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Nursing Home Admission and Initiation of Domiciliary Care After Ischemic Stroke – The Importance of Time to Thrombolysis

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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Objectives: There is a paucity of data on the risk of nursing home admission or domiciliary care initiation according to time to intravenous thrombolysis for ischemic stroke. We investigated the association between time to intravenous thrombolysis and the composite of nursing home admission or domiciliary care initiation in patients with acute ischemic stroke. Materials and Methods: In this nationwide cohort study, all stroke patients treated with intravenous thrombolysis (2011–2015) and alive at discharge were identified from the Danish Stroke Registry and other nationwide registries. The composite of nursing home admission or domiciliary care initiation one year post-discharge according to time to thrombolysis was examined with multivariable Cox regression. Results: The study population comprised 4,349 patients (median age 67 years [25th-75th percentile 57–75], 65.2% men). The median National Institutes of Health Stroke Scale score at presentation was 5, and the median time from symptom-onset to initiation of thrombolysis was 143 min. The absolute 1-year risk of the composite endpoint was 14.0% (95%CI, 11.5–16.8%) in the ≤90 min group, 16.6% (15.1–18.1%) in the 91–180min group, and 16.0% (14.0–18.2%) in the 181–270 min group. Compared with thrombolysis ≤90 min, time to thrombolysis between 91–180 min and 181–270 min was associated with a significantly higher risk of the composite endpoint (hazard ratio 1.31 [1.04–1.65] and 1.47 [1.14–1.91], respectively). Conclusions: In patients admitted with ischemic stroke, increasing time to thrombolysis was associated with a greater risk of the composite of nursing home admission or domiciliary care initiation. Continued efforts to shorten the time delay from symptom-onset to initiation of thrombolysis are warranted.

OriginalsprogEngelsk
Artikelnummer105916
TidsskriftJournal of Stroke and Cerebrovascular Diseases
Vol/bind30
Udgave nummer8
ISSN1052-3057
DOI
StatusUdgivet - aug. 2021

Bibliografisk note

Funding Information:
We thank The Danish Clinical Quality Program ? National Clinical Registries (RKKP) for making it possible to work with The Danish Stroke Registry.

Publisher Copyright:
© 2021 Elsevier Inc.

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

ID: 66797541