Quality and Outcomes of Acute Stroke Care for People With and Without Aphasia

OBJECTIVE: The study aimed to investigate whether the presence of aphasia was associated with differences in acute stroke care quality and to describe in-hospital outcomes. DESIGN: Observational cohort study of cross-sectional data from the biennial Stroke Foundation National Stroke Audit of Acute Services (2017, 2019, and 2021). Descriptive statistics and multivariable regression models were used to compare quality of care and in-hospital outcomes by aphasia status (care adjusted for hospital variation; outcomes adjusted for age, sex, prior function, stroke type, stroke severity indicators, and hospital variation). SETTING: Acute hospital services in Australia. PARTICIPANTS: Patients with stroke and aphasia status recorded (n=11,613) were included in the study. A total of 3122 (26.9%) patients had aphasia documented in clinical notes (aphasia 51% male; median age 78 y; no aphasia 58% male; median age 74 y). MAIN OUTCOME MEASURES: Quality of care indicators aligned with national evidence-based guidelines. In-hospital outcomes included complications, level of independence, survival, and discharge destination. RESULTS: Patients with aphasia were less likely to be assessed for mood impairment (23% vs 30%; adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], 0.65-0.81), receive risk factor education (59% vs 70%; aOR, 0.55; 95% CI, 0.48-0.64), or be involved in care plan development (83% vs 95%; aOR, 0.22; 95% CI, 0.18-0.28). Patients with aphasia were more likely to have a more severe stroke and had more in-hospital complications (aOR, 1.46; 95% CI, 1.30-1.63) and in-hospital deaths (aOR, 2.86; 95% CI, 2.36-3.49). They were less independent at discharge (aOR, 0.48; 95% CI, 0.42-0.56), less often discharged home (aOR, 0.63; 95% CI, 0.56-0.72), and more likely to be discharged to residential care (aOR, 1.52; 95% CI, 1.08-2.15). They were more likely to receive inpatient rehabilitation (aOR, 1.15; 95% CI, 1.01-1.30). CONCLUSIONS: Important differences exist in the quality of acute stroke care received by patients with aphasia. Targeted quality improvement in mood screening and risk factor education is needed.