Larson Sarah, John Shirlene, Gowrisankar Sriesakthi, Zhao Molly, Piner Brianna, Dallasta Isabella, Marsh Elisabeth B
Department of Neurology The Johns Hopkins School of Medicine Baltimore MD USA.
J Am Heart Assoc. 2025 May 6;14(9):e040986. doi: 10.1161/JAHA.124.040986. Epub 2025 Apr 25.
Poststroke follow-up is associated with decreased rehospitalization and improved long-term outcomes. However, rates are variable and dependent on numerous factors, some of which are fixed (age, sex) while others are potentially modifiable (medical knowledge, access to care). The National Institutes of Health has identified key factors for healthcare inequity using a framework based on Social Determinants of Health. It is currently unknown which of these factors are the largest drivers of poststroke follow-up.
We evaluated a prospectively collected cohort of ≈2600 patients treated for ischemic stroke between 2014 and 2022. Potential variables were identified using the Social Determinants of Health framework and categorized as nonmodifiable or modifiable. tests, , and regression analyses were used to investigate their association with the likelihood of follow-up.
Fifty-six percent of patients returned to the clinic. Greater degrees of impairment (due to stroke severity, advanced age, and premorbid condition), less education, scheduling inflexibility (due to occupation and employment status), and lack of home support were nonmodifiable factors associated with decreased follow-up rates. Greater postdischarge needs (evaluated by rehabilitation status and discharge disposition) along with less family involvement during the discharge process were also associated with lower rates.
This study identifies key factors associated with poor follow-up, defining an at-risk population. Modifiable factors may serve as targets for enhanced postdischarge support, suggesting that patients may benefit from interventions aimed at family support and improved communication with rehabilitation facilities. The approach underscores the value of integrating Social Determinants of Health considerations into patient management to ensure equitable and effective healthcare delivery.
卒中后随访与再住院率降低及长期预后改善相关。然而，随访率存在差异且取决于众多因素，其中一些是固定因素（年龄、性别），而其他因素则可能是可改变的（医学知识、医疗可及性）。美国国立卫生研究院使用基于健康社会决定因素的框架确定了医疗保健不公平的关键因素。目前尚不清楚这些因素中哪些是卒中后随访的最大驱动因素。
我们评估了2014年至2022年间前瞻性收集的约2600例缺血性卒中患者队列。使用健康社会决定因素框架确定潜在变量，并将其分类为不可改变或可改变的变量。采用检验、 、和回归分析来研究它们与随访可能性的关联。
56%的患者返回诊所。更高程度的功能障碍（由于卒中严重程度、高龄和病前状况）、教育程度较低、日程安排不灵活（由于职业和就业状况）以及缺乏家庭支持是与随访率降低相关的不可改变因素。出院后需求更大（通过康复状况和出院处置评估）以及出院过程中家庭参与较少也与较低的随访率相关。
本研究确定了与随访不佳相关的关键因素，明确了高危人群。可改变因素可能成为加强出院后支持的目标，这表明患者可能从旨在提供家庭支持和改善与康复机构沟通的干预措施中获益。该方法强调了将健康社会决定因素考量纳入患者管理以确保公平和有效医疗服务提供的价值。
