Home Health Care Research Articles

Impact of quality of service in the direct cost of integrated home care services

ABSTRACT The health and social care sectors grapple with challenges amid population growth and escalating service costs, necessitating enhanced management efficiency. This study centers on Quality of Service (QoS) in integrated home health and social care, assessing its impact on costs. Delving into financial considerations and user perspectives, we propose QoS measures based on consultations with stakeholders. To address the scheduling and routing problems associated with caregiver planning, we introduce a mixed integer linear programming model. We conduct a study and computational experiments to gain valuable insights into the relationship between QoS measures and the overall cost of the service. Findings empower managers to navigate the trade-off between QoS and expenses, offering valuable guidance for decision-making. Ultimately, this work contributes to the development of new strategies and approaches for more efficient and effective management of health and social care in the face of current challenges.

A customized adaptive large neighborhood search algorithm for solving a multi-objective home health care problem in a pandemic environment

This paper addresses a home health care routing and scheduling problem (HHCRSP) specifically focusing on the context of a pandemic environment. The investigated HHCRSP involves assigning appropriate caregivers to patients and optimizing caregiver routes while minimizing total travel costs, workload differences among caregivers, and negative patient preferences. The problem accounts for synchronized visits, lunch breaks, time windows, and special pandemic constraints (e.g., maximum total contact times for each caregiver and multi-trip routes). To our knowledge, this is the first study to address these constraints and goals simultaneously in the HHCRSP. To solve the problem, we propose a customized algorithm, AMOALNS, which combines archived multi-objective simulated annealing (AMOSA) with adaptive large neighborhood search (ALNS). Our AMOALNS generates a new solution iteratively through problem-specific heuristics within ALNS, employing a multi-objective optimization framework to intelligently disrupt and repair feasible solutions. The adaptive updating of heuristic weights is determined by the domination relation between the newly generated solution and non-dominated solutions stored in the archive of AMOSA. To show the performance of the AMOALNS through extensive experiments, we compare it with the epsilon constraint method and other state-of-the-art multi-objective algorithms in the literature. Additionally, we use Pareto front analysis to aid decision-makers in comprehending the shape of the Pareto front and making informed choices based on their preferences. The trade-off analysis shows that minimizing total travel costs is the hardest to achieve, and optimizing workload balancing is worthwhile. Also, most of the non-dominated solutions can simultaneously achieve low workload balancing and high preference of patients. Finally, the sensitivity analyses reveal that the time windows classifications and instances sizes have significant impact on the compromising solutions.

Status of Telenursing and Future Use Intentions in Home Health Care in the Post-COVID-19 Era

This study aimed to investigate the current status and workload of telenursing by home healthcare nurses in the post-COVID-19 era, where telenursing has become indispensable, and identify factors that influence the intention to use telenursing. This study employed a cross-sectional descriptive approach based on an online survey. A total of 137 active home care nurses were surveyed for over 6 weeks starting in December 2022. Among the participants, 33.8% (N = 44) responded that they were currently using telenursing services. Most telenursing was conducted for consultation and education, using various technologies. The intention to use telenursing was significantly higher among individuals with higher educational levels and telenursing experience. The greater the social influence, which indicates the extent to which people around them believe that telenursing should be used, and more positive the attitudes toward telenursing, the higher the intention to use it. A clear definition of telenursing is required to improve people’s understanding of telenursing before its official implementation in Korea. Telenursing may be used to provide health care education and consultation while maintaining the continuity of care not only for patients receiving home health care but also for community-dwelling patients. To recognize and evaluate current telenursing practices, telenursing content should be recorded accurately. Finally, attitudes toward telenursing and social influence must be considered when developing strategies to improve nurses’ intentions to use and activate telenursing in the near future.

