In-hospital mortality due to acute stroke continues to decline

Salvador Cruz-Flores

The rate of mortality among patients hospitalized with acute stroke continues to decrease nationwide, according to a study presented at the American Academy of Neurology annual meeting.

“Previously, a downward trend in stroke-related in-hospital mortality was noted from 1996 to 2006, reflecting advancements in acute stroke care,” Salvador Cruz-Flores, MD, MPH, professor and chair of the Texas Tech University Health Sciences Center El Paso’s department of neurology, and colleagues wrote.

Cruz-Flores and colleagues sought to determine nationwide trends in in-hospital mortality due to acute stroke between 2007 and 2014 using a nationally representative sample of all hospital discharges in the United States.

The researchers found that during the study period, there was an in increase in overall stroke hospitalizations from 1,017,414 in 2007-2008 to 1,114,960 in 2013-2014. In-hospital deaths related to stroke decreased from 8.98% in 2007-2008 to 7.34% in 2013-2014.

The odds of mortality declined among all stroke types assessed, including ischemic stroke (OR = 0.798; 95% CI, 0.762-0.835), subarachnoid hemorrhage (OR = 0.885; 95% CI, 0.810-0.968) and intracerebral hemorrhage (OR = 0.865, 95% CI, 0.824-0.908), and remained significant after adjustments for age, gender, race, medical comorbidities, in-hospital complications, insurance status and APR-DRG Severity scale.

“The decreasing mortality in patients hospitalized for stroke suggests an improved in-hospital care of stroke patients, which may be a reflection of better and standardized care across all hospitals, from better management of medical problems, such as hypertension and diabetes, to prevention of complications, to better multidisciplinary care during the hospital stay, to the higher utilization of specific treatments for stroke, such as tissue plasminogen activator or mechanical thrombectomy,” Cruz-Flores told Healio Internal Medicine.

“If indeed, the decreasing mortality is a reflection of better care, it behooves the medical community to adopt the protocols of care and guidelines for stroke care to continue to make an impact in outcome,” he added.

“Since the study is based on an administrative database, it lacks specificity as to specific conditions that are not reported in the dataset and that may impact outcome,” he said. – by Alaina Tedesco

Reference:

Afzal MR, et al. Continued nationwide decline in stroke related in-hospital mortality in United States. Presented at: American Academy of Neurology Annual Meeting. April 21-27, 2018; Los Angeles.

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.