Stroke Subtype and Risk of Subsequent Hospitalization

Don't just incompetently tell us the risk. DO THE RESEARCH THAT PREVENTS THE PROBLEM! Are you that blitheringly stupid? Useless.

Stroke Subtype and Risk of Subsequent Hospitalization

Kelly L. Sloane, MD https://orcid.org/0000-0001-9680-9565, Rebecca F. Gottesman, MD, PhD https://orcid.org/0000-0002-9504-1256, Michelle C. Johansen, MD, PhD https://orcid.org/0000-0003-0393-3589, Sara Jones Berkeley, PhD https://orcid.org/0009-0001-1041-5715, Josef Coresh, MD, PhD https://orcid.org/0000-0002-4598-0669, Anna Kucharska-Newton, PhD https://orcid.org/0000-0001-9864-467X, Wayne D. Rosamond, PhD, Andrea L.C. Schneider, PhD https://orcid.org/0000-0003-0026-5052, and Silvia Koton, PhD https://orcid.org/0000-0002-9327-7505Authors Info & Affiliations

February 13, 2024 issue

102 (3)

https://doi.org/10.1212/WNL.0000000000208035

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• Methods
• Results
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Abstract

Background and Objectives

Risk of readmission after stroke differs by stroke (sub)type and etiology, with higher risks reported for hemorrhagic stroke and cardioembolic stroke. We examined the risk and cause of first readmission by stroke subtype over the years post incident stroke.

Methods

Atherosclerosis Risk in Communities (ARIC) study participants (n = 1,412) with first-ever stroke were followed up for all-cause readmission after incident stroke. Risk of first readmission was examined by stroke subtypes (cardioembolic, thrombotic/lacunar, and hemorrhagic [intracerebral and subarachnoid]) using Cox and Fine-Gray proportional hazards models, adjusting for sociodemographic and cardiometabolic risk factors.

Results

Among 1,412 participants (mean [SD] age 72.4 [9.3] years, 52.1% women, 35.3% Black), 1,143 hospitalizations occurred over 41,849 person-months. Overall, 81% of participants were hospitalized over a maximum of 26.6 years of follow-up (83% of participants with thrombotic/lacunar stroke, 77% of participants with cardioembolic stroke, and 78% of participants with hemorrhagic stroke). Primary cardiovascular and cerebrovascular diagnoses were reported for half of readmissions. Over the entire follow-up period, compared with cardioembolic stroke, readmission risk was lower for thrombotic/lacunar stroke (hazard ratio [HR] 0.82, 95% CI 0.71–0.95) and hemorrhagic stroke (HR 0.74, 95% CI 0.58–0.93) in adjusted Cox proportional hazards models. By contrast, there was no statistically significant difference among subtypes when adjusting for atrial fibrillation and competing risk of death. Compared with cardioembolic stroke, thrombotic/lacunar stroke was associated with lower readmission risk within 1 month (HR 0.66, 95% CI 0.46–0.93) and during 1 month–1 year (HR 0.78, 95% CI 0.62–0.97), and hemorrhagic stroke was associated with lower risk during 1 month–1 year (HR 0.60, 95% CI 0.41–0.87). There was no significant difference between subtypes in readmission risk during later periods.

Discussion

Over 26 years of follow-up, 81% of stroke participants experienced a readmission. Cardiovascular and cerebrovascular diagnoses at readmission were most common across stroke subtypes. Though cardioembolic stroke has previously been reported to confer higher risk of readmission, in this study, the readmission risk was not statistically significantly different between stroke subtypes or over different periods when accounting for the competing risk of death.

Introduction

Stroke is the primary cause of adult disability in the United States.¹ With the increase in life expectancy and survival after stroke, the number of stroke survivors at risk of recurrence and readmission is rising,² posing significant burden to patients, their families, and the health system. In addition, stroke survivors account for significant health care costs estimated to be approximately $35 billion annually in the United States.³ Older age, recent cerebrovascular event, and greater stroke severity have been reported as predictive factors for hospitalization within the first year after stroke.^4-6 Readmissions are associated with higher rates of mortality, longer length of stay, and cost of care among patients.⁷ Based on stroke etiology, prior studies have suggested that hemorrhagic stroke confers higher risks of readmission and mortality, compared with ischemic stroke, especially within the first month after stroke.⁷ According to a study published in 2013, among ischemic strokes, cardioembolic stroke subtype confers the highest risk of readmission or mortality.⁸ However, the longitudinal risk of cause-specific hospitalization by stroke subtype is not well characterized nor is the risk of readmission at several time points post incident stroke.

Using data from the Atherosclerosis Risk in Communities (ARIC) study, a prospective population-based study, we aimed to determine risk and indications for poststroke hospital admission by stroke subtype (ischemic [cardioembolic vs thrombotic/lacunar] and hemorrhagic [intracerebral and subarachnoid]). We also assessed risk of all-cause hospitalization overall and during several periods (all follow-up time, within 1 month of incident stroke, 1 month to 1 year, 1 year to 5 years, and 5+ years after incident stroke), controlling for sociodemographic and cardiometabolic risk factors.

 

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