Abstract 2206: Trends in Mortality of Acute Ischemic Stroke after Hospital Discharge

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Introduction--- Advances in emergent treatment and hospital management of acute ischemic stroke (AIS) have decreased in-hospital mortality. Despite this early reduction in mortality, prior research has indicated that up to 25% of patients hospitalized for AIS will be dead one year after admission. We assessed the trends in prognosis for patients hospitalized for AIS. Methods--- We used the Myocardial Infarction Data Acquisition System (MIDAS) database, which includes demographic and clinical data on patients discharged with a primary diagnosis of cerebral infarction from all non-federal acute care hospitals in New Jersey between 1996 and 2007. Out-of-hospital deaths were assessed by matching MIDAS records with New Jersey death registration files. In-hospital, 1-year, and interval (discharge to 1-year) mortality were calculated. Total, cardiovascular disease (CVD), and non-CVD mortality were calculated. Log linear regression models were used for trend analysis. Multivariate logistic and Cox regression models were used to measure the effect of year of admission on in-hospital and 1-year mortality, respectively, after adjusting for demographics, comorbid conditions, and treatment. Statistical significance was defined as a P -value ≤ 0.05. Results--- 134,441 patients were admitted with a primary diagnosis of cerebral infarction during the study period. Significant declines were observed for in-hospital (10.4% to 8.1%, p<0.05) and 1-year (26.0% to 24.0%, p<0.05) mortality. No significant changes were observed in the interval death rate between hospital discharge and 1-year. Significant declines for in-hospital (7.4% to 5.5%, p<0.05) and 1-year (16.9% to 12.8%, p<0.05) CVD mortality were also observed ( Figure , Panel A). Trends in interval CVD showed significant declines after 2003, while interval non-CVD death rates steadily increased ( Figure , Panel B). Multivariate logistic analysis confirmed the declining likelihood of death from CVD versus non-CVD during the study period (OR = 0.954; 95% CI = 0.946 to 0.962). Conclusion--- Stroke patients admitted to New Jersey hospitals had a significant decline in in-hospital and 1-year mortality over the study period. This reduction was primarily driven by reductions in CVD death. Despite this trend no change was observed in interval mortality due to a 25% increase in non-CVD deaths.