aboriginal peoples present with cerebrovascular disease in the hospital setting

    assess mortality rate of Aboriginal patients with cerebrovascular disease

    This data was then compared to the non-Aboriginal population in Northern Ontario

    *The Registry of the Canadian Stroke Network (RCSN) is a project funded by the Canadian Stroke Network (CSN) that collects high quality clinical data from stroke patients annually. Patient data collected will characterize the entire stroke event

    Data from the Registry of the Canadian Stroke Network (RCSN) was analyzed to determine the demographics, risk factors, presentation of Aboriginal patients with cerebrovascular disease, the roles of underlying conditions, seven-day mortality, as well as Rankin score upon discharge from three Northern Ontario Stroke hospitals (Thunder Bay, Sudbury, North Bay). These statistics were then compared to the non-Aboriginal population from the same hospitals and from within the same time frame

    *Data was collected on 2,721 stroke subjects from Northern Ontario that were inputted into the RCSN database from July 1, 2003 to March 31, 2008.

    Since this study involved Aboriginal peoples, and in order to be compliant with the Canadian Institutes of Health Research (CIHR) guidelines, the community consultation process consisted of a formal letter being sent to Aboriginal liaisons for approval.

    The Aboriginal liaisons for this study will consist of the Grand Chiefs of Grand Council Treaty #3, Union of Ontario Indians, and Nishnawbe-Aski Nation

    *The ethnicity of the patient population with stroke in the database that were included for analysis were as follows:

    70% Aboriginal, 1% Asian, 2% Caribbean, 19% Caucasian, 1% East Indian, 2% Hispanic, 1% Pacific Islander, and 4% other.

    This distribution is representative of the proportion of each of these ethnic groups within the population of Northern Ontario

    Significance was defined as P