on May 17, 2007
Published online before print May 17, 2007, doi: 10.1161/STROKEAHA.106.481465
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Submitted on December 29, 2006
From Clinical Epidemiology Research Center (L.M.B., D.B., J.C.), Neurology Service (L.M.B.), and Medicine Service (D.M.B., J.C.) of the VA Connecticut Healthcare System, West Haven, Conn; Departments of Neurology (L.M.B.), Internal Medicine (D.M.B., J.C., T.M.), and Epidemiology and Public Health (L.M.B.), Yale University School of Medicine, New Haven, Conn; and Qualidigm (S.H., T.P.M.), Middletown, Conn. * To whom correspondence should be addressed. E-mail: Dawn.Bravata{at}yale.edu.
Background and Purpose--Stroke is a leading cause of hospital admission among the elderly. Although studies have examined subsequent vascular outcomes, limited data are available regarding the full burden of hospital readmission after stroke. We sought to determine the rates of hospital readmissions and mortality and the reasons for readmission over a 5-year period after stroke. Methods--This retrospective observational cohort study included Medicare beneficiaries aged >65 years who survived hospitalization for an acute ischemic stroke (International Classification of Diseases, Ninth Revision, Clinical Modification codes 434 and 436) and who were discharged from Connecticut acute care hospitals in 1995. This population was followed from discharge in 1995 through 2000 using part A Medicare claims and Social Security Administration mortality data. The primary outcome was hospital readmission and mortality and readmission diagnosis. Results--Among 2603 patients discharged alive, more than half had died or been readmitted at least once during the first year after discharge (1388/2603, 53.3%), and <15% survived admission-free for 5 years (372/2603, 14.3%). The reasons for hospital readmission varied over time, with stroke remaining a leading cause for readmission (3.9 to 6.1% of patients annually). Acute myocardial infarction accounted for a comparable number of readmissions (4.2 to 6.0% of patients annually). The most common diagnostic category associated with readmission, however, was pneumonia or respiratory illnesses, with an annual readmission rate between 8.2% and 9.0% throughout the first 5 years after stroke. Conclusions--Few stroke patients survive for 5 years without a hospital readmission. Between the acute care setting and readmission to the hospital, a window of opportunity may exist for interventions, beyond prevention of recurrent vascular events alone, to reduce the huge public health burden of poststroke morbidity.
Accepted on January 6, 2007
Readmission and Death After Hospitalization for Acute Ischemic Stroke. 5-Year Follow-Up in the Medicare Population
Dawn M. Bravata MD*;
Key words: brain ischemia • mortality • patient readmission
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Stroke 2007 38: 1727-1729.
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