Treatment and rehabilitation on a stroke unit improves 5-year survival - Acommunity-based study

Background and Purpose-We have previously reported a marked reduction in mo rtality up to 1 year after treatment and rehabilitation on a stroke unit ve rsus on general neurological and medical wards in unselected stroke patient s, In the present study we wanted to test the hypothesis that this mortalit y-reducing effect is not temporary but is long lasting. Methods-We performed a community-based comparison of outcome in 1241 stroke patients from 2 adjacent communities in Copenhagen: in one (Frederiksberg) , treatment and rehabilitation were provided on general neurological and me dical wards, and in the other (Bispebjerg), treatment and rehabilitation we re provided on a single large stroke unit. Results-The 2 stroke populations were comparable regarding age, sex, initia l stroke severity, lesion diameter on CT, and stroke subtype (hemorrhage/in farct), but patients treated on the stroke unit had a higher frequency of c omorbidity and lower incomes. One-year mortality was 39% (general wards) ve rsus 32% (stroke unit) (P=0.01). This difference was still present 5 years after stroke (71% versus 64%; P=0.02). In a multiple logistic regression mo del of 5-year mortality, treatment on a stroke unit reduced the relative ri sk of death by 40% (odds ratio, 0.60; 95% CI, 0.42 to 0.85; P<0.01), indepe ndent of age, sex, stroke severity, and comorbidity. Conclusions-The mortality-reducing effect of treatment and rehabilitation o n a dedicated stroke unit is long lasting rather than temporary. Stroke uni t treatment reduced the relative risk of death within 5 years after stroke by 40% in an unselected, community-based stroke population. These results e mphasize the need for organization of treatment and rehabilitation of unsel ected stroke patients on dedicated stroke units.