Effectiveness of Primary and Comprehensive Stroke Centers: PERFECT Stroke: A Nationwide Observational Study From Finland

Background and Purpose— Previous studies show better outcomes for patients with stroke receiving care in stroke units, but many different stroke unit criteria have been published. In this study, we explored whether stroke centers fulfilling standardized Brain Attack Coalition criteria produce better patient outcomes than hospitals without stroke centers. Methods— We did an observational register–linkage study of all patients with ischemic stroke treated in Finland between 1999 and 2006. After exclusion of recurrent strokes and nonanalyzable patients, we included 61 685 consecutive patients treated in 333 hospitals classified in national audits either as Comprehensive Stroke Centers, Primary Stroke Centers, or General Hospitals according to Brain Attack Coalition criteria. Primary outcome measures were case-fatality and being in institutional care 1 year after stroke. Results— Care in stroke centers was associated with lower 1-year case-fatality and reduced institutional care compared with General Hospitals. The number-needed-to-treat to prevent 1 death or institutional care at 1 year was 29 for Comprehensive Stroke Centers and 40 for Primary Stroke Centers versus General Hospitals. Patients treated in stroke centers had lower mortality during the entire follow-up of up to 9 years and their median survival was increased by 1 year. Conclusions— This study shows a clear association between the level of acute stroke care and patient outcome and supports use of published criteria for primary and comprehensive stroke centers.

[1]  H. Raspe,et al.  Semi-intensive stroke unit versus conventional care in acute ischemic stroke or TIA — A prospective study in Germany , 2009, Journal of the Neurological Sciences.

[2]  Gary A. Ford,et al.  Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. , 2008, Cerebrovascular diseases.

[3]  D. Leys,et al.  Facilities Available in European Hospitals Treating Stroke Patients , 2007, Stroke.

[4]  Peter Langhorne,et al.  Stroke Units in Their Natural Habitat: Systematic Review of Observational Studies , 2007, Stroke.

[5]  Adnan I. Qureshi,et al.  Guidelines for the Early Management of Adults With Ischemic Stroke , 2007 .

[6]  S. Nakaaki,et al.  Greater Impairment of Ability in the Divided Attention Task Is Seen in Alzheimer’s Disease Patients with Depression than in Those without Depression , 2007, Dementia and Geriatric Cognitive Disorders.

[7]  D. Leys,et al.  The Main Components of Stroke Unit Care: Results of a European Expert Survey , 2007, Cerebrovascular Diseases.

[8]  Giuseppe Micieli,et al.  Stroke-unit care for acute stroke patients: an observational follow-up study , 2007, The Lancet.

[9]  Peter Langhorne,et al.  Organised inpatient (stroke unit) care for stroke. , 2007, The Cochrane database of systematic reviews.

[10]  B. Norrving,et al.  Helsingborg Declaration 2006 on European Stroke Strategies , 2006, Cerebrovascular Diseases.

[11]  R. Sacco,et al.  Quality improvement in acute stroke , 2006, Neurology.

[12]  N. Lincoln,et al.  Ten year follow-up of a randomised controlled trial of care in a stroke rehabilitation unit , 2005, BMJ : British Medical Journal.

[13]  M. Hadley,et al.  Recommendations for Comprehensive Stroke Centers: A Consensus Statement From the Brain Attack Coalition , 2005, Stroke.

[14]  Anne W. Wojner-Alexandrov,et al.  Houston Paramedic and Emergency Stroke Treatment and Outcomes Study (HoPSTO) , 2005, Stroke.

[15]  S. Johnston,et al.  Do the Brain Attack Coalition’s criteria for stroke centers improve care for ischemic stroke? , 2005, Neurology.

[16]  A. Rudd,et al.  Stroke units: research and reality. Results from the National Sentinel Audit of Stroke , 2005, Quality and Safety in Health Care.

[17]  A. Rudd,et al.  Stroke Unit Care and Outcome: Results from the 2001 National Sentinel Audit of Stroke (England, Wales, and Northern Ireland) , 2005, Stroke.

[18]  V. Salomaa,et al.  Continuous 15-Year Decrease in Incidence and Mortality of Stroke in Finland: The FINSTROKE Study , 2004, Stroke.

[19]  J. Virtamo,et al.  Validation of stroke diagnosis in the National Hospital Discharge Register and the Register of Causes of Death in Finland , 1999, European Journal of Epidemiology.

[20]  V. Salomaa,et al.  The feasibility of combining data from routine Hospital Discharge and Causes-of-Death Registers for epidemiological studies on stroke , 2004, European Journal of Epidemiology.

[21]  S. Warach,et al.  Impact of Establishing a Primary Stroke Center at a Community Hospital on the Use of Thrombolytic Therapy: The NINDS Suburban Hospital Stroke Center Experience , 2003, Stroke.

[22]  E. Glader,et al.  Differences in Long-Term Outcome Between Patients Treated in Stroke Units and in General Wards: A 2-Year Follow-Up of Stroke Patients in Sweden , 2001, Stroke.

[23]  R E Latchaw,et al.  Recommendations for the establishment of primary stroke centers , 2000 .

[24]  S. Slørdahl,et al.  Stroke unit treatment. 10-year follow-up. , 1999, Stroke.

[25]  B. Norrving,et al.  Stroke units in their natural habitat: can results of randomized trials be reproduced in routine clinical practice? Riks-Stroke Collaboration. , 1999, Stroke.

[26]  Peter Martin,et al.  Stroke Units: An Evidence Based Approach. , 1999 .

[27]  E. DeLong,et al.  Comparing risk-adjustment methods for provider profiling. , 1998, Statistics in medicine.

[28]  S. Slørdahl,et al.  Stroke unit treatment. Long-term effects. , 1997, Stroke.

[29]  L. Iezzoni.  Risk Adjustment for Measuring Healthcare Outcomes , 1994 .