Factors associated with 1-year mortality after discharge for acute stroke: what matters?

ABSTRACT

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.

KEYWORDS:

• Stroke
• mortality
• ambulation
• rehabilitation

Acknowledgments

We gratefully acknowledge the hospitals that participated in this study: Bassett Medical Center, Cooperstown, NY; Lutheran Medical Center, Brooklyn, NY; Millard Fillmore Suburban Hospital, Williamsville, NY; Mount Sinai St Luke’s and Mount Sinai West, New York, NY; New York-Presbyterian/Columbia University Medical Center, New York, NY; New York-Presbyterian/Weill Cornell Medical Center, New York, NY; New York-Presbyterian/The Allen Hospital, New York, NY; St Charles Hospital, Port Jefferson, NY; Stony Brook University Hospital, Stony Brook, NY; The Mount Sinai Hospital, New York, NY. Additionally, we thank Alyse Sicklick, MD, (Gaylord Hospital, Wallingford, CT), Robin Hedeman, OTR, MHA (Select Medical), and Steven R. Levine, MD (SUNY Downstate Medical Center & College of Medicine, and Kings County Hospital Center, Brooklyn, NY), of the Northeast Cerebrovascular Consortium, and Joseph P. Anarella, MPH, Ian Brissette, PhD, and Anna Colello, Esq from the New York State Department of Health, for their support of this study.

Conflict of interest disclosures

Lee H. Schwamm, MD, serves as the Chair of the Get With The Guidelines®-Stroke Clinical Work Group and as a stroke systems consultant to the Massachusetts Department of Public Health. Janet Prvu-Bettger, ScD, reports funding from Patient-Centered Outcomes Research Institute and serves as a stroke systems consultant to the Ohio Department of Health.

Additional information

Funding

The study was supported in kind by the American Heart Association/American Stroke Association, The Northeast Cerebrovascular Consortium, and the New York State Department of Health.