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Clinical characteristics, in-hospital management, and outcomes of patients with in-hospital vs. community-onset ischaemic stroke: a hospital-based cohort study

BACKGROUND: Lack of high-quality national-level data on in-hospital ischaemic stroke hinders the development of tailored strategies for this subgroup's identification, treatment, and management. METHODS: We analyzed and compared clinical characteristics, in-hospital management measures, and out...

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Autores principales: Gu, Hong-Qiu, Wang, Chun-Juan, Yang, Xin, Zhao, Xing-Quan, Wang, Yi-Long, Liu, Li-Ping, Jiang, Yong, Li, Hao, Wang, Yong-Jun, Li, Zi-Xiao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544278/
https://www.ncbi.nlm.nih.gov/pubmed/37790077
http://dx.doi.org/10.1016/j.lanwpc.2023.100890
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author Gu, Hong-Qiu
Wang, Chun-Juan
Yang, Xin
Zhao, Xing-Quan
Wang, Yi-Long
Liu, Li-Ping
Jiang, Yong
Li, Hao
Wang, Yong-Jun
Li, Zi-Xiao
author_facet Gu, Hong-Qiu
Wang, Chun-Juan
Yang, Xin
Zhao, Xing-Quan
Wang, Yi-Long
Liu, Li-Ping
Jiang, Yong
Li, Hao
Wang, Yong-Jun
Li, Zi-Xiao
author_sort Gu, Hong-Qiu
collection PubMed
description BACKGROUND: Lack of high-quality national-level data on in-hospital ischaemic stroke hinders the development of tailored strategies for this subgroup's identification, treatment, and management. METHODS: We analyzed and compared clinical characteristics, in-hospital management measures, and outcomes, including death or discharge against medical advice (DAMA), major adverse cardiovascular events (MACEs), disability at discharge, and in-hospital complications between in-hospital and community-onset ischaemic stroke enrolled in the Chinese Stroke Center Association registry from August 2015 to December 2022. FINDINGS: The cohort comprised 14,948 in-hospital and 1,366,898 community-onset ischaemic stroke patients. In-hospital ischaemic stroke exhibited greater stroke severity, higher prevalence of comorbidities, more pre-admission medications, and had suboptimal management measures, for example, the onset-to-needle time within 4.5 h (83.3% vs. 93.1%; difference, −9.8% [−11.4% to −8.3%]), and antithrombotics at discharge (78.6% vs. 90.0%; difference, −11.4% [95% CI, −12.1% to −10.7%]). After adjusting for covariates, in-hospital ischaemic stroke remains associated with higher risks of unfavorable outcomes, including in-hospital death/DAMA (13.9% vs. 8.6%; adjusted risk difference [aRD], 2.2% [95% CI, 1.8%–2.7%]; adjusted odds ratio [aOR], 1.35 [95% CI, 1.25–1.45]), MACE (12.6% vs. 6.5%; aRD, 4.1% [95% CI, 3.5%–4.7%]; aOR, 1.68 [95% CI, 1.52–1.85]), and complications (23.7% vs. 12.1%; aRD, 6.5% [95% CI, 5.1%–7.9%]; aOR, 1.72 [95% CI, 1.64–1.80]), except for disability at discharge (41.1% vs. 33.1%; aRD, 0.4% [95% CI, −1.7% to 2.5%]; aOR, 0.99 [95% CI, 0.88–1.11]). INTERPRETATION: In-hospital ischaemic stroke demonstrated more severe strokes, worse vascular risk profiles, suboptimal management measures, and worse outcomes compared to community-onset ischaemic stroke. This emphasizes the urgent need for improved hospital systems of care and targeted quality improvement initiatives for better outcomes in in-hospital ischaemic stroke. FUNDING: 10.13039/501100012166National Key R&D Programme of China and Beijing Hospitals Authority.
