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(Stroke. 2004;35:1368.)
© 2004 American Heart Association, Inc.

Original Contributions

Health Care Resource Use After Acute Stroke in the Glycine Antagonist in Neuroprotection (GAIN) Americas Trial

Tanja Rundek, MD, PhD; Kirsten Nielsen, PhD; Stephen Phillips, MD, FRCPC; Karen C. Johnston, MD, MSc; Marg Hux, MSc David Watson, MSc for the GAIN Americas Investigators

From the Department of Neurology (T.R.), Neurological Institute, Columbia University, New York, NY; Global Health Outcomes (K.N.) and Cardiovascular and Urology Clinical Development and Medical Affairs (D.W.), GlaxoSmithKline, Research Triangle Park, NC; the Division of Neurology (S.P.), Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada; the Department of Neurology (K.C.J.), University of Virginia, Charlottesville, Va; Innovus Research Inc (M.H.), Burlington, Ontario, Canada.

Correspondence to Dr Kirsten Nielsen, Global Health Outcomes, GlaxoSmithKline, PO Box 13398, Research Triangle Park, NC 27709. E-mail Kirsten.E.Nielsen{at}gsk.com

Background and Purpose— To compare 3-month stroke outcomes and stroke-related health care resource use between the US and Canada in the Glycine Antagonist in Neuroprotection (GAIN) Americas study. Delivery of medical care for stroke patients, often driven by efforts to curb costs, varies substantially between countries. Data on the potential impact of these variations on clinical outcomes are sparse.

Methods— The analysis of health care resource included total length of stay (LOS) in hospital, intensive care unit (ICU), and acute-care ward or rehabilitation unit, or both; number of outpatient rehabilitation sessions and visits to a physician; place of residence after discharge; and employment status. Cox proportional hazards models and logistic regression were used to calculate survival hazards and predictors of favorable functional outcome (Barthel Index of 95 to 100).

Results— One thousand six hundred four patients who were independent before stroke (mean age: 69.9±12.7 years, 53% men, 85% ischemic stroke, 69% in the US) were included. Three-month survival and functional outcome did not differ between the US and Canada. Survival rate was 80% in both countries. Favorable functional outcome was achieved in 43% of Canadian and 47% of US patients. Fewer Canadian patients received treatment in ICU (19% versus 63% in the US), and Canadians had longer stays in hospital or rehabilitation facility (median: 33 days versus 16 days in the US).

Conclusion— Despite similar 3-month survival and functional outcome, patterns of health care resource varied substantially between the US and Canada. US patients had more intensive early care; Canadian patients had longer hospitalizations and rehabilitation care. Further research is required to determine the most cost-effective treatment and rehabilitation plan for people who have a stroke.

Key Words: stroke outcome • survival • outcome • health resources/utilization • economics, medical

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