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BACKGROUND AND PURPOSE: Changes to hospital systems were implemented from March 2020 in Australia in response to the coronavirus disease 2019 pandemic, including decreased resources allocated to stroke units. We investigate changes in the quality of acute care for patients with stroke or transient ischemic attack during the pandemic according to patients' treatment setting (stroke unit or alternate ward). METHODS: We conducted a retrospective cohort study of patients admitted with stroke or transient ischemic attack between January 2019 and June 2020 in the Australian Stroke Clinical Registry (AuSCR). The AuSCR monitors patients' treatment setting, provision of allied health and nursing interventions, prescription of secondary prevention medications, and discharge destination. Weekly trends in the quality of care before and during the pandemic period were assessed using interrupted time series analyses. RESULTS: In total, 18,662 patients in 2019 and 8,850 patients in 2020 were included. Overall, 75% were treated in stroke units. Before the pandemic, treatment in a stroke unit was superior to alternate wards for the provision of all evidence-based therapies assessed. During the pandemic period, the proportion of patients receiving a swallow screen or assessment, being discharged to rehabilitation, and being prescribed secondary prevention medications decreased by 0.58% to 1.08% per week in patients treated in other ward settings relative to patients treated in stroke units. This change represented a 9% to 17% increase in the care gap between these treatment settings during the period of the pandemic that was evaluated (16 weeks). CONCLUSIONS: During the first 6 months of the pandemic, widening care disparities between stroke units and alternate wards have occurred.

BACKGROUND: Difficulty using the upper extremity in everyday activities is common after stroke. Constraint-induced movement therapy (CIMT) has been shown to be effective in both sub-acute and chronic phases of stroke recovery and is recommended in clinical practice guidelines for stroke internationally. Despite reports of equivalence of outcome when stroke rehabilitation interventions are delivered using telehealth, there has been limited evaluation of CIMT when using this mode of delivery. ReCITE will (a) evaluate the feasibility and acceptability of CIMT when delivered via telehealth to stroke survivors (TeleCIMT) and (b) explore therapists' experiences and use of an online support package inclusive of training, mentoring and resources to support TeleCIMT delivery in clinical practice. METHODS: A prospective single-group, single blinded, study design with embedded process evaluation will be conducted. The study will be conducted at three outpatient services in Sydney, Australia. A multi-faceted therapist support package, informed by the Capabilities, Opportunity, Motivation- Behaviour model (COM-B), will be used to support occupational therapists to implement TeleCIMT as part of routine care to stroke survivors. Each service will recruit 10 stroke survivor participants (n = 30) with mild to moderate upper extremity impairment. Upper extremity and quality of life outcomes of stroke survivor participants will be collected at baseline, post-intervention and at a 4 week follow-up appointment. Feasibility of TeleCIMT will be evaluated by assessing the number of stroke participants who complete 80% of intensive arm practice prescribed during their 3 week program (i.e., at least 24 h of intensive arm practice). Acceptability will be investigated through qualitative interviews and surveys with stroke survivors, supporter surveys and therapist focus groups. Qualitative interviews with therapists will provide additional data to explore their experiences and use of the onlin

Background: There is uncertainty on whether the expected standards of acute stroke care have been maintained during the COVID-19 pandemic in Australia. Aim(s): To assess the quality of acute stroke care provided in the state of Victoria (most affected by COVID-19) compared to other states and territories of Australia during the pandemic. Method(s): Patients admitted with acute stroke or transient ischaemic attack from 61 hospitals contributing data to the Australian Stroke Clinical Registry in both 2019 and 2020 were included in this study. Interrupted time series analysis was conducted to assess trends in the provision of acute stroke care before and after the first wave (starting 1/3/2020) and second wave (9/7/2020-20/10/2020) of COVID-19 cases in Australia. Result(s): There were 37,392 patients (mean age 73 years, 56% male), including 26,117 with a clinical diagnosis of ischaemic stroke. Overall, 73% were treated in a stroke unit and 11% received intravenous thrombolysis (if ischaemic stroke). In the state of Victoria, the proportion of patients treated in a stroke unit decreased by 0.24% per week during the second wave (p=0.04). There was no change in door-toneedle times in Victoria during the second wave (p=0.246), but there was a concurrent decrease of 1.13 minutes per week in other states and territories (p<0.001). Trends in proportions of patients provided intravenous thrombolysis were similar between Victoria and other states. Conclusion(s): The COVID-19 pandemic has affected the quality of acute stroke care provided in Victoria in contrast to other states that were less impacted by the COVID-19 pandemic.

