Patterns in hospital readmissions after ischaemic stroke – An observational study from the Swedish stroke register (Riksstroke)

Abstract

Introduction While acute treatment and secondary prevention in stroke have undergone major improvements, hospital readmission after index stroke remains high. However, there are few reports on long-term readmission patterns. Patients and methods For this prospective observational study, data on demographics, functional status and living conditions were obtained from the Swedish Stroke Register (Riksstroke). Data on comorbidity and hospital readmissions up to five years post-index stroke were obtained from the Swedish National Patient Register. Patients were grouped based on number of readmissions: low (0–1) intermediate (2–4), high (5–9) or very high (≥10). Results Of the 10,092 patients included, 43.7% had been readmitted within 12 months and 74.0% within 5 years. There was an average of three readmissions per individual during the five-year interval. A small group of patients with a high-comorbidity burden accounted for the majority of readmissions: approximately 20% of patients accounted for 60% of readmissions, and 5% of patients accounted for 25%. Circulatory conditions were the most common cause followed by infectious disease, stroke, trauma and diseases of the nervous system other than stroke. The proportion of readmissions due to stroke decreased sharply in the first six months. Conclusion A small number of patients with a high degree of comorbidity accounted for the majority of hospital readmissions after index stroke. Our results highlight the need for further development of strategies to support high-risk comorbid stroke patients in the community setting. Further research describing characteristics and healthcare utilisation patterns in this group is warranted.

Hospital Readmissions and Mortality Among Fee‐for‐Service Medicare Patients With Minor Stroke or Transient Ischemic Attack: Findings From the COMPASS Cluster‐Randomized Pragmatic Trial

“… 37 Our 1‐year readmission rates are consistent with the Swedish Stroke Register, which reported that ≈44% of patients with ischemic stroke were readmitted in the first year. 38 Similarly, a claims‐based study from Taiwan that explored the relationship between initial stroke severity and risk of readmission found that 34% of patients with mild stroke were readmitted 1 year after discharge. 38 …”

“… 38 Similarly, a claims‐based study from Taiwan that explored the relationship between initial stroke severity and risk of readmission found that 34% of patients with mild stroke were readmitted 1 year after discharge. 38 …”

“…The reasons for readmission vary across studies, but recurrent stroke is often one of the most common readmission diagnoses and was in our study as well. 17 , 36 , 38 , 44 …”

Age in relation to comorbidity and outcome in patients with high-risk TIA or minor ischemic stroke: A Swedish national observational study

“…A recently published study of Swedish patients with ischemic stroke of any severity and etiology (mean age 78 years) points out an association between burden of comorbidity and re-admissions, and reports a higher proportion of re-admissions (44%) than in our study. 5 This difference could be explained by lower prevalence of comorbidities and lower mean age (73 years) in our study population. The overall mortality rate (6.9 deaths per 100 person-years within 1 year) was similar to previously reported rates for combined minor stroke/TIA populations, 14,15 all-severity AIS, 8,22 minor AIS alone, 15 and TIA alone.…”

“…3,4 Stroke patients with high-risk comorbidities are also demonstrated to have increased re-admission rates. 5 After non-cardioembolic TIA or AIS, single antiplatelet therapy has, until recently, been the mainstay for secondary prevention. [6][7][8] For patients with high-risk TIA and minor AIS, recent trials report positive results for dual antiplatelet therapy (DAPT) with aspirin and P2Y 12 -inhibitors, [9][10][11] and short-term DAPT with aspirin and clopidogrel is now recommended in guidelines.…”