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07-07-2010 | Stroke | Article

Even lacunar stroke patients benefit from organized care

Abstract

Free abstract

MedWire News: Stroke patients benefit from organized care regardless of the etiology of their stroke, research shows.

"Here, we show in a real-world setting that increasing level of organized stroke care is strongly associated with decreased mortality in each of the main ischemic stroke subtypes," say Eric Smith (University of Calgary, Alberta, Canada) and co-workers.

Rather than dividing the 6223 patients in the study according to whether they were admitted to a stroke unit, the team awarded them a grade of 0 to 3 on the organized care index (OCI). This was based on whether the patients received occupational therapy or physiotherapy, stroke team assessment, and treatment on a stroke unit.

Overall, patients with OCI grades of 2-3 were 69% less likely than those with grades of 0-1 to die within 30 days of stroke.

This effect was consistent for all TOAST stroke subtypes, the researchers report in the journal Neurology.

Mortality risk was reduced by 84% for patients with lacunar stroke, by 63% for those with cardioembolic stroke, by 57% for those with large-artery atherosclerotic stroke, and by 80% for those with other/undetermined stroke if they had an OCI grade of 2-3 rather than 0-1.

The absolute risk reductions ranged from 11% for large-artery atherosclerotic stroke to 26% for other/undetermined stroke, and the numbers needed to treat to prevent one death ranged from four to nine.

The beneficial effect of organized stroke care was reduced only slightly when patients given palliative care alone were removed from the analysis, suggesting that patients benefit from organized care even if they do not receive specialist interventions.

After accounting for confounders, the mortality risk reductions associated with higher OCI scores ranged from 84% for patients with lacunar stroke to 66% for those with large-artery atherosclerotic stroke.

"Our finding, that organized stroke care is associated with lower mortality in each of the ischemic stroke subtypes, has important implications for the organization of stroke systems of care," say Smith et al.

They note that limited access to specialist stroke care could lead to patient selection based on who is most likely to benefit from intensive care.

"Based on these data, patient selection for organized stroke care based on ischemic stroke subtype does not seem warranted," the researchers conclude.

"Our data suggest that all ischemic stroke subtypes benefit from organized care, including mild lacunar strokes and severe cardioembolic strokes."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Eleanor McDermid