Komorbidität bei Schlaganfallpatienten

Zusammenfassung

Zweitund Mehrerkrankungen verschlechtern bei Schlaganfallpatienten sowohl den akuten Verlauf als auch die Langzeitprognose. In einer Zusammenstellung von 134 Schlaganfallpatienten, die im ersten Quartal 2003 in der Schlaganfall-Spezialstation (Stroke Unit) des Universitätsklinikums Greifswald behandelt wurden, ergaben sich die Nebendiagnosen Hypertonus (77,6%), Diabetes mellitus (30,6%), koronare Herzerkrankung (26,8%), Vorhofflimmern (23,1%), Lungenerkrankung (23,8%), früherer Herzinfarkt (17,1%) und psychiatrische Erkrankung (8,2%). Hypertonus und Vorhofflimmern traten in diesem Kollektiv häufiger auf, als aus der Literatur bekannt ist. Zusätzlich geht dieser Beitrag auf Stürze und Frakturen bei Schlaganfallpatienten ein, die häufiger auftreten als in der Normalbevölkerung. Die große Zahl der nicht-neurologischen Nebendiagnosen macht eine interdisziplinäre Versorgung der Schlaganfallpatienten notwendig, wie sie in den überregionalen Stroke Units gegeben ist.

Summary

Stroke patients who suffer from additional diseases have a poorer prognosis in the acute stage of stroke and in the long term outcome. We analysed comorbidity in 134 stroke patients treated in the first quarter of 2003 in our Stroke Unit. Hypertension (77,6%), diabetes mellitus (30,6%), coronary heart disease (26,8%), atrial fibrillation (23,1%), lung disease (23,8%), preexistent myocardial infarction (17,1%) and psychiatric diseases (8,2%) were most frequently documented. Hypertension and atrial fibrillation occurred more often in our sample than previously reported in the literature. Additionally, we discuss the excess morbidity of fractures and falls in stroke patients compared to the general population. The high incidence of non-neurological diseases in stroke patients emphasizes the need for an interdisciplinary approach that has been successfully implemented in stroke units.