Health economic evaluation of a nurse-assisted online eye screening in home healthcare to reduce avoidable vision impairment (iScreen): study protocol for a cluster randomized controlled trial

BackgroundAmong older people undiagnosed and untreated vision impairment and blindness are common. The leading causes are uncorrected refractive errors and cataracts. Vision problems are associated with a lower quality of life, several health problems, and a higher chance of falling accidents and fractures. To eliminate avoidable vision impairment and blindness, targeted eye screening programs are recommended. Older patients, receiving home healthcare, have not yet been considered as a population at risk who could benefit from eye screening.MethodsA cluster-randomized controlled trial will be conducted to investigate the cost-effectiveness and cost-utility of online nurse-assisted eye screening in home healthcare, compared to care as usual, in reducing avoidable vision impairment. A healthcare and societal perspective will be used. The study will be performed in collaboration with several home healthcare organizations in the Netherlands. The online eye screening consists of near and distance visual acuity, followed by an Amsler grading test. Measurements in both groups will take place at baseline and after 6 and 12 months of follow-up. A total of 240 participants will be recruited. Older men and women (65 +), who receive home-based nursing and are cognitively able to participate, will be included. The primary outcome will be the change of two lines or more on the Colenbrander-1 M visual acuity chart between baseline and 12-month follow-up.DiscussionAn eye screening for populations at risk contributes to the detection of undiagnosed and untreated vision impairment. This may reduce the health-related consequences of vision loss and the high economic burden associated with vision impairment.Trial registrationClinicalTrials.gov NCT06058637. Registered on 27 September 2023.

Teamwork and Nurse Care Coordination in Home Healthcare.

Home healthcare agencies provide interdisciplinary care to millions of individuals annually. Care is typically led by registered nurses who often determine additional disciplines need to be included in the plan of care. We found that, although persons living with dementia represent about 30% of the home healthcare population, data from our home healthcare system showed that over a 1-year period with 36,443 home care episodes, only 29.6% had one or more social worker visits. Recognizing Alzheimer's disease-related dementia as a terminal condition and shifting toward a palliative care approach can be a challenge in home healthcare where care is focused on restorative care or rehabilitative goals with a primary focus on improvement in condition. The goal of this article is to present insights into nurse-led care coordination and teamwork and provide implications for practice.

The predictive value of anticholinergic drug exposure and the outcome of pneumonia: a Danish database study.

Older adults are susceptible to anticholinergic effects. Dysphagia and pneumonia are associated with anticholinergic usage, though a definitive causative relationship has not been established. There is no effective way to predict the prognosis of older adults with pneumonia; therefore, this study investigates the predictive value of anticholinergic burden. Patients aged 65years and above admitted for community-acquired pneumonia from 2011 to 2018 in Denmark were included through Danish registries. We calculated anticholinergic drug exposure using the CRIDECO Anticholinergic Load Scale (CALS). The primary outcome was in-hospital mortality, and other outcomes included intensive care unit admission, ventilator usage, length of stay, 30-day/90-day/1-year mortality, institutionalisation, home care utilisation and readmission. 186,735 patients were included in the in-hospital outcome analyses, 165,181 in the readmission analysis, 150,791 in the institutionalisation analysis, and 95,197 and 73,461 patients in the home care analysis at follow-up. Higher CALS score was associated with higher in-hospital mortality, with a mean risk increasing from 9.9% (CALS 0) to 16.4% (CALS >10), though the risk plateaued above a CALS score of 8. A higher CALS score was also associated with greater mortality after discharge, more home health care, more institutionalizations and higher readmission rates. High anticholinergic burden levels were associated with poor patient outcomes including short-/long-term mortality, dependence and readmission. It may be useful to calculate the CALS score on admission of older patients with pneumonia to predict their prognosis. This also highlights the importance of avoiding the use of drugs with a high anticholinergic burden in older patients.

Abstract WP7: Utilization and Outcomes Associated With DAPT and ASA Monotherapy Amongst Hospitalizations With Large Vessel Occlusion: A Nationwide Cross-Sectional Analysis

