22. European Stroke Conference 672 Acute stroke: clinical patterns and practice More equal stroke unit care over time. A 15-year follow up of socioeconomic disparities in stroke unit care in Sweden E.L. Glader1, H. Edlund2, M. Sukhova3, K. Asplund4, B. Norrving5, M. Eriksson6 On behalf of the Riks-Stroke Collaboration Department of Public Health and Clinical Medicine, Umeå University, Umeå, SWEDEN1, De-partment of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, SWE-DEN2, Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, SWEDEN3, Department of Public Health and Clinical Medicine, Umeå University, Umeå, SWE-DEN4, Department of Clinical Sciences, Section of Neurology, Lund University, Sweden, Lund, SWEDEN5, Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, SWEDEN6 Background Despite the compelling scientific evidence on the superiority of stroke unit (SU) care, far from all acute stroke patients have access to SU care. The main purpose of this study was to explore if pa-tients who were socioeconomically disadvantaged (low education or low income) had reduced ac-cess to SU care and if differences varied over time. Methods This study was based on 1995-2009 year cohort in Riks-Stroke, the Swedish stroke register. All pa-tients 18-74 years of age were included. Data on income and education was accessed from Statistics Sweden. Multiple logistic regression analyses were used to calculate odds ratios for stroke unit care in patient subgroups. Results Valid data was available for 124 173 patients. Highest level of education predicted access to stroke unit care (primary vs. secondary school (OR 1.04, 95% CI 1.01-1.07) and primary school vs. univer-sity (OR 1.06, 95% CI 1.01-1.10)). Differences in level of education diminished over time (p-value 0.001). Income was not associated with SU care and over time the proportion of patients treated in SUs increased at a similar rate in all income groups (p-value 0.12). There were statistically signifi-cant inequalities in access to SU care in disfavor for women and/or patients groups at high risk for unfavorable outcome, such as those with functional impairment and severe strokes. Conclusions Socioeconomic inequalities in access to stroke unit care were evident during the early years and di-minished as the total capacity for SU care increased. However, despite recommendations in national guidelines, there are still inequalities in SU care in Sweden. 702 © 2013 S. Karger AG, Basel Scientific Programme 673 Acute stroke: clinical patterns and practice WHAT ARE THE MAIN REASONS FOR EXCLUSION FROM AN EARLY REHABILITA-TION TRIAL (AVERT)? S. Speare1, J. Collier2, L. Churilov3, A. Thrift4, R. Lindley5, H. Dewey6, P. Langhorne7, J. Bern-hardt8 on behalf of the AVERT Trialist Collaboration Florey Institute of Neuroscience and Mental Health, Melbourne, AUSTRALIA1, Florey Insti-tute of Neuroscience and Mental Health, Melbourne, AUSTRALIA2, Florey Institute of Neurosci-ence and Mental Health, Melbourne, AUSTRALIA3, Monash University, Melbourne, AUSTRA-LIA4, University of Sydney, Sydney, AUSTRALIA5, Austin Hospital, Melbourne, AUSTRALIA6, University of Glasgow, Glasgow, UNITED KINGDOM7, Florey Institute of Neuroscience and Men-tal Health, Melbourne, AUSTRALIA8 Background: A Very Early Rehabilitation Trial (AVERT) is an ongoing multi-centre international randomised controlled trial testing whether rehabilitation commenced within 24 hours reduces death and disability. We aimed to explore reasons for non-recruitment into AVERT. Methods: All patients admitted with stroke are screened. Trial exclusion criteria include: hospital attendance >24 hours after stroke, premorbid disability, early deterioration, admission to ICU and participation in other trials. We used binary logistic regression analyses to explore potential reasons for non recruitment. Results: From July 2006 to December 2011, 44 hospitals screened 20,000 stroke patients with 1158 recruited (R), 18,842 not recruited (NR). Patients characteristics: Mean age (SD): R 70.5 yrs (13.0); NR 72.0 yrs (14.0); woman R 36.8%; NR 47.3%; infarct R 87.4%; NR 86.7%; stroke severity (NI-HSS); R mild 53.5%; mod 30.9%; severe 15.6%; NR mild 53.1%; mod 26.2%; severe 20.7%. In examining reasons for non recruitment, patients with mild stroke had greater odds of admission >24 hours (OR0.6 CI 95%0.5-0.6); women had greater odds of premorbid disability (OR1.5 CI 95%1.3- 1.6); greater age (OR 1.1 CI 95%1.1-1.1), haemorrhagic stroke (OR2.9 CI 95%2.5-3.3), and severe stroke (OR10.4 CI 95%9.2-11.6) were all associated with deterioration; and patients admitted to ICU had greater odds of having haemorrhagic stroke (OR2.6 CI 95% 2.2-3.1) or severe stroke (OR 4.3 CI 95% 3.8-4.8). Patients with haemorrhagic stroke had lower odds of recruitment to other trials (OR0.6 CI 95%0.5-0.9). Conclusion: Exclusion criteria are selected to minimise harm and maximize the likelihood of study completion. Results support a typical clinical pattern for non recruited patients.
Karger_ESC London_2013
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