Admission and Readmission/Death Patterns in Hospitalized and Non-hospitalized First-Ever-in-a-Lifetime Stroke Patients During the First Year: A Population-Based Incidence Study

Abreu, Pedro; Magalhães, Rui; Baptista, Diana; Azevedo, Elsa; Correia, Manuel

doi:10.3389/fneur.2021.685821

Cited by 5 publications

(3 citation statements)

References 44 publications

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“…Although none of the remaining studies assessed predictors of readmission costs, several of them identified predictors associated with increased readmission rates in stroke survivors and potentially indirectly associated with higher readmission costs. The recognition of these potentially modifiable predictors is important since it may help healthcare organizations better allocate resources and implement targeted readmission reduction policies [ 71 , 76 ].…”

Section: Discussionmentioning

confidence: 99%

Rapid systematic review of readmissions costs after stroke

Abreu,

Correia,

Azevedo

et al. 2024

Cost Eff Resour Alloc

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Background Stroke readmissions are considered a marker of health quality and may pose a burden to healthcare systems. However, information on the costs of post-stroke readmissions has not been systematically reviewed. Objectives To systematically review information about the costs of hospital readmissions of patients whose primary diagnosis in the index admission was a stroke. Methods A rapid systematic review was performed on studies reporting post-stroke readmission costs in EMBASE, MEDLINE, and Web of Science up to June 2021. Relevant data were extracted and presented by readmission and stroke type. The original study’s currency values were converted to 2021 US dollars based on the purchasing power parity for gross domestic product. The reporting quality of each of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results Forty-four studies were identified. Considerable variability in readmission costs was observed among countries, readmissions, stroke types, and durations of the follow-up period. The UK and the USA were the countries reporting the highest readmission costs. In the first year of follow-up, stroke readmission costs accounted for 2.1–23.4%, of direct costs and 3.3–21% of total costs. Among the included studies, only one identified predictors of readmission costs. Conclusion Our review showed great variability in readmission costs, mainly due to differences in study design, countries and health services, follow-up duration, and reported readmission data. The results of this study can be used to inform policymakers and healthcare providers about the burden of stroke readmissions. Future studies should not solely focus on improving data standardization but should also prioritize the identification of stroke readmission cost predictors.

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Section: Discussionmentioning

confidence: 99%

Rapid systematic review of readmissions costs after stroke

Abreu,

Correia,

Azevedo

et al. 2024

Cost Eff Resour Alloc

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“…4,5 The influence of recurrent embolism on the functional outcomes of post-stroke patients highlights the significance of investigating prevention strategies and enhancing long-term prognostic methods to stratify patient risk and improve functional outcomes. 6,7 For these reasons, evaluating a patient's early embolisation activity would be beneficial in optimising management and preventing a poorer outcome. Transcranial Doppler (TCD) provides a unique opportunity to detect embolic material in the cerebral circulation at the bedside in a non-invasive manner.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Detection of microemboli in patients with acute ischaemic stroke and atrial fibrillation suggests poor functional outcome

Castro,

Ferreira,

Malojcic

et al. 2023

European Stroke Journal

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Introduction: We investigated the burden of microembolic signals (MES) in patients with acute ischaemic stroke (AIS) and atrial fibrillation (AF), assessing their impact on functional outcomes. Patients and methods: This multicentre international prospective cohort study involved patients with AIS and either a known or newly diagnosed anticoagulant-naïve AF. All centres utilised the same transcranial Doppler machine for 1-h monitoring with bilateral 2 MHz probes within 24 h of symptom onset. Recordings underwent MES analysis by a blinded central reader. The primary objectives were to ascertain the MES proportion and its association with functional outcomes assessed by the modified Rankin scale (mRS) score at 90 days. Results: Between September 2019 and May 2021, we enrolled 61 patients, with a median age of 78 years (interquartile range 73–83) and a median stroke severity score of 11 (interquartile range 4–18). MES were observed in 14 patients (23%), predominantly unilateral (12/14, 86%), with a median rate of 6 counts/hour (interquartile range 4–18). MES occurrence was higher post-thrombectomy and among those with elevated brain natriuretic peptide levels ( p < 0.05). A worse mRS score of 3–6 was more frequent in patients with MES, occurring in 11/14 (79%), compared to those without MES, 20/47 (43%), with an adjusted odds ratio of 5.04 (95% CI, 1.15–39.4), p = 0.04. Conclusions: Nearly a quarter of patients with AIS and AF exhibited silent microembolization after the index event. Detecting MES within 24 h post-stroke (using transcranial Doppler) could signify a marker of poor functional outcomes. Subsequent trials will assess if very early antithrombotic treatment might enhance outcomes in this highly selective group of cardioembolic stroke patients. (Clinicaltrials.gov ID: NCT06018090).

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