Sage Journals: Discover world-class research

Abstract

Background

Little is known about the association between age and readmission within 30 days after hospitalization for acute ischemic stroke.

Aim

To examine the age-related differences in rate and principal reason of 30-day readmissions in patients hospitalized for acute ischemic stroke.

Methods

In this retrospective, population-based cohort study using State Inpatient Databases from eight US states, we identified all adults hospitalized for acute ischemic stroke. We grouped the patients into four age categories: < 65, 65–74, 75–84, and ≥85 years. Outcomes were any-cause readmission within 30 days of discharge from the index hospitalization for acute ischemic stroke and the principal diagnosis of 30-day readmission.

Results

We identified 620,788 hospitalizations for acute ischemic stroke. The overall 30-day readmission rate was 16.6% with an increase with advanced age. Compared to patients aged <65 years, the readmission rate was significantly higher in age 65–74 years (OR 1.19; 95% CI 1.16–1.21), in age 75–84 years (OR 1.29; 95% CI 1.27–1.31), and in ≥ 85 years (OR 1.24; 95% CI 1.22–1.27; all P<0.001). There was heterogeneity in the age-readmission rate association between men and women (P_interaction < 0.001). Overall, 45.8% of readmissions were assigned stroke-related conditions or rehabilitation care. Compared to younger adults, older adults were more likely to present with non-stroke-related conditions (46.1% in < 65 years, 50.6% in 65–74 years, 57.1% in 75–84 years, and 62.9% in ≥ 85 years; P<0.001).

Conclusions

Advanced age was associated with a higher 30-day readmission rate after acute ischemic stroke. Compared with younger adults, older adults were more likely to be readmitted for non-stroke-related conditions.

Keywords

Ischemic stroke readmission age sex

Get full access to this article

View all access options for this article.

References

Mozaffarian

Benjamin

et al.

Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation 2016; 133: e38–e360.

Hurley

Betts

et al.

Real-world costs of ischemic stroke by discharge status. Curr Med Res Opin 2017; 33: 371–378.

Lichtman

Leifheit-Limson

Jones

Wang

Goldstein

. Preventable readmissions within 30 days of ischemic stroke among Medicare beneficiaries. Stroke 2013; 44: 3429–3435.

Ovbiagele

Goldstein

Higashida

et al.

Forecasting the future of stroke in the United States: a policy statement from the American Heart Association and American Stroke Association. Stroke 2013; 44: 2361–2375.

Center for Medicare and Medicaid Service. Readmissions Reduction Program (HRRP), www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html (accessed 17 January 2018).

Joynt

Orav

Jha

. Thirty-day readmission rates for Medicare beneficiaries by race and site of care. JAMA 2011; 305: 675–681.

Agency for Healthcare Resource and Quality. Stroke: hospital 30-day, all-cause, risk-standardized readmission rate following acute ischemic stroke hospitalization, www.qualitymeasures.ahrq.gov/summaries/summary/49199 (2015, accessed 17 January 2018).

Ramirez

Kim-Tenser

Sanossian

et al.

Trends in acute ischemic stroke hospitalizations in the United States. J Am Heart Assoc 2016; 5: e003233.

Fonarow

Reeves

Zhao

et al.

Age-related differences in characteristics, performance measures, treatment trends, and outcomes in patients with ischemic stroke. Circulation 2010; 121: 879–891.

10.

Koton

Schneider

Rosamond

et al.

Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA 2014; 312: 259–268.

11.

Poisson

Glidden

Johnston

Fullerton

. Deaths from stroke in US young adults, 1989–2009. Neurology 2014; 83: 2110–2115.

12.

Davis

Olsen

Bommarito

et al.

All-Payer Analysis of heart failure hospitalization 30-day readmission: comorbidities matter. Am J Med 2017; 130: 93.e9–93.e28.

13.

Lichtman

Jones

Wang

Watanabe

Leifheit-Limson

Goldstein

. Outcomes after ischemic stroke for hospitals with and without Joint Commission-certified primary stroke centers. Neurology 2011; 76: 1976–1982.

