umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Stroke care in Sweden: Hospital care and patient follow-up based on Riks-Stroke, the National Quality Register for Stroke Care
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2003. , 92 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 838
Keyword [en]
stroke care, quality register, routine clinical practice, validation, sex differences, stroke units, atrial fibrillation, oral anticoagulants, post-stroke fatigue
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:umu:diva-94114ISBN: 91-7305-426-7 (print)OAI: oai:DiVA.org:umu-94114DiVA: diva2:756391
Public defence
2003-05-28, Tandläkarhögskolan, sal B, 9 trp., Umeå universitet, Umeå, 13:00
Opponent
Supervisors
Projects
digitalisering@umu
Note

Diss. (sammanfattning) Umeå : Umeå universitet, 2003

Available from: 2014-10-17 Created: 2014-10-03 Last updated: 2015-04-08Bibliographically approved
List of papers
1. Sex differences in stroke care and outcome in the Swedish national quality register for stroke care
Open this publication in new window or tab >>Sex differences in stroke care and outcome in the Swedish national quality register for stroke care
Show others...
2009 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 40, no 3, 909-914 p.Article in journal (Refereed) Published
Abstract [en]

Background and purpose: Previous reports concerning sex-related differences in stroke management and outcome are inconsistent and are sometimes difficult to interpret. We used data from a national stroke register to further explore possible differences between men and women in baseline characteristics, stroke treatment, and outcome.

Methods: This study included 24633 stroke events registered in Riks-Stroke, the Swedish national quality register for stroke care, during 2006. Information on background variables and treatment was collected during the hospital stay. After 3 months, the patients' living situation and outcome were assessed.

Results: Women were older than men when they had their stroke (mean age, 78.4 versus 73.6 years; P<0.001). On admission to the hospital, women were more often unconscious. Among conscious patients, there was no sex-related difference in the use of stroke unit care. Men and women had equal probability to receive thrombolysis and oral anticoagulants. Women were more likely to develop deep venous thromboses and fractures, whereas men were more likely to develop pneumonia during their hospital stay. Women had a lower 3-month survival, a difference that was associated with higher age and impaired level of consciousness on admission. Women were less often living at home at the 3-month follow-up. However, the difference in residency was not present in patients <85 years who were living at home without community support before the stroke.

Conclusions: Reported sex differences in stroke care and outcome were mainly explained by the women's higher age and lower level of consciousness on admission.

Place, publisher, year, edition, pages
New York: American Heart Association, 2009
Keyword
outcome, registry, sex, stroke, stroke management
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-19109 (URN)10.1161/STROKEAHA.108.517581 (DOI)19118246 (PubMedID)
Projects
digitalisering@umu
Available from: 2009-03-04 Created: 2009-03-04 Last updated: 2017-12-13Bibliographically approved
2. Differences in Long-Term Outcome Between Patients Treated in Stroke Units and in General Wards: A 2-Year Follow-Up of Stroke Patients in Sweden
Open this publication in new window or tab >>Differences in Long-Term Outcome Between Patients Treated in Stroke Units and in General Wards: A 2-Year Follow-Up of Stroke Patients in Sweden
Show others...
2001 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 32, 2124-2130 p.Article in journal (Refereed) Published
Abstract [en]

Background and Purpose— The long-term beneficial effects of stroke unit care have been proved in several randomized trials. However, there is a question of large-scale applicability in routine clinical practice of interventions used by dedicated investigators in small randomized trials. The objective of this study was to compare, 21/2 years after stroke, patients who had been treated in stroke units and those treated in general wards in routine clinical practice.

Methods— This is a prospective cohort study based on 8194 patients who were included, during the first 6 months in 1997, in Riks-Stroke, the Swedish National Register for quality assessment of acute stroke. Two years after the event, 5189 patients were still alive and 5104 were followed up with a postal questionnaire to which 4038 responded.

Results— Among the group of patients who were independent in activities of daily living (ADL) functions before the stroke, patients who were treated in stroke units were less often dependent in ADL functions, after adjustment for case mix (OR, 0.79; CI, 0.66 to 0.94). If they also lived at home before the stroke, then they had a lower case-fatality rate 2 years after the stroke (OR, 0.81; CI, 0.72 to 0.92).

Conclusions— Long-term beneficial effects of treatment in stroke units were shown for patients who were independent in ADL functions before the stroke. No benefits were shown for patients who were dependent on help for primary ADL before the stroke. Further studies on this group of patients with more detailed outcome measures are needed.

Place, publisher, year, edition, pages
American Heart Association, Inc., 2001
Keyword
follow-up studies, stroke management, stroke outcome, stroke units, Sweden
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-94816 (URN)10.1161/hs0901.095724 (DOI)
Projects
digitalisering@umu
Available from: 2014-10-17 Created: 2014-10-17 Last updated: 2017-12-05Bibliographically approved
3. Large variations in the use of oral anticoagulants in stroke patients with atrial fibrillation: A Swedish national perspective
Open this publication in new window or tab >>Large variations in the use of oral anticoagulants in stroke patients with atrial fibrillation: A Swedish national perspective
Show others...
2004 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 255, no 1, 22-32 p.Article in journal (Refereed) Published
Abstract [en]

Objectives. To explore nation-wide use of anticoagulation in stroke patients with atrial fibrillation, in routine clinical practice in Sweden.

