Outcomes measured by mortality rates, quality of life and degree of autonomy in the first year in stroke units in Spain
Mar, Javier (Hospital 'Alto Deba'- Unidad de Gestión Sanitaria)
Masjuan, Jaime (Hospital Universitario Ramón y Cajal (Madrid))
Oliva-Moreno, Juan (Universidad de Castilla-La Mancha. Departamento de Análisis Económico y Finanzas)
Gonzalez-Rojas, Nuria (Boehringer Ingelheim España)
Becerra, Virginia (Boehringer Ingelheim España)
Casado, Miguel Ángel (Pharmacoeconomics & Outcomes Research Iberia, Madrid)
Torres, Covadonga (Pharmacoeconomics & Outcomes Research Iberia, Madrid)
Yebenes, María (Pharmacoeconomics & Outcomes Research Iberia, Madrid)
Quintana, Manuel (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Álvarez Sabín, José (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Universitat Autònoma de Barcelona
CONOCES Investigators Group

Date:	2015
Abstract:	The primary objective of this sub analysis of the CONOCES study was to analyse outcomes in terms of mortality rates, quality of life and degree of autonomy over the first year in patients admitted to stroke units in Spain. The secondary objective was to identify the factors determining good prognosis. We studied a sample of patients who had suffered a confirmed stroke and been admitted to a Stroke Unit in the Spanish healthcare system. Socio-demographic and clinical variables and variables related to the level of severity (NIHSS), the level of autonomy (Barthel, modified Rankin) and quality of life (EQ-5D) were recorded at the time of admission and then three months and one year after the event. Factors determining prognosis were analysed using logistic regression and ROC curves. A total of 321 patients were recruited, 33% of whom received thrombolytic treatment, which was associated with better results on the Barthel and the modified Rankin scales and in terms of the risk of death. Mean quality of life measured through EQ-5D improved from 0. 57 at discharge to 0. 65 one year later. Full autonomy level measured by Barthel index increased from 30. 1% at discharge to 52. 8% at one year and by the modified Rankin scale from 51% to 71%. The rates for in-hospital and 1-year mortality were 5. 9% and 17. 4% respectively. Low NIHSS scores were associated with a good prognosis with all the outcome variables. The three instruments applied (NIHSS, Barthel and modified Rankin scales) on admission showed good discriminative ability for patient prognosis in the ROC curves. There has been a change in the prognosis for stroke in Spain in recent years as the quality of life at 1 year observed in our study is clearly higher than that obtained in other Spanish studies conducted previously. Moreover, survival and functional outcome have also improved following the introduction of a new model of care. These results clearly promote extension of the model based on stroke units and reinforced rehabilitation to the majority of the more than 100,000 strokes that occur annually in Spain.
Note:	Altres ajuts: The study has been funded by an unrestricted grant from Boehringer Ingelheim Spain.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Stroke ; Outcomes ; Disability ; Quality of life ; Stroke units ; Thrombolysis
Published in:	Health and quality of life outcomes, Vol. 13 (march 2015) , ISSN 1477-7525

DOI: 10.1186/s12955-015-0230-8
PMID: 25889480

9 p, 549.8 KB

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