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References
Contents
Academic Editor
- Jaume Sastre-Garriga
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[1]Thayabaranathan T, Kim J, Cadilhac DA, Thrift AG, Donnan GA, Howard G, et al. Global stroke statistics 2022. International Journal of Stroke. 2022; 17: 946–956.
[2]Instituto Nacional de Estadística y Geografía (INEGI). ESTADÍSTICAS DE DEFUNCIONES REGISTRADAS (EDR). México: INEGI; 2025. Available at: https://www.inegi.org.mx/programas/edr/ (Accedido: 16 Noviembre 2024).
[3]Gutiérrez-Jiménez E, Góngora-Rivera F, Martínez HR, Escamilla-Garza JM, Villarreal HJ, GECEN Investigators. Knowledge of ischemic stroke risk factors and warning signs after a health education program by medical students. Stroke. 2011; 42: 897–901. https://doi.org/10.1161/STROKEAHA.110.597062.
[4]Williams LS, Bruno A, Rouch D, Marriott DJ. Stroke patients’ knowledge of stroke. Influence on time to presentation. Stroke. 1997; 28: 912–915. https://doi.org/10.1161/01.str.28.5.912.
[5]Wein TH, Staub L, Felberg R, Hickenbottom SL, Chan W, Grotta JC, et al. Activation of emergency medical services for acute stroke in a nonurban population: the T.L.L. Temple Foundation Stroke Project. Stroke. 2000; 31: 1925–1928. https://doi.org/10.1161/01.str.31.8.1925.
[6]Jones SP, Jenkinson AJ, Leathley MJ, Watkins CL. Stroke knowledge and awareness: an integrative review of the evidence. Age and Ageing. 2010; 39: 11–22. https://doi.org/10.1093/ageing/afp196.
[7]Faiz KW, Sundseth A, Thommessen B, Rønning OM. Patient knowledge on stroke risk factors, symptoms and treatment options. Vascular Health and Risk Management. 2018; 14: 37–40. https://doi.org/10.2147/VHRM.S152173.
[8]Pu C, Guo JY, Yu-Hua-Yeh, Sankara P. Comparison of knowledge on stroke for stroke patients and the general population in Burkina Faso: a cross-sectional study. AIMS Public Health. 2020; 7: 723–735. https://doi.org/10.3934/publichealth.2020056.
[9]Saadatnia M, Hajiannejad N, Yazdabadi A, Tajmirriahi M, Nasr M. Public Stroke Knowledge, Awareness, and Response to Acute Stroke in Isfahan Iran: What is Less or Misinterpreted in Developing Countries. Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association. 2021; 30: 105670. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105670.
[10]Sirisha S, Jala S, Vooturi S, Yada PK, Kaul S. Awareness, Recognition, and Response to Stroke among the General Public-An Observational Study. Journal of Neurosciences in Rural Practice. 2021; 12: 704–710. https://doi.org/10.1055/s-0041-1735822.
[11]Romero-Bravo M, de la Cruz-Cosme C, Barbancho MA, García-Casares N. Conocimiento sobre el ictus en la población española. Una revisión sistemática [Knowledge on stroke in Spanish population. A systematic review]. Revista de Neurología. 2022; 74: 189–201. https://doi.org/10.33588/rn.7406.2021401.
[12]Hawkes MA, Ameriso SF, Willey JZ. Stroke knowledge in Spanish-speaking populations. Neuroepidemiology. 2015; 44: 121–129. https://doi.org/10.1159/000381100.
[13]Hawkes MA, Gomez-Schneider MM, Dossi DE, Melcon MO, Ameriso SF. Stroke Knowledge in the EstEPA Project, a Population-Based Study. Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association. 2021; 30: 105471. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105471.
[14]Dossi DE, Hawkes MA, Pujol-Lereis VA, Povedano GP, Rodríguez-Lucci F, Farez MF, et al. A Population-Based Survey of Stroke Knowledge in Argentina: The SIFHON Study. Neuroepidemiology. 2019; 53: 32–40. https://doi.org/10.1159/000497413.
