More than a third of stroke patients are rehospitalized within a year

In her PhD thesis, Anna Therese Bjerkreim has looked at short- and long-term readmission rates following ischemic stroke and transient ischemic attacks.


MAIN RESULTS:

  1. 30 day-, one year- and five year readmission rates following ischemic stroke are high.
  2. The most common reasons for rehospitalization are infections, a new cardiovascular event and symptom worsening.
  3. Age, comorbidities and stroke severety are associated with increased risk of rehospitalization.

THESIS DEFENCE:

Thesis: Hospital readmission after ischemic stroke or TIA.
Candidate: Anna Therese Bjerkreim
Time: September 6, 2019 at 12:30
Place: University of Bergen, BB building: Auditorium 1
Link to university website (in Norwegian)


SUMMARY:

(1) Infections, a new stroke, another cardiovascular event, and events related to the first stroke are the most common reasons for readmittance to hospital within the first year of an ischemic stroke. Higher age, higher burden of stroke risk factors, stroke caused by atherosclerosis, and impaired physical function are associated with rehospitalizations within three months. For the remainder of the follow-up period, age and prior myocardial infarction were identified as predictors of readmittance.

The study follows 1175 ischemic stroke patients who were treated at Haukeland University Hospital between 2007 and 2012. Almost 19 % of them were readmitted within three months, and almost 25 % were readmitted during the next nine months.

(2) One-year mortality is increased in patients who are readmitted within 30 days of an ischemic stroke or transient ischemic attack (TIA). The odds of early readmittance is higher in patients with strokes caused by large-artery atherosclerosis. In total, 11 % of the 1874 patients included in the study were readmitted within a month. For those with large-artery atherosclerosis the readmittance rate was 17 %. Frequent causes of readmittance were stroke-related events, infections, recurrent stroke or TIA, and cardiac disease.

(3) More than two thirds of 1453 patients were readmitted to hospital within five years of an ischemic stroke or TIA. Among those not readmitted during the first year, more than half were readmitted during the following four years. Patients admitted during the first year were older, had more severe strokes, poorer functional outcome and more complications during the first hospitalizations than those who were readmitted later.

(4) The risks of readmission and death within five years are especially high in patients with strokes due to cardioembolism. 81 % of these patients were readmitted, whereas the corresponding rates for strokes due to large-artery atherosclerosis, strokes of multiple aetiologies and  cryptogenic strokes were around 70 %. The readmittance and mortality was lowest among those with strokes due to small vessel occlusions, with 55 % readmitted within five years.

REFERENCES:

(1) Bjerkreim, A. T., Thomassen, L., Brøgger, J., Waje-Andreassen, U., & Næss, H. (2015). Causes and predictors for hospital readmission after ischemic strokeJournal of Stroke and Cerebrovascular Diseases24(9), 2095-2101.

(2) Bjerkreim, A. T., Khanevski, A. N., Selvik, H. A., Waje-Andreassen, U., Thomassen, L., Naess, H., & Logallo, N. (2018). The Impact of Ischaemic Stroke Subtype of 30-day Hospital Readmissions. Stroke research and treatment2018.

(3) Bjerkreim, A. T., Naess, H., Khanevski, A. N., Thomassen, L., Waje-Andreassen, U., & Logallo, N. (2019). One-year versus five-year hospital readmission after ischemic stroke and TIABMC neurology19(1), 15.

(4) Bjerkreim, A. T., Khanevski, A. N., Thomassen, L., Selvik, H. A., Waje-Andreassen, U., Naess, H., & Logallo, N. (2019). Five-year readmission and mortality differ by ischemic stroke subtype. Journal of the neurological sciences.