Deans' stroke musings: Socioeconomic Vulnerability Linked to Loss to Follow-Up After Acute Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, April 14, 2026

Socioeconomic Vulnerability Linked to Loss to Follow-Up After Acute Stroke

You wouldn't need to worry about this loss to follow-up if you delivered EXACT 100% RECOVERY PROTOCOLS upon discharge, because you know they would be fully recovered! Can't you people think at all?

Socioeconomic Vulnerability Linked to Loss Self-pay insurance and high functional impairment at discharge are significantly associated with increased odds of loss to follow-up within 12 months of acute stroke.

Clinical and socioeconomic factors, including functional disability and insurance status, are associated with loss to follow-up after hospitalization for acute stroke, according to a study published in Journal of Clinical Neuroscience. Patients discharged after hospitalization for acute stroke require multidisciplinary care to reduce risk for functional decline, stroke recurrence, and death. However, many health systems lack the infrastructure to support long-term care coordination following stroke. Researchers conducted a retrospective cohort analysis of patients admitted with acute stroke to Mount Sinai Hospital in New York City between January 1, 2016, and December 31, 2020. The primary outcome was loss to follow-up (LTFU) within 12 months of discharge, defined as the absence of any post-discharge encounters within the Mount Sinai Health System. Variable selection was performed using least absolute shrinkage and selection operator (LASSO) regression, followed by multivariable logistic regression to evaluate associations with LTFU.[T]his study demonstrated that patients with post-stroke LTFU were more likely to have increased medical complexity, markers of social vulnerability, and high functional impairment that may have prevented them from seeking follow-up care. Among 2597 patients included in the analysis, the mean (SD) age was 65.5 (15.6) years, and 50.8% were women. A total of 33.8% of patients were LTFU within 12 months of discharge. Compared with patients who maintained follow-up, patients who were LTFU were more likely to be men (52.9% vs 47.4%; P =.009), have intracerebral hemorrhage (12.1% vs 8.9%; P =.005), undergo endovascular treatment (12.8% vs 10.0%; P =.030), be transferred from another hospital (48.0% vs 40.7%; P =.003), and be discharged to an acute care facility (4.0% vs 0.87%; P <.001). They also had greater functional impairment, including modified Rankin Scale (mRS) scores of 4 to 5 at discharge (35.2% vs 30.2%; P =.006) and higher discharge National Institutes of Health Stroke Scale (NIHSS) scores (6.1 vs 4.9; P <.001).

In multivariable analysis, self-pay insurance (adjusted odds ratio [aOR], 3.8; 95% CI, 1.3–11.4; P =.016), discharge to an acute care facility (aOR, 5.3; 95% CI, 1.5–18.4; P =.009), and discharge mRS score of 5 (aOR, 2.4; 95% CI, 1.0–5.7; P =.045) were associated with increased odds of LTFU.

In contrast, Medicare coverage (aOR, 0.60; 95% CI, 0.40–0.92; P =.018), discharge to inpatient rehabilitation (aOR, 0.54; 95% CI, 0.34–0.86; P =.009), family history of stroke (aOR, 0.37; 95% CI, 0.18–0.76; P =.007), obesity (aOR, 0.40; 95% CI, 0.19–0.81; P =.012), renal insufficiency (aOR, 0.43; 95% CI, 0.23–0.81; P =.009), and depression (aOR, 0.27; 95% CI, 0.11–0.64; P =.003) were associated with decreased odds of LTFU, potentially reflecting greater baseline engagement with the healthcare system.

Study limitations include the single-center retrospective design, limited capture of social determinants of health, inability to account for follow-up outside the health system, and lack of post-discharge mortality data. “[T]his study demonstrated that patients with post-stroke LTFU were more likely to have increased medical complexity, markers of social vulnerability, and high functional impairment that may have prevented them from seeking follow-up care,” the study authors concluded. Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. References:

Kummer BR, Hwang SA, Agarwal P, et al. Exploring key risk factors for loss to follow-up after hospitalization for acute stroke. J Clin Neurosci. Published online February 26, 2026. doi:10.1016/j.jocn.2026.111951