Background: In clinical trials like SPS3, MATCH, CHANCE, and POINT, dual antiplatelet treatment (DAPT) has been compared to aspirin (ASA) alone for preventing symptomatic large vessel occlusion (LVO) and ischemic strokes. Based on the effect size in the aforementioned studies, nationwide research may provide a more complete assessment of outcomes and relationships and help fill knowledge gaps. We used a nationwide inpatient sample to evaluate the outcomes of symptomatic LVO among patients using DAPT versus ASA monotherapy. Methods: We performed a cross-sectional study of a nationwide inpatient sample (2003-2014) in adult LVO hospitalizations. The patients taking DAPT and ASA on admission were identified using ICD-9-CM code. The univariate analysis (chi-square test) and multivariable survey logistic regression analyses were performed to compare mortality, morbidity, discharge (home vs transfer to short-term hospital, skilled nursing facility, and home health care), and disability to calculate odds ratio with 95% CI using SAS 9.4. Results: Of 4,224,924 hospitalizations, 1.24% and 7.38% were on DAPT and ASA, respectively. In comparison to ASA monotherapy, DAPT users were associated with lower prevalence of mortality (2.2% vs 3.1%) and morbidity (3.8% vs 3.9%) with similar prevalence of discharge to the non-home (58.8% vs 58.8%), (p<0.0001). On weighted analysis, use of DAPT vs. ASA was associated with lower odds of mortality (DAPT: OR 0.45; 95%CI 0.39-0.51; ASA: 0.61, 0.58-0.64), morbidity (DAPT: 0.54, 0.49-0.61, ASA: 0.56, 0.54-0.59), discharge to non-home (DAPT: 0.78, 0.75-0.82, ASA: 0.80, 0.79-0.82), and disability (DAPT: 0.76, 0.73-0.80, ASA: 0.80, 0.78-0.82) compared to non-users. Conclusion: This comprehensive national investigation revealed that DAPT resulted in more favorable outcomes for individuals with symptomatic large vessel occlusion. There is a need for additional prospective studies to validate the findings and ascertain the most suitable population at risk for primary prevention of stroke.

Impact of Telemedicine on Home Healthcare: An Empirical Analysis

The adoption of new patient treatment initiatives has been necessitated by the current pandemic crisis and the need for social distancing to protect doctors and patients. The main initiatives to respond pandemic crisis is the adoption of telemedicine tools which provides for the diagnosis or medical service provided by a doctor to patients in digital mode. The aim is the remote monitoring of patients' health status, allowing direct involvement of patients at home. On these premises, this study offers a mapping of the digital solutions adopted in the Calabria region by health organizations during the Covid-19 pandemic with the aim of specifically analyzing the role of telemedicine in supporting home healthcare during the Covid-19. This study provides insights into the potential of telemedicine to support home healthcare, as a response to the Covid-19 crisis now and in the future.

Pilot Study to Determine the Effectiveness of a Home Health Nursing Simulation.

Demand for home care has increased due to the expansion of preventive care, people living longer with chronic conditions, and the need for healthcare services as the baby boom population ages. Nurses must be prepared to meet the needs of patients and families in the home setting. Home care nursing simulations have been utilized as a teaching-learning strategy in baccalaureate nursing education, yet less is known about their use with practicing home care nurses and associate degree nursing students. The purpose of this pilot study using simulation was to prepare practicing nurses and student nurses to respond using nursing skills and clinical judgment. The convenience sample consisted of associate degree nursing students (n = 9), practicing home healthcare nurses (n = 8), and nursing faculty (n = 2). The Simulation Effectiveness Tool - Modified (SET-M) Survey (Leighton et al., 2015) was utilized for data collection. Participants perceived the home healthcare simulation to be an effective practice experience with high overall agreement for Pre-briefing, Scenario-Confidence, Scenario-Learning, and Debriefing. The findings of this study provide data to support partnerships to provide home care simulation experiences for associate degree nursing students and practicing home care nurses.

Outcomes of Home Emergency Physical Readiness Education for Older Adults.

Emergency preparedness initiatives are a Medicare condition of participation in home healthcare, yet limited evidence on the impact of associated programming is available. The purpose of this exploratory pilot study was to examine the outcomes of an individualized emergency preparedness educational program provided by a physical therapist (PT) in the homes of older adults. The investigators recruited older adults (n = 30) using convenience sampling. An emergency preparedness education module was developed. Demographics, functional and environmental outcome measures, a pre- and post-education confidence survey, and learning outcomes were ascertained and analyzed. Participants reported being female (n = 23), 70 to 79 years (n = 15), and 19 individuals reported 35 different lifetime emergency events. Hearing and vision impairments, inability to change a battery or navigate stairs, and environmental deficits including clutter and poor lighting were identified. Closing bedroom doors at nighttime, functioning carbon monoxide and smoke detectors, creating an evacuation plan, and assembling first aid kits were learning outcomes. Trends toward increased confidence were identified, with statistically significant improvements in the ability to respond to a fire (P = .01), a heat wave (P = .03), and to crawl on hands and knees (P = .05) identified. This study provides emerging evidence that PTs have a role in improving an older adult's confidence to prepare for and respond to an emergency event.

