Stroke survivors face long-term increase in morbidity, mortality
MedWire News: The long-term course of acute ischemic stroke (AIS) is characterized by high rates of hospital readmission and mortality, a study of Medicare recipients indicates.
The findings highlight a need for better strategies to reduce the long-term burden associated with stroke, in terms of both clinical and economic consequences, say the study authors.
Kamakshi Lakshminaryan (University of Minnesota, Minneapolis, USA) and team studied the 5-year outcomes of a cohort of patients with AIS and a matched group of general Medicare patients without stroke.
The stroke patients were aged 65 years or older and were hospitalized in 19 hospitals in Minnesota during the year 2000; the stroke-free controls also lived in Minnesota and were matched by age, race, and gender.
Rates of mortality were higher in stroke patients than in controls at 1 year (24% vs 4%) and at 5 years (49% vs 24%). The adjusted hazard ratio (HR) for 5-year mortality was 4.4.
Similarly, rates of rehospitalization were higher in stroke patients versus controls at 1 year (49% vs 20%) and 5 years (83% vs 63%), with an adjusted HR of 2.6.
Further analysis revealed that stroke patients had significantly higher rates of hospitalization for specific causes, including recurrent ischemic stroke, heart failure, cardiac events, any vascular events, pneumonia, and hip fracture.
"The excess risk of mortality and rehospitalizations in the stroke cohort persisted beyond the initial aftermath of the acute stroke (ie, beyond 30 days poststroke) and persisted even after 1 year poststroke," note Lakshminaryan and co-authors in the journal Stroke.
In addition, healthcare costs were more than twice as high in stroke patients as in nonstroke controls.
The researchers say their study has two "take-home" messages. First, the much higher rate of cause-specific hospitalization in the stroke group suggests "considerable room for improvement in tertiary prevention (ie, prevention of complications) after stroke."
Second, current population-based surveillance efforts primarily track stroke incidence and prevalence.
"We argue that such surveillance should be expanded to include a more comprehensive tracking of stroke outcomes, including poststroke rehospitalizations," conclude Lakshminaryan et al.
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By Joanna Lyford