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
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.
More at link.
No comments:
Post a Comment