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Stroke patients may be better off at home

LONDON, UNITED KINGDOM. One-fifth of all hospital beds in the UK are taken up by stroke patients. Researchers at the Guy's Hospital School of Medicine now report that most stroke patients may actually be better off recovering at home. Their study involved 975 patients with a first stroke. Most (812) of those patients were admitted to hospital for treatment, but 163 stayed in their community and received care there. Three months after experiencing the stroke 30 per cent of the patients had died. The mortality rate among patients treated in hospital was 35 per cent as compared to only 8 per cent among those treated in the community. Only 47 per cent of the hospital-treated patients had returned to independent living three months after their stroke whereas 72 per cent of community-treated ones had done so. All told, the risk of dying or not returning to independent living was about twice as high among hospitalized patients as among those treated in the community; this held true even after adjusting for age, sex, ethnicity, atrial fibrillation, prior heart attack, independence in living prior to stroke, type of stroke, and clinical indicators for stroke severity.

The researchers are puzzled by their findings, but point out, "some hospital-based treatments are delivered haphazardly in the UK with no evidence for their use." They also suggest that inadequate nutrition and hydration, and hospital-acquired infections could help explain the increased mortality among hospital- admitted patients.
Bhalla, Ajay, et al. Does admission to hospital improve the outcome for stroke patients? Age and Ageing, Vol. 30, May 2001, pp. 197-203

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