[15]Góngora-Rivera F, Gutiérrez-Jiménez E, Zenteno MA, GEPEVC Investigators. Knowledge of ischemic stroke among a Mexico City population. Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association. 2009; 18: 208–213. https://doi.org/10.1016/j.jstrokecerebrovasdis.2008.10.002.
[16]Góngora-Rivera F, González-Aquines A, Muruet W, Barrera-Barrera S, Leal-Bailey H, Espinosa-Ortega MA, et al. Difference in Stroke Knowledge between Rural and Urban Communities in a Developing Country after Community-Based Stroke Educational Campaigns: Results from a Cross-Sectional Study. Neuroepidemiology. 2018; 51: 224–229. https://doi.org/10.1159/000490724.
[17]Feigin VL, Norrving B. A new paradigm for primary prevention strategy in people with elevated risk of stroke. International Journal of Stroke: Official Journal of the International Stroke Society. 2014; 9: 624–626. https://doi.org/10.1111/ijs.12300.
[18]Medvedev O, Truong QC, Merkin A, Borotkanics R, Krishnamurthi R, Feigin V. Cross-cultural validation of the stroke riskometer using generalizability theory. Scientific Reports. 2021; 11: 20516. https://doi.org/10.1038/s41598-021-98591-8.
[19]Parmar P, Krishnamurthi R, Ikram MA, Hofman A, Mirza SS, Varakin Y, et al. The Stroke Riskometer(TM) App: validation of a data collection tool and stroke risk predictor. International Journal of Stroke: Official Journal of the International Stroke Society. 2015; 10: 231–244. https://doi.org/10.1111/ijs.12411.
[20]Marquez-Romero JM, Romo-Martínez J, Hernández-Curiel B, Ruiz-Franco A, Krishnamurthi R, Feigin V. Assessing the individual risk of stroke in caregivers of patients with stroke. Arquivos de Neuro-Psiquiatria. 2024; 82: 1–5. https://doi.org/10.1055/s-0044-1779691.
[21]Sarfo FS, Akinyemi JO, Obiako R, Nichols M, Fakunle AG, Adusei N, et al. Effect of an Educational Intervention for Primary Stroke Risk Reduction in Ghana and Nigeria: Pilot Randomized Controlled Trial. Stroke. 2023; 54: 1660–1664. https://doi.org/10.1161/STROKEAHA.123.042618.
[22]Onwuakagba IU, Okoye EC, Kanu FC, Kalu CM, Akaeme DC, Obaji OC, et al. Population-based stroke risk profile from a West-African community. ENeurologicalSci. 2023; 33: 100483. https://doi.org/10.1016/j.ensci.2023.100483.
[23]Choi CU, Park CG. Estimating the probability of stroke in Korean hypertensive patients visiting tertiary hospitals using a risk profile from the Framingham study. BMC Neurology. 2009; 9: 16. https://doi.org/10.1186/1471-2377-9-16.
[24]Bestehorn K, Wahle K, Kirch W. Stroke risk screening of adults with hypertension: prospective cross-sectional study in primary care. Clinical Drug Investigation. 2008; 28: 281–289. https://doi.org/10.2165/00044011-200828050-00002.
[25]Sethi R, Hiremath JS, Ganesh V, Banerjee S, Shah M, Mehta A, et al. Correlation between Stroke Risk and Systolic Blood Pressure in Patients over 50 Years with Uncontrolled Hypertension: Results from the SYSTUP-India Study. Cardiovascular Therapeutics. 2021: 6622651. https://doi.org/10.1155/2021/6622651.
[26]GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. Neurology. 2021; 20: 795–820. https://doi.org/10.1016/S1474-4422(21)00252-0.
[27]Fan J, Li X, Yu X, Liu Z, Jiang Y, Fang Y, et al. Global Burden, Risk Factor Analysis, and Prediction Study of Ischemic Stroke, 1990–2030. Neurology. 2023; 101: e137–e150. https://doi.org/10.1212/WNL.0000000000207387.
