Abstract
Background: Hospitalization and readmission rates after a first-ever-in-a-lifetime stroke (FELS) are considered measures of quality of care and, importantly, may give valuable information to better allocate health-related resources. We aimed to investigate the hospitalization pattern and the unplanned readmissions or death of hospitalized (HospS) and non-hospitalized stroke (NHospS) patients 1 year after a FELS, based on a community register.Methods: Data about hospitalization and unplanned readmissions and case fatality 1 year after a FELS were retrieved from the population-based register undertaken in Northern Portugal (ACIN2), comprising all FELS in 2009–2011. We used the Kaplan–Meier method to estimate 1-year readmission/death-free survival and Cox proportional hazard models to identify independent factors for readmission/death.Results: Of the 720 FELS, 35.7% were not hospitalized. Unplanned readmission/death within 1 year occurred in 33.0 and 24.9% of HospS and NHospS patients, respectively. The leading causes of readmission were infections, recurrent stroke, and cardiovascular events. Stroke-related readmissions were observed in more than half of the patients in both groups. Male sex, age, pre- and post-stroke functional status, and diabetes were independent factors of readmission/death within 1 year.Conclusion: About one-third of stroke patients were not hospitalized, and the readmission/death rate was higher in HospS patients. Still, that readmission/death rate difference was likely due to other factors than hospitalization itself. Our research provides novel information that may help implement targeted health-related policies to reduce the burden of stroke and its complications.
Highlights
Nowadays, there is a general consensus that most stroke patients should be hospitalized to have access to specialized, highquality, evidence-based stroke interventions, increasing their chances of survival, improving their functional outcome, and preventing stroke recurrence [1,2,3,4]
We aimed to investigate the hospitalization pattern and its relevance, the overall 1-year readmission/death rate, and the incidence, causes, and risk factors of unplanned readmission or death of hospitalized stroke (HospS) and non-hospitalized stroke (NHospS) patients, based on a Portuguese community register of first-ever-in-a-lifetime stroke (FELS) patients presenting to the emergency department (ED)
Since two patients died in the ED and 73 patients died during their index hospitalization, 645 FELS patients were at risk of an unplanned readmission/death (Figure 1)
Summary
There is a general consensus that most stroke patients should be hospitalized to have access to specialized, highquality, evidence-based stroke interventions, increasing their chances of survival, improving their functional outcome, and preventing stroke recurrence [1,2,3,4]. Except for some particular types of stroke, such as transient ischemic attack and minor ischemic stroke (IS), few studies use population-based data to study how non-hospitalized stroke (NHospS) patients compare to hospitalized stroke (HospS) patients in terms of readmission after stroke [4, 8, 9]. Studying such differences may uncover important data that may help implement novel health policies regarding the allocation of stroke-related resources and public research funding. We aimed to investigate the hospitalization pattern and the unplanned readmissions or death of hospitalized (HospS) and non-hospitalized stroke (NHospS) patients 1 year after a FELS, based on a community register
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