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spelling pubmed-105442782023-10-03 Clinical characteristics, in-hospital management, and outcomes of patients with in-hospital vs. community-onset ischaemic stroke: a hospital-based cohort study Gu, Hong-Qiu Wang, Chun-Juan Yang, Xin Zhao, Xing-Quan Wang, Yi-Long Liu, Li-Ping Jiang, Yong Li, Hao Wang, Yong-Jun Li, Zi-Xiao Lancet Reg Health West Pac Articles BACKGROUND: Lack of high-quality national-level data on in-hospital ischaemic stroke hinders the development of tailored strategies for this subgroup's identification, treatment, and management. METHODS: We analyzed and compared clinical characteristics, in-hospital management measures, and outcomes, including death or discharge against medical advice (DAMA), major adverse cardiovascular events (MACEs), disability at discharge, and in-hospital complications between in-hospital and community-onset ischaemic stroke enrolled in the Chinese Stroke Center Association registry from August 2015 to December 2022. FINDINGS: The cohort comprised 14,948 in-hospital and 1,366,898 community-onset ischaemic stroke patients. In-hospital ischaemic stroke exhibited greater stroke severity, higher prevalence of comorbidities, more pre-admission medications, and had suboptimal management measures, for example, the onset-to-needle time within 4.5 h (83.3% vs. 93.1%; difference, −9.8% [−11.4% to −8.3%]), and antithrombotics at discharge (78.6% vs. 90.0%; difference, −11.4% [95% CI, −12.1% to −10.7%]). After adjusting for covariates, in-hospital ischaemic stroke remains associated with higher risks of unfavorable outcomes, including in-hospital death/DAMA (13.9% vs. 8.6%; adjusted risk difference [aRD], 2.2% [95% CI, 1.8%–2.7%]; adjusted odds ratio [aOR], 1.35 [95% CI, 1.25–1.45]), MACE (12.6% vs. 6.5%; aRD, 4.1% [95% CI, 3.5%–4.7%]; aOR, 1.68 [95% CI, 1.52–1.85]), and complications (23.7% vs. 12.1%; aRD, 6.5% [95% CI, 5.1%–7.9%]; aOR, 1.72 [95% CI, 1.64–1.80]), except for disability at discharge (41.1% vs. 33.1%; aRD, 0.4% [95% CI, −1.7% to 2.5%]; aOR, 0.99 [95% CI, 0.88–1.11]). INTERPRETATION: In-hospital ischaemic stroke demonstrated more severe strokes, worse vascular risk profiles, suboptimal management measures, and worse outcomes compared to community-onset ischaemic stroke. This emphasizes the urgent need for improved hospital systems of care and targeted quality improvement initiatives for better outcomes in in-hospital ischaemic stroke. FUNDING: 10.13039/501100012166National Key R&D Programme of China and Beijing Hospitals Authority. Elsevier 2023-08-31 /pmc/articles/PMC10544278/ /pubmed/37790077 http://dx.doi.org/10.1016/j.lanwpc.2023.100890 Text en © 2023 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Articles
Gu, Hong-Qiu
Wang, Chun-Juan
Yang, Xin
Zhao, Xing-Quan
Wang, Yi-Long
Liu, Li-Ping
Jiang, Yong
Li, Hao
Wang, Yong-Jun
Li, Zi-Xiao
Clinical characteristics, in-hospital management, and outcomes of patients with in-hospital vs. community-onset ischaemic stroke: a hospital-based cohort study
title Clinical characteristics, in-hospital management, and outcomes of patients with in-hospital vs. community-onset ischaemic stroke: a hospital-based cohort study
title_full Clinical characteristics, in-hospital management, and outcomes of patients with in-hospital vs. community-onset ischaemic stroke: a hospital-based cohort study
title_fullStr Clinical characteristics, in-hospital management, and outcomes of patients with in-hospital vs. community-onset ischaemic stroke: a hospital-based cohort study
title_full_unstemmed Clinical characteristics, in-hospital management, and outcomes of patients with in-hospital vs. community-onset ischaemic stroke: a hospital-based cohort study
title_short Clinical characteristics, in-hospital management, and outcomes of patients with in-hospital vs. community-onset ischaemic stroke: a hospital-based cohort study
title_sort clinical characteristics, in-hospital management, and outcomes of patients with in-hospital vs. community-onset ischaemic stroke: a hospital-based cohort study
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544278/
https://www.ncbi.nlm.nih.gov/pubmed/37790077
http://dx.doi.org/10.1016/j.lanwpc.2023.100890
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