[28]Arboix A, Arboix-Alió A, Hernández-Arrieta M. Escaso conocimiento de la enfermedad vascular cerebral en una muestra de jovenes adolescentes [Scant knowledge about cerebrovascular disease in a sample of teenagers]. Revista de Neurología. 2003; 37: 500. (En Español)
[29]Oró M, Sanahuja-Montesinos J, Hernández L, Setó E, Purroy F. Grado de conocimiento del ictus entre poblacion de area rural en la provincia de Lleida [The extent of knowledge about strokes among the population of a rural area in the province of Lleida]. Revista de Neurología. 2009; 48: 515–519. (En Español)
[30]Moreira E, Correia M, Magalhães R, Silva MC. Stroke awareness in urban and rural populations from northern Portugal: knowledge and action are independent. Neuroepidemiology. 2011; 36: 265–273. https://doi.org/10.1159/000328867.
Academic Editor
- Jaume Sastre-Garriga
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The Stroke Riskometer™ in the Outpatient Clinic as an Educational Campaign for Acute Ischemic Stroke
1 Facultad de Medicina de la Universidad Autónoma de Nuevo León, Monterrey, NL 64460, México
2 St. Michael’s Hospital Li Ka Shing Knowledge Institute, RADIS Lab, Toronto, ON M5B 1A6, Canada
3 Servicio de Medicina Interna, Hospital Universitario “José Eleuterio González”, Monterrey, NL 64460, México
4 Servicio de Neurología, Hospital Universitario “José Eleuterio González”, Monterrey, NL 64460, México
Abstract
Stroke is highly prevalent worldwide; however, associated symptoms and risk factors are unknown in the general population. Our aim was to describe the knowledge of early signs of stroke and its association with the risk of stroke at 5 and 10 years according to the “Stroke Riskometer™”.
This was an observational, descriptive, cross-sectional study, including adults in the Neurology outpatient clinic of the University Hospital “Dr. José Eleuterio González”. Vital signs were recorded, anthropometric and the “Stroke Riskometer™” measurements were collected, and the risks at 5 and 10 yearswere calculated. Patients were questioned about the early signs of stroke (with emphasis on the acronym FAST: F = Face uneven, A = Arm hanging down, S = Speech slurred, T = Time is vital [CAMALEÓN in Spanish]). Spearman’s evaluation was used to measure the association between risk and knowledge of signs.
A total of 300 participants were included; 208 (69.3%) were women and the mean age was 54.5 (±14.0) years. The most prevalent risk factors for stroke were sedentary lifestyle (46.3%), high blood pressure (40.0%), and diabetes (31.0%). The population median risk at 5 years was 3.6% (interquartile range (IQR) 1.9–7.0) and at 10 years 6.3% (IQR 3.1–14.0). Of all participants, 31.2% were aware of at least one early sign of stroke. No significant correlation was found between awareness of early signs and risk at 5 or 10 years (r = 0.039, p = 0.5; r = –0.05, p = 0.380, respectively).
Knowledge of the signs of stroke is low but remains an ongoing goal for educational campaigns in Mexico. A large-scale national and long-lasting campaign is necessary, given the high risk of stroke in the population.
