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.
Highlights
Stroke mortality has decreased worldwide during the last two de‐ cades (Feigin et al, 2014), but it is uncertain which factors have contributed
stroke units (SUs) treatment improves both survival and function, with patients treated at an SU having bet‐ ter outcomes compared to treatment on alternative wards (Stroke Unit Trialists’ Collaboration, 2013)
SU treatment is the gold standard treatment for stroke patients, and there have been some medical advances in recent years that have been shown to improve outcomes
Summary
Stroke mortality has decreased worldwide during the last two de‐ cades (Feigin et al, 2014), but it is uncertain which factors have contributed. Existing studies reporting trends in stroke risk factors or out‐ comes include either both hospitalized and nonhospitalized patients (Feigin et al, 2015; Feigin, Lawes, Bennett, Barker‐Collo, & Parag, 2009; Lecoffre et al, 2017; Lee, Shafe, & Cowie, 2011; Numminen, Kaste, Aho, Waltimo, & Kotila, 2000; Rothwell et al, 2004; Wieberdink, Ikram, Hofman, Koudstaal, & Breteler, 2012), or pa‐ tients treated in hospital, but not necessarily on an SU (Appelros et al, 2010, 2014; Arboix et al, 2008; Carrera, Maeder‐Ingvar, Rossetti, Devuyst, & Bogousslavsky, 2007; Nimptsch & Mansky, 2014). SU treatment is the gold standard treatment for stroke patients, and there have been some medical advances in recent years that have been shown to improve outcomes. Management on an SU is the gold standard treatment for stroke patients, and medical advances in recent years have been shown to improve outcomes. Secondary objectives were to investigate changes in stroke severity and other baseline characteristics in this population
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