Assessment of Exercise Capacity in Home Healthcare: Differences in Three Self-Paced Tests.

Submaximal functional tests of endurance are ubiquitous in clinical practice. This investigation compared cardiovascular responses, perceived exertion, and performance measures following the completion of three self-paced, 2-minute, functional tests of endurance. A pilot prospective, observational, cross-sectional design with 16 community-dwelling older participants compared heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), rating of perceived exertion (RPE), and performance measures following the completion of three randomly allocated self-paced activities. The three activities included 2 minutes of stepping in standing (2MSTD), 2 minutes of seated stepping (2MSIT), and a 2-minute walk test (2MWT). A within-subjects repeated measures ANOVA analyzed differences in change scores for cardiovascular and RPE responses. Pearson's correlations assessed associations in performance measures between the three tests. Standing stepping compared to seated stepping produced statistically higher change scores in HR, SBP, DBP, and RPE (p < .05). Further, 2MSTD revealed statistically higher SBP and RPE scores compared to 2MWT (p < .05). Large and moderate correlations were observed between number of steps completed in sitting and standing (r = 0.83, p < .01) and between standing steps and distance walked (r = 0.56, p = .02), respectively. This pilot investigation informs home care physical therapists that 2 minutes of self-paced stepping in standing produced the greatest change scores in all cardiovascular and perceived exertion responses. No significant differences were noted in HR between self-paced walking and standing stepping, and between standing and seated stepping. For patients unable to walk or step in standing, self-paced seated stepping may be a viable alternative.

Abstract TP262: Trends, Odds, Burdens and Outcomes of Metabolically Healthy Obesity in Stroke Related Hospitalizations of Elderly Patients - A Nationwide Analysis, 2016-2019

Background: Obesity has been associated with an increase in the risk of stroke and poor outcomes. Meanwhile, Metabolically healthy obesity (MHO) trends are understudied in association with stroke. In this study, we aim to analyze the MHO trends and outcomes with respect to Stroke. Methods: We queried the National Inpatient Sample (2016-2019) to identify Stroke hospitalizations in the elderly population (%E2%89%A565 years) with vs without MHO by using ICD-10 codes after excluding patients with Hypertension, analyze, and Diabetes Mellitus. Patients were categorized into a metabolically healthy obese MHO+ve cohort, BMI&gt; 30, and MHO-ve cohort, BMI&lt;30. Trends, demographics, comorbidities, and outcomes were then compared between the two cohorts. Results: Overall Prevalence of stroke was higher in the MHO-ve cohort (2.4% vs 1.4% p&lt;0.001) compared to the MHO+ve cohort. MHO-ve cohort often consisted of higher median age (78 vs 73 years), Males (48.2% vs 36.4%), Hispanics (5.1% vs 4.7%), whites (83.8% vs 82.3%), Asians (2.4% vs 1.1%) vs MHO +ve cohort (p&lt;0.001). The rate of death (15.9% vs 14.4%), Home health care requirements (16.6% vs 12.4%) was also higher in the MHO-ve cohort vs MHO+ve cohort. Conversely, the MHO+ve cohort had higher rates of smokers, Prior MI, Hypothyroidism, CKD, and OSA in comparison to the MHO-ve cohort. Univariate and Multivariate regression analysis adjusted for confounders did not show any significant association between Stroke and MHO. Conclusion: Excluding other cardiovascular disease risk factors such as hypertension, diabetes mellitus, and hyperlipidemia, the non-significant difference in in-hospital mortality between elderly stroke patients with vs without MHO suggests that MHO might not be a significant independent predictor of short-term mortality. Other factors likely influence this relationship. Further research is warranted for the investigation of the factors influencing the absence of a relationship between stroke and MHO.

Multi-Objective Home Health Care Routing and Scheduling With Sharing Service via a Problem-Specific Knowledge-Based Artificial Bee Colony Algorithm

Multi-Objective Home Health Care Routing and Scheduling With Sharing Service via a Problem-Specific Knowledge-Based Artificial Bee Colony Algorithm

Relationship between the Number of Pharmacists per Pharmacy and the Provision of Home Healthcare Services in Japan.