Keywords
- population knowledge
- risk factors
- stroke
- Mexico
- primary prevention
- Stroke Riskometer™ App
References
- [1]
Thayabaranathan T, Kim J, Cadilhac DA, Thrift AG, Donnan GA, Howard G, et al. Global stroke statistics 2022. International Journal of Stroke. 2022; 17: 946–956. - [2]
Instituto Nacional de Estadística y Geografía (INEGI). ESTADÍSTICAS DE DEFUNCIONES REGISTRADAS (EDR). México: INEGI; 2025. Available at: https://www.inegi.org.mx/programas/edr/ (Accedido: 16 Noviembre 2024). - [3]
Gutiérrez-Jiménez E, Góngora-Rivera F, Martínez HR, Escamilla-Garza JM, Villarreal HJ, GECEN Investigators. Knowledge of ischemic stroke risk factors and warning signs after a health education program by medical students. Stroke. 2011; 42: 897–901. https://doi.org/10.1161/STROKEAHA.110.597062. - [4]
Williams LS, Bruno A, Rouch D, Marriott DJ. Stroke patients’ knowledge of stroke. Influence on time to presentation. Stroke. 1997; 28: 912–915. https://doi.org/10.1161/01.str.28.5.912. - [5]
Wein TH, Staub L, Felberg R, Hickenbottom SL, Chan W, Grotta JC, et al. Activation of emergency medical services for acute stroke in a nonurban population: the T.L.L. Temple Foundation Stroke Project. Stroke. 2000; 31: 1925–1928. https://doi.org/10.1161/01.str.31.8.1925. - [6]
Jones SP, Jenkinson AJ, Leathley MJ, Watkins CL. Stroke knowledge and awareness: an integrative review of the evidence. Age and Ageing. 2010; 39: 11–22. https://doi.org/10.1093/ageing/afp196. - [7]
Faiz KW, Sundseth A, Thommessen B, Rønning OM. Patient knowledge on stroke risk factors, symptoms and treatment options. Vascular Health and Risk Management. 2018; 14: 37–40. https://doi.org/10.2147/VHRM.S152173. - [8]
Pu C, Guo JY, Yu-Hua-Yeh, Sankara P. Comparison of knowledge on stroke for stroke patients and the general population in Burkina Faso: a cross-sectional study. AIMS Public Health. 2020; 7: 723–735. https://doi.org/10.3934/publichealth.2020056. - [9]
Saadatnia M, Hajiannejad N, Yazdabadi A, Tajmirriahi M, Nasr M. Public Stroke Knowledge, Awareness, and Response to Acute Stroke in Isfahan Iran: What is Less or Misinterpreted in Developing Countries. Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association. 2021; 30: 105670. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105670. - [10]
Sirisha S, Jala S, Vooturi S, Yada PK, Kaul S. Awareness, Recognition, and Response to Stroke among the General Public-An Observational Study. Journal of Neurosciences in Rural Practice. 2021; 12: 704–710. https://doi.org/10.1055/s-0041-1735822. - [11]
Romero-Bravo M, de la Cruz-Cosme C, Barbancho MA, García-Casares N. Conocimiento sobre el ictus en la población española. Una revisión sistemática [Knowledge on stroke in Spanish population. A systematic review]. Revista de Neurología. 2022; 74: 189–201. https://doi.org/10.33588/rn.7406.2021401. - [12]
Hawkes MA, Ameriso SF, Willey JZ. Stroke knowledge in Spanish-speaking populations. Neuroepidemiology. 2015; 44: 121–129. https://doi.org/10.1159/000381100. - [13]
Hawkes MA, Gomez-Schneider MM, Dossi DE, Melcon MO, Ameriso SF. Stroke Knowledge in the EstEPA Project, a Population-Based Study. Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association. 2021; 30: 105471. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105471. - [14]
Dossi DE, Hawkes MA, Pujol-Lereis VA, Povedano GP, Rodríguez-Lucci F, Farez MF, et al. A Population-Based Survey of Stroke Knowledge in Argentina: The SIFHON Study. Neuroepidemiology. 2019; 53: 32–40. https://doi.org/10.1159/000497413. - [15]
Góngora-Rivera F, Gutiérrez-Jiménez E, Zenteno MA, GEPEVC Investigators. Knowledge of ischemic stroke among a Mexico City population. Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association. 2009; 18: 208–213. https://doi.org/10.1016/j.jstrokecerebrovasdis.2008.10.002. - [16]
