Sex-Related Differences in Quality of Care and Short-Term Mortality Among Patients With Acute Stroke in Denmark

119

Background and Purpose-Predictors of early case-fatality (3-day, 7-day, and 30-day) in first-ever ischemic stroke were identified and compared with predictors of late case-fatality (90-day and 1-year). Methods-A registry designed to register hospitalized patients with stroke in Denmark 2000 to 2007 holds 26 818 patients with first-ever ischemic stroke with information on stroke severity (Scandinavian Stroke Scale), CT scan, cardiovascular risk factors, marital status, and fatality within 1 year. Multiple logistic regression was used in identifying predictors. Results-Mean age was 71.2 years; 48.5% were women; mean Scandinavian Stroke Scale score was 43.9. Early case-fatality showed stroke severity and age were significant predictors of 3-day, 7-day, and 30-day case-fatality (nonlinear effect). In addition, atrial fibrillation (OR, 1.56) predicted 30-day case-fatality. For late case-fatality, significant predictors of 90-day and 1-year case-fatality were age, stroke severity (nonlinear effect), atrial fibrillation (OR, 1.37 and 1.57), and diabetes (OR, 1.35 and 1.33), respectively. Male gender (OR, 1.28), previous myocardial infarction (OR, 1.40), and smoking (OR, 1.21) were also associated with 1-year case-fatality. Alcohol consumption, hypertension, intermittent arterial claudication, and marital state had no influence. All case-fatality rates accelerated with increasing age, but 3-day and 7-day case-fatality rates tended to level off or decline at the highest ages. Conclusions-Age and stroke severity were the only significant predictors of fatality within the first poststroke week; they were associated with late case-fatality as well. Cardiovascular risk factors were associated with late case-fatality; with the exception of atrial fibrillation, they were not significantly associated with early case-fatality rates. (Stroke. 2011;42:2806-2812.)

Section: Predictors Of Late Case-fatalitysupporting

confidence: 65%

Predictors of Early and Late Case-Fatality in a Nationwide Danish Study of 26 818 Patients With First-Ever Ischemic Stroke

Andersen

Olsen

2011

119

“…Regarding mortality, the rate was higher for women in the unadjusted analysis, but this difference reversed after multivariate modeling with a higher probability of being alive for women at 3-month follow-up. Although this will remain a controversial issue, such a scenario has also been described by other authors 4,23 and stresses the importance to consider also demographic and clinical aspects besides sex when analyzing stroke mortality rates. Such investigations should also encompass the more complex construct of genderrelated diversity.…”

Section: June 2014mentioning

confidence: 70%

Sex-Related Differences of Acute Stroke Unit Care

Gattringer

Ferrari

Knoflach

et al. 2014

Background and Purpose-Sex-related differences in quality of acute stroke care are an important concern with limited data available, specifically regarding stroke unit (SU) setting. We used the prospective nationwide Austrian SU registry to address this issue. Methods-Our analysis covered an 8-year time period (January 2005 to December 2012) during which all patients with transient ischemic attack or ischemic stroke admitted to 1 of 35 Austrian SU had been captured in the registry. These data were analyzed for age-adjusted preclinical and clinical characteristics and quality of acute stroke care in men and women. In addition, we assessed the outcome at 3 months in multivariate analysis. Results-A total of 47 209 individuals (47% women) had received SU care. Women were significantly older (median age:77.9 versus 70.3 years), had higher pre-existing disability and more severe strokes. Correcting for age, no significant sex-related differences in quality of care were identified with comparable onset-to-door times, times to and rates of neuroimaging, as well as door-to-needle times and rates of intravenous thrombolysis (14.5% for both sexes). Despite equal acute stroke care and a comparable rate of neurorehabilitation, women had a worse functional outcome at 3-month follow-up (modified Rankin scale 3-5: odds ratio,

“…Finally, a nationwide study undertaken in Denmark could not link the observed sex-related differences in short-term mortality with differences in acute hospital care. 24 One main problem of the current study, and the reason for the stratified analyses undertaken within different data sets, is the confounding role of disease severity. The so-called confounding by severity, a type of confounding by indication, 25 can arise in observational studies when patients with worse prognosis preferentially receive, or do not receive, a particular treatment on the basis of such prognosis.…”

Section: Discussionmentioning

confidence: 99%

Noncompliance With Certain Quality Indicators Is Associated With Risk-Adjusted Mortality After Stroke

Abilleira¹,

Ribera²,

Permanyer-Miralda³

et al. 2012

Background and Purpose-To investigate the 30-day and 12-month mortality risks among hospitalized stroke patients according to compliance with guideline-based process indicators. Methods-We used data from the Second Stroke Audit and the Mortality Register of Catalonia (Spain). The audit retrospectively explored quality of stroke care based on compliance with indicators among patients discharged from all public hospitals in Catalonia in 2007; they were identified and selected through a pre-established sampling method. The magnitude of the independent association of each indicator with 30-day and 12-month mortality was assessed using logistic regression with generalized estimating equations to account for clustering of patients within hospitals. Generalized estimating equations modeling was initially restricted to patients alive Ͼ72 hours poststroke to control for confounding by severity. Analyses were also run in 3 other samples (all patients, patients alive Ͼ7 days, and patients alive Ͼ14 days). Results-Of 1767 stroke admissions in the Second Stroke Audit, 1697 patients survived Ͼ72 hours poststroke. Within this sample, the adjusted 30-day mortality risk was negatively associated with nonadherence to different indicators, of which only antithrombotics at discharge (OR, 4.3; 95% CI, 1.72-10.78) remained significant in all data sets. At 12 months, the adjusted mortality risk was negatively associated with management of hypertension (OR, 1.87; 95% CI, 1.22-2.86) and antithrombotics at discharge (OR, 2.79; 95% CI, 1.41-5.54). Both remained unchanged across different samples. Conclusions-Assessing the impact of quality of stroke care on mortality is complex and is hampered by residual confounding, particularly in the short-term. Nevertheless, this study suggests that at least a few indicators should be used to monitor quality of stroke services. (Stroke. 2012;43:1094-1100.)Key Words: acute stroke Ⅲ healthcare Ⅲ outcomes Ⅲ stroke care Ⅲ quality D espite recent dramatic reductions of mortality rates, stroke remains a health problem of first order.