Hospital Readmission Risk Following Initial Stroke High Among Older Adults

A significant percentage of patients with a history of stroke experience hospital readmission, with cardio- and cerebrovascular diagnoses being the most common cause for readmissions across stroke subtypes, according to study findings published in Neurology.

Previous research has shown a higher risk for hospital readmission and mortality following a hemorrhagic vs ischemic stroke; however, limited information is available on risk for all-cause hospitalization by stroke subtype and at different timepoints.

Therefore, researchers used data from the Atherosclerosis Risk in Communities (ARIC) study to determine risk for poststroke hospitalization, based on stroke subtype, as well as the risk for all-cause hospitalization.

Stroke and hospital admissions were identified through hospital records using the International Classification of Diseases (ICD) codes. Stroke was defined as the sudden or rapid onset of neurologic symptoms for more than 24 hours or death, which was later classified into thrombotic/lacunar, cardioembolic, and hemorrhagic stroke for the primary analysis.

Eligible participants were followed-up with at various timepoints from incident stroke hospitalization until the date of discharge from hospital readmission, death, or the end of follow-up, whichever occurred first.

Overall, 1412 patients (mean age, 72.4; 52.1% women; 35.3% Black) with a history of incident stroke were included in the study, with a total of 1143 hospitalizations over a period of 41,849 person-months. Median follow-up was 10.6 months and median time for poststroke hospital readmission was 9.7 months.

Although hospital readmissions decreased over time for all stroke subtypes, incidence rates (IRs) of all-cause hospital readmission were higher among those with cardioembolic stroke vs thrombotic/lacunar and hemorrhagic stroke (IRs, 38.9 vs 25.6 and 22.1, respectively). Of note, incidence of readmission was highest within the first month of incident stroke.

Among patients with cardioembolic stroke, cardiovascular diagnoses were reported to be the most common cause of poststroke hospitalizations (34.9%; 95% CI, 29.3%-40.9%), followed by cerebrovascular and respiratory causes (14.6%; 95% CI, 10.8%-19.4% and 8.4%; 95% CI, 5.6%-12.5%, respectively).

Among patients with thrombotic/lacunar stroke, cardio- and cerebrovascular causes were the most common (27.2%; 95% CI, 24.2%-30.5% and 23.9%; 95% CI, 21.0%-27.0%, respectively). Similar trends were seen with hemorrhagic stroke, as well, with regard to cardio- and cerebrovascular diagnoses (25.9%; 95% CI, 18.5%-35.1% and 23.2%; 95% CI, 16.1%-32.1%, respectively).

Results of the analysis showed that risk for readmission was higher with cardioembolic stroke than with thrombotic/lacunar and hemorrhagic stroke (hazard ratio [HR], 0.82; 95% CI, 0.71-0.95 and 0.74; 95% CI, 0.58-0.93, respectively). In addition, risk for hospitalization was also higher with cardioembolic vs thrombotic/lacunar and hemorrhagic stroke within 1 month to 1 year (HR 0.78; 95% CI, 0.62-0.97 and 0.60; 95% CI, 0.41-0.87, respectively).

Study limitations included the lack of inclusion of patients with transient ischemic stroke with a different risk for hospital readmission compared with that of the study population; the lack of confirmation by a standardized process of the stroke etiologies; and the lack of adjustment for atrial fibrillation.

The researchers noted that these findings highlighted the “importance of focusing strategies for reducing readmissions, which occur at high rates both in short term and long term after stroke and across all subtypes of stroke.”

They concluded, “Poststroke hospitalization represents an important target for optimizing stroke care and reducing health care costs.”