Thomas Gattringer1, Julia Ferrari1, Michael Knoflach1, Leonhard Seyfang1, Susanna Horner1, Kurt Niederkorn1, Valeriu Culea1, Markus Beitzke1, Wilfried Lang1, Christian Enzinger1, Franz Fazekas2. 1. From the Department of Neurology (T.G., S.H., K.N., V.C., M.B., C.E., F.F.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Neurology, Hospital Barmherzige Brueder, Vienna, Austria (J.F., W.L.); Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria (M.K.); and Center of Clinical Neurosciences, Danube University of Krems, Krems, Austria (L.S.). 2. From the Department of Neurology (T.G., S.H., K.N., V.C., M.B., C.E., F.F.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Neurology, Hospital Barmherzige Brueder, Vienna, Austria (J.F., W.L.); Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria (M.K.); and Center of Clinical Neurosciences, Danube University of Krems, Krems, Austria (L.S.). franz.fazekas@medunigraz.at.
Abstract
BACKGROUND AND PURPOSE: Sex-related differences in quality of acute stroke care are an important concern with limited data available, specifically regarding stroke unit (SU) setting. We used the prospective nationwide Austrian SU registry to address this issue. METHODS: Our analysis covered an 8-year time period (January 2005 to December 2012) during which all patients with transient ischemic attack or ischemic stroke admitted to 1 of 35 Austrian SU had been captured in the registry. These data were analyzed for age-adjusted preclinical and clinical characteristics and quality of acute stroke care in men and women. In addition, we assessed the outcome at 3 months in multivariate analysis. RESULTS: A total of 47 209 individuals (47% women) had received SU care. Women were significantly older (median age: 77.9 versus 70.3 years), had higher pre-existing disability and more severe strokes. Correcting for age, no significant sex-related differences in quality of care were identified with comparable onset-to-door times, times to and rates of neuroimaging, as well as door-to-needle times and rates of intravenous thrombolysis (14.5% for both sexes). Despite equal acute stroke care and a comparable rate of neurorehabilitation, women had a worse functional outcome at 3-month follow-up (modified Rankin scale 3-5: odds ratio, 1.26; 95% confidence interval [1.17-1.36]), but a lower mortality (odds ratio, 0.70; 95% confidence interval [0.78-0.88]) after correcting for confounders. CONCLUSIONS: We identified no disproportions in quality of care in the acute SU setting between men and women, but the outcome was significantly different. Further studies on the poststroke period including socioeconomic aspects are needed to clarify this finding.
BACKGROUND AND PURPOSE: Sex-related differences in quality of acute stroke care are an important concern with limited data available, specifically regarding stroke unit (SU) setting. We used the prospective nationwide Austrian SU registry to address this issue. METHODS: Our analysis covered an 8-year time period (January 2005 to December 2012) during which all patients with transient ischemic attack or ischemic stroke admitted to 1 of 35 Austrian SU had been captured in the registry. These data were analyzed for age-adjusted preclinical and clinical characteristics and quality of acute stroke care in men and women. In addition, we assessed the outcome at 3 months in multivariate analysis. RESULTS: A total of 47 209 individuals (47% women) had received SU care. Women were significantly older (median age: 77.9 versus 70.3 years), had higher pre-existing disability and more severe strokes. Correcting for age, no significant sex-related differences in quality of care were identified with comparable onset-to-door times, times to and rates of neuroimaging, as well as door-to-needle times and rates of intravenous thrombolysis (14.5% for both sexes). Despite equal acute stroke care and a comparable rate of neurorehabilitation, women had a worse functional outcome at 3-month follow-up (modified Rankin scale 3-5: odds ratio, 1.26; 95% confidence interval [1.17-1.36]), but a lower mortality (odds ratio, 0.70; 95% confidence interval [0.78-0.88]) after correcting for confounders. CONCLUSIONS: We identified no disproportions in quality of care in the acute SU setting between men and women, but the outcome was significantly different. Further studies on the poststroke period including socioeconomic aspects are needed to clarify this finding.
Authors: Mollie McDermott; Lynda D Lisabeth; Jonggyu Baek; Eric E Adelman; Nelda M Garcia; Erin Case; Morgan S Campbell; Lewis B Morgenstern; Darin B Zahuranec Journal: J Stroke Cerebrovasc Dis Date: 2017-05-04 Impact factor: 2.136
Authors: Negar Asdaghi; Jose G Romano; Kefeng Wang; Maria A Ciliberti-Vargas; Sebastian Koch; Hannah Gardener; Chuanhui Dong; David Z Rose; Salina P Waddy; Mary Robichaux; Enid J Garcia; Juan A Gonzalez-Sanchez; W Scott Burgin; Ralph L Sacco; Tatjana Rundek Journal: Stroke Date: 2016-08-23 Impact factor: 7.914
Authors: Tracy E Madsen; Heidi Sucharew; Brian Katz; Kathleen A Alwell; Charles J Moomaw; Brett M Kissela; Matthew L Flaherty; Daniel Woo; Pooja Khatri; Simona Ferioli; Jason Mackey; Sharyl Martini; Felipe De Los Rios La Rosa; Dawn Kleindorfer Journal: J Stroke Cerebrovasc Dis Date: 2015-11-23 Impact factor: 2.136
Authors: Venugopal Reddy Venna; Rajkumar Verma; Lena M O'Keefe; Yan Xu; Joshua Crapser; Brett Friedler; Louise D McCullough Journal: Stroke Date: 2014-09-09 Impact factor: 7.914