Study Gives 'Striking' Snapshot of Stroke Prognosis

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Nearly two-thirds of Medicare patients who are discharged after having a stroke will die or be readmitted to the hospital within a year, according to a new study in the journal Stroke.

The findings are “striking,” says study author Gregg C. Fonarow, MD, the Eliot Corday Professor of Cardiovascular Medicine and Science and the director of the Ahmanson-UCLA Cardiomyopathy Center in Los Angeles.

Fonarow and colleagues analyzed the death and hospital readmission rates for more than 91,000 Medicare beneficiaries treated for ischemic stroke at 625 hospitals from April 2003 and December 2006. The most common type of stroke, ischemic strokes occur when blood flow to the brain is blocked.

In-hospital death rates are about 14% within a month and 30% within one year of hospital admission for stroke. Within one year of hospital discharge, the stroke death or readmission rate is close to 62%, the new study showed. There were no improvements in death or rehospitalization rates from 2003 to 2006.

There was variation in rates by hospital. For example, the 30-day death rate after admission for stroke was as low as 9.8% in the top-performing hospitals to 17.8% in the bottom-performing hospitals, the study showed.

There were also no significant differences in readmission or death rates in hospitals that were certified as primary stroke centers. A primary stroke center is a hospital that provides emergency care to people having a stroke or admits stroke patients and offers additional care or transfers patients to a comprehensive stroke center when needed.

Findings Likely Apply to All Senior Citizens With Stroke
The new study only looked at Medicare beneficiaries, but the findings are likely generalizable, Fonarow says.

About 65% of patients hospitalized for stroke are aged 65 or older, which is the age that most people become eligible for Medicare. “The [new] findings thus are likely generalizable to these patients, however, whether similar findings would be seen in younger patients needs further study,” he says.

The death and rehospitalization rates seen in the study are likely due to the severity of the stroke, presence of other related health problems, and the in-hospital and follow-up care, he says.

“Between of the acute presentation with an ischemic stroke and a readmission to the hospital or postdischarge death, a window of opportunity exists for interventions to reduce the burden of postischemic stroke morbidity and mortality,” he says.

Patrick Lyden, MD, chairman of the department of neurology at Cedars-Sinai Medical Center in Los Angeles, says the findings likely apply to all senior citizens with stroke -- not just Medicare beneficiaries.

“It is very generalizable because most strokes occur in the Medicare-eligible population,” he says.

“Stroke patients are much more concerned about stroke-related disability,” he says. “What matters is are we making patients better. We need to be focusing on stroke-related disability and getting people treated in primary stroke centers.”

A clot-busting agent should be given as soon as possible after an ischemic stroke to reduce long-term damage, and this is more likely to be administered at a stroke center, he says.

Stroke warning signs include sudden numbness or weakness in the face, arm, or leg; sudden confusion, trouble speaking, sudden trouble walking, and/or a severe headache that comes on suddenly.

“Call 911 if you suspect a stroke,” Lyden says. “It is becoming more and more common for medics to direct people to stroke centers,” he says.

Aggressive Follow-up Care Can Lower Death, Readmission Rates After Stroke
Stroke is a slippery slope, says Irene Katzan, MD a stroke neurologist in the Neurological Institute at Cleveland Clinic and the director of Enterprise Stroke Systems in the Center for Outcomes Research and Evaluation in Ohio.

“Stroke is a bad disease and occurs in patients who are often sick and have other comorbid diseases,” she says. People who have strokes are often left severely disabled, and when you are disabled, you are prone to readmission and death, she says.

“This paper provides an overall national picture of how bad the problem is, and this is the tip of the iceberg because most people don’t die from a stroke, but are left functionally disabled,” she says. “These findings are not surprising, but it is sobering to see it in print on a national scale,” Katzan tells WebMD.

But aggressive follow-up care can help make a dent in these sobering statistics, she says.

“Once you leave the hospital, you should follow up with a neurologist or primary care physician so they reduce the chance of death or readmitted,” she says.


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