on June 19, 2008
Published online before print June 19, 2008, doi: 10.1161/STROKEAHA.107.510362
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Submitted on November 18, 2007
From the Stroke Research Unit (G.S.), Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto; Stroke Unit (M.D.H.), Departments of Clinical Neurosciences, Medicine, and Community Health Sciences, University of Calgary, Calgary; Department of Medicine (M.O.), McMaster University, Hamilton; Institute for Clinical Evaluative Sciences (J.F., M.K.K.), Toronto; Stroke Program (V.H.), Department of Clinical Neurological Sciences, London Health Sciences Center, University of Western Ontario, London; Division of General Internal Medicine and Clinical Epidemiology, Department of Medicine, University Health Network, and University Health Network Women's Health Program (M.K.K.), Toronto; and Department of Health Policy, Management and Evaluation (G.S., M.K.K.), University of Toronto, Toronto, Ontario, Canada. * To whom correspondence should be addressed. E-mail: saposnikg{at}smh.toronto.on.ca.
Background and Purpose—Seven-day, 30-day, and 1-year case-fatality indicators have been used to compare stroke care among hospitals, provinces, and countries and to implement quality improvement strategies. However, limited information is available concerning variables associated with stroke case fatality at these different points in time. We sought to identify and compare variables associated with 7-day, 30-day, and 1-year stroke fatality. Methods—This was a cohort study of consecutive patients with acute ischemic stroke admitted to 11 stroke centers in Ontario, Canada, between July 2003 and March 2005 and captured in the Registry of the Canadian Stroke Network (RCSN). The RCSN database was linked to administrative databases to capture all deaths occurring within 7, 30, and 365 days of hospital admission for ischemic stroke. Logistic regression was used to determine variables associated with stroke fatality at each time point. Outcome measures were all-location mortality within 7 days, 30 days, and 1 year of hospital admission. Results—Our cohort included 3631 patients admitted with ischemic stroke. Seven-day case fatality was 6.9% (249/3631), 30-day case fatality was 12.6% (457/3631), and 1-year case fatality was 23.6% (856/3631). In the multivariable analyses, stroke severity, neurologic deterioration during hospitalization, nonuse of antithrombotics during hospital admission, and lack of assessment by a stroke team were the most consistent predictors of case fatality at 7 days, 30 days, and 1 year after stroke. Physician experience in stroke management was inversely associated with 7-day and 30-day mortality, whereas age, comorbid illness, and pneumonia during hospital admission were associated with 30-day and 1-year mortality. Conclusions—Stroke severity and certain processes of care were associated with case fatality at 7days, 30 days, and 1 year after stroke. This information may be useful for comparing risk-adjusted case-fatality rates among hospitals and for implementing strategies to improve the processes and quality of care in the acute phase of stroke.
Revised on January 7, 2008
Accepted on January 18, 2008
Variables Associated With 7-Day, 30-Day, and 1-Year Fatality After Ischemic Stroke
Gustavo Saposnik MD, MSc, FAHA*;
Key words: stroke • mortality • health indicators • outcome research • organized care • health policy
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