Published online before print July 30, 2009, doi: 10.1161/STROKEAHA.109.554907
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(Stroke. 2009;40:3321.)
© 2009 American Heart Association, Inc.
Original Contributions |
Do All Age Groups Benefit From Organized Inpatient Stroke Care?
From the Stroke Research Unit (G.S.), Division of Neurology, Department of Medicine, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada; the Department of Health Policy, Management and Evaluation (G.S., M.K.), University of Toronto, Toronto, Ontario, Canada; the Division of General Internal Medicine and Clinical Epidemiology (M.K.), Department of Medicine, University Health Network, Toronto, Ontario, Canada; the University Health Network Women’s Health Program (S.B.C., A.M.D., M.D.H.), Toronto, Ontario, Canada, and Calgary Stroke Program, Department of Clinical Neurosciences; University of Calgary, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; and the Institute of Clinical Evaluative Sciences (J.F., M.K.K., G.S.), Toronto, Ontario, Canada, and the Canada Department of Medicine, McMaster University, Ontario, Canada.
Correspondence to Gustavo Saposnik, MD, MSc, FAHA, Chair, Stroke Outcome Research Canada (SORCan–www.sorcan.ca), 55 Queen Street East, Suite 931, St Michael’s Hospital, University of Toronto, Toronto, M5C 1R6, Canada. E-mail saposnikg{at}smh.toronto.on.ca
Background and Purpose— Organized inpatient stroke care consists of a multidisciplinary approach aimed at improving stroke outcomes. It is unclear whether elderly individuals benefit from these interventions to the same extent as younger patients. We sought to determine whether the reduction in mortality or institutionalization seen with organized stroke care was similar across all age groups.
Methods— This was a case–cohort study of patients with acute ischemic stroke seen between July 2003 and March 2005 and captured in the Registry of the Canadian Stroke Network. After stratifying by age category, we assessed for evidence of effect modification by age on the reduction in stroke fatality associated with stroke unit/organized care.
Results— Among 3631 patients with ischemic stroke, stroke case-fatality at 30 days was lower for patients admitted to a stroke unit compared with those admitted to general medical wards (10.2% versus 14.8%; P<0.0001 with an absolute risk reduction=4.6%, number needed to treat=22). All age groups achieved a similar benefit of stroke unit care versus general medical ward care (absolute risk reduction for 30-day stroke fatality was 4.5% for <60 years; 3.4% for 60 to 69 years; 5.3% for 70 to 79 years; and 5.5% for those >80 years). Increasing levels of organized care were associated with lower stroke fatality or institutionalization. The beneficial effect of stroke units/organized care on survival was seen even after adjustment for multiple prognostic factors and after excluding patients on palliative approach. There was no evidence of effect modification by age in any analyses.
Conclusions— Stroke units and organized inpatient care reduce death or institutionalization with the same magnitude of effect across all age groups.
Key Words: access to care • death • health policy • health services research • institutionalization • medicine • mortality • occupational therapy • organized care • outcome research • physiotherapy • stroke • stroke team • stroke unit