To track mortality and rehospitalizations over 5 years post-stroke in a stroke cohort and compare long-term risks of major complications to a matched non-stroke cohort.
A cohort design with a matched non-stroke comparison cohort was used. The stroke cohort (SC) was a validated database of acute ischemic stroke patients, 65 years or older, hospitalized across 19 Minnesota hospitals in the year 2000. The non-stroke cohort (NSC) was constructed by matching stroke cohort members on age, race and sex, to the year 2000 General Medicare Population. Both cohorts were tracked across 5 years of Medicare claims data to identify dates and causes of rehospitalization and death dates. Kaplan-Meier survival curves estimated cumulative incidence rates. Cox regression models were used to calculate adjusted hazard ratios (HR) and confidence intervals (CI).
Event rates and adjusted HR were: Mortality: 1 year SC=24%, NSC=4%; 5 years SC=49%, NSC= 24%; HR: 4.9 (95% CI 4.0-6.1). Overall rehospitalization rates: 1 year SC=49%, NSC=20%; 5 years SC=83%; NSC=63%; HR: 2.6 (95% CI 2.2-3.0). Cause specific 5-year rehospitalization rates were significantly higher in SC versus NSC for recurrent ischemic stroke, heart failure, cardiac events, any vascular events pneumonia and hip fractures. The excess risk of mortality and
rehospitalizations in the SC persisted beyond the initial aftermath of the acute stroke (i.e. beyond 30 days post-stroke) and persisted even after 1 year post-stroke.
The high rates of acute care readmissions in stroke survivors indcate a need for trials to prevent long-term post-stroke complications.
University of Minnesota M.S. thesis. May 2011. Major: Health services research, policy, and administration. Advisor: Beth A Virnig, PhD, MPH. 1 computer file (PDF) vi, 27 pages.
Five year rehospitalization outcomes in a cohort of acute ischemic stroke patients: medicare linkage study..
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