Few Stroke Patients Survive 5 Years Without Readmission to the Hospital

July 2, 2007 — A retrospective study shows that fewer than 15% of stroke patients survive without hospital readmission during the next 5 years; pneumonia and respiratory illness were the top reasons for readmission, followed by myocardial infarction and recurrent stroke.
"Common wisdom has been that patients who have had a stroke are likely to return to the hospital for treatment of another stroke," said lead author Dawn M. Bravata, MD, previously from VA Connecticut Healthcare System, VA Medical Center, and Yale University in New Haven, Connecticut, and now at Indiana University School of Medicine in Indianapolis, in a statement. "Our study found that, surprisingly, the most common reasons for readmission to the hospital were non-neurological, with pneumonia or other respiratory problem leading the list of reasons."
Their report appears in the June issue of Stroke.
Readmission Rates
Stroke is a major cause of hospitalization in the elderly, the authors write, but limited data are available on hospital readmission after a stroke.
In this study, Dr. Bravata and colleagues looked retrospectively at a cohort of fee-for-service Medicare beneficiaries aged 65 years or older who were admitted with a diagnosis of acute ischemic stroke between January 1 and December 31, 1995, to a Connecticut acute care hospital. Patients were followed up after discharge through to 2000, using Medicare part A claims and Social Security Administration mortality data.
Of 2603 patients who were discharged alive after their stroke, more than half died or had hospital readmission during the first year after discharge, and fewer than 15% survived free from either death or readmission by 5 years.
The reasons for readmission varied during the years, but recurrent stroke was a major reason for this, they note, accounting for 3.9% to 6.1% of readmissions annually. Acute myocardial infarction accounted for a similar number of readmissions, associated with 4.2% to 6.0% of readmissions annually.
However, the most common cause for readmission during follow-up was a diagnosis of pneumonia or other respiratory illness, with an annual readmission rate of 8.2% to 9.0% annually.
"Between the acute care for an ischemic stroke and a readmission to hospital, a window of opportunity exists for interventions to reduce the burden of post-stroke morbidity," the authors conclude. "For example, diagnosis and treatment of coronary artery disease or efforts to reduce hospitalizations for pneumonia (e.g. swallowing studies or vaccination) among post-stroke patients may reduce the readmission rates for patients after a stroke."
Their group is currently working on a study looking at whether interventions such as pneumonia and influenza vaccinations can reduce readmission rates.
This study was supported by the National Institute for Neurological Disorders and Stroke, a PRT Outcomes Award from the American Heart Association, an advanced career development award from the Department of Veterans Affairs Health Services Research and Development Service, and by the Robert Wood Johnson Generalist Physician Faculty Scholars Award Program. The authors have disclosed no relevant financial relationships.
Stroke. 2007;38:1899-1904.