Background: Aphasia is an acquired language disorder experienced by one in three people with stroke. Aphasia impairs the ability to communicate and negatively impacts quality of life. Little is known about whether the presence of aphasia influences aspects of stroke care and outcomes in Australian hospitals.
Aims: To investigate whether the presence of aphasia is associated with differences in the quality of acute stroke care and outcomes.
Methods: Observational study of cross-sectional data from the Stroke Foundation National Acute Services Audit conducted in 2017, 2019 and 2021 in Australia. Hospitals submit ~40 consecutive retrospective medical record audits. Processes of care analysed aligned with the Stroke Clinical Guidelines and the Acute Stroke Clinical Care Standards. In-hospital outcomes included complications, independence at discharge and discharge destination. Descriptive statistics and multivariable logistic regression were used to examine associations between aphasia status, processes of care, and patient outcomes (adjusted for age, sex, stroke type, prior function, severity, and hospital).
Results: Of the 11,613 audited patients, 3122 (26.9%) had aphasia (aphasia 51% male; median age 78 years IQR; no aphasia 58% male; median age 74 years IQR). Patients with aphasia had their mood assessed less often (23% versus 30%), received thrombolysis more often (17% versus 8%), and received risk factor education less often (59% versus 70%). There was no difference in being treated in a stroke unit (68% versus 72%). Patients with aphasia were more likely to experience one or more complication (aOR 1.46 95% CI 1.30, 1.63), were less independent at discharge (aOR 0.48 95% CI 0.42, 0.56) and were more likely to access inpatient rehabilitation (aOR 1.15 95% CI 1.01, 1.30).
Conclusion: Variations in stroke management and outcomes exist for people with aphasia post stoke. This study highlights the need for quality improvement initiatives and guideline recommendations to address potential inequities in care.