NEW YORK (Reuters Health) – Stroke patients who receive care in a stroke unit combined with early supported discharge are more likely to be living at home 5 years later than those who receive conventional follow-up care. That finding comes from a Norwegian team, reporting in the May issue of Stroke published online April 7.

Dr. Hild Fjaertof and colleagues at St. Olavs Hospital, Trondheim University Hospital, note that, following care in a stroke unit, early supported discharge (ESD) and further rehabilitation at home has improved outcomes. Their group has shown in a randomized trial that this strategy has beneficial effects up to 1 year, but whether the effects last longer than that has been unclear.

In the current paper, the researchers report outcomes at 5 years. Originally, 320 acute stroke patients received identical stroke unit care for 2 weeks. They were then randomly assigned to receive conventional follow-up care organized by the primary health care service, or ESD in which a coordinating mobile team “established a program and support system that allowed the patient to live at home as soon as possible and to continue rehabilitation at home or in a day clinic.”

The ESD team consisted of a physiotherapist, an occupational therapist, a nurse, and the part-time service of a physician.

At 5 years, more patients in the ESD group than the ordinary care group (38% vs 30%) showed an improvement in modified Rankin score from baseline, although the difference was not statistically significant, the investigators report.

Furthermore, 83 patients in the ED group had died or were institutionalized compared with 99 in the conventional care group, the team found. Among the surviving patients, 86% of those in the ESD group were living at home versus 70% of those who had received ordinary care.

“It is a challenge to integrate ESD in clinical practice,” Dr. Fjaertof and colleagues acknowledge, “because the service depends on available resources in the community and some difficult financial barriers have to be overcome.”

Nonetheless, they conclude, “Stroke unit service combined with ESD increases the patients’ chances of living at home with improved function up to 5 years after a stroke compared to traditional follow-up after stroke.”

Reference:

Stroke Unit Care Combined With Early Supported Discharge Improves 5-Year Outcome

Stroke 2011;42.