SUMMARY In a prospective controlled trial we compared the clinical outcome for unselected acute stroke patients in a non-intensjve stroke unit (n = 110) and in general medical wards (n = 183). The patients were comparable in age, marital state and functional impairment on admission. Case fatality rates over the first year after the stroke were similar in the two groups. By three months after the stroke, 15% of the survivors initially admitted to the stroke unit and 39% of those admitted to general medical wards remained hospitalized (p < 0.001). The corresponding figures by one year after the cerebrovascular accident were 12% and 28%, respectively (p < 0.05). A greater proportion of surviving stroke unit patients was independent in walking (0.10 > p > 0.05), personal hygiene (p < 0.05) and dressing (p < 0.001). Essential features of the stroke unit are team work headed by a stroke nurse, staff, patient and family education and very early onset of rehabilitation. We conclude that this strategy improves functional outcome and reduces the need for long-term hospital care.

In this study, 339 patients (154 men, 185 women) with a median age of 74 years (range 23–97) admitted to the Stroke Unit, Department of Neurology in 1986, have been followed up for 14 years. The diagnoses were intracerebral hemorrhage (ICH; 30, 8.8%), cardioembolic cerebral infarction (CE, 71, 20.9%), lacunar infarction (LI; 47, 13.9%) and atherosclerotic cerebral infarction (ACI; 191, 56.3%). The cumulative probabilities of recurrent stroke rates at 1-, 5- and 10-year follow-ups were 13.5% (95% confidence interval, CI, 9.6–17.4), 38.7% (95% CI 32.6–44.8) and 53.9% (95% CI 46.7–61.1). According to Cox proportional hazard regression analysis, age, severity of stroke, previous stroke and systolic blood pressure are each of importance in predicting recurrent stroke. During the observation period, 290 patients (85.5%) died. The mortality rate of 24.5% during the first year was 4.5 times higher compared to the normal population of the same age and gender. Patients with LI had lower mortality rates compared to ICH by the log rank test (p = 0.0275); to CE (p = 0.000) and to ACI (p = 0.049). Thirty-nine percent of all vascular deaths after the first year were caused by recurrent strokes. Fatal index/recurrent stroke occurred statistically more frequently in the CE group versus the non-CE one (p = 0.005). Cox proportional hazard regression analysis indicated that age, severity of stroke, previous stroke, heart failure and fasting blood glucose exceeding 6 mmol/l or history of diabetes were each predictors of mortality. In conclusion, this study has shown the worse outcomes for all subtypes of stroke compared to the normal population and also clearly pointed out independent predictors of recurrent stroke or death at the time of diagnosis.

SUMMARY The clinical outcome in 110 patients admitted to a non-intensive stroke unit was compared to that in 183 patients treated for acute stroke in general medical wards. At entry, the two groups of patients were closely similar in all prognostic indicators. Subsets of patients were analyzed in an attempt to identify groups that benefit more than others from stroke unit care.The stroke unit regime had little effect on short-term and long-term mortality rates in the entire stroke population as well as in subgroups. But after the care in the stroke unit, the need for long-term hospitalizatlon hi survivors was reduced (p = 0.0001). This difference hi favour of the stroke unit was independent of the patients' age, the extent of neurological deficit on admission and previous history. In subgroups where the general prognosis is fair or good (minor neurological deficits and < 75 yrs), SU care accelerated the process of rehabilitation, but the need for institutional care very late after the stroke was influenced only little. In groups with a poor general prognosis (major deficits and > 75 yrs), the ultimate proportion of patients able to return home was enhanced by SU care. It is concluded that care in a stroke unit benefits the great majority of stroke patients and that such a unit should be designed to admit all acute stroke patients without selection.

In a non-randomized controlled study carried out on 238 hospitalized patients with cerebral infarction, anticoagulant treatment (AC) was compared with the natural course in the prevention of transient ischemic attacks (TIA), cerebral infarction, stroke, stroke or death. 137 patients were allocated to AC, mean follow-up 30.5 months, and 101 patients were allocated to the controls (untreated group), mean follow-up 25.2 months. There were no statistically significant differences among the patients in the group who had suffered TIA (AC treated group 10.2%, untreated group 5.9%), cerebral infarction (AC treated group 10.2%, untreated group 11.9%), stroke (AC treated group 14.6%, untreated group 12.9%), stroke or death (AC treated group 22.6%, untreated group 19.8%). Minor bleedings occurred significantly more frequently (P less than 0.01) in the treated group. Severe bleedings occurred in 8 patients in the treated group (5.8%) compared to 1 of the controls (1%). It is concluded from the trial that AC can only seldom be recommended as prophylactic against new strokes in patients with cerebral infarction due to arterial thromboembolism.

ObjectivesTo assess long‐term prognosis after transient ischemic attack (TIA)/subtypes of stroke relative to secondary prophylactic treatment(s) given.Materials and MethodsRetro/prospective follow‐up of patients hospitalized in the Stroke Unit or in the Department of Neurology, Linköping, in 1986 and followed up to Feb. 2011.ResultsA total of 288 men were followed up for 2254 years (mean 7.8 years) and 261 women for 1984 years (mean 7.6 years). In men, the distribution to anticoagulants (AC) (warfarin treatment) was 18%, antiplatelet therapy (APT) usually ASA 75 mg/day 54%, untreated 27%, unknown 2%. In women, the distribution to AC was 15%, APT 60%, untreated 23%, unknown 2%, respectively. Mortality rates at 1 year, 10 years, and 25 years for men were 21%, 67%, and 93%, respectively, versus the rates in women of 24%, 71%, and 90%, respectively. Survival curves showed markedly increased risk of death compared to the normal population. AC treatment was more favorable for men regarding the annual risk of stroke, compared with APT (9.4% vs. 9.8%), as well as the risks of MI, (5.6% vs. 6.7%), and death (8.1% vs. 10.3%), compared to women for stroke (11.6% vs. 8.8%) and MI (5.3% vs. 3.7%) but not for death (8.3% vs. 8.4%). The risk of fatal bleeding was 0.86% annually on AC compared to 0.17% on APT. According to Cox regression analysis included patients with TIA/ischemic stroke, first‐line treatment had beneficial effects on survival: AC OR 0.67 (0.5–0.9), APT 0.67 (0.52–0.88) versus untreated.ConclusionsPatients with a history of TIA/stroke had a higher mortality rate versus controls, providing support for both primary and secondary prophylaxis regarding vascular risk factors for death. This study also provided support for secondary prophylactic treatment with either AC or ASA (75 mg once daily) to reduce the vascular risk of death unless there are contraindications.

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