Better outcomes for hospitalized patients with TIA when in stroke units: an observational study

Cadilhac, Dominique A., Kim, Joosup, Lannin, Natasha A., Levi, Christopher R., Dewey, Helen M., Hill, Kelvin, Faux, Steven, Andrew, Nadine E., Kilkenny, Monique F., Grimley, Rohan, Thrift, Amanda G., Grabsch, Brenda, Middleton, Sandy, Anderson, Craig S. and Donnan, Geoffrey A. (2016) Better outcomes for hospitalized patients with TIA when in stroke units: an observational study. Neurology, 86 22: 2042-2048. doi:10.1212/WNL.0000000000002715

Author Cadilhac, Dominique A.
Kim, Joosup
Lannin, Natasha A.
Levi, Christopher R.
Dewey, Helen M.
Hill, Kelvin
Faux, Steven
Andrew, Nadine E.
Kilkenny, Monique F.
Grimley, Rohan
Thrift, Amanda G.
Grabsch, Brenda
Middleton, Sandy
Anderson, Craig S.
Donnan, Geoffrey A.
Title Better outcomes for hospitalized patients with TIA when in stroke units: an observational study
Journal name Neurology   Check publisher's open access policy
ISSN 1526-632X
Publication date 2016-05-31
Year available 2016
Sub-type Article (original research)
DOI 10.1212/WNL.0000000000002715
Open Access Status Not yet assessed
Volume 86
Issue 22
Start page 2042
End page 2048
Total pages 7
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Collection year 2017
Language eng
Formatted abstract
Objectives: To investigate differences in management and outcomes for patients admitted to the hospital with TIA according to care on a stroke unit (SU) or alternate ward setting up to 180 days post event.

Methods: TIA admissions from 40 hospitals participating in the Australian Stroke Clinical Registry during 2010-2013 were assessed. Propensity score matching was used to assess outcomes by treatment group including Cox proportional hazards regression to compare survival differences and other appropriate multivariable regression models for outcomes including health-related quality of life and readmissions.

Results: Among 3,007 patients with TIA (mean age 73 years, 54% male), 1,110 pairs could be matched. Compared to management elsewhere in hospitals, management in an SU was associated with improved cumulative survival at 180 days post event (hazard ratio 0.57, 95% confidence interval 0.35-0.94; p = 0.029), despite not being statistically significant at 90 days (hazard ratio 0.66, 95% confidence interval 0.33-1.31; p = 0.237). Overall, there were no differences for being discharged on antihypertensive medication or with a care plan, and the 90- to 180-day self-reported outcomes between these groups were similar. In subgroup analyses of 461matched pairs treated in hospitals in one Australian state (Queensland), patients treated in an SU were more often prescribed aspirin within 48 hours (73% vs 62%, p < 0.001) and discharged on antithrombotic medications (84% vs 71%, p < 0.001) than those not treated in an SU.

Conclusions: Hospitalized patients with TIA managed in SUs had better survival at 180 days than those treated in alternate wards, potentially through better management, but further research is needed.
Keyword Stroke unit (SU)
Antithrombotic medications
Improved cumulative survival
Hospitalized patients with TIA
Management and outcomes for patients
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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