Abstract
Background: After a first-ever-in-a-lifetime stroke (FELS), hospital readmissions are common and associated with increased mortality and morbidity of stroke survivors, thus, raising the overall health burden of stroke. Population-based stroke studies on hospital readmissions are scarce despite it being an important healthcare service quality indicator. We evaluated unplanned readmissions or death during the first year after a FELS and their potential factors, based on a Portuguese community register.Methods: Data were retrieved from a population-based prospective register undertaken in Northern Portugal (ACIN2) in 2009–2011. Retrospective information about unplanned hospital readmissions and case fatality within 1 year after FELS index hospitalization (FELS-IH) was evaluated. Readmission/death-free survival 1 year after discharge was estimated using the Kaplan–Meyer method. Independent risk factors for readmission/death were identified using Cox proportional hazard models.Results: Unplanned readmission/death within 1 year occurred in 120 (31.6%) of the 389 hospitalized FELS survivors. In 31.2% and 33.5% of the cases, it occurred after ischemic stroke or intracerebral hemorrhage, respectively. Infections and cerebrovascular and cardiovascular diseases were the main causes of readmission. Of the readmissions, 65.3% and 52.5% were potentially avoidable or stroke related, respectively. The main cause of potentially avoidable readmissions was the continuation/recurrence of the event responsible for the initial admission or a closely related condition (71.2%). Male sex, age, previous and post-stroke functional status, and FELS-IH length of stay were independent factors of readmission/death within 1 year.Conclusions: Almost one-third of FELS survivors were readmitted/dead 1 year after their FELS-IH. This outcome persisted after the first months after stroke hospitalization in all stroke subtypes. More than half of readmissions were considered potentially avoidable or stroke related.
Highlights
After a first-ever-in-a-lifetime stroke (FELS) or transient ischemic attack (TIA), the use of hospital emergency services or hospital readmissions is common and associated with increased stroke mortality and morbidity, raising the overall health burden of stroke [1]
We aimed to study unplanned readmissions or death during the first year after a FELS and to identify their potential factors, based on a Portuguese community register
The sample was obtained from the second population-based register undertaken in Northern Portugal (ACIN2), comprising all FELS recorded between October 2009 and September 2011 in the population registered in the Health Centers Group of Western Porto main city (190,000 persons) and two health centers in rural regions in Northern Portugal (Mirandela and Vila Pouca de Aguiar, involving about 46,000 persons) [6]
Summary
After a first-ever-in-a-lifetime stroke (FELS) or transient ischemic attack (TIA), the use of hospital emergency services or hospital readmissions is common and associated with increased stroke mortality and morbidity, raising the overall health burden of stroke [1]. Many meaningful clinical associations may have been ignored since most studies only rely on large administrative or single-hospital databases, particular subtypes of stroke, or readmissions in the first 3 months after stroke [1, 4, 5]. This assertion is especially true in Portugal, where, to our knowledge, there are no population-based stroke readmission studies, and the corresponding information is scarce. We aimed to study unplanned readmissions or death during the first year after a FELS and to identify their potential factors, based on a Portuguese community register. We evaluated unplanned readmissions or death during the first year after a FELS and their potential factors, based on a Portuguese community register
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