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Effect of acute stroke unit care integrated with care continuum versus conventional treatment: A randomized 1-year study of elderly patients: the Göteborg 70+ Stroke Study.

Journal article
Authors Björn Fagerberg
Lisbeth Claesson
Gunilla Gosman-Hedström
Christian Blomstrand
Published in Stroke; a journal of cerebral circulation
Volume 31
Issue 11
Pages 2578-84
ISSN 1524-4628
Publication year 2000
Published at Wallenberg Laboratory
Institute of Clinical Neurosciences, Section of Neurological Diseases
Institute of Internal Medicine, Dept of Medicine
Pages 2578-84
Language en
Links www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords Activities of Daily Living, Aged, Aged, 80 and over, Cerebrovascular Accident, epidemiology, mortality, rehabilitation, Comorbidity, Continuity of Patient Care, Follow-Up Studies, Heart Diseases, epidemiology, Hospital Units, standards, utilization, Humans, Quality of Life, Severity of Illness Index, Survival Analysis, Sweden, epidemiology, Treatment Outcome
Subject categories Neurology

Abstract

BACKGROUND AND PURPOSE: The aim of the study was to compare the effect of conventional treatment with the effect of acute stroke unit care integrated with geriatric stroke unit care continuum. METHODS: A 1-year study was undertaken with 2:1 randomization to stroke unit care or conventional care, with assessment by an independent team. The study was composed of 249 elderly patients (aged >/=70 years) hospitalized for acute stroke, without previous cerebral lesion and without recognized need of care. Main outcome measures were patients at home after 1 year, ability in daily living activities, health-related quality of life score according to questionnaire, death or institutional care, and death or dependence. RESULTS: One hundred two patients (61%) in the stroke unit and 49 patients (59%) in the general ward group were alive and at home after 1 year (95% CI -10% to 16%). There were no significant differences in daily life activities or quality of life. In patients with concomitant cardiac disease, there was a reduction in death or institutional care after 3 months in the stroke unit group compared with the group receiving conventional care (28% versus 49%, respectively; 95% CI -40% to -3%). This effect did not remain after 1 year. Patients seeking care after 24 hours often had mild stroke and lived alone. CONCLUSIONS: There was no effect on the number of patients living at home after 1 year, but after 3 months of stroke unit care, a beneficial effect was found on mortality and the need for institutional care among those with concomitant heart disease. This study involved patients who were considerably older than those investigated in previous randomized studies of acute stroke unit care; thus, these findings will contribute to the specialized register of controlled trials in stroke.

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