Differences in Long-Term Outcome Between Patients Treated in Stroke Units and in General Wards

Author:

Glader Eva-Lotta1,Stegmayr Birgitta1,Johansson Lennarth1,Hulter-Åsberg Kersin1,Wester P.O.1

Affiliation:

1. From the Department of Public Health and Clinical Medicine (E.-L.G., B.S., P.O.W.), University Hospital, Umeå, Sweden; National Board of Health and Welfare (L.J.), Stockholm, Sweden; and the Department of Medicine, Enköping Hospital (K.H.-A.), Enköping, Sweden.

Abstract

Background and Purpose The long-term beneficial effects of stroke unit care have been proved in several randomized trials. However, there is a question of large-scale applicability in routine clinical practice of interventions used by dedicated investigators in small randomized trials. The objective of this study was to compare, 21/2 years after stroke, patients who had been treated in stroke units and those treated in general wards in routine clinical practice. Methods This is a prospective cohort study based on 8194 patients who were included, during the first 6 months in 1997, in Riks-Stroke, the Swedish National Register for quality assessment of acute stroke. Two years after the event, 5189 patients were still alive and 5104 were followed up with a postal questionnaire to which 4038 responded. Results Among the group of patients who were independent in activities of daily living (ADL) functions before the stroke, patients who were treated in stroke units were less often dependent in ADL functions, after adjustment for case mix (OR, 0.79; CI, 0.66 to 0.94). If they also lived at home before the stroke, then they had a lower case-fatality rate 2 years after the stroke (OR, 0.81; CI, 0.72 to 0.92). Conclusions Long-term beneficial effects of treatment in stroke units were shown for patients who were independent in ADL functions before the stroke. No benefits were shown for patients who were dependent on help for primary ADL before the stroke. Further studies on this group of patients with more detailed outcome measures are needed.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology

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