Changes in survival and characteristics among older stroke unit patients—1994 versus 2012. Issue 1 (25th November 2018)

• Record Type: Journal Article
• Authors: Labberton, Angela Susan; Rønning, Ole Morten; Thommessen, Bente; Barra, Mathias
• Is Part Of: Brain and behavior. Volume 9:Issue 1(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-11-25
• Subjects: cerebrovascular disorders -- mortality -- risk factors -- stroke; Neurology -- Periodicals; Neurosciences -- Periodicals; Psychology -- Periodicals; Psychiatry -- Periodicals; 616.8005
• DOI: 10.1002/brb3.1175
• Languages: English
• ISSNs: 2162-3279

Abstract

Abstract: Objectives: Treatment on organized stroke units (SUs) improves survival after stroke, and stroke mortality has decreased worldwide in recent decades; however, little is known of survival trends among SU patients specifically. This study investigates changes in survival and characteristics of older stroke patients receiving SU treatment. Materials & Methods: We compared 3‐year all‐cause mortality and baseline characteristics in two cohorts of stroke patients aged ≥60 consecutively admitted to the same comprehensive SU in 1994 ( n = 271) and 2012 ( n = 546). Results: Three‐year survival was 53.9% in 1994 and 56.0% in 2012, and adjusted hazard ratio (HR) was 0.99 (95% CI: 0.77–1.28). Adjusted 30‐day case fatality was slightly higher in 2012, 18.9% versus 16.2%, HR 1.68 (95% CI: 1.14–2.47). There were no significant between‐cohort differences in survival beyond 30 days. Patients in 2012 were older (mean age: 78.8 vs. 76.7 years) and more often admitted from nursing homes. There were higher rates of atrial fibrillation (33.7% vs. 21.4%) and malignancy (19.2% vs. 8.9%), and prescription of antiplatelets (46.9% vs. 26.2%) and warfarin (16.3% vs. 5.5%) at admission. Stroke severity was significantly milder in 2012, proportion with mild stroke 66.1% versus 44.3%. Conclusions: Three‐year survival in older Norwegian stroke patients treated on an SU remained stable despite improved treatment in the last decades. Differences in background characteristics may explain this lack of difference; patients in 2012 were older, more often living in supported care, and had higher prestroke comorbidity; however, their strokes were milder and risk factors more often treated. Abstract : Mortality by cohort, Kaplan‐Meier method. 1994 cohort (dotted line, n =271), 2012 cohort (solid line, n =545). p =0.75, log‐rank test.