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

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@article{1d49841103a84f4db94dcb06546f0262,
title = "Nursing Home Admission and Initiation of Domiciliary Care After Ischemic Stroke – The Importance of Time to Thrombolysis",
abstract = "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.",
keywords = "Epidemiology, Nursing home, Stroke, Thrombolytic therapy, Thrombolytic Therapy/adverse effects, Nursing Homes, Humans, Middle Aged, Patient Admission, Patient Discharge, Male, Time Factors, Fibrinolytic Agents/administration & dosage, Ischemic Stroke/diagnosis, Aged, 80 and over, Female, Registries, Databases, Factual, Risk Assessment, Time-to-Treatment, Risk Factors, Treatment Outcome, Home Care Services, Denmark/epidemiology, Aged, Infusions, Intravenous",
author = "Butt, {Jawad H.} and Christina Kruuse and Kristian Kragholm and Johnsen, {S{\o}ren Paaske} and Kristensen, {S{\o}ren Lund} and Eva Havers-Borgersen and Adelina Yafasova and Lauge {\O}stergaard and Gislason, {Gunnar H.} and Christian Torp-Pedersen and Lars K{\o}ber and Fosb{\o}l, {Emil L.}",
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: {\textcopyright} 2021 Elsevier Inc. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",
year = "2021",
month = aug,
doi = "10.1016/j.jstrokecerebrovasdis.2021.105916",
language = "English",
volume = "30",
journal = "Journal of Stroke and Cerebrovascular Diseases",
issn = "1052-3057",
publisher = "W.B./Saunders Co",
number = "8",

}

RIS

TY - JOUR

T1 - Nursing Home Admission and Initiation of Domiciliary Care After Ischemic Stroke – The Importance of Time to Thrombolysis

AU - Butt, Jawad H.

AU - Kruuse, Christina

AU - Kragholm, Kristian

AU - Johnsen, Søren Paaske

AU - Kristensen, Søren Lund

AU - Havers-Borgersen, Eva

AU - Yafasova, Adelina

AU - Østergaard, Lauge

AU - Gislason, Gunnar H.

AU - Torp-Pedersen, Christian

AU - Køber, Lars

AU - Fosbøl, Emil L.

N1 - 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.

PY - 2021/8

Y1 - 2021/8

N2 - 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.

AB - 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.

KW - Epidemiology

KW - Nursing home

KW - Stroke

KW - Thrombolytic therapy

KW - Thrombolytic Therapy/adverse effects

KW - Nursing Homes

KW - Humans

KW - Middle Aged

KW - Patient Admission

KW - Patient Discharge

KW - Male

KW - Time Factors

KW - Fibrinolytic Agents/administration & dosage

KW - Ischemic Stroke/diagnosis

KW - Aged, 80 and over

KW - Female

KW - Registries

KW - Databases, Factual

KW - Risk Assessment

KW - Time-to-Treatment

KW - Risk Factors

KW - Treatment Outcome

KW - Home Care Services

KW - Denmark/epidemiology

KW - Aged

KW - Infusions, Intravenous

UR - http://www.scopus.com/inward/record.url?scp=85107905071&partnerID=8YFLogxK

U2 - 10.1016/j.jstrokecerebrovasdis.2021.105916

DO - 10.1016/j.jstrokecerebrovasdis.2021.105916

M3 - Journal article

C2 - 34144336

AN - SCOPUS:85107905071

VL - 30

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

SN - 1052-3057

IS - 8

M1 - 105916

ER -

ID: 66797541