Unchanged survival in older stroke patients

Angela Susan Labberton has analysed key aspects of the stroke care pathway in a Norwegian cohort.


MAIN RESULTS:

  1. Pre-hospital delay after acute stroke is substantially reduced over the past decades.

  2. Overall survival following acute stroke treatment did not improve between 1994 and 2012.
  3. 28% are admitted to inpatient rehabilitation following acute stroke treatment.

THESIS DEFENCE:

Thesis: Stroke care in Norway. Temporal and international comparisons of pre-hospital delay, patient characteristics, access to inpatient rehabilitation and long-term survival following stroke unit treatment
Candidate: Angela Susan Labberton
Time: January 31, 2020 at 13:15
Place: Akershus University Hospital, Nye Nord: 4th floor Auditorium
Link to university website


SUMMARY:

(1) In 2012, more than half of the patients with acute stroke arrived Akershus University Hospital too late to benefit from thrombolysis treatment. Still, the delay was substantially smaller than in 1994, where only 19% arrived within three hours of symptom onset. At both time points, patients with more severe strokes had higher probability of being admitted within the three hour limit.

The study includes data from a total of 1070 stroke patients admitted to Akershus University Hospital in 1994 and 2012.

(2) Three-year survival was similar after treatment in the stroke unit in 1994 and 2012. At both time points, a little more than half of the patients were still alive after three years. 30-day mortality was slightly higher in 2012.

Treatment had improved but the 2012 patients were on average two years older and was more often admitted from nursing homes. The prevalences of atrial fibrillation and cancer were also higher in 2012, and stroke risk factors were more often treated with antiplatelet or warfarin. On the other hand, the 2012 cohort also had less severe strokes than patients admitted in 1993. 271 patients treated in 1994 and 546 in 2012 took part in the study, which includes only patients above 60 years of age.

(3) Patients with moderately severe strokes are more likely to be referred to inpatient rehabilitation. Referral rates are also higher in patients treated at a stroke unit. Norway and Australia select similarstroke patients for inpatient rehabilitation.

In this study, Labberton and co-workers compare referral rates for 723 Norwegian stroke patients with 553 patients treated at eight public hospitals in Australia. In Norway, 37% of the patients were referred to inpatient rehabilitation, compared to 48% in Australia. Admittance rates were 28% and 35%, respectively.


REFERENCES:

(1) Labberton, A. S., Faiz, K. W., Rønning, O. M., Thommessen, B., & Barra, M. (2018). Differences in and determinants of prehospital delay times among stroke patients—1994 Versus 2012Journal of Stroke and Cerebrovascular Diseases27(9), 2398-2404.

(2) Labberton, A. S., Rønning, O. M., Thommessen, B., & Barra, M. (2019). Changes in survival and characteristics among older stroke unit patients—1994 versus 2012. Brain and behavior9(1), e01175.

(3) Labberton, A. S., Barra, M., Rønning, O. M., Thommessen, B., Churilov, L., Cadilhac, D. A., & Lynch, E. A. (2019). Patient and service factors associated with referral and admission to inpatient rehabilitation after the acute phase of stroke in Australia and NorwayBMC health services research19(1), 871.