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

Background and Purpose-The long-term beneficial effects of stroke unit care have been proved in several randomized trials. However, there is a questio n of large-scale applicability in routine clinical practice of intervention s used by dedicated investigators in small randomized trials. The objective of this study was to compare, 21/2 years after stroke, patients who had be en treated in stroke units and those treated in general wards in routine cl inical practice. Methods-This is a prospective cohort study based on 8194 patients who were included, during the first 6 months in 1997, in Riks-Stroke, the Swedish Na tional Register for quality assessment of acute stroke. Two years after the event, 5189 patients were still alive and 5104 were followed up with a pos tal questionnaire to which 4038 responded. Results-Among the group of patients who were independent in activities of d aily living (ADL) functions before the stroke, patients who were treated in stroke units were less often dependent in ADL functions, after adjustment for case mix (OR, 0.79; CI, 0.66 to 0.94). If they also lived at home befor e the stroke, then they had a lower case-fatality rate 2 years after the st roke (OR, 0.81; Cl, 0.72 to 0.92). Conclusions-Long-term. beneficial effects of treatment in stroke units were shown for patients who were independent in ADL functions before the stroke . No benefits were shown for patients who were dependent on help for primar y ADL before the stroke. Further studies on this group of patients with mor e detailed outcome measures are needed.