Background: Environmental enrichment involves organization of the environment and provision of equipment to facilitate engagement in physical, cognitive, and social activities. In animals with stroke, it promotes brain plasticity and recovery. Aim(s): To assess the feasibility and safety of a patient-driven model of environmental enrichment incorporating access to communal and individual environmental enrichment. Method(s): A nonrandomized cluster trial with blinded measurement involving people with stroke (n = 193) in four rehabilitation units was carried out. Feasibility was operationalized as activity 10 days after admission to rehabilitation and availability of environmental enrichment. Safety was measured as falls and serious adverse events. Benefit was measured as clinical outcomes at three months, by an assessor blinded to group. Result(s): The experimental group (n = 91) spent 7% (95% CI -14 to 0) less time inactive, 9% (95% CI 0-19) more time physically, and 6% (95% CI 2-10) more time socially active than the control group (n = 102). Communal environmental enrichment was available 100% of the time, but individual environmental enrichment was rarely within reach (24%) or sight (39%). There were no between-group differences in serious adverse events or falls at discharge or three months or in clinical outcomes at three months. Conclusion(s): This patient-driven model of environmental enrichment was feasible and safe. However, the very modest increase in activity by people with stroke, and the lack of benefit in clinical outcomes three months after stroke do not provide justification for an efficacy trial.Copyright © 2021 World Stroke Organization.

Background and Aims: Globally, there were concerns about the quality of acute stroke care due to the COVID-19 pandemic. In this study, we compared the quality of acute stroke care provided in stroke units with alternate ward settings before and during the pandemic. Method(s): Patients admitted with stroke or transient ischaemic attack from 61 hospitals contributing data to the Australian Stroke Clinical Registry in 2019 and 2020 were included. Interrupted time series analysis was conducted to assess trends in the provision of acute stroke care before and after the first wave (starting 1/3/2020) and second wave (between 9/7/2020-20/10/2020) of COVID-19 cases in Australia. Result(s): Overall, 38, 295 patients were available for analysis (n=19, 164 in 2019, n=19, 131 in 2020 [provisional sample]). There were no differences in age and sex between years (mean age 73 years, 56% male). Fewer patients were provided treatment in a stroke unit in 2020 compared to 2019 (72% vs 77%, p<0.001). There were greater declines in the provision of hyperacute aspirin and secondary prevention at discharge in alternate wards than stroke units during the second wave (between 0.41% and 1.31% per week). Provision of mobilisation and swallow screening/assessment declined in alternate wards only. Provision of care planning at discharge improved in alternate wards relative to stroke units by 0.49% per week during the first wave and 1.14% per week during the second wave. Conclusion(s): The COVID-19 pandemic has affected the quality of acute stroke care. It is essential that patients continue to be treated in stroke units.

Background And Aims: Little is known about long-term outcomes associated with access to inpatient rehabilitation after stroke. Aim(s): to compare long-term outcomes for patients discharged directly home with those discharged to inpatient rehabilitation after stroke. Method(s): Data collected in the Australian Stroke Clinical Registry (2010-2013) were linked to hospital admission records and the national death index as part of the Stroke123 study. Multilevel multivariable regression analyses were conducted, adjusting for patient and hospital factors. Outcomes were death and hospital readmissions up to 365-days and health-related quality of life (HRQoL) at 90-180days. Result(s): 7,847 patients were included (median age 71 years, 59% male, 83% ischemic stroke); 4405 (56%) were discharged home and 3,442 (44%) to inpatient rehabilitation. Patients discharged directly home were more likely to be aged under 65 years and to walk independently at hospital admission. Patients discharged to inpatient rehabilitation had more comorbidities and greater odds of having dementia. Hazard of death was not significantly different between the two groups. Patients discharged directly home were more likely to be readmitted to hospital than patients discharged to inpatient rehabilitation (adjusted subhazard ratio [aSHR]:90-days 0.54, 95%CI 0.49, 0.61; aSHR:180-days 0.74, 95%CI 0.67, 0.82; aSHR:365-days 0.85, 95%CI 0.78, 0.93). Patients discharged directly home had higher HRQoL scores, but were more likely to report mobility problems (adjusted OR 0.54, 95%CI 0.47, 0.63). Conclusion(s): Patients discharged directly home have higher risks of readmission and self-reported mobility problems than patients discharged to inpatient rehabilitation. To reduce this disadvantage, better support is indicated for people who are discharged directly home after stroke.

