Shultz, Jessica

Importance: The increasing prevalence and clinical and clinical impact of chronic conditions (CCs) have been recognized as an important public health concern. Objectives: To evaluate trends in co-existing CCs and their association 30-day mortality and readmission rates in hospitalized patients with first-ever stroke and transient ischemic attack (TIA). Design: Retrospective study of patient hospitalized for first stroke or TIA. Results: Study cohort of 6,771 patients, hospitalized for first-ever stroke (n = 4,068 60.1%) and first-ever TIA (n = 2,703, 39.9%) with mean age 68.2 (standard deviation, ± 15.6) years, 51.4 % men, mean number of CCs 2.9 (± 1.7), 30-day mortality 8.6% and 30-day readmission rate 8.2%. The prevalence of multiple CCs was increased from 73.7% in 2005-2006 to 81.9% in 2013-2015, which was driven by a dramatic rise in the proportion of patient with ≥4 CCs from 27.4% to 46.4% during the study interval. In multivariable models, significant predictors of a) 30-day mortality were co-existing heart failure (HF) (odds ratio [OR] 1.45, 95% confidence interval [CI] 1.09-1.92), cardiac arrhythmia (OR 1.74, 95% CI 1.40-2.17), coronary artery disease(CAD) (OR 1.64, 95% CI 1.29-2.08), cancer (OR 1.67, 95% CI 1.31-2.14), and diabetes (HR 1.28, 95% CI 1.01-1.62) and b) 30-day readmission were co-existing HF (OR 1.45, 95% CI 1.06-1.99), chronic kidney disease (OR 1.55, 95% CI 1.17-2.04), CAD (OR 1.36, 95% CI 1.09-1.70), and cancer (OR 1.58, 95% CI 1.25-2.00), and patients with ≥4 co-existing CCs (OR 1.83, 95% CI 1.37-2.45). Conclusions and Relevance: In this large patient-population, we demonstrated a recent trend of continued increase in several CCs among hospitalized patients with acute stroke and TIA over 10-year period. Several CCs were associated with increased risk of 30-day all-cause mortality and readmission after initial hospitalization. Thus, interventions targeted to patients with CCs may improve these outcomes for patients with stroke and TIA.

Background and Purpose— We aimed at providing estimates of mortality associated with cardiometabolic comorbidity and incident readmission from cardiometabolic as compared with noncardiometabolic conditions after a first transient ischemic attack. Methods— Between 2000 and 2015, patients hospitalized for a first transient ischemic attack were examined for cardiometabolic comorbidities (diabetes mellitus, coronary artery disease, heart failure, and atrial fibrillation), 5-year incident hospitalization, and time to death. Results— Of 251 patients with transient ischemic attack, 134 (53%) had at least 1 and 55 (22%) had at least 2 cardiometabolic conditions. By 5 years, 491 readmissions (134 [27%] cardiometabolic and 357 [73%] noncardiometabolic) and 75 deaths (27 [36%] cardiometabolic and 47 [64%] noncardiometabolic) were observed. Mortality was increased with any concurrent cardiometabolic comorbidity (hazard ratio, 1.89; 95% confidence interval, 1.17–3.03; P =0.0089) with multiplicative mortality risk from a combination of coronary artery disease and heart failure. Each hospitalization was associated with a 1.5-fold risk of death (95% confidence interval, 1.37–1.64; P <0.0001). Risk of cardiometabolic and noncardiometabolic mortality was correlated with the corresponding category-specific readmission. Conclusions— Among patients hospitalized for first transient ischemic attack, 5-year mortality is associated with concurrent cardiometabolic comorbidity and rates of subsequent hospitalization.

AbstractBackgroundThe implications of early readmission on long‐term mortality after transient ischemic attack (TIA) are not known. We aimed at examining the effect of 180‐day readmission on subsequent long‐term mortality after index hospitalization for TIA.MethodsA retrospective study of patients hospitalized for first‐ever TIA at Mayo Clinic from 2000 through 2017. Patients readmitted within 180 days postdischarge were compared with those not readmitted in long‐term risk of death.ResultsOf 251 TIA patients aged 73 ± 15 years with 1509 person‐years of follow‐up, 65 (26%) were readmitted within 180 days of discharge and 125 died during a median follow‐up of 5.7 years. The mortality was 10 vs. 7 deaths per 100 person‐years in patients who were readmitted compared to those who were not readmitted with hazard ratio (HR) 1.73 (95% confidence interval [CI] 1.13–2.66). Other competing predictors of mortality were age ≥65 years (HR 5.70, 95% CI 2.72–11.96), cancer (HR 1.65, 95% CI 1.03–3.38), chronic obstructive pulmonary disease (HR 1.90, 95% CI 1.07–3.38), heart failure (HR 3.03, 95% CI 1.82–5.06), dementia (HR 5.87, 95% CI 3.27–10.52), creatinine ≥1.4 mg/dl (HR 1.89, 95% CI 1.17–3.06), and hemoglobin level <10 g/dl (HR 2.80, 95% CI 1.20–6.66).ConclusionsHospital readmission within 180 days of discharge from index TIA was associated with increased risk of death several years after initial readmission. Older age and several comorbidities identified during index hospitalization also confer increased risk for long‐term mortality.