Stroke-related mortality in a tertiary care hospital in Andalusia: Analysis and reflections

• Published in: Neurologia (Barcelona, Spain) Vol. 32; no. 9; p. 559
• Main Authors: Maestre-Moreno, J F, Fernández-Pérez, M D, Triguero-Cueva, L, Gutiérrez-Zúñiga, R, Herrera-García, J D, Espigares-Molero, A, Mínguez-Castellanos, A
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01-11-2017
• Subjects: Aged; Anticoagulants - therapeutic use; Atrial Fibrillation - complications; Female; Hospital Mortality; Humans; Intracranial Hemorrhages - complications; Male; Spain; Stroke - drug therapy; Stroke - mortality; Tertiary Care Centers; Mortalidad intrahospitalaria; In-hospital mortality; Stroke; Síndrome coronario agudo; Ictus hemorrágico; Oral anticoagulants; Haemorrhagic stroke; Ictus; Acute coronary syndrome; Ictus isquémico; Anticoagulación oral; Ischaemic stroke
• ISSN: 1578-1968
• DOI: 10.1016/j.nrl.2016.03.007

Stroke is a very common cause of death, especially in southern Spain. The present study analyses in-hospital mortality associated with stroke in an Andalusian tertiary care hospital.
We gathered the files of all patients who had died at Hospital Universitario Virgen de las Nieves in Granada in 2013 and whose death certificates indicated stroke as the cause of death. We also gathered stroke patients discharge data and compared them to that of patients with acute coronary syndrome (ACS).
A total of 825 patients had a diagnosis of stroke (96 deaths, 11.6%); of these, 562 had ischaemic stroke (44 deaths, 7.8%) and 263 haemorrhagic stroke (52 deaths, 19.7%). Patients with haemorrhagic stroke therefore showed greater mortality rate (OR=2.9). Patients in this group died after a shorter time in hospital (median, 4 vs 7 days; mean, 6 days). However, patients with ischaemic stroke were older and presented with more comorbidities. On the other hand, 617 patients had a diagnosis of ACS (36 deaths, 5.8%). The mortality odds ratio (MOR) was 2.1 (stroke/SCA). Around 23% of the patients who died from stroke were taking anticoagulants. 60% of the deceased patients with ischaemic stroke and 20% of those with haemorrhagic stroke had atrial fibrillation (AF); 35% of the patients with ischaemic stroke and AF were taking anticoagulants.
Stroke is associated with higher admission and in-hospital mortality rates than SCA. Likewise, patients with haemorrhagic stroke showed higher mortality rates than those with ischaemic stroke. Patients with fatal stroke usually had a history of long-term treatment with anticoagulants; 2 thirds of the patients with fatal ischaemic stroke and atrial fibrillation were not receiving anticoagulants. According to our results, optimising prevention in patients with AF may have a positive impact on stroke-related in-hospital mortality.