Deans' stroke musings: In-hospital mortality due to acute stroke continues to decline

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, May 14, 2018

In-hospital mortality due to acute stroke continues to decline

What specifically is being done to continue this? Or was this just blind dumb luck? Any hope of stopping the 5 causes of the neuronal cascade of death in the first week? Was there a strategy behind this?
https://www.healio.com/internal-medicine/neurology/news/online/%7B9ddcefcc-0dcd-4b81-8150-f5bdcf72c355%7D/in-hospital-mortality-due-to-acute-stroke-continues-to-decline?utm_source=selligent&utm_medium=email&utm_campaign=internal%20medicine%20news&m_bt=592835816269

The rate of mortality among patients hospitalized with acute stroke continues to decrease nationwide, according to a study presented at the American Academy of Neurology annual meeting.

“Previously, a downward trend in stroke-related in-hospital mortality was noted from 1996 to 2006, reflecting advancements in acute stroke care,” , professor and chair of the Texas Tech University Health Sciences Center El Paso’s department of neurology, and colleagues wrote.

Cruz-Flores and colleagues sought to determine nationwide trends in in-hospital mortality due to acute stroke between 2007 and 2014 using a nationally representative sample of all hospital discharges in the United States.

The researchers found that during the study period, there was an in increase in overall stroke hospitalizations from 1,017,414 in 2007-2008 to 1,114,960 in 2013-2014. In-hospital deaths related to stroke decreased from 8.98% in 2007-2008 to 7.34% in 2013-2014.

The odds of mortality declined among all stroke types assessed, including ischemic stroke (OR = 0.798; 95% CI, 0.762-0.835), subarachnoid hemorrhage (OR = 0.885; 95% CI, 0.810-0.968) and intracerebral hemorrhage (OR = 0.865, 95% CI, 0.824-0.908), and remained significant after adjustments for age, gender, race, medical comorbidities, in-hospital complications, insurance status and APR-DRG Severity scale.

“The decreasing mortality in patients hospitalized for stroke suggests an improved in-hospital care of stroke patients, which may be a reflection of better and standardized care across all hospitals, from better management of medical problems, such as hypertension and diabetes, to prevention of complications, to better multidisciplinary care during the hospital stay, to the higher utilization of specific treatments for stroke, such as tissue plasminogen activator or mechanical thrombectomy,” Cruz-Flores told Healio Internal Medicine.

“If indeed, the decreasing mortality is a reflection of better care, it behooves the medical community to adopt the protocols of care and guidelines for stroke care to continue to make an impact in outcome,” he added.

“Since the study is based on an administrative database, it lacks specificity as to specific conditions that are not reported in the dataset and that may impact outcome,” he said. – by Alaina Tedesco

Reference:

Afzal MR, et al. Continued nationwide decline in stroke related in-hospital mortality in United States. Presented at: American Academy of Neurology Annual Meeting. April 21-27, 2018; Los Angeles.

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.