Important factors in predicting mortality outcome from stroke: findings from the Anglia Stroke Clinical Network Evaluation Study

Phyo Kyaw Myint, Max O Bachmann, Yoon Kong Loke, Stanley D Musgrave, Gill M Price, Rachel Hale, Anthony Kneale Metcalf, David A. Turner, Diana J Day, Elizabeth A Warburton, John F Potter

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Abstract

Background: Although variation in stroke service provision and outcomes have been previously investigated, it is less well known what service characteristics are associated with reduced short and medium-term mortality. Methods: Data from a prospective multicentre study (2009-2012) in eight acute regional NHS trusts with a catchment population of about 2.6 million were used to examine the prognostic value of patient related factors and service characteristics on stroke mortality outcome at 7-day, 30-day, and 365 days post stroke, and time to death within one year. Results: A total of 2,388 acute stroke patients (mean (standard deviation) 76.9 (12.7) years; 47.3% men, 87% ischaemic stroke) were included in the study. Among patients characteristics examined increasing age, haemorrhagic stroke, total anterior circulation stroke type, higher prestroke frailty, history of hypertension and ischaemic heart disease, and admission hyperglycaemia predicted one year mortality. Additional inclusion of stroke service characteristics controlling for patient and service level characteristics showed varying prognostic impact of service characteristics on stroke mortality over the disease course during first year after stroke at different time points. The most consistent finding was the benefit of higher nursing levels; an increase in one trained nurses per 10 beds was associated with reductions in 30-day mortality of 11-28%(p<0.0001) and in one year mortality of 8-12% (p<0.001). Conclusions: There appears to be consistent and robust evidence of direct clinical benefit on mortality up to one year after acute stroke of higher numbers of trained nursing staff over and above that of other recognized mortality risk factors.
Original languageEnglish
Pages (from-to)83-90
Number of pages8
JournalAge and Ageing
Volume46
Early online date28 Oct 2016
DOIs
Publication statusPublished - 2017

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Stroke
Mortality
Nursing Staff
Hyperglycemia
Multicenter Studies
Myocardial Ischemia
Nursing
Nurses
Prospective Studies
Hypertension
Population

Keywords

  • stroke
  • services
  • staffing
  • outcome
  • mortality

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Important factors in predicting mortality outcome from stroke : findings from the Anglia Stroke Clinical Network Evaluation Study. / Myint, Phyo Kyaw; Bachmann, Max O; Loke, Yoon Kong; Musgrave, Stanley D; Price, Gill M; Hale, Rachel; Metcalf, Anthony Kneale; Turner, David A.; Day, Diana J; Warburton, Elizabeth A; Potter, John F.

In: Age and Ageing, Vol. 46, 2017, p. 83-90.

Research output: Contribution to journalArticle

Myint, PK, Bachmann, MO, Loke, YK, Musgrave, SD, Price, GM, Hale, R, Metcalf, AK, Turner, DA, Day, DJ, Warburton, EA & Potter, JF 2017, 'Important factors in predicting mortality outcome from stroke: findings from the Anglia Stroke Clinical Network Evaluation Study' Age and Ageing, vol. 46, pp. 83-90. https://doi.org/10.1093/ageing/afw175
Myint, Phyo Kyaw ; Bachmann, Max O ; Loke, Yoon Kong ; Musgrave, Stanley D ; Price, Gill M ; Hale, Rachel ; Metcalf, Anthony Kneale ; Turner, David A. ; Day, Diana J ; Warburton, Elizabeth A ; Potter, John F. / Important factors in predicting mortality outcome from stroke : findings from the Anglia Stroke Clinical Network Evaluation Study. In: Age and Ageing. 2017 ; Vol. 46. pp. 83-90.
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abstract = "Background: Although variation in stroke service provision and outcomes have been previously investigated, it is less well known what service characteristics are associated with reduced short and medium-term mortality. Methods: Data from a prospective multicentre study (2009-2012) in eight acute regional NHS trusts with a catchment population of about 2.6 million were used to examine the prognostic value of patient related factors and service characteristics on stroke mortality outcome at 7-day, 30-day, and 365 days post stroke, and time to death within one year. Results: A total of 2,388 acute stroke patients (mean (standard deviation) 76.9 (12.7) years; 47.3{\%} men, 87{\%} ischaemic stroke) were included in the study. Among patients characteristics examined increasing age, haemorrhagic stroke, total anterior circulation stroke type, higher prestroke frailty, history of hypertension and ischaemic heart disease, and admission hyperglycaemia predicted one year mortality. Additional inclusion of stroke service characteristics controlling for patient and service level characteristics showed varying prognostic impact of service characteristics on stroke mortality over the disease course during first year after stroke at different time points. The most consistent finding was the benefit of higher nursing levels; an increase in one trained nurses per 10 beds was associated with reductions in 30-day mortality of 11-28{\%}(p<0.0001) and in one year mortality of 8-12{\%} (p<0.001). Conclusions: There appears to be consistent and robust evidence of direct clinical benefit on mortality up to one year after acute stroke of higher numbers of trained nursing staff over and above that of other recognized mortality risk factors.",
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note = "The Anglia Stroke Clinical Network Evaluation Study (ASCNES) is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (PB-PG-1208-18240). This paper presents independent research funded by the NIHR under its Research for Patient Benefit (RfPB) programme (Grant Reference Number PB-PG-1208-18240). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. EAW receives funding support from the NIHR Biomedical Research Centre award to Cambridge",
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T1 - Important factors in predicting mortality outcome from stroke

