Health Risks Rise for Medicare Patients in Year After Stroke

THURSDAY Dec. 16, 2010 -- Within a year of having a stroke, almost two-thirds of Medicare patients die or wind up back in the hospital, a new study reports.

The findings highlight the need for better quality care for stroke patients, in the hospital and after they are sent home, experts noted.

"Patients with acute ischemic stroke are at very high risk for recurrent hospitalization and post-discharge mortality," said Dr. Gregg C. Fonarow, chief of cardiology at UCLA's David Geffen School of Medicine and the study's lead researcher.

"These findings underscore the need to better understand the patterns and causes of deaths and readmission after ischemic stroke and to develop strategies aimed at avoiding those that are preventable," he said.

"Between the acute presentation with an ischemic stroke and a readmission to the hospital or post-discharge death, a window of opportunity exists for interventions to reduce the burden of post-ischemic stroke morbidity and mortality," Fonarow added.

The report was published online Dec. 16 in Stroke.

For the study, Fonarow's team collected data on 91,134 Medicare patients, who averaged 79 years old and had been treated for a stroke at 625 hospitals. All hospitals took part in the American Heart Association's Get with the Guidelines program, which helps facilities improve care for people with heart disease or who've had a stroke.

The researchers found that 14.1 percent of stroke patients died within 30 days of their stroke and 31.1 percent died within a year. In addition, 61.9 percent of stroke patients were readmitted to the hospital or died in the year after their stroke.

"However, these outcomes after stroke greatly vary by which hospital the patient received care at," Fonarow said.

When the researchers compared the data among hospitals, they found that 9.8 percent of the stroke patients at the top-performing hospitals died within 30 days, compared with 17.8 percent of stroke patients treated at the worst-performing hospitals.

Moreover, there has been no improvement in death or rehospitalization rates after stroke among Medicare patients between 2003 and 2006, the study found.

"Increased efforts to prevent strokes are critical," Fonarow said. "For patients presenting with acute stroke, this is an important need to better implement hospital, transition-of-care and outpatient strategies aimed at avoiding those deaths and rehospitalizations that are preventable."

Commenting on the study, Dr. Ralph L. Sacco, chairman of neurology at the University of Miami Miller School of Medicine and president of the American Heart Association, said that though the death and rehospitalization rates seem high, the patients in the study were older and many had other medical problems, such as heart disease, diabetes or heart failure.

"That's probably in keeping with a Medicare population," he said. "We recognize that stroke patients have other comorbidities that can lead to rehospitalization."

According to the study, people were rehospitalized for conditions that included atrial fibrillation, a prior stroke or heart attack, heart disease and diabetes. "This is not a healthy group," Sacco said.

He noted that guidelines have concentrated on in-hospital care, but new guidelines are being developed to improving outpatient care after a stroke. The goal of these guidelines is to reduce deaths and rehospitalizations, he said.

"Better adherence, compliance and medical management are needed post-discharge," Sacco said.

And, he added, people such as those in the study may not have a long life expectancy, but they deserve a good quality of life in the time they have remaining. "Anything we can do to avoid rehospitalization and improve quality of life after stroke would be helpful," he said.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more on stroke.

Posted: December 2010


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