One-year versus five-year hospital readmission after ischemic stroke and TIA

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

doi:10.1186/s12883-019-1242-5

Abstract

BackgroundThe burden of hospital readmission after stroke is substantial, but little knowledge exists on factors associated with long-term readmission after stroke. In a cohort comprising patients with ischemic stroke and transient ischemic attack (TIA), we examined and compared factors associated with readmission within 1 year and first readmission during year 2–5.MethodsPatients with ischemic stroke or TIA who were discharged alive between July 2007 and October 2012, were followed for 5 years by review of medical charts. The timing and primary cause of the first unplanned readmission were registered. Cox regression was used to identify independent risk factors for readmission within 1 year and first readmission during year 2–5 after discharge.ResultsThe cohort included 1453 patients, of whom 568 (39.1%) were readmitted within 1 year. Of the 830 patients that were alive and without readmission 1 year after discharge, 439 (52.9%) were readmitted within 5 years. 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. Cardiovascular comorbidity and secondary preventive treatment did not differ between the two groups of readmitted patients. Higher age, poorer functional outcome, coronary artery disease and hypertension were independently associated with readmission within both 1 year and during year 2–5. Peripheral artery disease was independently associated with readmission within 1 year, and atrial fibrillation was associated with readmission during year 2–5.ConclusionsMore than half of all patients who survived the first year after stroke without any readmissions were readmitted within 5 years. Patients readmitted within 1 year and between years 2–5 shared many risk factors for readmission, but they differed in age, functional outcome and occurrence of complications during the index admission.

Highlights

The burden of hospital readmission after stroke is substantial, but little knowledge exists on factors associated with long-term readmission after stroke
The study findings are inconsistent, factors associated with 1-year readmission include older age [2, 7,8,9,10], 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
The study cohort included 1453 patients discharged alive from our stroke unit, of whom 1303 (89.7%) were diagnosed with ischemic stroke and 150 (10.3%) were diagnosed with transient ischemic attack (TIA)

Summary

Introduction

The burden of hospital readmission after stroke is substantial, but little knowledge exists on factors associated with long-term readmission after stroke. In a cohort comprising patients with ischemic stroke and transient ischemic attack (TIA), we examined and compared factors associated with readmission within 1 year and first readmission during year 2–5. The neurological and functional impairments often improve during the first year after stroke, but the number of readmitted patients. The study findings are inconsistent, factors associated with 1-year readmission include older age [2, 7,8,9,10], 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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