Poststroke Care

Abstract

M ajor advances in acute stroke management have been seen over the past decade, including the use of thrombolysis, antithrombotic therapy, and organized in-hospital stroke care. However, relatively few studies have evaluated the effectiveness of these interventions in routine clinical practice, or have assessed issues related to delivery of services, access to care, and long-term care after discharge from stroke.In this issue of Stroke, Bravata et al 1 contribute to our understanding of outcomes after stroke by analyzing readmissions and deaths in the first 5 years after a hospitalization for stroke. The target population included stroke survivors aged over 65 years who were Medicare beneficiaries and who were discharged from Connecticut acute care hospitals in 1995. This population was followed from discharge in 1995 through 2000 using Medicare claims and Social Security Administration mortality data. Among 2603 patients discharged alive, 40% were readmitted at least once within the first year of discharge, 53% had died or been readmitted within 1 year and only 15% survived admission-free for 5 years. Leading causes for readmission included pneumonia (8.2% to 9.0%), stroke (3.9% to 6.1%) and acute myocardial infarction (4.2% to 6.0%). There was no apparent association between length of hospital stay and readmission rate (unreported data kindly provided by the authors, 2007), and no information was available on potential patient and system factors associated with higher hospital readmission rates.Lower readmission rates of 25% to 27% within 1 year have been previously reported. 2,3 These studies found that the average number of days of rehospitalization was 23. 2 Stroke was the single most frequent reason for readmission followed by cardiac disease, with no significant differences among ethnic groups (blacks, Hispanics, and whites). 3 However, the strikingly high death and readmission rates after stroke published by Bravata et al are consistent with findings from some previous reports. For example, in a study including veterans living in the state of Florida, 12-month rehospitalization rate was 31.1%, whereas mortality rate was 11.7%. Dual or triple system use (Veterans Health Administration, Medicare, or Medicaid), malnutrition, dysphagia and stroke type were associated with hospital readmissions. 4 In another study including Medicare beneficiaries from 11 metropolitan regions in the eastern of US, mortality (18% to 23%) and rehospitalization (37% to 47%%) rates 11 months after stroke were similar for 30-day survivors. 5 What Does This Study Add toOur Knowledge?The study of Bravata et al revealed a mixed picture with regard to the often neglected battle against stroke: long-term poststroke care. This descriptive study confirms the enormous impact of stroke on hospitalization-free survival. However, the reasons behind the high observed death and readmission rates remain incompletely understood, and the reader may wonder whether these rates were expected or unexpected.Were these findings the natural consequence o...

Hospital readmission within 10 years post stroke: frequency, type and timing

“…The parameters chosen for both need to be clinically relevant [29]. However, there are few clinical studies that outline and analyze stroke outcomes in the long term and can help us determine long-term relevance [30]. With this study we hope to have contributed to this body of evidence.…”

Five-Year Rehospitalization Outcomes in a Cohort of Patients With Acute Ischemic Stroke

“…Trials focusing on different models of healthcare delivery to stroke survivors in the community and interventions to improve the follow-up care to this population are needed. 18 Strategies to reduce morbidity, mortality and healthcare costs due to stroke have to continue over the long-term, beyond the first year after stroke. Second, current population based surveillance efforts primarily track stroke incidence and prevalence.…”

Evaluation of IScore validity in a Greek cohort of patients with type 2 diabetes

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