Survival benefits persist after stroke unit care
MedWire News: Patients with stroke are more likely to survive if they are treated in a dedicated stroke center, with survival benefits persisting for up to 9 years, say Finnish researchers.
Atte Meretoja (Helsinki University Central Hospital) and colleagues assessed outcomes of 61,685 stroke patients treated in 333 Finnish hospitals. They report their findings in the journal Stroke.
In all, 32.5% of patients were treated in a comprehensive stroke center (CSC), 17.5% were treated in a primary stroke center (PSC), and 50.0% were admitted to a general hospital.
These centers were defined according to the Brain Attack Coalition criteria, with CSCs providing a full service, including thrombolysis in under 60 minutes and specialist procedures such as hemicraniectomy, ventricular drainage, and carotid endarterectomy. PSCs provide a dedicated unit with specialist staff, but more basic services; for example, thrombolysis is not necessarily available at all hours.
At 1 year after stroke, 27.3% of patients treated in general hospitals had died, compared with 19.1% of those treated in PSCs and 16.6% of those treated in CSCs.
Patients treated in general hospitals were significantly older than those admitted to stroke centers, were more often female, and had more comorbidities. But the reduced mortality risk associated with stroke center treatment persisted after accounting for these factors, with mortality rates of 20.8% for CSCs and 21.7% for PSCs, compared with 23.3% for general hospitals.
Patients’ mortality risk remained 13% and 10% lower if they were treated in a CSC and a PSC, respectively, rather than in a general hospital, for up to 9 years of follow-up.
The proportion of patients requiring institutional care at 1 year was also reduced by stroke center treatment, at 10.5% and 10.6% for those treated in CSCs and PSCs, respectively, versus 11.6% for those treated in general hospitals. This equated to a number needed to treat of 29 for CSCs and 40 for PSCs to allow one more patient to live at home at 1 year after stroke.
Editorialist Mark Alberts (Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA) said: “When extrapolated across a global population, a 1% to 2% reduction in mortality translates into at least 50,000 to 100,000 lives saved each year.”
He also noted the cost savings inherent in the increased numbers of patients able to return home after a stroke.
“From all currently available data, it seems clear that we have proved the concept that stroke centers save lives and improve outcomes at the same time as preventing subsequent strokes,” Alberts concluded.
But he said that proving additional benefits of stroke centers may become difficult as even nonspecialist hospitals continue to adopt some of the best practices for stroke care.
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By Eleanor McDermid