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 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.
AD - From Stroke and Ageing Research, School of Clinical Sciences at Monash Health (D.A.C., J.K., N.E.A., M.F.K., A.G.T.), and Eastern Health Clinical School (H.M.D.), Monash University, Victoria; Stroke Division (D.A.C., J.K., H.M.D., N.E.A., M.F.K., B.G., G.A.D.), Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria; La Trobe University (N.A.L.), Victoria; University of Newcastle (C.R.L.), New South Wales; National Stroke Foundation (K.H.), Victoria; St Vincent's Health Australia (Sydney) (S.F., S.M.), New South Wales; Sunshine Coast Clinical School (R.G.), The University of Queensland; Australian Catholic University (S.M.), New South Wales; The George Institute for Global Health (C.S.A.), Royal Prince Alfred Hospital, Camperdown, New South Wales; and Central Clinical School (C.S.A.), The University of Sydney, New South Wales, Australia. dominique.cadilhac@monash.edu.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 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.
PY - 2016 SN - 1526-632X (Electronic)