Predictors of hospital readmission 1 year after ischemic stroke

Abstract

Predictors of short-term readmission after ischemic stroke have been previously identified, but few studies analyzed predictors of long-term readmission, namely early imaging findings and treatment with intravenous thrombolysis (IVT). To characterize predictors of hospital readmission during the first year after hospitalization for ischemic stroke. The study consists of a retrospective cohort of consecutive ischemic stroke patients admitted in a Portuguese university hospital during 2013, who survived index hospitalization. We collected clinical and imaging information using the electronical clinical record. Information concerning 1-year unplanned hospital readmissions was assessed using the Portuguese electronic Health Data Platform. Descriptive and univariate analyses, Kaplan-Meier survival curve and multivariate survival analysis with Cox regression model were used. We included 480 patients, 50.6 % women, median age 79 years (interquartile range = 68-85). One-year hospital readmissions occurred in 165 patients [34.4 %, 95 % confidence interval (95 % CI) 30.2-38.7]. The main causes for readmission were infectious diseases (43.8 %), ischemic stroke or transient ischemic attack recurrence (13.2 %) and cardiac diseases (6.4 %). In-hospital mortality associated with readmission was 23.0 %. The independent predictors of 1-year hospital readmission after ischemic stroke were admission mini-National Institute of Health Stoke Scale [hazards ratio (HR) 1.05, 95 % CI 1.02-1.08, p = 0.002], and mild or absent early signs of ischemia on admission computed tomography (CT) (HR 0.54, 95 % CI 0.32-0.91, p = 0.021) and IVT (HR 0.11, 95 % CI 0.01-0.80, p = 0.029). Hospital readmission during the first year after ischemic stroke occurs in 1/3 of patients and is associated with high in-hospital mortality. Clinical stroke severity, early signs of ischemia on admission CT, and treatment with IVT are independent predictors of 1-year hospital readmission.

Five-year readmission and mortality differ by ischemic stroke subtype

“…Other studies show that infections are the cause of 12-34% of early readmissions and 15-44% of all readmissions within one year. 95,103,104,158 We found that infections caused 17% of all first readmissions after ischemic stroke and TIA during the first 90 days and 19% within one year. After five years, about 30% had been readmitted with an infection, with an especially high proportion during the first 30 days.…”

“…3 The early period following discharge represents an especially vulnerable period for readmission, as readmission within the first 90 days represents more than half of all readmission happening within one year after discharge. [102][103][104][105] Within five years, less than 15% of all stroke patients are alive and have never been readmitted, and after ten years, the number of patients alive and never readmitted declines to 6.6%. 105,106 Links between stroke and other diseases increases the susceptibility for infections.…”

“…Other studies vary slightly in the frequency of readmitted patients but show similar trends for the timing of readmissions. [102][103][104][105] The early phase after stroke might thus be regarded as a particularly vulnerable and unstable period. Regardless of the initial admission diagnose, it has been argued that the increased risk of readmission in the early phase after discharge may be caused by an acquired condition of vulnerability, a so-called "post-hospital syndrome".…”

“…Few other studies on readmission after stroke have included ischemic stroke subtype. 95,104,214,215 A retrospective study of 265 ischemic stroke or TIA patients found no difference in the risk of 30-day readmission among the stroke subtypes, whereas a study of 987 young stroke patients included in the late 1980s and followed until 2009, found a significantly increased risk of readmission for the CE subtype. 214,215 Other studies have reported that LAA or CE subtype independently increases the risk of 30-day readmission and that the CE subtype increases the risk of one-year readmission.…”

One-year Versus Five-year Hospital Readmission after Ischemic Stroke and TIA

“…[4][5][6] In line with previously reported 1-year readmission rates between 31% and 55%, we found that 39% were readmitted within the first year after discharge. [2,3,6,15,16] The high rates of readmission during the first year after stroke might reflect an increased vulnerability for post-stroke complications such as infections, recurrent stroke and other cardiovascular events in the early phase after stroke. [1] We also found that more than half of all patients that survived for 1 year without any readmission were readmitted within 5 years.…”