Five-year readmission and mortality differ by ischemic stroke subtype

Abstract

Background. Stroke aetiology may affect the risk and causes of readmission after ischaemic stroke (IS) and transient ischaemic attack (TIA) due to differences in risk factors, functional outcome, and treatment. We aimed to examine frequencies, causes, and risk of 30-day readmission by stroke subtype, determine predictors of 30-day readmission, and study the impact of 30-day readmissions on one-year mortality. Methods. All surviving patients admitted with IS or TIA from July 2007 to December 2013 were followed by review of medical records for all unplanned readmissions within 30 days after discharge. Stroke subtype was classified as largeartery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), stroke of other determined aetiology (SOE), or stroke of undetermined aetiology (SUE). Cox regression analyses were performed to assess the risk of 30-day readmission for the stroke subtypes and identify predictors of 30-day readmission, and its impact on one-year mortality. Results. Of 1874 patients, 200 (10.7%) were readmitted within 30 days [LAA 42/244 (17.2%), CE 75/605 (12.4%), SVO 12/205 (5.9%), SOE 6/32 (18.8%), SUE 65/788 (8.3%)]. The most frequent causes of readmissions were stroke-related event, infection, recurrent stroke/ TIA, and cardiac disease. After adjusting for age, sex, functional outcome, length of stay, and the risk factor burden, patients with LAA and SOE subtype had significantly higher risks of readmission for any cause, recurrent stroke or TIA, and stroke-related events. Predictors of 30-day readmission were higher age, peripheral arterial disease, enteral feeding, and LAA subtype. Thirty-day readmission was an independent predictor of one-year mortality. Conclusions. Patients with LAA or SOE have a high risk of 30-day readmission, possibly caused by an increased risk of recurrent stroke and stroke-related events. Awareness of the risk of readmission for different causes and appropriate handling according to stroke subtype may be useful for preventing some readmissions after stroke.

Admission and Readmission/Death Patterns in Hospitalized and Non-hospitalized First-Ever-in-a-Lifetime Stroke Patients During the First Year: A Population-Based Incidence Study

“…During the first year after stroke, infections, recurrent stroke, and cardiovascular events were the leading causes of readmission in both HospS and NHospS cohorts. Disability, age, sex, and vascular risk factors are recognized predictors of post-stroke infections (7,36), yet, we did not find differences in the incidence of infections in both groups. Our proportion of readmissions due to cerebro-cardiovascular causes confirms that the vascular risk remains elevated in the long-term and that stroke may be a sentinel event that confers the longstanding risk of adverse outcomes, stressing the need for long-term risk reduction management strategies in both cohorts (37).…”

“…Our data showed that HospS patients were more likely to be readmitted or deceased within 1 year than NHospS patients, even though HospS patients could have had early access to secondary prevention measures and rehabilitation. The poorer outcome in the HospS group might be explained by important differences in clinical characteristics, namely, HospS patients had more cardiac comorbidities (namely, atrial fibrillation), worse poststroke functional status, and different stroke subtype/etiology (less lacunar/small artery occlusion strokes) than NHospS patients, and previously published studies have associated those factors with in-hospital worse stroke outcome/morbidity and readmission risk factors (7,(28)(29)(30). Furthermore, hospitalization has associated inherent hazards and heightened risks (4) that may have contributed to a worse functional status at discharge in HospS patients, a net effect of pre-existing comorbidities, stroke severity, and in-hospital complications, known to be linked to a higher risk of readmission (28).…”

MicroRNA miR-497 is closely associated with poor prognosis in patients with cerebral ischemic stroke

“…Besides, it was observed that among four different types of CIS, miR-497 was the lowest in patients with CS, followed by SIP and RIND, and miR-497 expression in TIA patients was the highest. Referring to the severity of four CIS types [33], we can confirm once again that the decrease of miR-497 predicts the severity of CIS progression.…”

The Relationship between Serum Periostin Levels and Neutrophil–Lymphocyte Ratio with Lesion Localization and Acute Prognosis in Acute Ischemic Stroke

“…Several studies have shown that life expectancy in severe lesions is low. 7 , 8 Many scales have been developed to describe neurological dysfunction in patients with ischemic stroke. These scales are used to gain insight into patient prognosis, and to aid in the decision-making process regarding optimal therapy and follow-up of patients.…”