The individual and combined impacts of pre-existing diabetes and dementia on ischemic stroke outcomes: a registry-based cohort study

Individually, diabetes mellitus and dementia are associated with poorer outcomes after stroke. However, the combined impact of these pre-existing factors on acute ischemic stroke (AIS) outcomes has not been examined. All consecutive patients with AIS admitted to Norfolk and Norwich University Hospit...

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Bibliographic Details
Published in:	BMC cardiovascular disorders Vol. 24; no. 1; pp. 396 - 12
Main Authors:	Kyaw, Kyi Lae Shune, Pana, Tiberiu A, Bettencourt-Silva, Joao H, Metcalf, Anthony K, Myint, Phyo K, Potter, John F
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 30-07-2024 BioMed Central BMC
Subjects:	Acute ischaemic stroke Aged Aged, 80 and over Analysis Care and treatment Cognitive appraisal Comorbidity Complications and side effects Creatinine Delirium Dementia Dementia - diagnosis Dementia - epidemiology Dementia - mortality Dementia disorders Diabetes Diabetes mellitus Diabetes Mellitus - diagnosis Diabetes Mellitus - epidemiology Diabetes Mellitus - mortality Diagnosis Disability Disability Evaluation Disease Electronic records England - epidemiology Female Hematology Hemoglobin Hospital Mortality Hospitals Humans Ischemia Ischemic Stroke - diagnosis Ischemic Stroke - epidemiology Ischemic Stroke - mortality Length of Stay Male Middle Aged Missing data Mortality Outcomes Patient outcomes Patients Prognosis Recurrence Registries Regression analysis Risk Assessment Risk Factors Software Statistical analysis Stroke Stroke (Disease) Stroke patients Time Factors Transient ischemic attack United Kingdom Variables England United Kingdom United Kingdom > UK Diabetes Outcomes Acute ischaemic stroke Dementia
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Summary:	Individually, diabetes mellitus and dementia are associated with poorer outcomes after stroke. However, the combined impact of these pre-existing factors on acute ischemic stroke (AIS) outcomes has not been examined. All consecutive patients with AIS admitted to Norfolk and Norwich University Hospitals between 2003 and 2016 (catchment population ~ 900,000) were divided into four groups: those with neither diabetes nor dementia (reference), with diabetes without dementia, with dementia without diabetes, and with both co-morbidities. In-hospital mortality, length of hospital stay (LoS), and disability outcomes were analysed using logistic regressions. Post-discharge mortality and recurrence were assessed using Cox regressions. Additionally, interaction terms were added to the models for the short-term outcomes and long-term mortality to test for synergistic effects of diabetes and dementia. Models were adjusted for age, sex, Oxfordshire Community Stroke Project classification, comorbidities, hematological and biochemical measures, and antithrombotic medications. The cohort was 10,812 patients with 52% females and a median age of 80. The median follow-up was 3.8 years for stroke recurrence and 5.5 years for mortality. No significant differences between the four groups existed for in-hospital mortality and post-stroke disability. Patients with dementia had significantly longer LoS (OR 2.25 [95% CI: 1.34-3.77] and 1.31 [1.02-1.68] with and without diabetes, respectively). Patients with both comorbidities had the highest risk of stroke recurrence (HR 2.06 [1.12-3.77]), followed by those with only dementia (1.59 [1.15-2.20]) and only diabetes (1.25 [1.06-1.49]). Similarly, the patient group with both diabetes and dementia had the highest long-term mortality risk (1.76 [1.33-2.37]). The hazard ratios for patients with only dementia and only diabetes were 1.71 [1.46-2.01] and 1.19 [1.08-1.32], respectively. No significant interactions were seen between diabetes and dementia with regards to their effects on the outcomes. Individual and cumulative impacts of the two conditions on long-term mortality and stroke recurrence were notable. However, no synergistic impact of the two comorbidities were seen on the stroke outcomes tested in our study. Therefore, tailoring the management of stroke patients based on additional requirements associated with each pre-existing condition will be more impactful towards improving outcomes.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1471-2261 1471-2261
DOI:	10.1186/s12872-024-04050-3