Abstract:

Objective  To analyze the reasons for loss of follow-up after discharge among acute ischemic stroke patients during the outbreak of novel coronavirus pneumonia.

Methods  The high-risk patients with acute ischemic stroke who were hospitalized in Department of Neurology, the Affiliated Hospital of Weifang Medical University from January 2020 to December 2020 were enrolled in this retrospective study. According to the electronic medical records, the patients without recheck at the clinic for 3 months after discharge were included in the lost to follow-up group, and the other patients were included in the no lost to follow-up group. The clinical information of electronic medical records were collected. A questionnaire was conducted on the patients by on-site visit, calling and survey. The clinical information and questionnaires results between the two groups were compared to analyze the factors of loss of follow-up. In addition, the open questioning method was used to investigate the reasons for the loss of follow-up.

Results  There were 495 discharged patients, of whom 167 patients were lost to follow-up, and 328 were followed up. The proportion of stroke recurrence (31.1% vs. 21.0%, P=0.013), hypertension (54.5% vs. 43.0%, P=0.015) and previous stroke (52.1% vs. 39.3%, P=0.007), and NIHSS score at discharge (3.67±1.76 points vs. 3.25±1.12 points, P<0.001) in the lost to follow-up group were higher than those in no lost to follow-up group, and the percentage of taking secondary prevention drugs after discharge (69.5% vs. 86.3%, P<0.001) was lower than that in no lost to follow-up group. The main reasons for the loss of follow-up were "epidemic reasons, felling unsafe for going to the hospital" (18.0%), "using traditional Chinese medicine treatment" (13.8%), "buy medicine at the drugstore" (13.2%), "having recovered" (8.4%), "lack of caregivers" (7.2%), and "a follow-up visit at the local hospital" (6.6%).

Conclusions  The patients with acute ischemic stroke who were lost to follow-up after discharge had a higher proportion of hypertension and previous stroke, severe neurological deficit at discharge, a lower proportion of taking secondary prevention drugs after discharge, and a higher risk of stroke recurrence. The COVID-19 was the most common reason for the loss of follow-up during the epidemics.

Key words: Acute ischemic stroke; Outpatient department; Follow up; Lost to follow-up;Novel coronavirus pneumonia

摘要：

目的 分析新型冠状病毒肺炎疫情期间急性缺血性卒中患者出院后门诊随诊失访情况及失访原因。

方法 连续入组2020年1-12月在潍坊医学院附属医院神经内科住院的高危急性缺血性卒中患者，根据电子病历系统记录，筛选出出院后连续3个月未前往门诊复诊的患者为失访组。根据病历提取患者住院期间信息，包括人口学资料、血管危险因素、TOAST分型、症状等。采用现场、电话询问、调查访问相结合的方法对患者进行问卷调查，包括患者的职业、学历、婚姻、医保等信息。比较失访组与未失访组上述指标的差异。进一步采用开放式提问方法调查失访组的主要失访原因。 

结果 研究期间出院的495例患者中，未失访患者共328例，失访患者167例。失访组卒中复发率高于未失访组（31.1% vs. 21.0%，P =0.013），高血压（54.5% vs. 43.0%，P =0.015）、既往卒中（52.1% vs.39.3%，P =0.007）比例和出院时NIHSS（3.67±1.76分 vs. 3.25±1.12分，P＜0.001）均高于未失访组，院外服用二级预防药物比例（69.5% vs . 86.3%，P＜0.001）低于未失访组，差异有统计学意义。失访组的失访原因主要为“疫情原因，担心去医院不安全”（18.0%），“现在采用中药治疗”（13.8%），“能在药店买到药”（13.2%），“已经痊愈”（8.4%），“儿女不在身边，去不了”（7.2%），“已在当地医院随诊”（6.6%）。

结论 急性缺血性卒中患者出院后失访组高血压、既往卒中比例较高，出院时神经功能缺损较重，院外二级预防药物使用比例较低，且卒中复发率高。受新冠肺炎疫情影响是疫情期间患者出院后门诊随诊失访最主要的原因。

关键词: 急性缺血性卒中; 门诊; 随诊; 失访; 新型冠状病毒肺炎