Quality of Care and One-Year Outcomes in Patients with Diabetes Hospitalised for Stroke or TIA: A Linked Registry Study,Journal of Stroke & Cerebrovascular Diseases

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Quality of Care and One-Year Outcomes in Patients with Diabetes Hospitalised for Stroke or TIA: A Linked Registry Study
Journal of Stroke & Cerebrovascular Diseases ( IF 2.0 ) Pub Date : 2021-09-10 , DOI: 10.1016/j.jstrokecerebrovasdis.2021.106083
Muideen T. Olaiya ₁ , Dominique A. Cadilhac _{1,

2} , Joosup Kim _{1,

2} , Amanda G. Thrift ₁ , Barbora de Courten ₁ , Nadine E. Andrew _{1,

3} , Rohan Grimley _{1,

4} , Craig S. Anderson _{5,

6} , Vijaya Sundararajan ₇ , Natasha A. Lannin ₈ , Christopher Levi ₉ , Helen M. Dewey ₁₀ , Monique F. Kilkenny _{1,

2}

Affiliation

Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, VIC, Australia
Peninsula Clinical School, Central Clinical School, Monash University, VIC, Australia
Sunshine Coast Clinical School, School of Medicine, Griffith University, Birtinya, QLD, Australia
The University of Sydney, NSW, Australia
The George Institute for Global Health, Sydney NSW, Australia; and The George Institute for Global Health at Peking University Health Science Center, China
Department of Public Health, La Trobe University, Bundoora VIC, Australia
Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC; and Alfred Health, Melbourne, VIC, Australia
University of Newcastle, Newcastle, NSW, Australia
Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia

Objectives

To evaluate key quality indicators for acute care and one-year outcomes following acute ischaemic stroke (IS), intracerebral haemorrhage (ICH), or transient ischaemic attack (TIA) by diabetes status.

Materials and Methods

Observational cohort study (2009-2013) using linked data from the Australian Stroke Clinical Registry and hospital records. Diabetes was ascertained through review of hospital records. Multilevel regression models were used to evaluate the association between diabetes and outcomes, including discharge destination, and mortality and hospital readmissions within one-year of stroke/TIA.

Results

Among 14,132 patients (median age 76 years, 46% female), 22% had diabetes. Compared to patients without diabetes, those with diabetes were equally likely to receive stroke unit care, but were more often discharged on antihypertensive agents (79% vs. 68%) or with a care plan (50% vs. 47%). In patients with TIA, although 86% returned directly home after acute care, those with diabetes more often had a different discharge destination than those without diabetes. Diabetes was associated with greater all-cause mortality (hazard ratio 1.13, 95% CI 1.04-1.23) in patients with IS/ICH; and with both greater all-cause (1.81, CI 1.35-2.43) and CVD mortality (1.75, CI 1.06-2.91) in patients with TIA. Similarly, diabetes was associated with greater rates of all-cause readmission in both patients with IS/ICH and TIA.

Conclusions

Despite good adherence to best care standards for acute stroke/TIA, patients with comorbid diabetes had worse outcomes at one-year than those without comorbid diabetes. Associations of diabetes with poorer outcomes were more pronounced in patients with TIA than those with IS/ICH.

中文翻译：

因中风或 TIA 住院的糖尿病患者的护理质量和一年结果：一项关联的注册研究

目标

根据糖尿病状态评估急性缺血性卒中 (IS)、脑内出血 (ICH) 或短暂性脑缺血发作 (TIA) 后急性护理和一年结果的关键质量指标。

材料和方法

观察性队列研究（2009-2013）使用来自澳大利亚中风临床登记处和医院记录的关联数据。通过查看医院记录确定糖尿病。多级回归模型用于评估糖尿病与结局之间的关联，包括出院目的地、死亡率和卒中/TIA 一年内再入院。

结果

在 14,132 名患者（中位年龄 76 岁，46% 为女性）中，22% 患有糖尿病。与未患糖尿病的患者相比，患有糖尿病的患者接受卒中病房护理的可能性相同，但出院时服用抗高血压药物（79% 对 68%）或有护理计划（50% 对 47%）的情况更多。在 TIA 患者中，虽然 86% 的患者在接受急诊治疗后直接回家，但糖尿病患者的出院目的地往往与非糖尿病患者不同。在 IS/ICH 患者中，糖尿病与更高的全因死亡率相关（风险比 1.13，95% CI 1.04-1.23）；TIA 患者的全因死亡率（1.81，CI 1.35-2.43）和 CVD 死亡率（1.75，CI 1.06-2.91）都更高。同样，在 IS/ICH 和 TIA 患者中，糖尿病与更高的全因再入院率相关。