Changes in survival and characteristics among older stroke unit patients—1994 versus 2012

Abstract

ObjectivesTreatment on organized stroke units (SUs) improves survival after stroke, and stroke mortality has decreased worldwide in recent decades; however, little is known of survival trends among SU patients specifically. This study investigates changes in survival and characteristics of older stroke patients receiving SU treatment.Materials & MethodsWe compared 3‐year all‐cause mortality and baseline characteristics in two cohorts of stroke patients aged ≥60 consecutively admitted to the same comprehensive SU in 1994 (n = 271) and 2012 (n = 546).ResultsThree‐year survival was 53.9% in 1994 and 56.0% in 2012, and adjusted hazard ratio (HR) was 0.99 (95% CI: 0.77–1.28). Adjusted 30‐day case fatality was slightly higher in 2012, 18.9% versus 16.2%, HR 1.68 (95% CI: 1.14–2.47). There were no significant between‐cohort differences in survival beyond 30 days. Patients in 2012 were older (mean age: 78.8 vs. 76.7 years) and more often admitted from nursing homes. There were higher rates of atrial fibrillation (33.7% vs. 21.4%) and malignancy (19.2% vs. 8.9%), and prescription of antiplatelets (46.9% vs. 26.2%) and warfarin (16.3% vs. 5.5%) at admission. Stroke severity was significantly milder in 2012, proportion with mild stroke 66.1% versus 44.3%.ConclusionsThree‐year survival in older Norwegian stroke patients treated on an SU remained stable despite improved treatment in the last decades. Differences in background characteristics may explain this lack of difference; patients in 2012 were older, more often living in supported care, and had higher prestroke comorbidity; however, their strokes were milder and risk factors more often treated.

Associations between length of stay and municipal characteristics for a large Norwegian stroke unit

“…Labberton et al for a thorough discussion and definition of comprehensive stroke units. [21] patients resident in Ahus' catchment area are treated at Ahus unless they experience a stroke while traveling. In general, this holds of all acute medical emergencies that require hospitalisation in Norway: hospital of admission is dictated by geographical location of the patient.…”

Stroke Mimics on the Stroke Unit – Temporal trends 2008–2017 at a large Norwegian university hospital

“…Increased emphasis on stroke as a medical emergency and the ‘time is brain’ paradigm after the breakthrough of intravenous thrombolytic therapy has likely resulted in a lower threshold for admissions to an SU for suspected strokes and TIAs. For example, TIAs were not routinely admitted to hospitals in Norway prior to 2011, and there is evidence that milder strokes (NIHHS at arrival) are hospitalized more often than two decades ago 40 . An almost inevitable consequence of such a medically desired intake policy is an increase in ED and SU admissions for patients who prove to have other conditions than acute stroke.…”

“…were not routinely admitted to hospitals in Norway prior to 2011, and there is evidence that milder strokes (NIHHS at arrival) are hospitalized more often than two decades ago. 40 An almost inevitable consequence of such a medically desired intake policy is an increase in ED and SU admissions for patients who prove to have other conditions than acute stroke. Another way to view this is that if the health system's sensitivity for stroke increase, then the specificity must almost surely suffer somewhat.…”

Stroke unit demand in Norway – present and future estimates

“…Although declining stroke incidence rates have been observed in high-income countries over the last 30 years, the trend in absolute numbers is offset by an aging population [ 8 – 10 ], and more liberal admission guidelines [ 3 , 11 ]. Recent estimates of incidence rates in Norway have found a decline in age- and sex-adjusted incidence for IS and non-significant trends for intracerebral haemorrhage (ICH) and TIA during the years 2010–2015 [ 12 , 13 ].…”

“…Recent estimates of incidence rates in Norway have found a decline in age- and sex-adjusted incidence for IS and non-significant trends for intracerebral haemorrhage (ICH) and TIA during the years 2010–2015 [ 12 , 13 ]. In addition, there appears to be a general reduction in the average length of stay (LOS) for stroke patients [ 11 ]. On the other hand, similar reductions in admission rates for SM are not found [ 7 , 14 , 15 ].…”