For Medicare beneficiaries with acute ischemic stroke,
the NIH Stroke Scale provided substantial prognostic information regarding
30-day mortality risk, according to recent study results.
“There has been growing interest in reporting
outcomes with stroke, particularly from medical beneficiaries hospitalized with
CVD, including acute ischemic stroke,” Gregg C. Fonarow, MD, of the
division of cardiology at the University of California, Los Angeles, said
during a presentation at the American Heart Association’s Emerging Science
Gregg C. Fonarow
Fonarow said the objectives of the study were to
quantify the relation and risk discrimination of the initial NIH Stroke Scale
with 30-day mortality rates among Medicare beneficiaries hospitalized with
acute ischemic stroke and to identify potential categories of the NIH Stroke
Scale that provide optimal discrimination of 30-day mortality risk.
Researchers linked data from the Get With The Guidelines
(GWTG)-Stroke registry with enrollment files and inpatient claims from CMS
between April 2003 to December 2006. More than 33,700 patients with acute
ischemic stroke had documented NIH Stroke Scale, of whom 33,102 (mean age, 79
years; 58% women) were included in the study. Outcome measures included
all-cause mortality within 30 days from time of admission.
Overall, 13.6% of patients died within the first 30
days, according to study results. Increasing NIH Stroke Scale score had a
strong graded relation to higher 30-day mortality. For patients with an NIH
Stroke Scale score of zero, 30-day mortality rate was 2.3% vs. more than 75%
for patients with a score of at least 40.
Placing patients into four NIH Stroke Scale categories,
researchers found 30-day mortality rates of 4.2% for category zero to seven;
13.9% for eight to 13; 31.6% for 14 to 21; and 53.5% for 22 to 42. Broken into
three categories, 30-day mortality rates were 3.6% in zero to five, 11.6% in
six to 13 and 39.9% in 14 to 42. Study results showed excellent discrimination
provided in a model with NIH Stroke Scale alone whether included as a
continuous variable, four categories or three categories.
“In acute ischemic stroke with categorization of
the NIH Stroke Scale in three or four groups, patients can be readily
identified as being at low, medium or high risk for 30-day mortality, even in
the absence of any other clinical variable,” Fonarow said. “These
findings highlight the importance of having a valid specific measure of stroke
severity, such as the NIH Stroke Scale, as a determinant of mortality after
acute ischemic stroke from Medicare beneficiaries.”
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Disclosure: Dr. Fonarow is a Get With The
Guidelines committee member.