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

ABSTRACT: OBJECTIVES:Treatment 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 & METHODS:We 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). RESULTS:Three-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%. CONCLUSIONS:Three-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.

SUBMITTER: Labberton AS

PROVIDER: S-EPMC6346673 | biostudies-other | 2019 Jan

REPOSITORIES: biostudies-other

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

Labberton Angela Susan AS Rønning Ole Morten OM Thommessen Bente B Barra Mathias M

Brain and behavior 20181125 1

<h4>Objectives</h4>Treatment 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.<h4>Materials & methods</h4>We compared 3-year all-cause mortality and baseline characteristics in two cohorts of stroke patients aged ≥60 consecutively ad ...[more]

PMID: 30474214

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Project description:BackgroundNationwide data on the clinical profile and outcomes of ischemic stroke in younger adults are still scarce. Our aim was to analyze clinical characteristics and outcomes of young patients with first-ever ischemic stroke compared to older patients.MethodsThe National Acute Stroke ISraeli registry is a nationwide prospective hospital-based study performed triennially. Younger adults, aged 50?years and younger, were compared with patients, aged 51-84?years regarding risk factors, clinical presentation, stroke severity, stroke etiology, and outcomes. A logistic model for stroke outcome was fitted for each age group.Results336 first-ever ischemic strokes were identified among patients aged 50?years and younger and 3,243 among patients 51-84?years. Younger adults had lower rates of traditional vascular risk factors, but 82.7% had at least one of these risk factors. Younger adults were more likely to be male (62.8%), current smokers (47.3%), and to have a family history of stroke (7.4%). They tended to have less common stroke presentation such as sensory disturbances or headache and were more likely to arrive at the hospital independently by car. The majority of young adults (70%) had a favorable outcome (modified Ranking Scale; mRS???1) at discharge, but 11.7% had poor outcome (mRS?>?3) and 18.2% had an in-hospital complication. According to a multivariable regression model, in young adults, only baseline stroke severity (National Institute of Health Stroke Scale?>?5) was associated with poor outcome at discharge (p?<?0.001), whereas in older adults, stroke severity (p?<?0.001), female gender (OR?=?1.35, CI 95% 1.03-1.76), older age (OR?=?1.08, CI 95% 1.01-1.16), atrial fibrillation (OR?=?1.62, CI 95% 1.16-2.26), and anterior circulation territory (OR?=?2.10, CI 95% 1.50-2.94) were all significantly associated with poor outcome.ConclusionOur findings, in this nationwide registry, demonstrate the relatively high rate of smoking and family history of stroke, and the lower rate of hospital arrival by ambulance among young adults. This calls for increasing awareness to the possibility of stroke among young adults and for better prevention, especially smoking cessation.

Project description:RationaleAdmission to an intensive care unit (ICU) may be beneficial to patients with pneumonia with uncertain ICU needs; however, evidence regarding the association between ICU admission and mortality for other common conditions is largely unknown.ObjectivesTo estimate the relationship between ICU admission and outcomes for hospitalized patients with exacerbation of chronic obstructive pulmonary disease (COPD), exacerbation of heart failure (HF), or acute myocardial infarction (AMI).MethodsWe performed a retrospective cohort study of all acute care hospitalizations from 2010 to 2012 for U.S. fee-for-service Medicare beneficiaries aged 65 years and older admitted with COPD exacerbation, HF exacerbation, or AMI. We used multivariable adjustment and instrumental variable analysis to assess each condition separately. The instrumental variable analysis used differential distance to a high ICU use hospital (defined separately for each condition) as an instrument for ICU admission to examine marginal patients whose likelihood of ICU admission depended on the hospital to which they were admitted. The primary outcome was 30-day mortality. Secondary outcomes included hospital costs.ResultsAmong 1,555,798 Medicare beneficiaries with COPD exacerbation, HF exacerbation, or AMI, 486,272 (31%) were admitted to an ICU. The instrumental variable analysis found that ICU admission was not associated with significant differences in 30-day mortality for any condition. ICU admission was associated with significantly greater hospital costs for HF ($11,793 vs. $9,185, P < 0.001; absolute increase, $2,608 [95% confidence interval, $1,377-$3,840]) and AMI ($19,513 vs. $14,590, P < 0.001; absolute increase, $4,922 [95% confidence interval, $2,665-$7,180]), but not for COPD.ConclusionsICU admission did not confer a survival benefit for patients with uncertain ICU needs hospitalized with COPD exacerbation, HF exacerbation, or AMI. These findings suggest that the ICU may be overused for some patients with these conditions. Identifying patients most likely to benefit from ICU admission may improve health care efficiency while reducing costs.

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

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

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