Schlüsselwörter

Schlaganfall - Komorbidität - Stroke Unit

Keywords

Stroke - comorbidity - stroke unit

• Literatur

• 1 American Heart Association. Stroke Statistics. Dallas/Tex.: American Heart Association y2000.
• 2 Longhorne P, William BO, Gichrist W, Howie K. Do stroke units save lives?. Lancet 1993; 342: 395-8.
• 3 Jorgenson HS, Nakayama H, Raaschou HA, Lason K, Hübbe P, Ohlson TS. Stroke unit treatment: long-term effects. Stroke 1991; 22: 1026-31.
• 4 Jorgenson HS, Kammergaard LP, Houth J, Nakayama H, Raachou HA, Larsen K, Hübbe P, Olson TS. Who benefits from treatment and rehabilitation in a stroke unit?. Stroke 2000; 31: 434-8.
• 5 International Society of Hypertension Writing Group (ISH). Statement on blood pressure lowering and stroke prevention. J Hypertens 2003; 21: 651-3.
• 6 Guidelines Committee. 2003 European Society of Hypertension/European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1001-53.
• 7 PATS Collaborative Group. Post-stroke antihypertensive treatment study: A preliminary result. Chin Med J 1995; 108: 710-7.
• 8 Progress Collaborative Study Group. Randomised trial of a perindopril-based blood pressure lowering regime among 6105 individuals with prior stroke or transient ischemic attack. Lancet 2001; 358: 1033-41.
• 9 Klungel Oh, Stricker BHC, Paes AH, Seidell JC, Bakker A, Coko Z, Breteler MM, DeBoer A. Excess stroke among hypertensiv men and women attributed to undertreatment of hypertension. Stroke 1999; 30: 1312-28.
• 10 Leonardi-Bee J, Bath PM, Phillips SJ, Sondercock PAG. Blood pressure and clinical outcome in the International Stroke Trial (IST). Stroke 2002; 33: 1315-8.
• 11 Vickrey BG, Rector TS, Wickstrom SL, Guzy PM, Sloss EM, Gorelick PB. Occurrence of secondary ischemic events among persons with atherosclerotic vascular disease. Stroke 2002; 33: 901-6.
• 12 Burshfiel CM, Curb JD, Rodriques BL, Abbott RD, Chiu D, Yano K. Glucose intolerance and 22-year stroke incidence. The Honolulu Heart Program. Stroke 1994; 25: 951-7.
• 13 Manson JE, Colditz EA, Stampfer MJ, Willett WC, Krolewski AS. A prospective study of maturity onset diabetes mellitus in coronary heart disease and stroke in women. Arch Int Med 1991; 151: 1141-7.
• 14 Shinozaki K, Naritomi H, Shimiziu T, Suzuki T, Ikebushi M. Role of insulin resistance associated with compensatory hyperinsulinemia in ischemic stroke. Stroke 1996; 27: 37-43.
• 15 Falk RH. Atrial Fibrillation. N Engl J Med 2001; 344: 1067-77.
• 16 Hart RG, Palacio S, Pearce LA. Atrial fibrillation, Stroke, and acute antithrombotic therapy. Stroke 2002; 33: 2722-5.
• 17 Benjamin EJ, Wolf PA, Dàgostino RG, Silberhatz H, Kannel WB, Lewy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998; 98: 946-52.
• 18 Hart RG, Halperin JL. Atrial Fibrillation and stroke. Concepts and controversies. Stroke 2001; 32: 803-12.
• 19 AHA/ASA Scientific Statement. Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke. Circulation 2003; 108: 1278-84.
• 20 The International Stroke Trial (IST). A randomized trial of aspirin, subcuataneous heparin, both or neither among 19435 stroke patients. Lancet 1997; 349: 1569-81.
• 21 Hacke W, Kaste M, Fieschi C. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: the European Cooperative Acute Stroke Study (ECASS). JAMA 274: 1017-25.
• 22 ESPS study group. European Stroke Prevention Study (ESPS). Stroke 1990; 21: 1122-30.
• 23 CAPRIE Steering Committee. A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE). Lancet 1996; 348: 1329-39.
• 24 Dexter DD, Whisnant JP, Conoly DC. The association of stroke and coronary heart disease: a population study. Mayo Clin Proc 1987; 62: 1077-83.
• 25 Hartmann A, Rundek T, Mast H. Mortality and causes of death after first ever stroke. The North Manhatten Stroke Study. Neurology 2001; 57: 2000-5.
• 26 Sacco RL, Wolf PA, Kannel WB. Survival and recurrence following stroke. The Framingham Study. Stroke 1982; 13: 290-5.
• 27 Mooe T, Olofsson B-O, Stegmayr B, Erikssion P. Ischemic stroke. Impact of recent myocardial infarction. Stroke 1999; 30: 997-1001.
• 28 Aben I, Denollel J, Lousberg R, Verhey F, Wojciechowski F, Honig A. Personality and vulnerability to depression in stroke patients. Stroke 2002; 23: 2391-8.
• 29 Carson AJ, MacHale S, Lawrie AK, Dennis M, House A, Shaarpe M. Depression after stroke and lesion location: A systematic review. Lancet 2000; 356: 122-6.
• 30 Vataja R, Pohjasvaarat T, Leppavouri A, Antyla R, Aronen HJ, Salonen O, Kaste M. Magnet resonance imaging correlates of depression after stroke. Arch Gen Psychiatry 2001; 58: 925-31.
• 31 King RB. Quality of Life after stroke. Stroke 1996; 27: 1467-72.
• 32 Dennis MS, Lo KM, McDowall M, West T. Fractures after stroke. Stroke 2002; 33: 728-30.
• 33 Poole KE, Reeve J, Wartburton EA. Falls, fractures and osteoporosis after stroke: time to think about protection?. Stroke 2002; 33: 1432-6.
• 34 Katzaan IL, Cebul RD, Husak SH, Dawson NV, Baker MD. The effect of pneumonia on mortality among hospitalized patients for acute stroke. Neurology 2003; 60: 620-5.
• 35 Prass K, Meisel C, Höflich C, Braun J, Halle E, Wolf T, Ruscher K, Victorov IV, Priller J, Dirnagel U, Volk HD, Meisel A. Stroke-induced immunodeficiency promotes spontaneous bacterial infections and is mediated by sympathetic activation reversal by poststroke T helper cell Type 1-like immunostimulation. J Exp Med 2003; 198: 725-36.