Impact of Poststroke Medical Complications on 30-Day Readmission Rate

Shah, Sonia; Corado, Carlos; Bergman, Deborah; Curran, Yvonne; Bernstein, Richard A.; Naidech, Andrew M.

doi:10.1016/j.jstrokecerebrovasdis.2015.04.037

Cited by 42 publications

(44 citation statements)

References 37 publications

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“…[24–26,29,36–39] Prior studies on the effect of medical complications on stroke outcome mainly focused on death and disability. [23–31] In a recent analysis from the Berlin Stroke Registry study, an effect of acute complications on mortality in ischemic stroke patients was observed, such that the risk of death was 2.5-times higher in participants with in-hospital complications when compared with those without complications. [27] Similarly, we previously showed that the risk of death was significantly higher in stroke patients with in-hospital medical complications than in those without complications, even after adjusting for traditional cerebrovascular risk factors, baseline severity of neurological impairment, anticoagulant treatment, and thrombolytic treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have demonstrated that medical complications are strong risk factors for poor outcome in patients with stroke. [23–31] Data from the China National Stroke Registry (CNSR) further confirmed that in-hospital medical complications were independently associated with a greater risk of death or dependency in patients with stroke. [32,33] Despite this evidence, little is known about the association of medical complications with recurrent stroke.…”

Section: Introductionmentioning

confidence: 99%

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In-hospital medical complications associated with stroke recurrence after initial ischemic stroke

Wang

Zhao

et al. 2016

Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

In-hospital medical complications associated with stroke recurrence after initial ischemic stroke

Wang

Zhao

et al. 2016

Medicine

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“…We prospectively monitored for post-stroke in-hospital medical complications 10 including recurrent ischemic stroke after index AIS or TIA. Recurrent IS after hospitalization was determined via telephonic interview supplemented by utilizing an electronic surveillance system of hospital records at any of 3 health system hospitals with confirmation by manual review of the medical record in all instances of reported recurrent AIS or TIA.…”

Section: Methodsmentioning

confidence: 99%

Challenges in the Medical Management of Symptomatic Intracranial Stenosis in an Urban Setting

Sangha

Naidech

Corado

et al. 2017

Stroke

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Background and Purpose Since the SAMMPRIS trial, aggressive medical management (AMM), which includes dual antiplatelet therapy (DAPT) and high-dose statin (HDS) therapy, is recommended for patients with symptomatic ICAD. However, limited data on the “real-world” application of this regimen exist. We hypothesized that recurrent stroke risk among patients treated with AMM is similar to the medical arm of the SAMMPRIS cohort. Methods Using a prospective registry, we identified all patients admitted between August 2012 and March 2015 with 1) confirmed ischemic stroke (IS) or transient ischemic attack (TIA); 2) independently adjudicated symptomatic ICAD; and 3) follow-up at 30 days. We analyzed 30-day risk of recurrent IS stratified by treatment: 1) AMM: DAPT plus HDS therapy, 2) HDS alone, and 3) DAPT alone. We also assessed 30-day risk among patients who met prespecified SAMMPRIS eligibility criteria. Results Among 99 patients who met study criteria (51.5% male, 54.5% black, mean age 68.2 ± 11.2 years), 49 (48.5%) patients were treated with AMM, 69 (69.7%) with DAPT, and 73 (73.7%) with HDS therapy. At 30 days, 20 (20.2%) patients had recurrent strokes in the territory of stenosis. Compared to the risk in the medical arm of SAMMPRIS (4.4%), the 30-day risk of recurrent stroke was 20.4% in AMM patients, 21.5% in HDS patients, 22.4% in DAPT patients, and 23.2% in SAMMPRIS-eligible patients (all p<0.001). Conclusions Recurrent stroke risk within 30 days in patients with symptomatic ICAD was higher than that observed in the medical arm of SAMMPRIS even in the subgroup receiving aggressive medical management. Replication of the SAMMPRIS findings requires further prospective study.

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“…Despite this, in‐hospital mortality is decreasing (Bejot et al., ; Otite et al., ), resulting in more patients available for readmission. Complications during stroke admission are associated with 30‐day readmission (Shah et al., ). Most studies on 30‐day readmission after stroke have focused on ischemic stroke, and there is sparse research on readmission after ICH.…”

Section: Introductionmentioning

confidence: 99%

Thirty‐day readmission after spontaneous intracerebral hemorrhage

et al. 2018

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BackgroundIntracerebral hemorrhage (ICH) is the most severe form of stroke, but data on readmission after ICH are sparse. We aimed to determine frequency, causes, and predictors of 30‐day readmission after ICH.Materials and MethodsThis retrospective cohort study includes all spontaneous ICH survivors admitted to the stroke unit at Haukeland University Hospital in Bergen in Norway from July 2007 to December 2013. Patients were followed by review of electronic medical charts, and the first unplanned readmission within 30 days after discharge was used as final outcome. Cox regression analysis was performed to identify predictors of 30‐day readmission.ResultsWe identified 226 patients with spontaneous ICH, 70 (31.0%) of whom died before discharge or were discharged to palliative care. Of the remaining 156 ICH survivors, 28 (18.0%) were readmitted within 30 days. Median time to readmission was 12 days (IQR 4.5 – 18.5). Most patients were readmitted due to infections (N = 13). None of the patients were readmitted with recurrent stroke. Pneumonia and enteral feeding during the index hospitalization were associated with readmission for infections (both p < .01). Age was the only independent predictor of readmission (HR 1.06, 95% CI 1.02 – 1.11, p = .006).ConclusionsAlmost one in five of our spontaneous ICH survivors was readmitted within 30 days, and most readmissions were caused by infections.

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Impact of Poststroke Medical Complications on 30-Day Readmission Rate

Cited by 42 publications

References 37 publications

In-hospital medical complications associated with stroke recurrence after initial ischemic stroke

In-hospital medical complications associated with stroke recurrence after initial ischemic stroke

Challenges in the Medical Management of Symptomatic Intracranial Stenosis in an Urban Setting

Thirty‐day readmission after spontaneous intracerebral hemorrhage

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