Impact of Diabetes, Hypertension and Heart Failure on Stroke Rehabilitation Care

Abstract

Background: Stroke patients who have multiple comorbidities at inpatient rehabilitation admission might experience poorer outcomes than those without comorbidities. Some differences in outcomes between these two groups may be based on age and type of comorbidity. Materials and Methods: Retrospective administrative data from an inpatient stroke rehabilitation unit in a Southwestern Ontario hospital were examined to determine the independent associations between diabetes, hypertension, and heart failure in stroke patients and rehabilitation length of stay (LOS), functional gains in rehabilitation, and discharge destination. We also examined the associations between CHADS2 score and rehabilitation LOS, functional gains in rehabilitation, and discharge destination. Results: Seven hundred and seven cases of stroke subcategorized as experiencing mild (n = 193), moderate (n = 454), and severe (n = 60) stroke were included in the study. Of these patients, 16.4% (n = 116) had type 2 diabetes, 58.7% (n = 415) had hypertension, and 5.8% (n = 41) had congestive heart failure (CHF) prior to stroke. CHF patients were significantly (p = 0.02) older, had significantly (p = 0.014) lower mean FIM gains and were discharged to residential care facilities compared to non-CHF cases. A higher CHADS2 score was significantly associated with Lower FIM gains and discharge to longer term settings. Conclusion: Significant differences exist in the functional gains and discharge disposition of stroke patients based on age of patient, type of comorbidity in stroke, and CHADS2 score.