ISCHEMIC STROKE - OUTCOMES, PATIENT MIX, AND PRACTICE VARIATION FOR NEUROLOGISTS AND GENERALISTS IN A COMMUNITY

A variety of methods was used to compare patient mix, practice variati on, survival, and recurrence after first ischemic stroke among Rochest er, MN residents. The significance of the results for neurologists and generalists was examined. Age, stroke severity, congestive heart fail ure (CHF), and the interaction between atrial fibrillation and patient groups were determinants of survival. Without atrial fibrillation, pa tients on neurology services and patients on general services with neu rology consultation had better survival than those without neurology c onsultation, adjusting for age, stroke severity, and CHF, With atrial fibrillation, patients on general services with neurology consultation had no better survival compared with those without neurology consulta tion; patients on neurology services had worse survival (p = 0.002). T here was no difference in stroke recurrence. Evaluation by a neurologi st is associated with better survival for most patients with ischemic stroke but not those with atrial fibrillation. Only a randomized trial can determine whether this association is causal.