Most Ischemic Stroke Patients Die Or Are Back In Hospital Within Twelve Months

61.9% of Medicare beneficiaries with ischemic stroke who leave hospital, are either rehospitalized or dead with twelve months, researchers from the University of California-Los Angeles wrote in Stroke: Journal of the American Heart Association. Nearly 15% of ischemic stroke patients die within 30 days of being hospitalized. Medicare beneficiary rehospalization and death rates did not get any better from 2003 to 2006, the authors added, highlighting the need for quality improvement interventions.

The American Heart Association informs that stroke is the second leading cause of hospitalizations among American elderly. 87% of all strokes are ischemic strokes.

There are two main types of stroke:

Ischemic stroke – a thrombus (blood clot) forms that blocks bloodflow to part of the brain. The clot can form elsewhere in the body, break off and become free-floating (embolus). The embolus eventually makes its way through the bloodstream to the brain, where it can cause an ischemic stroke.

Hemorrhagic stroke – a blood vessel on the surface of the brain bursts (ruptures) and fills the space between the skull and the brain with blood (subarachnoid hemorrhage). It can also occur if a defective artery in the brain bursts, filling the surrounding tissue with blood (cerebral hemorrhage).

Both types of stroke result from not enough blood flow to the brain and an accumulation of blood that places excessive pressure on the brain.

Gregg C. Fonarow, M.D., study lead author, explained that very few studies have examined the full burden of rehospitalization and death following ischemic stroke. Fonarow and team set out to find out what ischemic stroke mortality and rehospitalization rates were at 30 days and 12 months for Medicare beneficiaries. They also aimed to see whether these rates varied from hospital-to-hospital.

Fonarow said:“We looked at readmission in addition to mortality because it is expensive to the healthcare system and may represent a potentially preventable, adverse event for patients.”
They gathered data from the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke initiative involving 91,134 Medicaire patients who had been treated at 625 hospitals between April 2003 and December 2006.

Fonarow said:“The Get With The Guidelines-Stroke database linked to Medicare data provided a very valuable opportunity to analyze outcomes for ischemic stroke patients from all regions of the country and from a broad group of acute care hospitals. Clinical data, coupled with long-term outcome data, was not previously available for Medicare beneficiaries at the national level.”
Below are some highlighted results of their findings:

Nearly 15% of ischemic stroke patients die within 30 days of being admitted to hospital.
Over 30% of ischemic stroke patients die within 12 months of being admitted to hospital.
61.9% of ischemic stroke patients who are discharged from hospital are either re-admitted or die within twelve months
Death or hospitalization rates among Medicare beneficiaries with acute stroke from 2003 to 2006 did not improve

Fonarow said:“These findings underscore the need for quality improvement interventions and systems of care that will improve early, intermediate, and long-term outcomes of patients with acute ischemic stroke. Standardizing evidence-based practices that focus on reducing the risks of preventable deaths or readmissions for ischemic stroke patients may be critical.

Most of the variation in outcomes was unexplained by patient and hospital characteristics. This suggests that other factors, including treatment provided, systems of care, care transitions and outpatient follow-up, may explain much of the variation in outcomes.”

The study did not include patients enrolled in managed care, uninsured individuals or patients under the age of 65, the authors added. It only included patients in fee-for-service Medicare.

Hospital-Level Variation in Mortality and Rehospitalization for Medicare Beneficiaries With Acute Ischemic Stroke”

Gregg C. Fonarow, MD; Eric E. Smith, MD, MPH; Mathew J. Reeves, PhD; Wenqin Pan, PhD; DaiWai Olson, PhD; Adrian F. Hernandez, MD, MHS; Eric D. Peterson, MD, MPH; Lee H. Schwamm, MD
Stroke. 2010 doi: 10.1161/STROKEAHA.110.601831

Written by Christian Nordqvist

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