Readmission and Death After Hospitalization for Acute Ischemic Stroke

Abstract

Background and Purpose-Stroke is a leading cause of hospital admission among the elderly. Although studies have examined subsequent vascular outcomes, limited data are available regarding the full burden of hospital readmission after stroke. We sought to determine the rates of hospital readmissions and mortality and the reasons for readmission over a 5-year period after stroke. Methods-This retrospective observational cohort study included Medicare beneficiaries aged Ͼ65 years who survived hospitalization for an acute ischemic stroke (International Classification of Diseases, Ninth Revision, Clinical Modification codes 434 and 436) and who were discharged from Connecticut acute care hospitals in 1995. This population was followed from discharge in 1995 through 2000 using part A Medicare claims and Social Security Administration mortality data. The primary outcome was hospital readmission and mortality and readmission diagnosis. Results-Among 2603 patients discharged alive, more than half had died or been readmitted at least once during the first year after discharge (1388/2603, 53.3%), and Ͻ15% survived admission-free for 5 years (372/2603, 14.3%). The reasons for hospital readmission varied over time, with stroke remaining a leading cause for readmission (3.9 to 6.1% of patients annually). Acute myocardial infarction accounted for a comparable number of readmissions (4.2 to 6.0% of patients annually). The most common diagnostic category associated with readmission, however, was pneumonia or respiratory illnesses, with an annual readmission rate between 8.2% and 9.0% throughout the first 5 years after stroke. Conclusions-Few stroke patients survive for 5 years without a hospital readmission. Between the acute care setting and readmission to the hospital, a window of opportunity may exist for interventions, beyond prevention of recurrent vascular events alone, to reduce the huge public health burden of poststroke morbidity.

Thirty‐day recurrence after ischemic stroke or TIA

“…There is scant information on stroke recurrence in Norway, but our rate is low compared to many large international incidence studies (Bravata, Ho, Meehan, Brass, & Concato, 2007; Lovett et al, 2004; Sacco et al, 1994; Smith, Frytak, Liou, & Finch, 2005). Most of these studies included patients dating several decades back.…”

Early Hospital Readmission is a Predictor of One-Year Mortality in Community-Dwelling Older Medicare Beneficiaries

“…Among the 304 readmissions, the median (IQR) time to readmission was 11 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) days. The most common readmission diagnoses by CCS Level 3 category were congestive heart failure, pneumonia, coronary atherosclerosis without acute myocardial infarction, cardiac dysrhythmias, and obstructive chronic bronchitis, which together accounted for 25 % of readmissions.…”

“…Among all hospitalized Medicare beneficiaries (including community-dwelling and institutionalized elders, as well as younger disabled Medicare beneficiaries), nearly one in five were readmitted within 30 days, and over one-third were readmitted within 90 days. 1 These readmitted individuals have been described in some detail; research has identified early readmission risk factors for general 2,3 and geriatric populations, [4][5][6] as well as those with specific diseases such as heart failure, 7 stroke, 8 and chronic obstructive pulmonary disease. 9 Individuals readmitted early are more likely to have multiple medical comorbidities, greater length of stay during the index hospitalization, and additional recent hospitalizations.…”

Hospital readmission rates in Medicare

“…In particular, the highest rates of readmission are shown to be among those with heart failure, pneumonia and chronic obstructive pulmonary disease (COPD) conditions at discharge [9] . Bravata and colleagues report high rates of readmissions for stroke patients [16] . Another study found that heart attack, pneumonia, and congestive heart failure are three key diagnoses that require special attention due to higher than average readmission rates [17] .…”