Association Between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality

Abstract

Context-Although stroke centers are widely accepted and supported, little is known about their impact on patient outcomes.Objective-To examine the association between admission to stroke centers for an acute ischemic stroke and mortality.Design, Setting, and Participants-Observational study using data from the New York Statewide Planning and Research Cooperative System. We compared mortality for patients admitted with acute ischemic stroke (n=30,947) between 2005 and 2006 at designated stroke centers and non-designated hospitals using differential distance to hospitals as an instrumental variable to adjust for potential pre-hospital selection bias. Patients were followed for mortality for 1 year after the index hospitalization through 2007. To assess whether our findings were specific to stroke, we also compared mortality for patients admitted with gastrointestinal hemorrhage (n=39,409) or acute myocardial infarction (n=40,024) at designated stroke centers and nondesignated hospitals.Main Outcome Measure-Thirty-day all-cause mortality.Correspondence: Ying Xian, MD, PhD; Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705; Tel: (585) Fax: (919) 668-7058; ying.xian@duke.edu. AUTHOR CONTRIBUTIONS Dr Xian had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Previous Presentation:This study was presented in part at the 2010 American Heart Association Quality of Care and Outcomes Research Conference, Washington, DC, May 20, 2010 Role of the Sponsor: The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHA and AHRQ.Disclaimer: This study used a linked SPARCS-SSADMF database. The interpretation and reporting of these data are the sole responsibility of the authors. Results-Among 30,947 patients with acute ischemic stroke, 15,297 (49.4%) were admitted to designated stroke centers. Using the instrumental variable analysis, admission to designated stroke centers was associated with greater use of thrombolytic therapy (4.8% vs. 1.7%; adjusted difference 2.2%, 95% CI, 1.6% to 2.8%; P<0.001) and lower 30-day all-cause mortality (10.1% vs. 12.5%; adjusted mortality difference: −2.5%, 95% CI, −3.6% to −1.4%; P<0.001). Differences in mortality also were observed at all time points, including at 1-day, 7-day, and 1-year follow-up. Moreover, the outcome differences were specific to stroke, as stroke centers and non-stroke centers had similar 30-day all-cause mortality rates among those with acute myocardial infarction (adjusted mortality difference: +0.3%, 95% CI, −0.5% to 1.0%; P=0.50) and/or gastrointestinal hemorrhage (adjusted mortality difference: +0.1%, 95% CI, −0.9% to 1.1%; P=0.83). NIH Public AccessConclusions-Admission to a designated stroke center for acute isc...

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