Stroke-related mortality in a tertiary care hospital in Andalusia: Analysis and reflections

Abstract Objectives Stroke is a very common cause of death, especially in southern Spain. The present study analyses in-hospital mortality associated with stroke in an Andalusian tertiary care hospital. Methods We gathered the files of all patients who had died at Hospital Universitario Virgen de las Nieves in Granada in 2013 and whose death certificates indicated stroke as the cause of death. We also gathered stroke patients discharge data and compared them to that of patients with acute coronary syndrome (ACS). Results A total of 825 patients had a diagnosis of stroke (96 deaths, 11.6%); of these, 562 had ischaemic stroke (IS) (44 deaths, 7.8%) and 263 haemorrhagic stroke (HS) (52 deaths, 19.7%). Patients with HS therefore showed greater mortality rate (odds ratio, OR 2.9). Patients in this group died after a shorter time in hospital (median, 4 vs. 7 days; mean, 6 days). However, patients with IS were older and presented with more comorbidities. On the other hand, 617 patients had a diagnosis of ACS (36 deaths, 5.8%). The mortality odds ratio was 2.1 (stroke/SCA). Around 23% of the patients who died from stroke were taking anticoagulants. 60% of the deceased patients with IS and 20% of those with HS had atrial fibrillation (AF); 35% of the patients with IS and AF were taking anticoagulants. Conclusions Stroke is associated with higher admission and in-hospital mortality rates than SCA. Likewise, patients with HS showed higher mortality rates than those with IS. Patients with fatal stroke usually had a history of long-term treatment with anticoagulants; two-thirds of the patients with fatal IS and AF were not receiving anticoagulants. According to our results, optimising prevention in patients with AF may have a positive impact on stroke-related in-hospital mortality.