Hospital Readmissions at 30 Days Declining for Stroke Patients

However, the decline appears to be related to other conditions, say researchers, with readmissions specific to stroke staying constant over time.

Hospital Readmissions at 30 Days Declining for Stroke Patients

Thirty-day hospital readmissions after ischemic and hemorrhagic stroke have declined over a recent 6-year period, down 4% between 2010 and 2015, according to the results of a new study.

Still, investigators report that a “considerable proportion” of stroke patients are readmitted to hospital each year, with 13.7% of patients with intracerebral hemorrhage rehospitalized within 30 days. Overall, 12.4% of subjects with acute ischemic stroke and 11.5% of patients with subarachnoid hemorrhage were readmitted within 30 days between 2010 and 2015. 

The number of patients who return to the hospital following a stroke is worrisome, said senior investigator Farhaan Vahidy, MBBS, PhD (McGovern Medical School at the University of Texas Health Science Center, Houston). Not only are readmissions problematic for patients and their families, all of whom are adjusting to a “new normal” following stroke, but readmissions stress the healthcare system and increase costs. “If a little more than one in 10 patients are returning to the hospital, it is a concerning number,” said Vahidy. “Keep in mind, when we look at the absolute numbers of patients—our analysis looked at more than 2 million patients—it’s a tremendous number.”

In the new study published August 17, 2018, in JAMA Network Open, researchers led by Arvind B. Bambhroliya, MD (McGovern Medical School at the University of Texas Health Science Center), utilized data from the Nationwide Readmissions Database, which was developed by the Agency for Healthcare Research and Quality. In total, they identified 2,078,854 stroke discharges between 2010 and 2015. The average patient age was 70 years, and 52% of subjects were female.

To TCTMD, Vahidy said there are publicly reported readmission measures based on data from the US Centers for Medicare & Medicaid Services (CMS), but these analyses are limited to patients with ischemic stroke 65 years of age and older. “We now know that stroke is no longer a disease of the elderly,” said Vahidy. “The proportion of patients affected by stroke who are younger than 60, or younger than 50, has increased over the last 10 years,” he said. “The risk profile is changing, the demographics are changing, and all of this is leading to vascular disease occurring in younger and younger patients.”

Overall, there was a 3.3% annual decline in hospital readmissions between 2010 and 2014. Over the entire study period, there was a statistically significant annual decline in the likelihood of 30-day readmission by 4.0% after controlling for changes in case mix across the study years. More than 90% of the readmissions to hospital were unplanned, with acute cerebrovascular disease and septicemia the number one and two reasons for readmission. Approximately 20% of subjects were readmitted to hospital with the same primary diagnosis as that of the index hospitalization.

Despite the annual declines in hospital readmission, Vahidy said that’s about it for the good news. “In analyzing the data, our hypothesis was that we had expected to see a decline,” he said. “We tried to piece out why the decline was happening and that’s where the optimism ends. . . . Readmissions resulting from a second stroke, or a condition related to the second stroke—those have actually not declined. Unfortunately, in some cases, those readmissions have gone up.”

Vahidy suspects that the overall reduction in hospital readmissions is driven by reductions in other conditions, such as cardiac or renal events, among others. “We believe the primary thing that needs to be addressed is secondary stroke prevention,” he said.

We tried to piece out why the decline was happening and that’s where the optimism ends. . . . Readmissions resulting from a second stroke, or a condition related to the second stroke—those have actually not declined. Farhaan Vahidy

In addition, the researchers also analyzed stroke readmissions across hospitals (teaching and nonteaching) and based on hospital stroke volume. Vahidy told TCTMD there had been a concern that high-volume, academic teaching centers might have a higher rate of hospital readmissions because these centers tend to serve as safety-net hospitals who treat sicker, more complicated cases. In total, there 1,397 hospitals included in their analysis and the median stroke volume was 99 cases per year.

There was no difference in the likelihood of hospital readmissions within 30 days between academic and nonteaching hospitals with a low annual stroke volume. However, as annual stroke volumes increased, there was a greater likelihood of readmission among nonteaching hospitals compared with academic medical centers.

“What these data are suggesting is that the quality of care provided at large, academic hospitals might have something to do with being able to handle a large volume of stroke patients,” said Vahidy. “They are able to keep readmission rates constant despite the fact they are treating more patients.” These types of analyses, which provide more granularity than is currently available in the CMS publicly reported data, can help empower patients and families and allow them to make more informed decisions, added Vahidy.

Michael O’Riordan is the Associate Managing Editor for TCTMD and a Senior Journalist. He completed his undergraduate degrees at Queen’s…

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  • Bambhroliya and Vahidy report no relevant conflicts of interest.

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