Home Hospitalization Service for Acute Uncomplicated First Ischemic Stroke in Elderly Patients: A Randomized Trial

Abstract

Objectives: To evaluate whether home treatment of elderly patients with acute uncomplicated first ischemic stroke is associated with different mortality rates and clinical outcomes from those of patients treated on a general medical ward (GMW). Design: Randomized, controlled, single‐blind trial. Setting: S. Giovanni Battista Hospital of Turin. Participants: One hundred twenty elderly patients admitted to the emergency department of the hospital with first acute ischemic stroke were randomized to home treatment from a geriatric home hospitalization service (GHHS) or to GMW treatment. Measurement: Main outcome was cumulative survival at 6 months in the two groups. Residual functional impairment, neurological deficit, depression, morbidity, and admission to rehabilitation and long‐term care facilities were considered as secondary outcomes in survivors. Results: One hundred twenty patients (mean age 82; 54 men and 66 women) were enrolled (60 in each study arm). The cumulative proportion of cases surviving at 6 months was 0.65 in the GHHS group and 0.60 in GMW group (log‐rank test P=.53). Functional and neurological parameters were significantly improved in both GHHS and GMW patients, without significant differences between the two groups. Depression score was significantly better in home‐treated patients (P<.001), who were more likely to remain at home at 6 months than hospital‐treated patients and had a lower rate of select medical complications. Conclusion: Home‐treated elderly patients with ischemic stroke have better depressive scores and lower rates of admission to nursing homes. These results should prompt further studies to evaluate home hospitalization for elderly stroke patients.

Avoiding hospital admission through provision of hospital care at home: a systematic review and meta-analysis of individual patient data

“…Electronic searching yielded a total of 2186 citations, of which 10 trials [11][12][13][14][15][16][17][18][19][20] (with a total of 1327 participants) were eligible for inclusion in the systematic review ( Figure 1, Appendix 2 (available at www.cmaj.ca/cgi/content/full/180/2 /175/DC2). The 10 trials were from 4 countries: Australia, Italy, New Zealand and the United Kingdom.…”

“…We invited the investigators of these trials, which had recruited a total of 969 participants, to contribute data to the meta-analysis of individual patient data. [11][12][13][15][16][17]20 The investigators for 5 of the 7 trials contributed data for a total of…”

“…*The randomized controlled trials (RCTs) of other interventions also included 1 unpublished trial by Dey, Woodman and the Manchester FASTER Trial Group. 11,12,15,17,20 One trialist could not be contacted (n = 25 participants), 16 and another declined to participate (n = 100 participants). 13 Follow-up times ranged from 1 week to 12 months across all 10 of the trials.…”

“…Trials included in the systematic review involved patients with chronic obstructive pulmonary disease, 11,16 patients recovering from a moderately severe stroke who were clinically stable, 12,17 and older patients with an acute medical condition. 13,15,20 In addition, there was one trial each for patients with cellulitis, 14 patients with community-acquired pneumonia 18 and frail elderly patients with dementia.…”

Hospital at Home for Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…The Hospital at Home Service (HHS) is operating in Torino at S. Giovanni Battista Hospital, a large urban University teaching and tertiary-care hospital (Aimonino Ricauda et al, 2004Ricauda et al, , 2005Tibaldi et al, 2004Tibaldi et al, , 2009). …”