Significant variation in mortality and functional outcome after acute ischaemic stroke between western countries: data from the tinzaparin in acute ischaemic stroke trial (TAIST)
- L J Gray1,
- N Sprigg1,
- P M W Bath1,
- P Sørensen2,
- E Lindenstrøm2,
- G Boysen3,
- P P De Deyn4,
- P Friis5,
- D Leys6,
- R Marttila7,
- J-E Olsson8,
- D O’Neill9,
- B Ringelstein10,
- J-J van der Sande11,
- A G G Turpie12,
- for the TAIST Investigators
- 1Institute of Neuroscience, University of Nottingham, Nottingham, UK
- 2Leo Pharma A/S, Ballerup, Denmark
- 3Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
- 4Department of Neurology, University of Antwerp, Antwerp, Belgium
- 5Vest-Agder Sentralsykehus, Kristiansand, Norway
- 6Clinique Neurologique, CHRU de Lille, Lille, France
- 7Department of Neurology, Turku University Central Hospital, Turku, Finland
- 8Institute for Neurology, Universitetssjukhuset, Linköping, Sweden
- 9Department of Age Related Health Care, Adelaide and Meath Hospital, Dublin, Ireland
- 10Neurology Clinic, Universität Münster, Münster, Germany
- 11Slotervaartziekenhuis, Amsterdam, Netherlands
- 12Hamilton General Hospital, Hamilton, Canada
- Correspondence to: Professor Philip Bath Division of Stroke Medicine, University of Nottingham, D Floor, South Block, Queen’s Medical Centre, Nottingham NG7 2UH, UK; philip.bath{at}nottingham.ac.uk
- Received 2 February 2005
- Accepted 12 July 2005
- Revised 20 May 2005
- Published Online First 26 July 2005
Abstract
Background: The medical care of patients with acute stroke varies considerably between countries. This could lead to measurable differences in mortality and functional outcome.
Objective: To compare case mix, clinical management, and functional outcome in stroke between 11 countries.
Methods: All 1484 patients from 11 countries who were enrolled into the tinzaparin in acute ischaemic stroke trial (TAIST) were included in this substudy. Information collected prospectively on demographics, risk factors, clinical features, measures of service quality (for example, admission to a stroke unit), and outcome were assessed. Outcomes were adjusted for treatment assignment, case mix, and service relative to the British Isles.
Results: Differences in case mix (mostly minor) and clinical service (many of prognostic relevance) were present between the countries. Significant differences in outcome were present between the countries. When assessed by geographical region, death or dependency were lower in North America (odds ratio (OR) adjusted for treatment group only = 0.52 (95% confidence interval, 0.39 to 0.71) and north west Europe (OR = 0.54 (0.37 to 0.78)) relative to the British Isles; similar reductions were found when adjustments were made for 11 case mix variables and five service quality measures. Similarly, case fatality rates were lower in North America (OR = 0.44 (0.30 to 0.66)) and Scandinavia (OR = 0.50 (0.33 to 0.74)) relative to the British Isles, whether crude or adjusted for case mix and service quality.
Conclusions: Both functional outcome and case fatality vary considerably between countries, even when adjusted for prognostic case mix variables and measures of good stroke care. Differing health care systems and the management of patients with acute stroke may contribute to these findings.
- ASU, acute stroke unit
- BIOMED, European study of stroke care
- GAIN, glycine antagonist (GV 150526) in acute stroke
- IST, international stroke trial
- mRS, modified Rankin Scale
- SSS, Scandinavian Neurological Stroke Scale
- SRU, stroke rehabilitation unit
- TAIST, tinzaparin in acute ischaemic stroke trial
Footnotes
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Published Online First 26 July 2005
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Competing interests: There are no completing interests for any of the authors in terms of the analysis presented here, but all authors apart from LJG and NS were involved in the original TAIST trial. PMWB, PS, GB, PDD, PF, DL, RM, JEO, DO, BR, JJVDS, and AGGT were on the trial steering committee for TAIST, and EL works for Leo Pharma A/S.
