Stroke center survival benefits confirmed
MedWire News: A major US study has revealed that patients are more likely to survive a stroke if they are admitted to a designated stroke center.
"Importantly, the lower mortality at designated stroke centers was specific to stroke and was not found for other acute life-threatening conditions, suggesting that the mortality benefit was related to stroke center designation, rather than to overall quality improvement efforts at designated stroke centers," say the researchers.
The findings published in JAMA also show that patients are more likely to undergo thrombolysis if treated in a stroke center rather than another hospital, with 4.8% versus 1.7% of patients receiving the treatment.
Ying Xian (Duke Clinical Research Institute, Durham, North Carolina) and team derived thrombolysis and mortality rates from data on 30,947 stroke patients treated within New York State from 2005 to 2006. Almost half (49.4%) of these were treated in a designated stroke center (designation based on Brain Attack Coalition criteria).
In all, 10.1% of patients died within 30 days of admission to a stroke center, whereas 12.5% of those admitted to other hospitals died within the same period.
This equated to a significant 2.5% 30-day survival difference in favor of stroke center treatment, after accounting for confounders including age, gender, race, health insurance status, and comorbidities.
There were also significant absolute survival benefits at other time points: 0.3% at 1 day, 1.3% at 7 days, and 3.0% at 1 year after stroke.
Xian et al attribute the survival benefit to stroke center designation, rather than general high standards at these hospitals, as there were no survival benefits seen for two other life-threatening conditions. Specifically, there were nonsignificant 0.3% and 0.1% survival benefits in favor of treatment at other hospitals for patients with myocardial infarction and gastrointestinal hemorrhage, respectively.
The researchers note that to date just one previous study, conducted in Finland, has demonstrated improved survival among stroke patients admitted to a stroke center.
"Our study extends the findings from this prior study, as systems of stroke care in the USA may differ substantially from other national healthcare systems (especially those with universal health coverage)," they say.
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By Eleanor McDermid