Important factors in predicting mortality outcome from stroke: findings from the Anglia Stroke Clinical Network Evaluation Study.
Although variation in stroke service provision and outcomes have been previously investigated, it is less well known what service characteristics are associated with reduced short- and medium-term mortality.



Data from a prospective multicentre study (2009–12) in eight acute regional NHS trusts with a catchment population of about 2.6 million were used to examine the prognostic value of patient-related factors and service characteristics on stroke mortality outcome at 7, 30 and 365 days post stroke, and time to death within 1 year.



A total of 2,388 acute stroke patients (mean (standard deviation) 76.9 (12.7) years; 47.3% men, 87% ischaemic stroke) were included in the study. Among patients characteristics examined increasing age, haemorrhagic stroke, total anterior circulation stroke type, higher prestroke frailty, history of hypertension and ischaemic heart disease and admission hyperglycaemia predicted 1-year mortality. Additional inclusion of stroke service characteristics controlling for patient and service level characteristics showed varying prognostic impact of service characteristics on stroke mortality over the disease course during first year after stroke at different time points. The most consistent finding was the benefit of higher nursing levels; an increase in one trained nurses per 10 beds was associated with reductions in 30-day mortality of 11–28% (P < 0.0001) and in 1-year mortality of 8–12% (P < 0.001).



There appears to be consistent and robust evidence of direct clinical benefit on mortality up to 1 year after acute stroke of higher numbers of trained nursing staff over and above that of other recognised mortality risk factors.
Norwich Medical School, University of East Anglia, Norwich, UK.|Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Scotland, UK|Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
Phyo Kyaw
PK
Myint
Norwich Medical School, University of East Anglia, Norwich, UK.
Max
M
O Bachmann
Norwich Medical School, University of East Anglia, Norwich, UK.|Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Yoon Kong
YK
Loke
Norwich Medical School, University of East Anglia, Norwich, UK.
Stanley
S
D Musgrave
Norwich Medical School, University of East Anglia, Norwich, UK.
Gill M
GM
Price
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Rachel
R
Hale
Norwich Medical School, University of East Anglia, Norwich, UK.|Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Anthony Kneale
AK
Metcalf
Norwich Medical School, University of East Anglia, Norwich, UK.
David A
DA
Turner
Addenbrooke's Hospital, Cambridge, UK.
Diana J
DJ
Day
Addenbrooke's Hospital, Cambridge, UK.|Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
Elizabeth
E
A Warburton
Norwich Medical School, University of East Anglia, Norwich, UK.|Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
John F
JF
Potter
D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009738:Nursing Service, Hospital; D009741:Nursing Staff, Hospital; D010561:Personnel Staffing and Scheduling; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000451:nursing / Q000628:therapy*; D013997:Time Factors; D016526:Workload