Background: Use of environmental enrichment significantly improves sensorimotor recovery in experimental stroke. The AREISSA trial, a multi-site (N=4), cluster, cross-over trial, determined whether a patient-driven model of environmental enrichment reduced stroke survivor inactivity and was safe in the clinical setting. Aim(s): This qualitative sub-study within AREISSA sought to describe stroke survivor perceived barriers and enablers to engaging in activity during rehabilitation in a site that had implemented a patientdriven model of environmental enrichment. Method(s): The environmental enrichment under investigation in AREISSA included access to communal and individual physical, cognitive and social stimulation. Face to face semi-structured interviews were conducted (by a speech pathologist) with stroke survivors (n=31) following discharge from rehabilitation. Descriptive content qualitative methods using thematic analysis were used. Result(s): Seven main themes arose: (i) poor communication between staff and patients regarding activity options limits awareness and subsequent engagement, (ii) family provides lots of support and facilitates engagement, (iii) stroke related disability limits capacity for activity, (iv) personal preferences, beliefs and personality types influence activity choice, (v) socialisation (involving patients, visitors and staff) promotes activity, (vi) hospital rules, real or perceived can limit activity, and (vii) wayfinding and hospital layout has an effect on engagement. Conclusion(s): Stroke survivor heterogeneity (stroke & personality related factors), hospital culture and the built environment were perceived to impede activity in an enriched rehabilitation environment. Future iterations of this model of environmental enrichment must address these barriers and build in greater involvement of family and opportunities for socialisation.

OBJECTIVE: To investigate the risk of death from cardiovascular disease between patients who were and were not prescribed antihypertensive medication following stroke or TIA. METHOD(S): This was a large cohort study using routinely collected prospective data from the Australian Stroke Clinical Registry. Patients registered between 2009 and 2013 who were discharged to the community or rehabilitation were included. Cases were linked to the National Death Index to determine the date and cause of death. Propensity score matching with stratification was utilized to compare between similar subgroups of patients. Multivariable competing risks regression, with noncardiovascular death as a competing risk, was conducted to investigate the association between the prescription of antihypertensive medications and cardiovascular death at 180 days after admission. RESULT(S): Among 12,198 patients from 40 hospitals, 70% were prescribed antihypertensive medications. Patients who were older, were treated in a stroke unit, and had better socioeconomic position were more often discharged from hospital with an antihypertensive medication. Including only patients within propensity score quintiles with acceptable levels of balance in covariates between groups (n = 8,786), prescription of antihypertensive medications was associated with a 23% greater reduction in the subhazard of cardiovascular death compared to those who were not prescribed these agents (subhazard ratio 0.77; 95% confidence interval 0.61 to 0.97). CONCLUSION(S): People who are prescribed antihypertensive medications at discharge from hospital after a stroke or TIA demonstrate better cardiovascular and all-cause survival outcomes than those not prescribed these agents.Copyright © 2018 American Academy of Neurology.

