title: Outcomes measured by mortality rates, quality of life and degree of autonomy in the first year in stroke units in Spain.
abstract: BACKGROUND
  The primary objective of this sub analysis of the CONOCES study was to analyse outcomes in terms of mortality rates, quality of life and degree of autonomy over the first year in patients admitted to stroke units in Spain. The secondary objective was to identify the factors determining good prognosis.
  
  
  METHODS
  We studied a sample of patients who had suffered a confirmed stroke and been admitted to a Stroke Unit in the Spanish healthcare system. Socio-demographic and clinical variables and variables related to the level of severity (NIHSS), the level of autonomy (Barthel, modified Rankin) and quality of life (EQ-5D) were recorded at the time of admission and then three months and one year after the event. Factors determining prognosis were analysed using logistic regression and ROC curves.
  
  
  RESULTS
  A total of 321 patients were recruited, 33% of whom received thrombolytic treatment, which was associated with better results on the Barthel and the modified Rankin scales and in terms of the risk of death. Mean quality of life measured through EQ-5D improved from 0.57 at discharge to 0.65 one year later. Full autonomy level measured by Barthel index increased from 30.1% at discharge to 52.8% at one year and by the modified Rankin scale from 51% to 71%. The rates for in-hospital and 1-year mortality were 5.9% and 17.4% respectively. Low NIHSS scores were associated with a good prognosis with all the outcome variables. The three instruments applied (NIHSS, Barthel and modified Rankin scales) on admission showed good discriminative ability for patient prognosis in the ROC curves.
  
  
  CONCLUSIONS
  There has been a change in the prognosis for stroke in Spain in recent years as the quality of life at 1 year observed in our study is clearly higher than that obtained in other Spanish studies conducted previously. Moreover, survival and functional outcome have also improved following the introduction of a new model of care. These results clearly promote extension of the model based on stroke units and reinforced rehabilitation to the majority of the more than 100,000 strokes that occur annually in Spain.
authors.affiliation: Clinical Management Service, Alto Deba Hospital, Mondragon, Spain. javier.marmedina@osakidetza.net.|Unidad de Gestión Sanitaria, Hospital 'Alto Deba', Avenida Navarra 16, 20500, Mondragón, Spain. javier.marmedina@osakidetza.net.
authors.forename: Javier
authors.initials: J
authors.lastname: Mar
authors.affiliation: Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal. Universidad de Alcalá, Madrid, Spain. jmasjuan.hrc@salud.madrid.org.
authors.forename: Jaime
authors.initials: J
authors.lastname: Masjuan
authors.affiliation: Department of Economic Analysis, Universidad de Castilla La Mancha and REDISSEC, Toledo, Spain. Juan.OlivaMoreno@uclm.es.
authors.forename: Juan
authors.initials: J
authors.lastname: Oliva-Moreno
authors.affiliation: Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain. nuria.gonzalez-rojas@boehringer-ingelheim.com.
authors.forename: Nuria
authors.initials: N
authors.lastname: Gonzalez-Rojas
authors.affiliation: Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain. virginia.becerra@gmail.com.
authors.forename: Virginia
authors.initials: V
authors.lastname: Becerra
authors.affiliation: Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain. ma_casado@porib.com.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Casado
authors.affiliation: Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain. ctorres@porib.com.
authors.forename: Covadonga
authors.initials: C
authors.lastname: Torres
authors.affiliation: Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain. myebenes@porib.com.
authors.forename: María
authors.initials: M
authors.lastname: Yebenes
authors.affiliation: Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain. maquintana@vhebron.net.
authors.forename: Manuel
authors.initials: M
authors.lastname: Quintana
authors.affiliation: Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain. josalvarez@vhebron.net.
authors.forename: Jose
authors.initials: J
authors.lastname: Alvarez-Sabín
mesh_terms: D000368:Aged; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D026684:Personal Autonomy; D011379:Prognosis; D011788:Quality of Life / Q000523:psychology*; D020127:Recovery of Function; D018570:Risk Assessment; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000401:mortality* / Q000523:psychology*; D016896:Treatment Outcome