Ullberg Teresa, Zia Elisabet, Petersson Jesper, Norrving Bo
Department of Neurology, Skåne University Hospital, Lund University, Malmö/Lund, Sweden.
Eur Stroke J. 2016 Jun;1(2):114-121. doi: 10.1177/2396987316650597. Epub 2016 May 19.
Information on follow-up practices after stroke in clinical routine are sparse. We studied the probability of doctor's follow-up within 90, 120, 180, and 365 days after hospital discharge, and how patient characteristics were associated with the probability of follow-up, in a large unselected stroke cohort.
Data on patients living in southern Sweden, hospitalized with acute ischemic stroke or intracerebral hemorrhage 1 January 2008 to 31 December 2010, were obtained from the Swedish stroke register (Riksstroke) and merged with administrative data on doctor's visits during the year following stroke.
Complete data were registered in 8164 patients. The cumulative probability of a doctor's follow-up was 76.3% within 90 days, 83.6% within 120 days, 88.7% within 180 days, and 93.1% within 365 days. Using Cox regression calculating hazard ratios (HR), factors associated with 90-day follow-up were: female sex HR = 1.066 (95%CI: 1.014-1.121), age: ages 65-74 HR = 0.928 (95%CI: 0.863-0.999), ages 75-84 HR = 0.943 (95%CI: 0.880-1.011), ages 85 + HR = 0.836 (95%CI: 0.774-0.904), pre-stroke dependency in activities of daily living (ADL): HR = 0.902 (95%CI = 0.819-0.994), prior stroke HR = 0.902 (95%CI: 0.764-0.872), and severe stroke HR = 0.506 (95%CI: 0.407-0.629). In patients discharged to assisted living, the following factors were associated with lower follow-up probability: living alone pre-stroke HR = 0.836 (95%CI: 0.736-0.949), and pre-stroke dependency HR = 0.887 (95%CI: 0.775-0.991).
This study was based on hospital administrative data of post-stroke doctor's visits, but may be confounded by attendance for other conditions than stroke.
One in four stroke patients was not followed up within three months after hospital discharge. Vulnerable patients with high age, pre-stroke ADL dependency, and prior stroke were less likely to receive doctor's follow-up.
临床常规中关于卒中后随访情况的信息较少。我们在一个未经过筛选的大型卒中队列中，研究了出院后90天、120天、180天和365天内医生随访的概率，以及患者特征与随访概率之间的关联。
获取了2008年1月1日至2010年12月31日期间在瑞典南部因急性缺血性卒中或脑出血住院的患者数据，这些数据来自瑞典卒中登记处（Riksstroke），并与卒中后一年内医生诊疗的管理数据进行了合并。
8164例患者的完整数据被记录。医生随访的累积概率在90天内为76.3%，120天内为83.6%，180天内为88.7%，365天内为93.1%。使用Cox回归计算风险比（HR），与90天随访相关的因素有：女性HR = 1.066（95%CI：1.014 - 1.121），年龄：65 - 74岁HR = 0.928（95%CI：0.863 - 0.999），75 - 84岁HR = 0.943（95%CI：0.880 - 1.011），85岁及以上HR = 0.836（95%CI：0.774 - 0.904），卒中前日常生活活动（ADL）依赖HR = 0.902（95%CI = 0.819 - 0.994），既往卒中HR = 0.902（95%CI：0.764 - 0.872），以及重度卒中HR = 0.506（95%CI：0.407 - 0.629）。在出院后入住辅助生活机构的患者中，以下因素与较低的随访概率相关：卒中前独居HR = 0.836（95%CI：0.736 - 0.9·49），以及卒中前依赖HR = 0.887（95%CI：0.775 - 0.991）。
本研究基于卒中后医生诊疗的医院管理数据，但可能因除卒中之外的其他疾病就诊情况而产生混淆。
四分之一的卒中患者在出院后三个月内未得到随访。高龄、卒中前ADL依赖以及既往有卒中史的脆弱患者接受医生随访的可能性较小。
