Stroke unit care revisited: who benefits the most? A cohort study of 105 043 patients in Riks-Stroke, the Swedish Stroke Register
- A Terént1,
- K Asplund2,
- B Farahmand3,
- K M Henriksson4,
- B Norrving5,
- B Stegmayr2,
- P-O Wester2,
- K H Åsberg6,
- S Åsberg1
- 1Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
- 2Department of Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden
- 3Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
- 4Department of Laboratory Medicine, Lund University Hospital, Lund, Sweden
- 5Department of Neurology, Lund University Hospital, Lund, Sweden
- 6Drug and Therapeutic Committee, County Council of Uppsala, Uppsala, Sweden
- Dr A Terént, Department of Medical Sciences, Uppsala University Hospital, SE-75185 Uppsala, Sweden;
- Received 28 November 2008
- Revised 19 February 2009
- Accepted 20 February 2009
- Published Online First 29 March 2009
Background: Treatment at stroke units is superior to treatment at other types of wards. The objective of the present study is to determine the effect size of stroke unit care in subgroups of patients with stroke. This information might be useful in a formal priority setting.
Methods: All acute strokes reported to the Swedish Stroke Register from 2001 through 2005 were followed until January 2007. The subgroups were age (18–64, 65–74, 75–84, 85+ years and above), sex (male, female), stroke subtype (intracerebral haemorrhage, cerebral infarction and unspecified stroke) and level of consciousness (conscious, reduced, unconscious). Cox proportional hazards and logistic regression analyses were used to estimate the risk for death, institutional living or dependency.
Results: 105 043 patients were registered at 86 hospitals. 79 689 patients (76%) were treated in stroke units and 25 354 patients (24%) in other types of wards. Stroke unit care was associated with better long-term survival in all subgroups. The best relative effect was seen among the following subgroups: age 18–64 years (hazard ratio (HR) for death 0.53; 0.49 to 0.58), intracerebral haemorrhage (HR 0.61; 0.58 to 0.65) and unconsciousness (HR 0.70; 0.66 to 0.75). Stroke unit care was also associated with reduced risk for death or institutional living after 3 months.
Conclusions: Stroke unit care was associated with better long-term survival in all subgroups, but younger patients, patients with intracerebral haemorrhage and patients who were unconscious had the best relative effect and may be given the highest priority to this form of care.
Funding: The National Board of Health and Welfare and the Federation of Swedish County Councils have sponsored Riks-Stroke. The AstraZeneca Company, Epidemiology Unit, has sponsored the present study.
Competing interests: AT has received a research grant from AstraZeneca. BF and KH are employed at the Epidemiology Department, AstraZeneca R&D.
Ethics approval: Ethics approval was provided by the Ethical Committee of Umeå University Hospital.
AT initiated the study, carried out the statistical analyses and drafted the report. BF and SÅ retrieved and structured data from the databases used. KA, KHÅ, BN, BS, AT and P-OW were members of the Riks-Stroke steering committee and revised the report. KH also revised the report.