Góngora-Rivera F, González-Aquines A, Muruet W, Barrera-Barrera S, Leal-Bailey H, Espinosa-Ortega MA, et al. Difference in Stroke Knowledge between Rural and Urban Communities in a Developing Country after Community-Based Stroke Educational Campaigns: Results from a Cross-Sectional Study. Neuroepidemiology. 2018; 51: 224–229. https://doi.org/10.1159/000490724. - [17]
Feigin VL, Norrving B. A new paradigm for primary prevention strategy in people with elevated risk of stroke. International Journal of Stroke: Official Journal of the International Stroke Society. 2014; 9: 624–626. https://doi.org/10.1111/ijs.12300. - [18]
Medvedev O, Truong QC, Merkin A, Borotkanics R, Krishnamurthi R, Feigin V. Cross-cultural validation of the stroke riskometer using generalizability theory. Scientific Reports. 2021; 11: 20516. https://doi.org/10.1038/s41598-021-98591-8. - [19]
Parmar P, Krishnamurthi R, Ikram MA, Hofman A, Mirza SS, Varakin Y, et al. The Stroke Riskometer(TM) App: validation of a data collection tool and stroke risk predictor. International Journal of Stroke: Official Journal of the International Stroke Society. 2015; 10: 231–244. https://doi.org/10.1111/ijs.12411. - [20]
Marquez-Romero JM, Romo-Martínez J, Hernández-Curiel B, Ruiz-Franco A, Krishnamurthi R, Feigin V. Assessing the individual risk of stroke in caregivers of patients with stroke. Arquivos de Neuro-Psiquiatria. 2024; 82: 1–5. https://doi.org/10.1055/s-0044-1779691. - [21]
Sarfo FS, Akinyemi JO, Obiako R, Nichols M, Fakunle AG, Adusei N, et al. Effect of an Educational Intervention for Primary Stroke Risk Reduction in Ghana and Nigeria: Pilot Randomized Controlled Trial. Stroke. 2023; 54: 1660–1664. https://doi.org/10.1161/STROKEAHA.123.042618. - [22]
Onwuakagba IU, Okoye EC, Kanu FC, Kalu CM, Akaeme DC, Obaji OC, et al. Population-based stroke risk profile from a West-African community. ENeurologicalSci. 2023; 33: 100483. https://doi.org/10.1016/j.ensci.2023.100483. - [23]
Choi CU, Park CG. Estimating the probability of stroke in Korean hypertensive patients visiting tertiary hospitals using a risk profile from the Framingham study. BMC Neurology. 2009; 9: 16. https://doi.org/10.1186/1471-2377-9-16. - [24]
Bestehorn K, Wahle K, Kirch W. Stroke risk screening of adults with hypertension: prospective cross-sectional study in primary care. Clinical Drug Investigation. 2008; 28: 281–289. https://doi.org/10.2165/00044011-200828050-00002. - [25]
Sethi R, Hiremath JS, Ganesh V, Banerjee S, Shah M, Mehta A, et al. Correlation between Stroke Risk and Systolic Blood Pressure in Patients over 50 Years with Uncontrolled Hypertension: Results from the SYSTUP-India Study. Cardiovascular Therapeutics. 2021: 6622651. https://doi.org/10.1155/2021/6622651. - [26]
GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. Neurology. 2021; 20: 795–820. https://doi.org/10.1016/S1474-4422(21)00252-0. - [27]
Fan J, Li X, Yu X, Liu Z, Jiang Y, Fang Y, et al. Global Burden, Risk Factor Analysis, and Prediction Study of Ischemic Stroke, 1990–2030. Neurology. 2023; 101: e137–e150. https://doi.org/10.1212/WNL.0000000000207387. - [28]
Arboix A, Arboix-Alió A, Hernández-Arrieta M. Escaso conocimiento de la enfermedad vascular cerebral en una muestra de jovenes adolescentes [Scant knowledge about cerebrovascular disease in a sample of teenagers]. Revista de Neurología. 2003; 37: 500. (En Español) - [29]
Oró M, Sanahuja-Montesinos J, Hernández L, Setó E, Purroy F. Grado de conocimiento del ictus entre poblacion de area rural en la provincia de Lleida [The extent of knowledge about strokes among the population of a rural area in the province of Lleida]. Revista de Neurología. 2009; 48: 515–519. (En Español) - [30]
Moreira E, Correia M, Magalhães R, Silva MC. Stroke awareness in urban and rural populations from northern Portugal: knowledge and action are independent. Neuroepidemiology. 2011; 36: 265–273. https://doi.org/10.1159/000328867.
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