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22. European Stroke Conference 523 Epidemiology of stroke Variation in stroke outcome across geographical regions: data from the ‘Efficacy of Nitric Ox-ide in Stroke’ (ENOS) trial P.M.W Bath1, A Houlton2, K Krishnan3, S Ellender4, T Payne5, N Sprigg6 University of Nottingham, Division of Stroke, Nottingham, UNITED KINGDOM1, University of Nottingham, Division of Stroke, Nottingham, UNITED KINGDOM2, University of Nottingham, Division of Stroke, Nottingham, UNITED KINGDOM3, University of Nottingham, Division of Stroke, Nottingham, UNITED KINGDOM4, University of Nottingham, Division of Stroke, Notting-ham, UNITED KINGDOM5, University of Nottingham, Division of Stroke, Nottingham, UNITED KINGDOM6 Background: Stroke outcomes have shown previously to vary widely around the world. We assess whether such variation continues to be present. Methods: Data from the on-going ENOS trial were assessed, these including 3556 participants re-cruited from 7 geographical regions (Africa, north America, south Asia, south-east Asia, Australasia, Europe and UK). Functional outcome (modified Rankin Scale, mRS >2) and mortality at day 90 were compared across regions relative to the UK using logistic regression with adjustment for base-line clinical covariates alone (age, sex, pre-stroke mRS, diabetes, IHD, AF, hypertension, systolic BP, severity, stroke type, TACS syndrome, time to randomisation, year of randomisation), and then in combination with treatment factors (admission to acute stroke unit, alteplase, physiotherapy, oc-cupational therapy, speech/language therapy, antithrombotic, lipid lowering, antihypertensive). Results: 69% of patients came from the UK. In unadjusted analysis, mRS varied significantly by re-gion (p=<0.0001) with the best outcome in SE Asia. Similarly, death rates varied significantly with the lowest rate also in SE Asia. Functional outcome was better in all regions, except N America, relative to the UK when adjusted for clinical +/- treatment factors. Death varied between the regions when adjusted for clinical +/- treatment factors. Conclusion: Variation in outcome after stroke continues to be present, even after adjustment for clin-ical and treatment factors. However, the discrepancy between findings for functional outcome and death suggest that interpretation of the meaning of mRS scores may still vary geographically. 622 © 2013 S. Karger AG, Basel Scientific Programme 524 Epidemiology of stroke Variations in stroke care and outcome up to One Year After Stroke in Six European Popula-tions: The European Register of Stroke (EROS) Investigators S. Ayis1, C. McKevitt2, I. Wellwood3, A. Bhalla4, A.G. Rudd5, A. Di Carlo6, Y. Bejot7, D. Rygle-wicz8, D. Rastenyte9, P. Langhorne10, M. Dennis11, B. Coker12, C.D.A. Wolfe13 King’s College London, London, UNITED KINGDOM1, King’s College London, London, UNITED KINGDOM2, Center for Stroke Research Berlin, Berlin, GERMANY3, King’s College London, London, UNITED KINGDOM4, King’s College London, London, UNITED KINGDOM5, Institute of Neurosciences, Italian National Research Council, Florence, ITALY6, University of Bur-gundy, University Hospital of Dijon, Dijon, FRANCE7, Department of Neurology, Institute of Psy-chiatry and Neurology, Warsaw, POLAND8, Institute of Cardiology, Kaunas University of Medicine, Kaunas, LITHUANIA9,Academic Section of Geriatric Medicine, University of Glasgow, Glasgow, UNITED KINGDOM10, Division of Clinical Neurosciences, Western General Hospital,, Edinburgh, UNITED KINGDOM11, King’s College London, London, UNITED KINGDOM12, King’s College London, London, UNITED KINGDOM13, , London14 Background: Although there are reports of variations in the processes of stroke care and outcomes internationally, appropriate adjustment for confounding factors to improve the interpretation of these variations is rarely achieved. We aim to investigate variations in post-acute stroke care and to ex-plore the associations of these with Activities of Daily Living (ADL) and health-related quality of life (HRQoL) at 3 and 12 months after stroke. Methods: Data were obtained from six population stroke registers: France; Lithuania; UK; Spain; Poland, and Italy between 2004 and 2006. We examined the Organised Care Index (OCI) for acute care and post discharge access to general practitioner (GP), hospital doctor, community nurse and therapists. Outcomes: the physical component summary (PCS) and the mental component summa-ry (MCS) of SF-12, and ADL dependency. Mixed effect regression models were used to investigate variations and multivariable relations. Results: We studied 1388 one year stroke survivors; mean age 69.1 (SD: 13.1) and 52.6% were fe-males. Wide variations in case-mix, processes of care, and outcomes were found. Access to highest OCI level vary widely, range (26% - 63.4%). Overall 38.5% have some ADL dependency; 11.2% were seen by physiotherapist (PT), range (0.4% - 34.8); 54.3% were seen by a GP, range (40.8% - 80.2%) at one year after stroke. Mean predicted PCS range was (37.3(se: 0.4) to 43.6 (se: 0.9)), and MCS (39.0 (se, 0.5) to 52.9 (se, 0.5)) after adjustments for case mix, socio- demographic factors, post- acute care, OCI and interactions. PCS predictors were age, arm power, ability to walk, and in-continence, while MCS predictors were the verbal components of Glasgow Coma Scale (GCS) and incontinence. Conclusions: Wide variations in ADL dependency and HRQoL were identified but not fully ex-plained by adjustments for severity, and care. Wide variations in pre and post discharge care were found and populations with very low access to care were identified.


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