What are the risks of hospital readmission from 3 months to 1 year after a cerebrovascular accident (CVA) or stroke?

From the Guidelines

Patients who have experienced a stroke should be monitored closely for readmission risks from 3 months to 1 year after their initial event, with a focus on comprehensive secondary prevention and rehabilitation to reduce morbidity, mortality, and improve quality of life. Approximately 20-30% of stroke survivors are readmitted during this period, most commonly due to recurrent stroke, cardiovascular complications, infections, and falls 1. To reduce readmission risk, patients should adhere to a comprehensive secondary prevention regimen including antiplatelet therapy (aspirin 81-325mg daily, clopidogrel 75mg daily, or combination therapy depending on stroke type and risk factors), appropriate anticoagulation for those with atrial fibrillation (such as apixaban 5mg twice daily, rivaroxaban 20mg daily, or warfarin with target INR 2-3), and high-intensity statin therapy (atorvastatin 40-80mg or rosuvastatin 20-40mg daily) 1.

Some key points to consider in the management of stroke patients include:

• Blood pressure should be maintained below 130/80 mmHg using appropriate antihypertensives 1
• Regular follow-up appointments should occur at 1,3,6, and 12 months post-discharge with a neurologist or stroke specialist to monitor recovery, medication adherence, and address complications 1
• Patients should also receive rehabilitation services as needed, including physical, occupational, and speech therapy 1
• Early recognition of warning signs such as new weakness, speech changes, severe headaches, or dizziness is crucial, and patients should be educated to seek immediate medical attention if these occur 1
• Physical activity is particularly important for the prevention of secondary complications related to recurrent stroke and other CVDs, and patients should be encouraged to engage in moderate-intensity physical activity on a regular basis 1

This comprehensive approach addresses the multifactorial nature of post-stroke complications and helps prevent readmissions during this critical recovery period, ultimately improving morbidity, mortality, and quality of life for stroke survivors 1.

From the Research

Readmission to Hospital from 3 Months to 1 Year After Stroke

• The rate of readmission to hospital after stroke is significant, with 30.5% of patients being readmitted within 1 year following initial discharge 2.
• The most common causes of readmissions between 30-364 days are stroke and post-stroke sequelae (15.0% of readmissions), followed by sepsis (9.4% of readmissions), and acute renal failure (3.0% of readmissions) 2.
• Patients at increased risk of readmission are older, have longer initial lengths of stay, and more often have modifiable comorbidities, including vascular risk factors, depression, epilepsy, and drug abuse 2.
• Social determinants associated with increased readmission include living in an urban setting, living in zip-codes with the lowest median income, and having Medicare insurance 2.

Risk Factors for Readmission

• Older age (71.6 vs. 69.8 years, p<0.001) and longer initial lengths of stay (7.6 vs. 6.2 days, p<0.001) are significant risk factors for readmission 2.
• Modifiable comorbidities, such as hypertension, diabetes, atrial fibrillation, depression, epilepsy, and drug abuse, increase the risk of readmission 2.
• The use of sedative/hypnotic medications is also associated with a higher rate of readmission to acute care 3.

Prevention of Readmission

• Efforts to reduce readmissions should focus on optimizing secondary stroke and infection prevention, particularly among older socially disadvantaged patients 2.
• The use of clopidogrel and/or aspirin for ischemic stroke/transient ischemic attack may help minimize the risk for recurrent stroke, but the risk of bleeding should be carefully considered 4, 5, 6.