Abstract T P109: Discharge Disposition and Functional Status of Patients Suffering a Secondary Stroke Versus First Stroke

Abstract

Background: Stroke recurrence is a consistent and independent predictor of disability, institutionalization and death, often resulting in a stepwise decline into dependency in stroke survivors. However, few reliable estimates of the long-term functional outcome after stroke are available. Objective: To compare discharge disposition (home with no services, home with home health, acute rehabilitation [ARU], skilled nursing facility [SNF], or hospice) and functional status measured using the Modified Rankin Scale (mRS), at hospital discharge, 30- and 90-day follow-up among patients with secondary vs. first stroke. Methods and Results: A retrospective analysis was conducted of 236 acute stroke patients- average age 75.9±13.7, male (49.6%), married (52%), Caucasian (82%), secondary stroke survivors (25.4%) admitted our hospital between June-December, 2012. A greater number of patients with first stroke were discharged home with no services (48.9% vs. 28.3%, p = .001) or to an ARU (21% vs. 15%, p = 0.001) whereas a greater number of patients with secondary stroke (38.3% vs. 14%, p = 0.002) were discharged to a SNF; there were no significant differences in the number of patients discharged home with home healthcare or hospice. The average number of comorbities (1.2 ± 1.7 vs. 3.5 ± 1.9, p < 0.001) and length of stay (3.7±3.4 vs. 6.0±8.4, p = 0.005) were higher for secondary vs. first stroke survivors. The mRS scores at discharge and follow-up were higher for secondary vs. first stroke patients (all p’s < 0.050, Figure). Conclusion: Secondary stroke was associated with lower mRS scores at discharge and follow-up and confirms previous reports that secondary stroke survivors have higher disability and worse outcomes than first stroke survivors. Our findings support the need to implement strategies to promote self-care behaviors and prevent recurrent stroke in all stroke survivors to reduce the burden associated with this condition.