Comprehensive stroke centers may be effective at lowering all-cause mortality

Patients with hemorrhagic stroke were significantly more likely to be alive 90 days after the episode if they were admitted to comprehensive stroke centers instead of primary stroke or nonstroke centers, according to an administrative database analysis.

The 90-day all-cause mortality rates were 35 percent among patients at comprehensive stroke centers and 40.3 percent among patients at primary stroke or nonstroke centers.

Lead researcher James S. McKinney, MD, assistant professor of neurology at the Rutgers-Robert Wood Johnson Medical School in New Brunswick, N.J., and colleagues published their findings online in the JAMA on May 6.

They mentioned that hemorrhagic strokes account for approximately 20 percent of strokes and are frequently associated with death or neurological disability. The two types of hemorrhagic strokes are intracerebral hemorrhage or subarachnoid hemorrhage.

In this study, they analyzed the Myocardial Infarction Data Acquisition System database, which included information on patients discharged from all nonfederal acute care hospitals in New Jersey with a primary diagnosis of intracerebral hemorrhage or subarachnoid hemorrhage between 1996 and 2012.

Of the more than 4.1 million cardiovascular-related admissions during that time period, the researchers identified 36,981 patients who fit their criteria. The patients were admitted to 87 hospitals: 13 were comprehensive stroke centers, 52 were primary stroke centers and 22 were nonstroke centers.

Forty percent of the patients with hemorrhagic strokes were admitted to a comprehensive stroke center, while the remaining 60 percent were admitted to a primary stroke or nonstroke center.

After a year, the all-cause mortality rates were 39.3 percent among patients at comprehensive stroke centers and 45.7 percent among patients at primary stroke or nonstroke centers.

Researchers also found that patients transferred to comprehensive stroke centers were less likely to die within 90 days compared to those who remained at primary stroke or nonstroke centers.

Patients at the comprehensive stroke centers were more likely to be younger, male and have private health insurance coverage and were less likely to have comorbid conditions such as hypertension, diabetes, atrial fibrillation or renal disease. They were also more likely to receive neurosurgical or endovascular interventions.