TY - JOUR
T1 - Factors associated with 1-year mortality after discharge for acute stroke
T2 - what matters?
AU - Magdon-Ismail, Zainab
AU - Ledneva, Tatiana
AU - Sun, Mingzeng
AU - Schwamm, Lee H.
AU - Sherman, Barry
AU - Qian, Feng
AU - Bettger, Janet Prvu
AU - Xian, Ying
AU - Stein, Joel
N1 - Publisher Copyright:
© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2018/11/17
Y1 - 2018/11/17
N2 - Objective: To evaluate factors associated with 1-year mortality after discharge for acute stroke. Methods: In this retrospective cohort study, we studied 305 patients with ischemic stroke or intracerebral hemorrhage discharged in 2010/2011. We linked Get With The Guidelines®-Stroke clinical data with New York State administrative data and used multivariate regression models to examine variables related to 1-year all-cause mortality poststroke. Results: The mean age was 68.6 ± 14.8 years and 51.1% were women. A total of 146 (47.9%) were discharged directly home, 96 (31.5%) to inpatient rehabilitation facilities (IRFs), and 63 (20.7%) to skilled nursing facilities (SNFs). Overall, 24 (7.9%) patients died within 1-year post-discharge. Older age (adjusted odds ratio [OR] 1.05, 95% confidence interval [CI] 1.00–1.10), higher National Institutes of Health Stroke Scale (NIHSS) on admission (OR 1.10, 95% CI 1.03–1.17), and discharge destination (IRF vs. home, OR 0.10, 95% CI 0.01–0.94; and SNF vs. home, OR 2.22, 95% CI 0.71–6.95) were factors associated with 1-year all-cause mortality. When ambulation status at discharge was added to the model, ambulation with assistance and non-ambulation were significantly associated with mortality (ambulatory with assistance vs. ambulatory, OR 9.42, 95% CI 1.87–47.61; nonambulatory vs. ambulatory, OR 12.65, 95% CI 1.89–84.89). Conclusions: While age and NIHSS on admission are important predictors of long-term outcomes, factors at discharge–ambulation status at discharge and discharge destination–are associated with 1-year mortality post-discharge for acute stroke and therefore could represent therapeutic targets to improve long-term survival in future studies.
AB - Objective: To evaluate factors associated with 1-year mortality after discharge for acute stroke. Methods: In this retrospective cohort study, we studied 305 patients with ischemic stroke or intracerebral hemorrhage discharged in 2010/2011. We linked Get With The Guidelines®-Stroke clinical data with New York State administrative data and used multivariate regression models to examine variables related to 1-year all-cause mortality poststroke. Results: The mean age was 68.6 ± 14.8 years and 51.1% were women. A total of 146 (47.9%) were discharged directly home, 96 (31.5%) to inpatient rehabilitation facilities (IRFs), and 63 (20.7%) to skilled nursing facilities (SNFs). Overall, 24 (7.9%) patients died within 1-year post-discharge. Older age (adjusted odds ratio [OR] 1.05, 95% confidence interval [CI] 1.00–1.10), higher National Institutes of Health Stroke Scale (NIHSS) on admission (OR 1.10, 95% CI 1.03–1.17), and discharge destination (IRF vs. home, OR 0.10, 95% CI 0.01–0.94; and SNF vs. home, OR 2.22, 95% CI 0.71–6.95) were factors associated with 1-year all-cause mortality. When ambulation status at discharge was added to the model, ambulation with assistance and non-ambulation were significantly associated with mortality (ambulatory with assistance vs. ambulatory, OR 9.42, 95% CI 1.87–47.61; nonambulatory vs. ambulatory, OR 12.65, 95% CI 1.89–84.89). Conclusions: While age and NIHSS on admission are important predictors of long-term outcomes, factors at discharge–ambulation status at discharge and discharge destination–are associated with 1-year mortality post-discharge for acute stroke and therefore could represent therapeutic targets to improve long-term survival in future studies.
KW - Stroke
KW - ambulation
KW - mortality
KW - rehabilitation
UR - http://www.scopus.com/inward/record.url?scp=85054414193&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85054414193&partnerID=8YFLogxK
U2 - 10.1080/10749357.2018.1499303
DO - 10.1080/10749357.2018.1499303
M3 - Article
C2 - 30281414
AN - SCOPUS:85054414193
SN - 1074-9357
VL - 25
SP - 576
EP - 583
JO - Topics in Stroke Rehabilitation
JF - Topics in Stroke Rehabilitation
IS - 8
ER -