Background: Use of environmental enrichment significantly improves sensorimotor recovery in experimental stroke. The AREISSA trial, a multi-site (N=4), cluster, cross-over trial, determined whether a patient-driven model of environmental enrichment reduced inactivity and was safe in the clinical setting. Aim(s): This qualitative sub-study within AREISSA sought to describe the staff experience of implementing a patient-driven model of environmental enrichment for stroke survivors in a mixed rehabilitation unit. Method(s): The environmental enrichment implemented by the multi-disciplinary teams at sites participating in AREISSA included access to communal and individual physical, cognitive and social stimulation. Purposive sampling of these teams was employed to ensure most disciplines were represented. Participants (n=22) completed telephone based semi-structured interviews. Descriptive content qualitative methods using thematic analysis were used. Result(s): Five main themes arose: (i) staff attitudes, awareness and engagement with the model of environmental enrichment influenced implementation, (ii) the built environment made implementation difficult, (iii) activity limitations restricted stroke survivor engagement with environmental enrichment, (iv) stroke survivor preference for how to spend non-therapy time differed, and (v) stroke survivor mood was variable and affected engagement in activity. Conclusion(s): Implementation and stroke survivor use of a patient-driven model of environmental enrichment was perceived by staff to be influenced predominantly by stroke survivor-specific variables. Staff behaviour and knowledge, and the built environment were also perceived to affect successful implementation. These results highlight the complexities of clinical translation of environmental enrichment and can inform future attempts to improve activity by stroke survivors.

Background and Purpose-In multicultural Australia, some patients with stroke cannot fully understand, or speak, English. Language barriers may reduce quality of care and consequent outcomes after stroke, yet little has been reported empirically. Methods-An observational study of patients with stroke or transient ischemic attack (2010-2015) captured from 45 hospitals participating in the Australian Stroke Clinical Registry. The use of interpreters in hospitals, which is routinely documented, was used as a proxy for severe language barriers. Health-Related Quality of Life was assessed using the EuroQoL-5 dimension-3 level measured 90 to 180 days after stroke. Logistic regression was undertaken to assess the association between domains of EuroQoL-5 dimension and interpreter status. Results-Among 34562 registrants, 1461 (4.2%) required an interpreter. Compared with patients without interpreters, patients requiring an interpreter were more often women (53% versus 46%; P<0.001), aged =75 years (68% versus 51%; P<0.001), and had greater access to stroke unit care (85% versus 78%; P<0.001). After accounting for patient characteristics and stroke severity, patients requiring interpreters had comparable discharge outcomes (eg, mortality, discharged to rehabilitation) to patients not needing interpreters. However, these patients reported poorer Health-Related Quality of Life (visual analogue scale coeffcient,-9; 95% CI,-12.38,-5.62), including more problems with self-care (odds ratio: 2.22; 95% CI, 1.82, 2.72), pain (odds ratio: 1.84; 95% CI, 1.52, 2.34), anxiety or depression (odds ratio: 1.60; 95% CI, 1.33, 1.93), and usual activities (odds ratio: 1.62; 95% CI, 1.32, 2.00). Conclusions-Patients requiring interpreters reported poorer Health Related Quality of Life after stroke/transient ischemic attack despite greater access to stroke units. These fndings should be interpreted with caution because we are unable to account for prestroke Health Related Quality of Life. Further

Background: Variation from evidence-based care contributes to increased deaths and disability after stroke. Aim(s): To determine whether iterative quality improvement interventions (individually and collectively) change clinical practice and improve stroke care. Method(s): Before-and-after design comparing 20 self-selected Queensland hospitals across four time-points: T0 [baseline:03/2004-06/2012]; T1 [financial incentives for stroke unit care: 07/2012-02/2014]; T2 [externally facilitated quality improvement program (Stroke Link) incorporating clinical performance feedback; +/- action plan; ongoing support:03/ 2014-10/2014], T3 [post-measurement:11/2014-12/2015] compared to temporal trends in 23 other Australian hospitals contributing data to the Australian Stroke Clinical Registry. Outcome(s): Primary: net change in composite score (proportion of processes achieved of 8 pre-defined processes) [T0 vs T3]. Secondary: change in individual processes; composite score change comparing hospitals that did vs did not develop action plans in T2. Multivariable analyses adjusted for patient clustering by hospital. Result(s): Patient characteristics were similar across time-points (45-47% female, median age 73-75 years) in 23,800 Queensland patients (11,894 [T0]; 4781 [T3]); and n=20,484 from comparator hospitals (5,903 [T0]; 5,188 [T3]). Primary Outcome: 18% absolute improvement in composite score (coeff 0.18 95% CI 0.15, 0.21) compared to no change in comparator hospitals (95%CI -0.03, 0.03). Overall, 6/8 individual processes improved e.g. stroke unit admission odds ratio [OR] 1.57, intravenous thrombolysis if ischaemic stroke OR 1.41; mobilised during admission OR 2.19. Hospitals developing action plans had greater improvements in composite score (coeff 0.23 95%CI 0.09, 0.37). Conclusion(s): In Queensland hospitals positive changes in clinician practice were achieved from quality improvement interventions implemented during the Stroke123 study. Application in other settings

