Trends in treatment and outcomes for acute stroke patients in Ontario, 1992-1998.
BACKGROUND
Several interventions have been shown to be of benefit to patients with stroke (hereafter referred to as stroke patients) in clinical trials, but the net effect of these interventions in the general stroke population has not been established. The purpose of this study was to evaluate temporal trends in the characteristics, treatments, and outcomes of acute stroke patients in the province of Ontario.


METHODS
We conducted a population-based retrospective cohort study using linked administrative databases of all 91 419 patients discharged with a most-responsible diagnosis of acute stroke from acute care hospitals in Ontario from April 1, 1992, to March 31, 1999 (fiscal years 1992-1998).


RESULTS
The average age and proportion of stroke patients with co-existing diseases increased over time. The proportion of elderly patients 65 years and older who received warfarin sodium (Coumadin) and statins increased during the study period (14.6% to 19.6% [P =.001] and 2.7% to 15.0% [P<.001], respectively). Declines in the median length of stay (11 to 8 days [P<.001]) and risk-adjusted in-hospital mortality (21.9% to 18.9% [P<.001]) were significant, but the 30-day mortality rates for acute stroke stayed relatively constant (19.7% to 19.0% [P =.18]). We found a moderate decline in risk-adjusted 1-year mortality (34.1% to 32.0% [P<.001]) and stroke readmission rates (12.1% to 9.9% [P =.001]).


CONCLUSIONS
Improvements in the outcomes of stroke patients have occurred in Ontario during the 1990s, despite an increasing proportion of elderly stroke patients with multiple comorbidities. Increasing use of secondary prevention medications may explain this trend.
Tu
Jack V
JV
Institute for Clinical Evaluative Sciences, G106-2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5. tu@ices.on.ca
Gong
Yanyan
Y
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D009864:Ontario; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage
D000925:Anticoagulants; D014859:Warfarin