T2 - findings from the Anglia Stroke Clinical Network Evaluation Study

AU - Myint, Phyo Kyaw

AU - Bachmann, Max O

AU - Loke, Yoon Kong

AU - Musgrave, Stanley D

AU - Price, Gill M

AU - Hale, Rachel

AU - Metcalf, Anthony Kneale

AU - Turner, David A.

AU - Day, Diana J

AU - Warburton, Elizabeth A

AU - Potter, John F

N1 - The Anglia Stroke Clinical Network Evaluation Study (ASCNES) is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (PB-PG-1208-18240). This paper presents independent research funded by the NIHR under its Research for Patient Benefit (RfPB) programme (Grant Reference Number PB-PG-1208-18240). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. EAW receives funding support from the NIHR Biomedical Research Centre award to Cambridge

PY - 2017

Y1 - 2017

N2 - Background: Although variation in stroke service provision and outcomes have been previously investigated, it is less well known what service characteristics are associated with reduced short and medium-term mortality. Methods: Data from a prospective multicentre study (2009-2012) in eight acute regional NHS trusts with a catchment population of about 2.6 million were used to examine the prognostic value of patient related factors and service characteristics on stroke mortality outcome at 7-day, 30-day, and 365 days post stroke, and time to death within one year. Results: A total of 2,388 acute stroke patients (mean (standard deviation) 76.9 (12.7) years; 47.3% men, 87% ischaemic stroke) were included in the study. Among patients characteristics examined increasing age, haemorrhagic stroke, total anterior circulation stroke type, higher prestroke frailty, history of hypertension and ischaemic heart disease, and admission hyperglycaemia predicted one year mortality. Additional inclusion of stroke service characteristics controlling for patient and service level characteristics showed varying prognostic impact of service characteristics on stroke mortality over the disease course during first year after stroke at different time points. The most consistent finding was the benefit of higher nursing levels; an increase in one trained nurses per 10 beds was associated with reductions in 30-day mortality of 11-28%(p<0.0001) and in one year mortality of 8-12% (p<0.001). Conclusions: There appears to be consistent and robust evidence of direct clinical benefit on mortality up to one year after acute stroke of higher numbers of trained nursing staff over and above that of other recognized mortality risk factors.

AB - Background: Although variation in stroke service provision and outcomes have been previously investigated, it is less well known what service characteristics are associated with reduced short and medium-term mortality. Methods: Data from a prospective multicentre study (2009-2012) in eight acute regional NHS trusts with a catchment population of about 2.6 million were used to examine the prognostic value of patient related factors and service characteristics on stroke mortality outcome at 7-day, 30-day, and 365 days post stroke, and time to death within one year. Results: A total of 2,388 acute stroke patients (mean (standard deviation) 76.9 (12.7) years; 47.3% men, 87% ischaemic stroke) were included in the study. Among patients characteristics examined increasing age, haemorrhagic stroke, total anterior circulation stroke type, higher prestroke frailty, history of hypertension and ischaemic heart disease, and admission hyperglycaemia predicted one year mortality. Additional inclusion of stroke service characteristics controlling for patient and service level characteristics showed varying prognostic impact of service characteristics on stroke mortality over the disease course during first year after stroke at different time points. The most consistent finding was the benefit of higher nursing levels; an increase in one trained nurses per 10 beds was associated with reductions in 30-day mortality of 11-28%(p<0.0001) and in one year mortality of 8-12% (p<0.001). Conclusions: There appears to be consistent and robust evidence of direct clinical benefit on mortality up to one year after acute stroke of higher numbers of trained nursing staff over and above that of other recognized mortality risk factors.

KW - stroke

KW - services

KW - staffing

KW - outcome

KW - mortality

U2 - 10.1093/ageing/afw175

DO - 10.1093/ageing/afw175

M3 - Article

VL - 46

SP - 83

EP - 90

JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

ER -