Background: Given the potential differences in etiology and impact, the treatment and outcome of younger patients (aged 18-64 years) require examination separately to older adults (aged >=65 years) who experience acute stroke. Method(s): Data from the Australian Stroke Clinical Registry (2010-2015) including demographic and clinical characteristics, provision of evidence-based therapies and health-related quality of life (HRQoL) post-stroke was used. Descriptive statistics and multilevel regression models were used for group comparisons. Result(s): Compared to older patients (age >=65 years) among 26,220 registrants, 6,526 (25%) younger patients (age 18-64 years) were more often male (63 vs. 51%; p < 0.001), born in Australia (70 vs. 63%; p < 0.001), more often discharged home from acute care (56 vs. 38%; p < 0.001), and less likely to receive antihypertensive medication (61 vs. 73%; p < 0.001). Younger patients had a 74% greater odds of having lower HRQoL compared to an equivalent aged-matched general population (adjusted OR 1.74, 95% CI 1.56-1.93, p < 0.001). Conclusion(s): Younger stroke patients exhibited distinct differences from their older counterparts with respect to demographic and clinical characteristics, prescription of antihypertensive medications and residual health status.Copyright © 2017 S. Karger AG, Basel.

Exhibition:Why are we both attracted and repulsed by Blood?During our curatorial journey, we quickly discovered that blood is polarising. While it is crucial to keeping us alive – filling seven percent of our body – blood still commonly makes us feel uncomfortable. It is this fascinating positive/negative dichotomy that is fundamental to the narrative we explored. Blood is a powerful cultural symbol of positive and negative associations, one that represents life and death, health and sickness, and attraction and repulsion.STROKE: OCCLUSION AND FLOWArtist John McGhee3D Virtual Reality Experience - Oculus Rift HeadsetThis series of virtual reality experiences focus on immersing the user in actual clinical stroke data. The imagery displayed on the Oculus Rift headset is a direct visualisation of 3D clinical Magnetic Resonance Imaging (MRI) and Computed Tomography CT data. The datasets were acquired from stroke survivors with a history of cardiovascular disease and high cholesterol. When wearing the headset, users are able to move along the arteries in the brain by means of a video game controller. They can follow the path of the red blood cells from the aorta to the site of the stroke. In this series, three of the most common types of stroke were visualised, including ischaemic strokes caused by vessel occlusion, thromboembolism, and a haemorrhagic stroke caused by aneurysm rupture.McGhee has created visual imagery drawn from the cinematic, directly influenced by the feature film ‘Fantastic Voyage’. The aesthetic experience uses 3D computer generated imagery (CGI) atmospherics and augmented components such as arterial plaque on the blood vessel walls and red blood cells. All of these visual features increase the feeling of embodiment.

