Document Type

Journal Article

Publication Title

Journal of the Neurological Sciences

Volume

466

Publisher

Elsevier

School

School of Medical and Health Sciences

RAS ID

75808

Funders

National Health and Medical Research Council / Monash University / Queensland Health / Stroke Foundation / The AuSCR / Florey Institute of Neuroscience and Mental Health / Stroke Foundation / Heart Foundation (105737)

Grant Number

NHMRC Numbers : 1034415, 1154273, 1175821, 1072053

Comments

Thayabaranathan, T., Wallace, S. J., Kim, J., Kilkenny, M. F., Olaiya, M. T., Andrew, N. E., ... & Stroke123 Investigators. (2024). Impact of quality of care on outcomes in survivors of stroke with aphasia: A linked registry and hospital data observational study. Journal of the Neurological Sciences, 466. https://doi.org/10.1016/j.jns.2024.123251

Abstract

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.

DOI

10.1016/j.jns.2024.123251

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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