on August 20, 2009
Published online before print August 20, 2009, doi: 10.1161/STROKEAHA.109.558759
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Submitted on May 25, 2009
From Stroke Research Unit (G.S.), Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Neurology (S.E.B.), Department of Medicine, Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Department of Neuroscience Research (A.H.), Ottawa Health Research Institute; University of Ottawa. Ontario, Canada; Institute of Clinical Evaluative Sciences (G.S., J.F., J.T., M.K.K.), Ontario. Canada; Division of General Internal Medicine and Clinical Epidemiology (J.T., M.K.K.), Department of Medicine, University Health Network, Toronto, Ontario, Canada; University Health Network Women's Health Program Toronto, Ontario, Canada; Department of Health Policy (G.S., J.T., M.K.K.), Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. * To whom correspondence should be addressed. E-mail: saposnikg{at}smh.toronto.on.ca.
Background and Purpose—Limited information is available on the effect of age on stroke management and care delivery. Our aim was to determine whether access to stroke care, delivery of health services, and clinical outcomes after stroke are affected by age. Methods—This was a prospective cohort study of patients with acute ischemic stroke in the province of Ontario, Canada, admitted to stroke centers participating in the Registry of the Canadian Stroke Network between July 1, 2003 and March 31, 2005. Primary outcomes were the following selected indicators of quality stroke care: (1) use of thrombolysis; (2) dysphagia screening; (3) admission to a stroke unit; (4) carotid imaging; (5) antithrombotic therapy; and (6) warfarin for atrial fibrillation at discharge. Secondary outcomes were risk-adjusted stroke fatality, discharge disposition, pneumonia, and length of hospital stay. Results—Among 3631 patients with ischemic stroke, 1219 (33.6%) were older than 80 years. There were no significant differences in stroke care delivery by age group. Stroke fatality increased with age, with a 30-day risk adjusted fatality of 7.1%, 6.5%, 8.8%, and 14.8% for those aged 59 or younger, 60 to 69, 70 to 79, and 80 years or older, respectively. Those aged older than 80 years had a longer length of hospitalization, increased risk of pneumonia, and higher disability at discharge compared to those younger than 80. This group was also less likely to be discharged home. Conclusions—In the context of a province-wide coordinated stroke care system, stroke care delivery was similar across all age groups with the exception of slightly lower rates of investigations in the very elderly. Increasing age was associated with stroke severity and stroke case-fatality.
Accepted on June 23, 2009
Age Disparities in Stroke Quality of Care and Delivery of Health Services
Gustavo Saposnik MD, MSc, FAHA*;
Key words: access to care • health policy • health services research • medicine • mortality • occupational therapy • organized care • outcome research • physiotherapy • stroke team • stroke unit