A high-risk population for stroke recurrence exists among home-based stroke survivors discharged from an acute care hospital: A retrospective analysis

Abstract

Objectives

To examine whether the factors determining discharge destination after acute-phase treatment for stroke differ based on recurrence risk levels.

Design

Retrospective study.

Setting

General acute care hospital.

Participants

Acute ischemic stroke survivors (n = 1219).

Main outcome measures

Patients were stratified using the Stroke Prognosis Instrument II (SPI-II) and evaluated through forced-entry multiple logistic regression analysis. Among the independent variables, the primary outcome measure was the modified Rankin Scale (mRS) at discharge. Covariates included age, sex, and histories of diabetes, cerebral infarction, cerebral hemorrhage, coronary artery disease, hypertension, and congestive heart failure. The dependent variable grouped participants into those discharged home and those discharged to a medical facility.

Results

Among the 1219 included participants, 914 were classified into the home care group and 305 into the medical facility care group. SPI-II-based stratification revealed that 78.665% of the home care group had a moderate or higher risk of stroke recurrence. Multiple logistic regression analysis demonstrated that mRS at discharge was a significant factor across all stratified models, while age was a significant factor only within the moderate-risk group.

Conclusions

Discharge decisions after acute-phase treatment were primarily influenced by short-term functional independence, as reflected by mRS, rather than recurrence risk levels. Thus, a substantial proportion of stroke survivors with a high recurrence risk transitioned to home care. These findings highlight the need to revise current medical and social welfare services and to develop targeted strategies for stroke recurrence prevention, based on a more detailed understanding of the living environments of stroke survivors.