Objectives: Stroke has devastating consequences at all ages and among patients with language barriers this may impact more substantially on health-related quality-of-life (HRQoL). We aimed to compare patient characteristics, quality of hospital care indicators, and outcomes between patients who did and did not require an interpreter. Method(s): Data from the Australian Stroke Clinical Registry (AuSCR) obtained January 2010 to December 2013 (n = 40 hospi- tals). Multilevel regression models were used in group comparisons. HRQoL was assessed with the EQ-5D-3L and EQ5D visual analogue scale (VAS) at 90-180 days. Result(s): Among 16,887 registrants, 701 (4.1%) required an interpreter. Compared to patients without language barriers, patients with language barriers were more likely to be aged 75 years or older (69% vs. 52%, p < 0.001) and be unable to walk on admission (72% vs. 61%, p < 0.001). Patients with language barriers had greater access to most quality indicators (stroke unit care 84% vs. 76%, p < 0.001). After accounting for patient characteristics and stroke severity, patients with language barriers had comparable discharge outcomes (e.g. mortality, discharged rehabilitation) to patients without language barriers. At median 101 days post stroke, patients with language barriers reported more problems with mobility (65% vs, 50%), self-care (56% vs, 32%), activity (73% vs, 57%), pain (66% vs, 49%) and anxiety or depression (60% vs, 46%) and lower median VAS score barriers (median 60 vs. 71; p < 0.001 for all comparisons). Conclusion(s): Patients who had language barriers presented to hospital with more severe strokes and although they received good access to quality stroke care they experienced poorer HRQoL after stroke. Determination of the underlying reasons for such differences in severity and outcome may be of value in the care of patients with stroke who require an interpreter.

Objectives: To assess whether the quality of care received by patients with stroke admitted to acute care hospitals varied by age group. Method(s): Quality of care was assessed for patients admitted to 40 hospitals registered in the Australian Stroke Clinical Registry (AuSCR; 2010-2013). Primary outcomes were the processes of care (POCs) recorded in AuSCR: admitted to a Stroke Unit (SU); received tPA if an ischemic stroke; prescribed antihypertensive medication at discharge; or received a discharge care plan if discharged to the community. Age was categorised into 5 groups and each group compared to the rest of the sample. Multivariable analysis was used to assess the association with outcome. Models were adjusted for gender, previous stroke, in-hospital stroke, socioeconomic status, stroke type, stroke severity and patient clustering. Result(s): Data were available for 14571 episodes of care (47% female, 64% ischaemic stroke). Age was associated with receiving each of the POCs with variations in the direction of the association age by subgroup. Those aged 65-74 years were most likely to receive recommended POCs, especially SU care (aOR: 1.27, 95% CI: 1.13, 1.43) and tPA (aOR: 1.29, 95% CI: 1.10, 1.51). Age >84 years was associated with a reduced odds of receiving SU care (aOR: 0.74, 95% CI: 0.66, 0.82), tPA (aOR: 0.59, 95% CI: 0.50, 0.70) and a discharge care plan (aOR: 0.75, 95% CI: 0.65, 0.87). Aged <55 (aOR: 0.36, 0.32, 0.41) or age 55-64 years (aOR: 0.81, 85%CI: 0.72, 0.92) were associated with not being prescribed antihypertensive medication. Conclusion(s): Our results confirm that age bias may exist with regards to stroke care delivery in Australia. This bias is not always specific to older patients.

Background: Literature on the 'weekend' effect on stroke care has variable conclusions. Our aim was to compare quality of care and outcomes for patients (with stroke/TIA) discharged on weekdays compared with those discharged on weekends. Method(s): Data from the Australian Stroke Clinical Registry (AuSCR) between January 2010 and December 2013 (n = 40 hospitals) were analysed. Differences in pro-cesses of care by timing of discharge were described. Multilevel regression and survival analyses (up to 180 days post event) were undertaken. Result(s): Among 14,693 eligible registrants, 1,270 (8.7%) were discharged on weekends (54% male; median age 74 years). Compared to those discharged on weekdays, patients discharged on weekends were more likely to have had a TIA (weekend 31% vs 19%; p< 0.001), could walk on admission (51% vs 41%; p<0.001) and less often received stroke unit care (68% vs 79%; p < 0.001). Patients discharged on weekends were discharged to home more often (65% vs 50%; p = 0.001), but were less often pre-scribed antihypertensive medication at discharge (63% vs 70%; p < 0.001) or received a care plan if discharged to the community (42% vs 48%; p = 0.001). After accounting for patient characteristics and clustering by hospital, patients discharged on weekends had a one day shorter length-of-stay (coefficient - 1.41, 95% CI: - 1.8 to - 1.03) and were more likely to die within 180 days (HR: 1.30, 95%CI: 1.07 to 1.60) than those discharged on weekdays. Conclusion(s): Patients with stroke or TIA discharged on weekends were more likely to receive sub-optimal discharge care and have a worse outcome. Understanding the factors related to poor outcomes is important.

