Stroke outcome in those over 80 - A multicenter cohort study across Canada

Background and Purpose - The prevalence of stroke in elderly patients has been increasing in recent years. However, limited information is available about the burden of stroke in individuals over 80. We sought to evaluate differences in clinical outcomes in Canadians over 80 years old hospitalized for an acute ischemic stroke. Methods - The authors conducted a multicenter cohort study including all hospital admissions for ischemic stroke identified from the Canadian Hospital Morbidity and Mortality Database from April 2003 to March 2004. The Hospital Morbidity and Mortality Database contains a national database that contains patient-level sociodemographic, diagnostic, procedural, and administrative information from across Canada. Multivariable analysis was performed using logistic regression. The primary outcome was 7-day case fatality and fatality at discharge. Secondary end points included intensive care unit admissions, medical complications, gender differences, length of hospital stay, and discharge disposition. Results - We analyzed 26 676 patients with ischemic stroke admitted to 606 hospitals across Canada. Mean age (SD) was 74 +/- 13 years. Overall, 10 171 (38%) were aged 80 years or older. Case fatality at discharge was 5.7% (age < 59), 8.6% (age 60 to 69), 13.4% (age 70 to 79), and 24.2% (age >= 80; P < 0.001). Patients aged 80 and over were less likely to be admitted to the intensive care unit (7.7% versus 15.3%; P < 0.001) and discharged to their prestroke residence (47.2% for those over 80 versus 61.6% for patients younger than 80; P < 0.001). Median length of stay was longer in those over 80 (10 days versus 7 days; P < 0.0001). In the multivariable analysis for the older group, admission to the intensive care unit, low socioeconomic status, and admission to a nonacademic institution were associated with increased fatality after adjusting for covariates. Conclusions - Aging of the population is a growing reality in Western societies and this translates into an increasing demand on healthcare systems. In our study, patients with stroke over 80 had higher risk-adjusted fatality, longer hospitalization, and were less likely to be discharged to their original place of residence. Strategies need to be implemented to facilitate equal access to specialized stroke care for the elderly.