Design.  Cross-sectional cohort study.

Setting. Patients included in Riks-Stroke, the Swedish national quality register for stroke care, during 2001.

Subjects. Hospitals with incomplete coverage were excluded, leaving 4538 stroke patients with atrial fibrillation amongst 18 276 stroke patients from 75 hospitals in six health care regions.

Main outcome measure.  Treatment with oral anticoagulants.

Results. At stroke onset, the proportion of patients with atrial fibrillation and first-ever stroke, receiving oral anticoagulants as primary prevention was 11.0% (range 8.4–13.5% between regions and 2.5–24.4% between hospitals). Younger age, male sex and diabetes at stroke onset independently predicted primary prevention with oral anticoagulants. The proportion of stroke patients with atrial fibrillation receiving oral anticoagulants as secondary prevention at discharge was 33.5% (range 29.9–40.6% between regions and 16.4–61.9% between hospitals). Independent predictors for secondary prevention were younger age, male sex and independent activities of daily life (ADL) function before the stroke, being discharged to home, being fully conscious on admission and health care region.

Conclusion.  There were variations between hospitals and regions that differences in age, sex, functional impairments and comorbidities could not fully explain. This indicates that evidence-based primary and secondary prevention of embolic stroke is insufficiently practised. Local factors seem to determine whether patients with atrial fibrillation gain access to optimal prevention of stroke or not.

Place, publisher, year, edition, pages
John Wiley & Sons, 2004
Keyword
Administration, Oral, Aged, Aged, 80 and over, Anticoagulants/*administration & dosage, Atrial Fibrillation/complications/*drug therapy, Attitude of Health Personnel, Cerebral Hemorrhage/complications, Cerebral Infarction/complications/prevention & control, Cerebrovascular Accident/complications/*prevention & control, Cohort Studies, Cross-Sectional Studies, Female, Hospitalization, Humans, Male, Middle Aged, Platelet Aggregation Inhibitors/therapeutic use, Recurrence, Risk Factors
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-12952 (URN)10.1046/j.0954-6820.2003.01253.x (DOI)14687235 (PubMedID)
Projects
digitalisering@umu
Available from: 2007-04-25 Created: 2007-04-25 Last updated: 2017-12-14Bibliographically approved
4. Poststroke Fatigue: A 2-Year Follow-Up Study of Stroke Patients in Sweden
Open this publication in new window or tab >>Poststroke Fatigue: A 2-Year Follow-Up Study of Stroke Patients in Sweden
2002 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 33, 1327-1333 p.Article in journal (Refereed) Published
Abstract [en]

Background and Purpose Fatigue is common among stroke patients. This study determined the prevalence of fatigue among long-term survivors after stroke and what impact fatigue had on various aspects of daily life and on survival.

Methods— This study was based on Riks-Stroke, a hospital-based national register for quality assessment of acute stroke events in Sweden. During the first 6 months of 1997, 8194 patients were registered in Riks-Stroke, and 5189 were still alive 2 years after the stroke. They were followed up by a mail questionnaire, to which 4023 (79%) responded. Patients who reported that they always felt depressed were excluded.

Results— To the question, “Do you feel tired?” 366 (10.0%) of the patients answered that they always felt tired, and an additional 1070 (29.2%) were often tired. Patients who always felt tired were on average older than the rest of the study population (74.5 versus 71.5 years, P<0.001); therefore, all subsequent analyses were age adjusted. Fatigue was an independent predictor for having to move into an institutional setting after stroke. Fatigue was also an independent predictor for being dependent in primary activities of daily living functions. Three years after stroke, patients with fatigue also had a higher case fatality rate.

Conclusions— Fatigue is frequent and often severe, even late after stroke. It is associated with profound deterioration of several aspects of everyday life and with higher case fatality, but it usually receives little attention by healthcare professionals. Intervention studies are needed.

Place, publisher, year, edition, pages
American Heart Association, Inc., 2002
Keyword
fatigue, follow-up studies, outcome
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-94809 (URN)10.1161/01.STR.0000014248.28711.D6 (DOI)
Projects
digitalisering@umu
Available from: 2014-10-17 Created: 2014-10-17 Last updated: 2017-12-05Bibliographically approved

Open Access in DiVA

Stroke care in Sweden(12985 kB)247 downloads
File information
File name FULLTEXT01.pdfFile size 12985 kBChecksum SHA-512
b32bd8fe56e2acfbda035aefadf7657918d5d7e96a8e3e7718d48d2fc292536d79835c9dc168368418be532d6bc4b8772287bc2e824e5d1d58b5a3378ff2b8eb
Type fulltextMimetype application/pdf

Search in DiVA

By author/editor
Glader, Eva-Lotta
By organisation
Medicine
Clinical Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 247 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 220 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf