TY - JOUR
T1 - Quality of Care and One-Year Outcomes in Patients with Diabetes Hospitalised for Stroke or TIA
T2 - A Linked Registry Study
AU - Olaiya, Muideen T.
AU - Cadilhac, Dominique A.
AU - Kim, Joosup
AU - Thrift, Amanda G.
AU - Courten, Barbora de
AU - Andrew, Nadine E.
AU - Grimley, Rohan
AU - Anderson, Craig S.
AU - Sundararajan, Vijaya
AU - Lannin, Natasha A.
AU - Levi, Christopher
AU - Dewey, Helen M.
AU - Kilkenny, Monique F.
N1 - Funding Information:
The study was funded as part of the National Health and Medical Research Council (NHMRC) Stroke123 Partnership Grant ( 1034415 ), with partnership funding from Monash University, Queensland Health and the Stroke Foundation (Australia). The AuSCR, during the period of data used in this research, received funding from the Florey Institute of Neuroscience and Mental Health, the Stroke Foundation (Australia), consumer and industry donations. The following authors receive Research Fellowship support from the NHMRC : MFK ( 1109426 ), NEA ( 1072053 ), AGT ( 1042600 ), DAC ( 1063761 co-funded Heart Foundation, 1154273 ), and NAL ( 1112158 ). BDC is supported by a Royal Australasian College of Physicians Fellows Career Development Fellowship.
Funding Information:
The study was funded as part of the National Health and Medical Research Council (NHMRC) Stroke123 Partnership Grant (1034415), with partnership funding from Monash University, Queensland Health and the Stroke Foundation (Australia). The AuSCR, during the period of data used in this research, received funding from the Florey Institute of Neuroscience and Mental Health, the Stroke Foundation (Australia), consumer and industry donations. The following authors receive Research Fellowship support from the NHMRC: MFK (1109426), NEA (1072053), AGT (1042600), DAC (1063761 co-funded Heart Foundation, 1154273), and NAL (1112158). BDC is supported by a Royal Australasian College of Physicians Fellows Career Development Fellowship. We thank members of the Australian Stroke Clinical Registry (AuSCR) Steering Committee and staff from the George Institute for Global Health and the Florey Institute of Neuroscience and Mental Health who manage the AuSCR (Online Supplement). We also thank the hospital clinicians (Online Supplement) and patients who contribute data to the AuSCR. We acknowledge the Departments of Health in Queensland, New South Wales, Victoria and Western Australia who undertook the data linkage for this project and each state data collection agency that provided access to these data.
Publisher Copyright:
© 2021 Elsevier Inc.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/11
Y1 - 2021/11
N2 - Objectives: To evaluate key quality indicators for acute care and one-year outcomes following acute ischaemic stroke (IS), intracerebral haemorrhage (ICH), or transient ischaemic attack (TIA) by diabetes status. Materials and Methods: Observational cohort study (2009-2013) using linked data from the Australian Stroke Clinical Registry and hospital records. Diabetes was ascertained through review of hospital records. Multilevel regression models were used to evaluate the association between diabetes and outcomes, including discharge destination, and mortality and hospital readmissions within one-year of stroke/TIA. Results: Among 14,132 patients (median age 76 years, 46% female), 22% had diabetes. Compared to patients without diabetes, those with diabetes were equally likely to receive stroke unit care, but were more often discharged on antihypertensive agents (79% vs. 68%) or with a care plan (50% vs. 47%). In patients with TIA, although 86% returned directly home after acute care, those with diabetes more often had a different discharge destination than those without diabetes. Diabetes was associated with greater all-cause mortality (hazard ratio 1.13, 95% CI 1.04-1.23) in patients with IS/ICH; and with both greater all-cause (1.81, CI 1.35-2.43) and CVD mortality (1.75, CI 1.06-2.91) in patients with TIA. Similarly, diabetes was associated with greater rates of all-cause readmission in both patients with IS/ICH and TIA. Conclusions: Despite good adherence to best care standards for acute stroke/TIA, patients with comorbid diabetes had worse outcomes at one-year than those without comorbid diabetes. Associations of diabetes with poorer outcomes were more pronounced in patients with TIA than those with IS/ICH.
AB - Objectives: To evaluate key quality indicators for acute care and one-year outcomes following acute ischaemic stroke (IS), intracerebral haemorrhage (ICH), or transient ischaemic attack (TIA) by diabetes status. Materials and Methods: Observational cohort study (2009-2013) using linked data from the Australian Stroke Clinical Registry and hospital records. Diabetes was ascertained through review of hospital records. Multilevel regression models were used to evaluate the association between diabetes and outcomes, including discharge destination, and mortality and hospital readmissions within one-year of stroke/TIA. Results: Among 14,132 patients (median age 76 years, 46% female), 22% had diabetes. Compared to patients without diabetes, those with diabetes were equally likely to receive stroke unit care, but were more often discharged on antihypertensive agents (79% vs. 68%) or with a care plan (50% vs. 47%). In patients with TIA, although 86% returned directly home after acute care, those with diabetes more often had a different discharge destination than those without diabetes. Diabetes was associated with greater all-cause mortality (hazard ratio 1.13, 95% CI 1.04-1.23) in patients with IS/ICH; and with both greater all-cause (1.81, CI 1.35-2.43) and CVD mortality (1.75, CI 1.06-2.91) in patients with TIA. Similarly, diabetes was associated with greater rates of all-cause readmission in both patients with IS/ICH and TIA. Conclusions: Despite good adherence to best care standards for acute stroke/TIA, patients with comorbid diabetes had worse outcomes at one-year than those without comorbid diabetes. Associations of diabetes with poorer outcomes were more pronounced in patients with TIA than those with IS/ICH.
KW - Diabetes
KW - Mortality/Survival
KW - Outcomes
KW - Quality
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85115659550&partnerID=8YFLogxK
U2 - 10.1016/j.jstrokecerebrovasdis.2021.106083
DO - 10.1016/j.jstrokecerebrovasdis.2021.106083
M3 - Article
C2 - 34517297
AN - SCOPUS:85115659550
SN - 1052-3057
VL - 30
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 11
M1 - 106083
ER -