Home healthcare services provided by community pharmacists are essential for maintaining community care, especially in Japan's aging population. Personnel shortage in pharmacies is occasionally cited as the reason why pharmacies are unable to provide home healthcare services. This study examined the relationship between the number of pharmacists in each pharmacy and the provision of home healthcare services. The number of full-time and part-time pharmacists per pharmacy has a positive impact on the provision of home healthcare services. Moreover, the larger the number of pharmacists per pharmacy, the easier it is for the pharmacy to provide home healthcare services. With regard to pharmacies with one full-time pharmacist, there are more pharmacies that provide home healthcare services when the population density of municipalities where the pharmacy is located is high. However, the impact of the number of pharmacists on population density became obscure when the number of full-time pharmacists per pharmacy was three or more. Taken together, these findings indicate that the provision of home healthcare services by pharmacies is related to the number of pharmacists per pharmacy and the population density of the area. This could have implications for widening regional disparities in home healthcare services.

Continuity of care in home health care scheduling: a rolling horizon approach

Continuity of care in home health care scheduling: a rolling horizon approach

Place of care in the last three years of life for Medicare beneficiaries

BackgroundMost older adults prefer aging in place; however, patients with advanced illness often need institutional care. Understanding place of care trajectory patterns may inform patient-centered care planning and health policy decisions. The purpose of this study was to characterize place of care trajectories during the last three years of life.MethodsLinked administrative, claims, and assessment data were analyzed for a 10% random sample cohort of US Medicare beneficiaries who died in 2018, aged fifty or older, and continuously enrolled in Medicare during their last five years of life. A group-based trajectory modeling approach was used to classify beneficiaries based on the proportion of days of institutional care (hospital inpatient or skilled nursing facility) and skilled home care (home health care and home hospice) used in each quarter of the last three years of life. Associations between group membership and sociodemographic and clinical predictors were evaluated.ResultsThe analytic cohort included 199,828 Medicare beneficiaries. Nine place of care trajectory groups were identified, which were categorized into three clusters: home, skilled home care, and institutional care. Over half (59%) of the beneficiaries were in the home cluster, spending their last three years mostly at home, with skilled home care and institutional care use concentrated in the final quarter of life. One-quarter (27%) of beneficiaries were in the skilled home care cluster, with heavy use of skilled home health care and home hospice; the remaining 14% were in the institutional cluster, with heavy use of nursing home and inpatient care. Factors associated with both the skilled home care and institutional care clusters were female sex, Black race, a diagnosis of dementia, and Medicaid insurance. Extended use of skilled home care was more prevalent in southern states, and extended institutional care was more prevalent in midwestern states.ConclusionsThis study identified distinct patterns of place of care trajectories that varied in the timing and duration of institutional and skilled home care use during the last three years of life. Clinical, socioregional, and health policy factors influenced where patients received care. Our findings can help to inform personal and societal care planning.

Real world outcomes, healthcare utilisation and costs of Alzheimer's disease in England

BackgroundEvidence on health and social care resource utilisation and associated costs, and how this varies across people with Alzheimer's disease (AD) dementia is limited. MethodsRetrospective cohort, using the Discover dataset, which includes linked health and social care records for approximately 2.5 million people in North-West London. Individuals were followed up from the latter of 2010 or from diagnosis of AD dementia (index) up to 2019. Outcomes were overall survival, care home admission, health and social care utilisation and associated costs, and cardiovascular outcomes. Variation was explored in subpopulations and by stratifying by cost quintile. Generalised linear modelling was used to estimate the association between clinical and demographic characteristics and healthcare costs. ResultsThe cohort included 18,116 people diagnosed with AD dementia whose mean age at index was 81 years, 62 % were female and 65 % were of white ethnicity. Median survival from index was 4.9 years (95 %CI: 4.8–5.0). Mean healthcare costs were £4,548(£4,491–£4,604) per person year(ppy). Healthcare costs for the 48 % who used social care were £5,433ppy(£5,353–£5,514) and social care costs were £24,374ppy(£24,372–£24,376). In the overall cohort costs in the highest cost quintile were £13,665ppy(£13,420–£13,911), of which 70 % was from inpatient hospitalisation. Subpopulations admitted to care home (£7,535 £7,362–£7,709), with cardiovascular disease (£6,106;£5,990–£6,222) and with type 2 diabetes (£6,049;£5,901–£6,198) accrued the highest healthcare costs. Factors most strongly associated with cost were dying during follow up (+£2,224;£2,010–£2,493), being frail (+£1,246;£1,051–£1,440) and prior stroke (+£1,207;£908–£1,507). ConclusionCharacteristics of individuals with high healthcare costs include requirement for social care and cardiometabolic comorbidities. Identifying individuals early in their disease course may improve health outcomes and reduce the cost of AD dementia in later life.

