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Association between stroke center hospitalization for acute ischemic stroke and mortality.
Abstract
Although stroke centers are widely accepted and supported, little is known about their
effect on patient outcomes.To examine the association between admission to stroke
centers for acute ischemic stroke and mortality.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 nondesignated hospitals using differential distance
to hospitals as an instrumental variable to adjust for potential prehospital selection
bias. Patients were followed up 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.Thirty-day all-cause mortality.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 lower
30-day all-cause mortality (10.1% vs 12.5%; adjusted mortality difference, -2.5%;
95% confidence interval [CI], -3.6% to -1.4%; P < .001) and greater use of thrombolytic
therapy (4.8% vs 1.7%; adjusted difference, 2.2%; 95% CI, 1.6% to 2.8%; P < .001).
Differences in mortality also were observed at 1-day, 7-day, and 1-year follow-up.
The outcome differences were specific for stroke, as stroke centers and nondesignated
hospitals had similar 30-day all-cause mortality rates among those with gastrointestinal
hemorrhage (5.0% vs 5.8%; adjusted mortality difference, +0.3%; 95% CI, -0.5% to 1.0%;
P = .50) or acute myocardial infarction (10.5% vs 12.7%; adjusted mortality difference,
+0.1%; 95% CI, -0.9% to 1.1%; P = .83).Among patients with acute ischemic stroke,
admission to a designated stroke center was associated with modestly lower mortality
and more frequent use of thrombolytic therapy.
Type
Journal articleSubject
HumansBrain Ischemia
Myocardial Infarction
Acute Disease
Gastrointestinal Hemorrhage
Thrombolytic Therapy
Hospitalization
Aged
Aged, 80 and over
Middle Aged
Hospitals, Special
New York
Female
Male
Stroke
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https://hdl.handle.net/10161/21641Published Version (Please cite this version)
10.1001/jama.2011.22Publication Info
Xian, Ying; Holloway, Robert G; Chan, Paul S; Noyes, Katia; Shah, Manish N; Ting,
Henry H; ... Friedman, Bruce (2011). Association between stroke center hospitalization for acute ischemic stroke and mortality.
JAMA, 305(4). pp. 373-380. 10.1001/jama.2011.22. Retrieved from https://hdl.handle.net/10161/21641.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Eric David Peterson
Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of
Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical
Research Institute (DCRI), Durham, NC, USA.
Dr Peterson is the Principal Investigator of the National Institute of Health, Lung
and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional
Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial He is also
the Principal I
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Ying Xian
Adjunct Associate Professor in the Department of Neurology
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