Bravata Dawn M, Ho Shih-Yieh, Meehan Thomas P, Brass Lawrence M, Concato John
Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516, USA.
Stroke. 2007 Jun;38(6):1899-904. doi: 10.1161/STROKEAHA.106.481465. Epub 2007 May 17.
Stroke is a leading cause of hospital admission among the elderly. Although studies have examined subsequent vascular outcomes, limited data are available regarding the full burden of hospital readmission after stroke. We sought to determine the rates of hospital readmissions and mortality and the reasons for readmission over a 5-year period after stroke.
This retrospective observational cohort study included Medicare beneficiaries aged >65 years who survived hospitalization for an acute ischemic stroke (International Classification of Diseases, Ninth Revision, Clinical Modification codes 434 and 436) and who were discharged from Connecticut acute care hospitals in 1995. This population was followed from discharge in 1995 through 2000 using part A Medicare claims and Social Security Administration mortality data. The primary outcome was hospital readmission and mortality and readmission diagnosis.
Among 2603 patients discharged alive, more than half had died or been readmitted at least once during the first year after discharge (1388/2603, 53.3%), and <15% survived admission-free for 5 years (372/2603, 14.3%). The reasons for hospital readmission varied over time, with stroke remaining a leading cause for readmission (3.9 to 6.1% of patients annually). Acute myocardial infarction accounted for a comparable number of readmissions (4.2 to 6.0% of patients annually). The most common diagnostic category associated with readmission, however, was pneumonia or respiratory illnesses, with an annual readmission rate between 8.2% and 9.0% throughout the first 5 years after stroke.
Few stroke patients survive for 5 years without a hospital readmission. Between the acute care setting and readmission to the hospital, a window of opportunity may exist for interventions, beyond prevention of recurrent vascular events alone, to reduce the huge public health burden of poststroke morbidity.
中风是老年人住院的主要原因。尽管已有研究对后续血管事件进行了考察，但关于中风后再次入院的全部负担的数据有限。我们试图确定中风后5年内的再次入院率、死亡率以及再次入院的原因。
这项回顾性观察队列研究纳入了年龄大于65岁、因急性缺血性中风住院存活（国际疾病分类第九版临床修订本编码434和436）且于1995年从康涅狄格州急性护理医院出院的医疗保险受益人。利用医疗保险A部分理赔数据和社会保障管理局的死亡率数据，对该人群从1995年出院至2000年进行随访。主要结局是再次入院、死亡率以及再次入院诊断。
在2603例存活出院的患者中，超过一半在出院后的第一年至少有过一次死亡或再次入院（1388/2603，53.3%），不到15%的患者5年未再次入院存活（372/2603，14.3%）。再次入院的原因随时间变化，中风仍是再次入院的主要原因（每年患者的3.9%至6.1%）。急性心肌梗死导致的再次入院人数相当（每年患者的4.2%至6.0%）。然而，与再次入院相关的最常见诊断类别是肺炎或呼吸道疾病，在中风后的前5年中，年再次入院率在8.2%至9.0%之间。
很少有中风患者能5年不再次入院存活。在急性护理环境和再次入院之间，可能存在一个干预机会窗口，除了预防复发性血管事件外，还可减轻中风后发病的巨大公共卫生负担。
