Five-year readmission and mortality differ by ischemic stroke subtype

Anna Therese Bjerkreim,Andrej Netland Khanevski,Lars Thomassen,Henriette Aurora Selvik,Ulrike Waje-Andreassen,Halvor Naess,Nicola Logallo

doi:10.1016/j.jns.2019.06.007

Abstract

BackgroundIschemic stroke subtype may influence the risk of readmission and mortality after ischemic stroke (IS) and transient ischemic attack (TIA) due to differences in comorbidity, risk factors, and stroke severity. We aimed to study the five-year incidence and risk of all-cause readmission, cause-specific readmission and mortality after IS or TIA by stroke subtype. MethodsThe medical records of 1453 patients admitted with IS or TIA to the stroke unit at Haukeland University Hospital, Norway, between 2007 and 2012 were reviewed for identification of unplanned readmissions within five years after discharge. Stroke etiology was classified as large-artery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), stroke of other determined etiology (SOE), multiple etiologies (ME), or cryptogenic stroke (CS). Kaplan-Meier estimates and Cox regression analyses were used to determine incidences and risk of readmission and death. ResultsThe five-year incidence of all-cause readmission was 72.6% (74% LAA, 81% CE, 65% SVO, 55% SOE, 71% ME, and 67% CS), with infections, cardiac disease, stroke-related events and fractures as the most frequent causes. Compared to patients with other subtypes, SVO subtype had a 21% lower risk of all-cause readmission and a 48% lower risk of death, whereas CE had a 25% higher risk of all cause readmission and a 34% higher risk of death. CE subtype also had a 75% higher risk of readmission due to cardiac disease, whereas CS subtype had a 44% lower risk of readmission with cardiac disease. ConclusionThe five-year incidence of readmission and mortality varied among the stroke subtypes. The risk of readmission and death are especially high in patients with CE subtype, and lowest for patients with SVO subtype.

Highlights

The other organs exist to keep the brain functioning normally
Our results demonstrate that the incidence and causes of readmission vary by ischemic stroke subtype, and that readmission contributes to higher mortality in stroke patients
Patients readmitted within 1 year were older, had more severe strokes, poorer functional outcome, and a higher occurrence of complications during index admission than patients readmitted during year 2–5

Summary

Introduction

The other organs exist to keep the brain functioning normally. Any change in the brain’s function and activity profoundly affects living. Cardiovascular risk factors, neurological deficits, functional outcome, and early recurrence differ between the subtypes [11–13]; stroke subtype may influence the rates and causes of 30-day readmission. After adjusting for age, sex, functional outcome, length of stay, and the risk factor burden, patients with LAA and SOE subtype had significantly higher risks of readmission for any cause, recurrent stroke or TIA, and stroke-related events. This study aimed at assessing frequencies, causes, and factors associated with early and late unplanned readmissions within 1 year after discharge from ischemic stroke hospitalization. The study findings are inconsistent, factors associated with 1-year readmission include older age [2, 7–10], a history of stroke [2], diabetes mellitus, [11] coronary artery disease [2], in-hospital complications [2, 10], longer length of hospital stay [2, 7, 11], and poor functional outcome [2, Bjerkreim et al BMC Neurology (2019) 19:15. It is possible that patients readmitted within the first year differ from patients that experience the first readmission later, as the early readmission may to a higher extent be directly related to acute post-stroke complications and the post-acute stroke treatment, and patients readmitted within the first year may be more severely impaired than patients readmitted later

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Discussion

Conclusion