Nadine E Andrew1,2, Monique F Kilkenny2,3, Vijaya Sundararajan4, Joosup Kim2,3, Steven G Faux5,6, Amanda G Thrift2, Trisha Johnston7, Rohan Grimley2,8, Melina Gattellari9, Judith M Katzenellenbogen10, Helen M Dewey11, Natasha A Lannin12, Craig S Anderson13,14,15,16, Dominique A Cadilhac2,3. 1. Department of Medicine, Peninsula Clinical School, Central Clinical School (N.E.A.), Monash University, VIC, Australia. 2. Stroke & Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (N.E.A., M.F.K., J.K., A.G.T., R.G., D.A.C.), Monash University, VIC, Australia. 3. Florey Institute of Neuroscience and Mental Health, VIC, Australia (M.F.K., J.K., D.A.C.). 4. Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, VIC, Australia (V.S.). 5. St Vincent's Hospital, NSW, Australia (S.G.F.). 6. University of New South Wales, NSW, Australia (S.G.F.). 7. Health Statistics Branch, Queensland Department of Health, QLD, Australia (T.J.). 8. School of Medicine, Griffith University, QLD, Australia (R.G.). 9. Department of Neurology, Royal Prince Alfred Hospital, NSW, Australia (M.G.). 10. School of Population and Global Health, The University of Western Australia, WA, Australia (J.M.K.). 11. Eastern Health Clinical School, Monash University, VIC, Australia (H.M.D.). 12. Department of Neuroscience, Central Clinical School (N.A.L.), Monash University, VIC, Australia. 13. Royal Prince Alfred Hospital, NSW, Australia (C.S.A.). 14. The George Institute for Global Health, NSW, Australia (C.S.A.). 15. Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, NSW, Australia (C.S.A.). 16. The George Institute for Global Health at Peking University Health Science Center China (C.S.A.).
Abstract
BACKGROUND AND PURPOSE: A comprehensive understanding of the long-term impact of stroke assists in health care planning. We aimed to determine changes in rates, causes, and associated factors for hospital presentations among long-term survivors of stroke. METHODS: Person-level data from the AuSCR (Australian Stroke Clinical Registry) during 2009 to 2013 were linked with state-based health department emergency department and hospital admission data. The study cohort included adults with first-ever stroke who survived the first 6 months after discharge from hospital. Annualized rates of hospital presentations (nonadmitted emergency department or admission)/person/year were calculated for 1 to 12 months prior, and 7 to 12 months (inclusive) after hospitalization. Multilevel, negative binomial regression was used to identify associated factors after adjustment for prestroke hospital presentations and stratification for perceived impairment status. Perceived impairments to health were defined according to the subscales and visual analog health status scores on the 5-Dimension European Quality of Life Scale. RESULTS: There were 7183 adults with acute stroke, 7-month survivors (median age 72 years; 56% male; 81% ischemic, and 42% with impairment at 90-180 days) from 39 hospitals included in this landmark analysis. Annualized presentations/person increased from 0.88 (95% CI, 0.86-0.91) to 1.25 (95% CI, 1.22-1.29) between the prestroke and poststroke periods, with greater rate increases in those with than without perceived impairment (55% versus 26%). Higher presentation rates were most strongly associated with older age (≥85 versus 65 years, incidence rate ratio, 1.52 [95% CI, 1.27-1.82]) and greater comorbidity score (incidence rate ratio, 1.06 [95% CI, 1.02-1.10]), whereas reduced rates were associated with greater social advantage (incidence rate ratio, 0.71 [95% CI, 0.60-0.84]). Poststroke hospital presentations (7-12 months) were most frequently related to recurrent cardiovascular and cerebrovascular events and sequelae of stroke. CONCLUSIONS: A large increase in annualized hospital presentation rates after stroke indicates the potential for improved community management and support for this vulnerable patient group.
BACKGROUND AND PURPOSE: A comprehensive understanding of the long-term impact of stroke assists in health care planning. We aimed to determine changes in rates, causes, and associated factors for hospital presentations among long-term survivors of stroke. METHODS: Person-level data from the AuSCR (Australian Stroke Clinical Registry) during 2009 to 2013 were linked with state-based health department emergency department and hospital admission data. The study cohort included adults with first-ever stroke who survived the first 6 months after discharge from hospital. Annualized rates of hospital presentations (nonadmitted emergency department or admission)/person/year were calculated for 1 to 12 months prior, and 7 to 12 months (inclusive) after hospitalization. Multilevel, negative binomial regression was used to identify associated factors after adjustment for prestroke hospital presentations and stratification for perceived impairment status. Perceived impairments to health were defined according to the subscales and visual analog health status scores on the 5-Dimension European Quality of Life Scale. RESULTS: There were 7183 adults with acute stroke, 7-month survivors (median age 72 years; 56% male; 81% ischemic, and 42% with impairment at 90-180 days) from 39 hospitals included in this landmark analysis. Annualized presentations/person increased from 0.88 (95% CI, 0.86-0.91) to 1.25 (95% CI, 1.22-1.29) between the prestroke and poststroke periods, with greater rate increases in those with than without perceived impairment (55% versus 26%). Higher presentation rates were most strongly associated with older age (≥85 versus 65 years, incidence rate ratio, 1.52 [95% CI, 1.27-1.82]) and greater comorbidity score (incidence rate ratio, 1.06 [95% CI, 1.02-1.10]), whereas reduced rates were associated with greater social advantage (incidence rate ratio, 0.71 [95% CI, 0.60-0.84]). Poststroke hospital presentations (7-12 months) were most frequently related to recurrent cardiovascular and cerebrovascular events and sequelae of stroke. CONCLUSIONS: A large increase in annualized hospital presentation rates after stroke indicates the potential for improved community management and support for this vulnerable patient group.
Entities:
Keywords:
big data; health services; hospitalization; patient readmissions; quality of life; stroke; stroke and neuroscience