Better survival of older patients with stroke managed in a collaborative stroke pathway.

Abstract

Purpose: To compare the survival of stroke patients over 70 years old managed in the collaborative Stroke Pathway dedicated to the OLD patients (SPOLD) with those referred to conventional rehabilitation wards.

Methods: This longitudinal observational retrospective cohort study involved over 70 years old patients referred from the same neurovascular emergency unit in a university hospital in France to a post-stroke geriatric unit within the SPOLD pathway, compared to patients referred to conventional rehabilitation ward during the same period. Initial stroke severity and comorbidities were assessed using the NIHSS score and the Charlson index, respectively. The primary endpoint was 2-year survival, analyzed using Cox models for both the entire cohort and a propensity score-matched cohort to control for referral bias.

Results: The study included 262 patients with a mean age of 84.5 ± 6.7 years, of whom 122 (46.6%) were male. Patients in the SPOLD group (n = 101) had significantly higher age, NIHSS scores, and Charlson indices compared to those in the conventional rehabilitation ward (n = 161). Adjusted mortality was significantly lower in SPOLD patients (OR: 0.525, 95% CI: 0.298 to 0.924, p = 0.025). In the propensity score-matched cohort, mortality was also significantly lower for SPOLD patients (OR: 0.426, 95% CI: 0.212 to 0.857, p = 0.017).

Conclusion: This study suggests that this collaborative organization between a neurovascular emergency unit and a rehabilitation geriatric unit may be associated with a better survival of older patients after stroke.