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Kevin Agostino NOSM Medical Student Dr. Saleem Malik Associate Professor NOSM

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

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Kevin Agostino NOSM Medical Student Dr. Saleem Malik Associate Professor NOSM

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  1. Kevin Agostino NOSM Medical Student Dr. SaleemMalik Associate Professor NOSM Analysis of the Presentation of Aboriginal Patients to the Regional Stroke Program in Northern Ontario

  2. 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: • Hemorrhagic • Ischemic

  3. Classification of Stroke (CVA) • Hemorrhagic • Intracerebral Hemorrhage • Subarachnoid Hemorrhage • Ischemic • Transient Ischemic Attack • Thrombotic Stroke • Embolic Stroke • Systemic Hypoperfusion

  4. Traditional Risk Factors • Diabetes • Hyperlipidemia • Hypertension • Atrial Fibrillation • Smoking • Genetics

  5. Rationale • Few studies exist • Risks associated with cerebrovascular disease higher in the Aboriginal population

  6. Goals • The goals of this study were to: • Assess the demographics • Understand roles of underlying conditions and risk factors • Explore presentation of cerebrovasculardisease • Assess mortality rate • Compared to non-Aboriginal population

  7. Methods • Three Northern Ontario Stroke hospitals • Registry of the Canadian Stroke Network (RCSN) was analyzed to determine: • Demographics • Risk factors • Presentation • Roles of underlying conditions • Rankin score upon discharge • Seven-day mortality

  8. Subjects • 2,721 stroke subjects from Northern Ontario inputted into the RCSN database • The community consultation process was undertaken • Three Aboriginal liaisons

  9. Results • Ethnicity of Patient Population with Stroke: • 70% Aboriginal • 1% Asian • 2% Caribbean • 19% Caucasian • 1% East Indian • 2% Hispanic • 1% Pacific Islander • 4% other

  10. Results • Mean age of stroke: • Aboriginal males: 62.45 yrs • Males in other population: 70.31 yrs • Aboriginal females: 57.07 yrs • Females 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

  11. Results • Diabetes: • Aboriginal population: 56.3% • Other population: 24.9% • Valvular Heart Disease: • Other population: 5.2% • Aboriginal population: 0% • AtrialFibrillation or Flutter: • Other population: 14.2% • Aboriginal population: 6.8%

  12. Results • Hypertension: • 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%

  13. Results • Deep 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 endarterectomyor stenting, and previous TIA: • little clinical significance

  14. Results • Current 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%)

  15. Results • Ischemic 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%

  16. Conclusions • Mean 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: • Smoking • Binge Drinking

  17. Conclusions • Significant contributors to stroke: • Diabetes • Hypertension • Hyperlipidemia • Most prevalent stroke type: • Ischemic Stroke

  18. Acknowledgements • The Registry of the Canadian Stroke Network (RCSN) • Northwestern Ontario Regional Stroke Network • Dr. David Howse, Neurology, Medical Director of the Regional Stroke Program • Cheryl Bain, Coordinator RCSN • Diane Hiscox, Coordinator of the Regional Stroke Program

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