14.

Medicare. 30-day unplanned readmission and death measures, www.medicare.gov/HospitalCompare/Data/30-day-measures.html (accessed 17 January 2018).

15.

Hasegawa

Gibo

Tsugawa

Shimada

Camargo

Jr . Age-related differences in the rate, timing, and diagnosis of 30-day readmissions in hospitalized adults with asthma exacerbation. Chest 2016; 149: 1021–1029.

16.

project Hcau. Clinical Classification Software (CCS) for ICD-9-CM, www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp (accessed 4 May 2017).

17.

Elixhauser

Steiner

Harris

Coffey

. Comorbidity measures for use with administrative data. Med Care 1998; 36: 8–27.

18.

Patel

Deshmukh

Pant

et al.

Contemporary trends of hospitalization for atrial fibrillation in the United States, 2000 through 2010: implications for healthcare planning. Circulation 2014; 129: 2371–2379.

19.

Shah

Corado

Bergman

et al.

Impact of poststroke medical complications on 30-day readmission rate. J Stroke Cerebrovasc Dis 2015; 24: 1969–1977.

20.

Fonarow

Smith

Reeves

et al.

Hospital-level variation in mortality and rehospitalization for medicare beneficiaries with acute ischemic stroke. Stroke 2011; 42: 159–166.

21.

Smith

Liou

Frytak

Finch

. 30-day survival and rehospitalization for stroke patients according to physician specialty. Cerebrovasc Dis 2006; 22: 21–26.

22.

Vahidy

Donnelly

McCullough

et al.

Nationwide Estimates of 30-day readmission in patients with ischemic stroke. Stroke 2017; 48: 1386–1388.

23.

Forti

Maioli

Procaccianti

et al.

Independent predictors of ischemic stroke in the elderly: prospective data from a stroke unit. Neurology 2013; 80: 29–38.

24.

Dharmarajan

Hsieh

Lin

et al.

Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA 2013; 309: 355–363.

25.

Ashton

Kuykendall

Johnson

Wray

. The association between the quality of inpatient care and early readmission. Ann Intern Med 1995; 122: 415–421.

26.

Bhalla

Grieve

Tilling

Rudd

Wolfe

. Older stroke patients in Europe: stroke care and determinants of outcome. Age Aging 2004; 33: 618–624.

27.

Palnum

Petersen

Sorensen

et al.

Older patients with acute stroke in Denmark: quality of care and short-term mortality. A nationwide follow-up study. Age Aging 2008; 37: 90–95.

28.

Krumholz

. Post-hospital syndrome—an acquired, transient condition of generalized risk. N Engl J Med 2013; 368: 100–102.

29.

Walkey

Wiener

Ghobrial

Curtis

Benjamin

. Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. JAMA 2011; 306: 2248–2254.

30.

Towfighi

Saver

Engelhardt

Ovbiagele

. A midlife stroke surge among women in the United States. Neurology 2007; 69: 1898–1904.

31.

Di Carlo

Lamassa

Baldereschi

et al.

Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke 2003; 34: 1114–1119.

32.

Kapral

Fang

Hill

et al.

Sex differences in stroke care and outcomes: results from the Registry of the Canadian Stroke Network. Stroke 2005; 36: 809–814.

33.

McDermott

Lisabeth

Baek

et al.

Sex disparity in stroke quality of care in a community-based study. J Stroke Cerebrovasc Dis 2017; 26: 1781–1786.

34.

Dreyer

Dharmarajan

Kennedy

et al.

Sex differences in 1-year all-cause rehospitalization in patients after acute myocardial infarction: a prospective observational study. Circulation 2017; 135: 521–531.

35.

Olson

Wood

Delate

et al.

Positive predictive values of ICD-9 codes to identify patients with stroke or TIA. Am J Manag Care 2014; 20: e27–e34.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.49 MB

Age-related differences in the rate and diagnosis of 30-day readmission after hospitalization for acute ischemic stroke

Abstract

Background

Aim

Methods

Results

Conclusions

Keywords

Get full access to this article

References

Supplementary Material