Effect of Remote and Virtual Technology on Home Dialysis.

In the United States, regulatory changes dictate telehealth activities. Telehealth was available to patients on home dialysis as early as 2019, allowing patients to opt for telehealth with home as the originating site and without geographic restriction. In 2020, coronavirus disease 2019 was an unexpected accelerant for telehealth use in the United States. Within nephrology, remote patient monitoring has most often been applied to the care of patients on home dialysis modalities. The effect that remote and virtual technologies have on home dialysis patients, telehealth and health care disparities, and health care providers' workflow changes are discussed here. Moreover, the future use of remote and virtual technologies to include artificial intelligence and artificial neural network model to optimize and personalize treatments will be highlighted. Despite these advances in technology challenges continue to exist, leaving room for future innovation to improve patient health outcome and equity. Prospective studies are needed to further understand the effect of using virtual technologies and remote monitoring on home dialysis outcomes, cost, and patient engagement.

Electronic medication administration record (eMAR) in Swedish home healthcare-Implications for Nurses' and nurse Assistants' Work environment: A qualitative study.

The electronic medication administration record (eMAR) is an eHealth system that has replaced the traditional paper-based medication administration used in many healthcare settings. Research has highlighted that eHealth technologies can change working methods and professional roles in both expected and unexpected ways. To date, there is sparse research that has explored how nurses and nurse assistants (NA) in home healthcare experience eMAR in relation to their work environment. The aim was to explore how nurses and nurse assistants experienced their work environment, in terms of job-demand, control, and support in a Swedish home healthcare setting where an electronic medication administration record had been implemented to facilitate delegation of medical administration. We took a qualitative approach, where focus groups were used as data collection method. The focus groups included 16 nurses and nine NAs employed in a Swedish municipality where an eMAR had been implemented 6 months before the first focus groups were performed. The analysis adapted the job-demand-control-support model, by condensing the professionals' experiences into the three categories of demand, control, and support, in alignment with the model. NAs experienced high levels of job demand and low levels of job control. The use of the eMAR limited NAs' ability to control their work, in terms of priorities, content, and timing. In contrast, the nurses described demands as high but manageable, and described having a high level of control. Both professions found the eMar supportive. Nurses and NAs in home healthcare experienced changes in their work environment regarding demand, control, and support when an eMAR was implemented to facilitate delegation of medical administration. In general, nurses were satisfied with the eMAR. However, NAs felt that the eMAR did not cover all aspects of their daily work. Healthcare organisations should be aware of the changes that digitalisation processes entail in the work environment of nurses and NAs in home healthcare.

Association of Prediabetes and Recurrent Stroke in Atrial Fibrillation Patients: A Population-Based Analysis of Hospitalizations and Outcomes.

Prediabetes is a risk factor for ischemic stroke in atrial fibrillation (AF) patients, yet, its impact on recurrent stroke in AF patients remains understudied. Using the 2018 National Inpatient Sample, we investigated the link between Prediabetes and recurrent stroke in AF patients with prior stroke or transient ischemic attack (TIA). Among 18,905 non-diabetic AF patients, 480 (2.5%) had prediabetes. The prediabetic group, with a median age of 78, exhibited a two-fold higher risk of recurrent stroke compared to the non-prediabetic cohort (median age 82), as evidenced by both unadjusted (OR 2.14, 95% CI 1.72-2.66) and adjusted (adjusted for socio-demographics/comorbidities, OR 2.09, 95% CI 1.65-2.64, p < 0.001). The prediabetes cohort, comprising more male and Black patients, demonstrated associations with higher Medicaid enrollment, admissions from certain regions, and higher rates of hyperlipidemia, smoking, peripheral vascular disease, obesity, and chronic obstructive pulmonary disease (all p < 0.05). Despite higher rates of home health care and increased hospital costs in the prediabetes group, the adjusted odds of all-cause mortality were not statistically significant (OR 0.55, 95% CI 0.19-1.56, p = 0.260). The findings of this study suggest that clinicians should be vigilant in managing prediabetes in AF patients, and strategies to prevent recurrent stroke in this high-risk population should be considered.