Background and Purpose-Uncertainty exists over whether quality improvement strategies translate into better health-related quality of life (HRQoL) and survival after acute stroke. We aimed to determine the association of best practice recommended interventions and outcomes after stroke. Methods-Data are from the Australian Stroke Clinical Registry during 2010 to 2014. Multivariable regression was used to determine associations between 3 interventions: received acute stroke unit (ASU) care and in various combinations with prescribed antihypertensive medication at discharge, provision of a discharge care plan, and outcomes of survival and HRQoL (EuroQoL 5-dimensional questionnaire visual analogue scale) at 180 days, by stroke type. An assessment was also made of outcomes related to the number of processes patients received. Results-There were 17 585 stroke admissions (median age 77 years, 47% female; 81% managed in ASUs; 80% ischemic stroke) from 42 hospitals (77% metropolitan) assessed. Cumulative benefits on outcomes related to the number of care processes received by patients. ASU care was associated with a reduced likelihood of death (hazard ratio, 0.49; 95% confidence interval, 0.43-0.56) and better HRQoL (coefficient, 21.34; 95% confidence interval, 15.50-27.18) within 180 days. For those discharged from hospital, receiving ASU+antihypertensive medication provided greater 180-day survival (hazard ratio, 0.45; 95% confidence interval, 0.38-0.52) compared with ASU care alone (hazard ratio, 0.64; 95% confidence interval, 0.54-0.76). HRQoL gains were greatest for patients with intracerebral hemorrhage who received care bundles involving discharge processes (range of increase, 11%-19%). Conclusions-Patients with stroke who receive best practice recommended hospital care have improved long-term survival and HRQoL.Copyright © 2017 American Heart Association, Inc.

Objectives: To investigate differences in management and outcomes for patients admitted to the hospital with TIA according to care on a stroke unit (SU) or alternate ward setting up to 180 days post event. Method(s): TIA admissions from 40 hospitals participating in the Australian Stroke Clinical Registry during 2010-2013 were assessed. Propensity score matching was used to assess outcomes by treatment group including Cox proportional hazards regression to compare survival differences and other appropriate multivariable regression models for outcomes including health-related quality of life and readmissions. Result(s): Among 3,007 patients with TIA (mean age 73 years, 54% male), 1,110 pairs could be matched. Compared to management elsewhere in hospitals, management in an SU was associated with improved cumulative survival at 180 days post event (hazard ratio 0.57, 95% confidence interval 0.35-0.94; p 5 0.029), despite not being statistically significant at 90 days (hazard ratio 0.66, 95% confidence interval 0.33-1.31; p 5 0.237). Overall, there were no differences for being discharged on antihypertensive medication or with a care plan, and the 90- to 180-day self-reported outcomes between these groups were similar. In subgroup analyses of 461matched pairs treated in hospitals in one Australian state (Queensland), patients treated in an SU were more often prescribed aspirin within 48 hours (73% vs 62%, p , 0.001) and discharged on antithrombotic medications (84% vs 71%, p , 0.001) than those not treated in an SU. Conclusion(s): Hospitalized patients with TIA managed in SUs had better survival at 180 days than those treated in alternate wards, potentially through better management, but further research is needed.Copyright © 2016 American Academy of Neurology.

Background: Limited information exists on the quality of care provided to patients with transient ischemic attack (TIA) who are admitted to hospitals. Aim(s): To compare the treatment of TIA with the treatment of ischemic stroke (IS) and to investigate differences in the treatment of TIA based on stroke unit management. Method(s): Data from the Australian Stroke Clinical Registry (AuSCR) from 2010-13 were utilized. Univariable analysis was conducted to assess differences in processes of care received because the processes of care we investigated were universally applicable to both groups. Due to the large sample size, statistical significance was defined as a p-value <=0.01. Result(s): There were 3007 episodes of TIA and 10576 episodes of IS. Compared to patients with IS, fewer patients with TIA were managed on a stroke unit (TIA 72% vs IS 85%, p < 0.001), fewer received a care plan at discharge (TIA 44% vs IS 58%, p < 0.001), and fewer received an antihypertensive medication at discharge (67% vs 71%, p = 0.002). The proportion of patients discharged on antithrombotic medication was similar between groups (77% for TIA and 76% for IS, p = 0.281). When compared to patients with TIA not managed on a stroke unit, those managed on a stroke unit were more often discharged with antihypertensive medications (70% vs 62%, p < 0.001) and with antithrombotic medications (81% vs 71%, p < 0.001). Conclusion(s): There are opportunities for improved stroke prevention in patients hospitalized with TIA. Greater access to stroke units for patients with TIA may improve access to prevention management.

