New York. Patients treated in special stroke units do better than those who are treated in general hospital wards or at home, even if the latter groups receive care from stroke specialists, British researchers suggest.

"Stroke units are more effective than a specialist stroke team or specialist (home) care in reducing mortality, institutionalization, and dependence after stroke," said Lalit Kaira of Guy’s, King’s and St. Thomas’ School of Medicine in London, and colleagues.

The researchers randomly assigned 457 patients with moderate stroke to receive care in one of three ways: at home with the assistance of stroke specialists, in the hospital general ward with the assistance of stroke specialists, or in specialized stroke units. The patients were evaluated three times in the year following their stroke.

"Patients managed on the stroke unit were less likely to die or be institutionalized compared with those managed at home or managed by the stroke team [in hospital wards]," Kaira and colleagues report in the Sept. 9 issue of The Lancet.

Patients treated in general wards were more than three times more likely to die within a year, despite having a team of stroke specialists involved in their care, the report indicates.

Patients who were assigned to home care actually did better than those assigned to the wards, but this is probably because about one third of these patients were readmitted to the hospital and treated in the special stroke unit, the researchers explain.

Compared with those treated in the hospital wards or at home, patients treated in the stroke unit were also better able to care for themselves, less disabled, and more likely to be living independently one year after their stroke, Kaira’s team found.

The researchers suggest that the main reason for the difference in outcomes is that patients in the stroke units received more therapy than those managed in wards or at home.

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