Advances in Stroke
Health Policy/Outcomes Research 2013
Since the last advances article on health policy and outcomes,1 selected developments include new knowledge on long-term outcomes after stroke and their policy relevance, associations of neighborhood disadvantage with stroke mortality, growth and effect of regionalized systems of stroke care, and preliminary research relevant to policies on early stroke mortality as a hospital performance measure.
Long-Term Outcome After Stroke
The South London Stroke Register of incident strokes across a multiethnic, urban population reported that long-term survival gradually improved in consecutive cohorts of patients with stroke from 1995 to 2010, and higher survival was associated with stroke unit admission (hazard ratio, 0.75; P<0.0001).2 Concurrently, stroke unit admission had increased dramatically from 19% in 1995 to 1997 to 78% by 2007 to 2009. Although evidence of benefit from stroke units has existed for several decades, there have been barriers to widespread adoption that may be addressed through local or national policies.
Annual assessments for depressive symptoms in this registry cohort demonstrated that the presence of depressive symptoms after stroke is dynamic, often being of short duration but with a high risk of recurrence over time.3 About one third of patients were depressed at 3 months after stroke, with resolution of symptoms among half of those by 1 year. However, depression was detected …