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

Australian Stroke Clinical Registry Consortium

Research output: Contribution to journalArticleResearchpeer-review

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 5 0.029), despite not being statistically significant at 90 days(hazard ratio 0.66, 95 confidence interval 0.33?1.31; p 5 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 461 matched 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.
Original languageEnglish
Pages (from-to)2042 - 2048
Number of pages7
JournalNeurology
Volume86
Issue number22
DOIs
Publication statusPublished - 2016

Cite this

Australian Stroke Clinical Registry Consortium. / Better outcomes for hospitalized patients with TIA when in stroke units: an observational study. In: Neurology. 2016 ; Vol. 86, No. 22. pp. 2042 - 2048.
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title = "Better outcomes for hospitalized patients with TIA when in stroke units: an observational study",
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 5 0.029), despite not being statistically significant at 90 days(hazard ratio 0.66, 95 confidence interval 0.33?1.31; p 5 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 461 matched 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.",
author = "Cadilhac, {Dominique Ann-Michelle} and Joosup Kim and Lannin, {Natasha A} and Levi, {Christopher Royce} and Dewey, {Helen M} and Kelvin Hill and Steven Faux and Andrew, {Nadine Elizabeth} and Kilkenny, {Monique Femia} and Grimley, {Rohan S} and Thrift, {Amanda Gay} and Brenda Grabsch and Sandy Middleton and Anderson, {Craig S} and Donnan, {Geoffrey A} and {Australian Stroke Clinical Registry Consortium}",
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Better outcomes for hospitalized patients with TIA when in stroke units: an observational study. / Australian Stroke Clinical Registry Consortium.

In: Neurology, Vol. 86, No. 22, 2016, p. 2042 - 2048.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Better outcomes for hospitalized patients with TIA when in stroke units: an observational study

AU - Cadilhac, Dominique Ann-Michelle

AU - Kim, Joosup

AU - Lannin, Natasha A

AU - Levi, Christopher Royce

AU - Dewey, Helen M

AU - Hill, Kelvin

AU - Faux, Steven

AU - Andrew, Nadine Elizabeth

AU - Kilkenny, Monique Femia

AU - Grimley, Rohan S

AU - Thrift, Amanda Gay

AU - Grabsch, Brenda

AU - Middleton, Sandy

AU - Anderson, Craig S

AU - Donnan, Geoffrey A

AU - Australian Stroke Clinical Registry Consortium

PY - 2016

Y1 - 2016

N2 - 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 5 0.029), despite not being statistically significant at 90 days(hazard ratio 0.66, 95 confidence interval 0.33?1.31; p 5 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 461 matched 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.

AB - 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 5 0.029), despite not being statistically significant at 90 days(hazard ratio 0.66, 95 confidence interval 0.33?1.31; p 5 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 461 matched 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.

UR - http://www.ncbi.nlm.nih.gov/pubmed/27164692

U2 - 10.1212/WNL.0000000000002715

DO - 10.1212/WNL.0000000000002715

M3 - Article

VL - 86

SP - 2042

EP - 2048

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 22

ER -