Background and purpose: Stroke has devastating consequences at all ages but particularly so among younger adults, with impacts on health-related quality-of-life (HRQoL), roles and usual activities including work. We aimed to compare patient characteristics, quality of hospital care indicators, and outcomes for younger (age <65 years) compared with older (65+ years) adults with stroke. Method(s): Data were from the prospective Australian Stroke Clinical Registry (AuSCR) obtained January 2010 to December 2013 (40 hospitals). Multilevel regression models were used in group comparisons HRQoL was assessed with the EQ-5D visual analogue scale (VAS) at 90-180 days; median VAS scores of AuSCR participants were compared to population norm scores (VAS of 100 = perfect health). Result(s): Among 16,780 registrants, 4,149 (33%) were aged <65 years. Compared to older patients, younger patients were more likely male (63% vs. 51%) and could walk on admission (49% vs. 35%; p < 0.001). Fewer younger patients were discharged on an antihypertensive agent(s) (57% vs. 71%; p < 0.001). After accounting for patient and hospital characteristics, younger patients were more likely to be discharged home (adjusted odds ratio [aOR] 1.88, 95% CI 1.72-2.06) and less often received inpatient rehabilitation (aOR 0.09, 95% CI 0.07-0.15). The net difference in median VAS score was greater in younger patients (DELTA10 points AuSCR 76 vs. norms 86) compared to older patients (DELTA5 points AuSCR: 70 vs. norms 75). Conclusion(s): Compared to older patients, younger patients have different characteristics and in-hospital management, and experience greater HRQoL declines after stroke compared to the age-matched normal population.

Background: Prescription of antihypertensive medication at discharge from hospital following stroke is recommended in clinical guidelines. How adherence to guidelines and associated outcomes vary by stroke subtype is unclear. Aim(s): To compare 90-180 day outcomes between patients who were and were not prescribed antihypertensive medication at discharge between transient ischemic attack (TIA), ischemic stroke and intracerebral hemorrhage (ICH). Method(s): We assessed patients discharged from 40 hospitals with a diagnosis of stroke and registered in the Australian Stroke Clinical Registry (AuSCR; 2010-2013). Multivariable analyses were adjusted for age, gender, previous stroke, socioeconomic status, stroke severity and patient clustering. Dependent variables were HRQoL (EQ-5D Visual Analogue Scale (VAS) 0-100) and 180-day mortality (National Death Index data). Combined HRQoL and death outcomes were calculated using the EQ-5D utility score (-1 to 1, deaths = 0). Result(s): Outcomes were available for 6,679 eligible registrants (median [Q1:Q3] age 76 [66:84] years, 45% female). Most (73%) were prescribed antihypertensive medications at discharge with minor variation by subtype (ICH 71%, ischemic 74%, TIA 72%, p = 0.02). Patients with ICH prescribed antihypertensive medications had better outcomes for the VAS (coefficient: 5.5, 95% CI 0.5, 10.4), survival at 180 days (aOR 3.3, 95% CI: 2.0, 5.6) and EQ-5D utility score (coefficient: 0.2, 95% CI: 0.1, 0.3) than those not prescribed these agents. Patients with ischemic stroke and prescribed antihypertensive medication had better survival (aOR: 2.1, 95% CI: 1.7, 2.6) than patients not prescribed these medications. Conclusion(s): Our findings highlight the importance of prescribing antihypertensive medications at discharge to improve stroke outcomes, especially for ICH.