Impact of quality of care on outcomes in survivors of stroke with aphasia: A linked registry and hospital data observational study.

Autor: Thayabaranathan T; School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Centre of Research Excellence in Stroke Rehabilitation, Australia; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia. Electronic address: tharshanah.thayabaranathan@monash.edu., Wallace SJ; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia., Kim J; School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Centre of Research Excellence in Stroke Rehabilitation, Australia; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; Stroke theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia., Kilkenny MF; School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Centre of Research Excellence in Stroke Rehabilitation, Australia; Stroke theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia., Olaiya MT; School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia., Andrew NE; Centre of Research Excellence in Stroke Rehabilitation, Australia; Peninsula Clinical School, Central Clinical School, Monash University, VIC, Australia., Brogan E; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia; Speech Pathology Department, Fiona Stanley and Fremantle Hospitals Group., Baker C; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; Speech Pathology Department, Monash Health, Victoria, Australia., Godecke E; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia; Sir Charles Gairdner Hospital, Perth, Western Australia, Australia., Copland DA; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia., Rose ML; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia., Birhanu MM; School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Stroke theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia., Cadilhac DA; School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Centre of Research Excellence in Stroke Rehabilitation, Australia; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; Stroke theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia.
Jazyk: angličtina
Zdroj: Journal of the neurological sciences [J Neurol Sci] 2024 Nov 15; Vol. 466, pp. 123251. Date of Electronic Publication: 2024 Sep 21.
DOI: 10.1016/j.jns.2024.123251
Abstrakt: Background: The impact of hospital care quality on patient outcomes in post-stroke aphasia remains unclear. We investigated the impact of nationally-endorsed acute stroke treatments on outcomes post-stroke, by aphasia status.
Methods: Patient-level data from the Australian Stroke Clinical Registry (2009-2013) linked to national deaths, hospital emergency presentations and admissions data were used. Aphasia was identified for the index stroke event (ICD-10 diagnosis code R47.0). Impact of receiving an optimal stroke care bundle (stroke unit care, antihypertensive medication at discharge and discharge care plan) and an acute ischemic stroke (AIS) care bundle (stroke unit care, intravenous thrombolysis and aspirin within 48 h of admission) on outcomes were analysed using multivariable regression models with propensity score adjustment.
Results: The study included 12,690 patients with a median age of 76, 54 % male, and 26 % with aphasia. Non-receipt of the optimal stroke care bundle was associated with worse survival, compared to optimal care, in people with aphasia (HR: 3.37; 95 % CI 2.10, 5.40; p < 0.05) and without aphasia (HR: 2.10; 95 % CI 1.19, 3.69; p < 0.05). Notably, the dose-response effect on survival was more pronounced in individuals with aphasia. In those who received the AIS care bundle, readmission within 12 months was greater in those without aphasia (vs aphasia, p-value interaction = 0.001), whereas survival was similar (p-value interaction = 0.731).
Conclusions: Survivors of stroke with aphasia who did not receive the optimal stroke care bundle, had worse survival at 12 months post-stroke. Ensuring eligible patients receive the optimal stroke care bundle is crucial for improving their 12-month survival.
Competing Interests: Declaration of competing interest D.A.C is the current Data Custodian for the AuSCR. D.A.C reports receiving restricted grants from Boehringer Ingelheim, Ipsen, Medtronic, and Shire outside the work presented today. M.F·K is a member of the AuSCR Management Committee and the Research Advisory Committee of the Stroke Foundation, reports receiving educational grants from Amgen Australia and GSK outside the submitted work. All other authors report no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
(Copyright © 2024. Published by Elsevier B.V.)
Databáze: MEDLINE
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