Koristeći metode biomedicinske statistike vršena je analiza pokazatelja bolesti 5.845 bolesnika s dijagnozom moždanog udara liječenih u Klinici za neurologiju KBC-a Split tijekom vremenskog razdoblja od 2009. do 2013. godine. Analizom općih karakteristika cijelog uzorka uočeno je da je najčešća bila dijagnoza ishemijskog moždanog udara (IMU), te da je ista postavljena u 87,70% bolesnika. 80,99% ispitanika bilo je živo u trenutku otpusta- Dijagnoza nevalvularne atrijske fibrilacije (NvAF) postavljena je u 12,30% bolesnika. Promatrajući kretanja tijekom promatranog razdoblja uočeno je da proporcija bolesnika sa NvAF iskazuje trend porasta, te je kreiran linearni trend model koji je u visokom stupnju reprezentativan. Promatrajući ispitanike prema spolu uočeno je da je dijagnoza IMU bila češća u žena, dok je preživljenje u trenutku otpusta bilo više u muških bolesnika. NvAF je bila značajno češća u oboljelih žena. Povezujući dijagnozu i ishod bolesti moguće je zaključiti da bolesnici s dijagnozom IMU u većem stupnju prežive bolest u odnosu na bolesnike s moždanim krvarenjem (ICH). I u bolesnika s moždanim udarom i NvAF najčešća je bila dijagnoza IMU. Promatrajući uzorak prema godinama promatranja uočeno je da je kretanje proporcije preživjelih muških bolesnika s ICH jednaka (konstantna), škao i da je konstantna proporcija umrlih žena s IMU. Prosječna starosna dob ispitanika u različitim godinama promatranja nije se statistički značajno razlikovala, dok je broj dana hospitalizacije u prve dvije godine bilježio pad, a zatim kontinuirani rast. Broj bolesnika sa NvAF koji primaju antikoagulantnu terapiju u prevenciji moždanog udara raste, a u porastu je i broj bolesnika kojima je tijekom hospitalizacije zbog moždanog udara preporučen taj vid liječenja. Suradnja svih razina zdravstvene zaštite, edukacija bolesnika i obitelji kao i edukacija zdravstvenih djelatnika preduvjet su dobroj prevenciji ove bolesti koja je kompleksan socioekonomski problem.
|Abstract (english)|| |
Largest percentage of patients with non-valvular atrial fibrillation, which were hospitalized for a stroke, did not take anticoagulant therapy prior to hospitalization, despite a high risk of thromboembolism. In the last few years the number of patients which take this type of treatment in order to prevent cerebrovascular diseases, has increased. Also, there is increasing number of patients hospitalized for a stroke to whom is recommended intake of anticoagulant therapy during hospitalization or after discharge. In collaboration with the patient, family and general practitioner, optimal treatment results for patients are achieved. The key factors in the successful treatment of patients are: education of patients and families about the importance of taking anticoagulant therapy, adequate compliance in proper administration of the drug and collaboration with the primary health care. Stroke is a disease that requires multidisciplinary collaboration as well as social and economic support of the whole community; therefore, an important place must be given to prevention. A healthy lifestyle, regular systematic reviews and similar general guidelines for the prevention of disease definitely have their place in prevention. It is important to provide to the patient education on dietotherapy, and education about signs of potential complications of taking anticoagulant therapy. Regular controls of INR (international normalized ratio), initially once a week, then once a month, are mandatory.
Although the life span for the appearance of a stroke dropped, the most affected are the elderly. This population requires special care from the family and wider social community. The risk of possible complications and side effects is the most likely reason why the anticoagulant therapy, despite the guidelines, is not applicable to the extent that it should.
Adherence to appropriate treatment guidelines, tracking of new knowledge with training of health professionals, are a precondition for an adequate and effective care and prevention of a stroke. By using the methods of biomedical statistics, we analyzed indicators of the disease on 5,845 patients from Clinical Hospital Centre Split, in the period from 2009 to 2013.
Analysis of the general characteristics of the entire sample revealed that the most common diagnosis was cerebrovascular insult, for the 87.70% of patients. Atrial fibrillation was observed in 12.30% of patients, and 80.99% of the patients survived the disease. In the period from 2009 to 2013 we can see that the proportion of patients with atrial fibrillation is
rising, with linear increasing trend, which is highly representative. Dividing the respondents by sex it was observed that cerebrovascular insult was more characteristic for women, while the higher degree of survival was observed in men. Atrial fibrillation is also more characteristic for females. By connecting the diagnosis and outcome of the disease, it can be concluded that patients with the stroke to a greater degree survive the disease. Observing the sample according to observation for years, we found that the the movement of the male patients with stroke is constant. This means that the proportion of deaths from the stroke in female sex is also constant. The average age of subjects in different years of observation was not significantly different, while the length of hospitalization (days) in the first two years have fallen, and then continued to grow. The number of patients with atrial fibrillation who are taking anticoagulant therapy to prevent cerebrovascular disease is growing. There has been an increase in the number of stroke patients that during hospitalization start anticoagulant therapy, or are advised on release. Cooperation at all levels of health care, education of patients and families, as well as education of healthcare teams, are a precondition for a good prevention of this disease, which is a complex socio-economic problem.