And yet that still leaves the 30day mortality too high. What is the followup strategy to get them even lower? What did the autopsies have to say about why they died? They died from neuronal death, not the stroke which is probably on the death certificate.
http://www.medpagetoday.com/Cardiology/Strokes/56129?
Stroke care coordinated regionally to cover primary prevention to
rehabilitation and ensure appropriate interventions, such as
thrombolysis and stroke unit care, was associated with lower stroke
mortality, a population-based study from Canada showed.
Provinces with integrated systems of stroke care saw crude 30-day mortality rates decline from 15.8% in 2003/2004 to 12.7% in 2012/2013, whereas provinces that didn't have such systems saw no such decline, with those rates remaining 14.5% at both time points.
And
"there was a clear reduction in relative mortality in provinces with
stroke systems vs those without," with a significant adjusted incidence
rate ratio of 0.85 for 30-day in-hospital mortality among stroke or
transient ischemic attack (TIA) patients starting with the fiscal year
2009/2010, Michael D. Hill, MD, of the University of Calgary, Alberta, and colleagues reported online in Neurology.
"The surveys indicated that facilities in provinces with such systems
were more likely to care for patients on a stroke unit, and have timely
access to a stroke prevention clinic and telestroke services," they
added.
The study considered a total of 319,972 stroke or TIA patients in the
Canadian Institute of Health Information's Discharge Abstract Database
over 11 fiscal years in five provinces with integrated systems and seven
provinces or territories (excluding Quebec).
The findings demonstrate that stroke systems of care do indeed make a difference, which wasn't a foregone conclusion, Jeffrey J. Fletcher, MD, of the University of Michigan in Ann Arbor, and Jennifer J. Majersik, MD, of the University of Utah in Salt Lake City, noted in an accompanying editorial:
"To improve stroke patient care, the American Heart
Association/American Stroke Association (AHA/ ASA) provided policy
recommendations in 2013 for key elements of stroke systems of care,
including emergency medical services (EMS) routing policies, use of
telemedicine where specialists are scarce, multidisciplinary and
protocol-driven in-hospital care, conduction of quality improvement
programs, and access to poststroke rehabilitation.
"In
2014, the AHA/ASA considered the evidence for factors that may have
contributed to the accelerated decline in stroke mortality over the past
few decades and found surprisingly sparse evidence for outcomes
improvement resulting from integration of these distinct elements into a
stroke system of care."
That 2014 document had cited potentially strong effects but suggested such systems "have not been in place long enough to indicate their influence on the decline."
The Canadian data still couldn't provide causal proof or say which
components were key, and were missing data on factors like thrombolysis,
intensity of life-sustaining therapies, or early rehabilitation, the
editorialists noted, but "despite these limitations, the positive
findings are encouraging" anyway.
The Canadian healthcare system differs from fragmented systems
lacking federal or state level coordination, Fletcher and Majersik
pointed out:
"However, these are perhaps the data we have been missing: rather
than attempting to provide piecemeal evidence, this work shows that
enacting full-spectrum stroke systems improves stroke mortality. The
authors have highlighted an opportunity that may have profound
implications for reducing the global burden of stroke: implementation of
centralized systems of stroke care with high-level government
oversight."
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