High death rates and rehospitalization found among Medicare stroke patients
Within one year after having a stroke, two thirds of Medicare recipients die or are readmitted to the hospital, shown in a new report. The study, conducted by UCLA researchers highlights the need for improved care following an ischemic cardiovascular event.
The rate of death found one year after admission to the hospital for stroke was 31.1 percent and readmission rate was 56.7 percent. Overall, the study showed a 61.9 percent of patients were readmitted or rehospitalized within one year.
Unadjusted death rate for stroke in the first year was 26.7 percent and 6.1 percent of patient died in the hospital. Thirty days after admission 14.1 percent of patients died.
The research team analyzed records of 90,000 Medicare patients admitted to the hospital between 2003 and 2006 to 625 hospitals. Data was taken from the “Get With the Guidelines–Stroke Program”, a national registry that tracks admissions for stroke.
"We need to better understand the patterns and causes of mortality and readmission after acute stroke to help avoid the hospitalizations and deaths that are preventable,” said Gregg C. Fonarow, the study's first author and associate chief of the division of cardiology at the David Geffen School of Medicine at UCLA.
The study is the first to find the high rates of stroke deaths and readmissions across the country that Fonarow says are “quite alarming”. The average age of patients was 79 years old; 58 percent were female and 82 percent were white.
Another finding was wide variations of rehospitalization and stroke related deaths among facilities. The best hospitals had a 14.4 percent rate of death and readmission and the worst rate was 28.6 percent. Many readmissions were for stroke complications such as pneumonia.
"There is a two-fold difference between the best and worst performing hospitals," Fonarow said. "We may be able to standardize treatment programs to help close this gap."
Public education about calling 911 for symptoms of stroke was also noted from the analysis. Many patients arrived at the hospital via private vehicle; something the researchers emphasize interferes with time to treatment and outcomes.
The new study shows gaps in care that the researchers say highlight a need for improvement. Fonarow says better understanding of the patterns found in the study can help “avoid the hospitalizations and deaths” found in the study related to ischemic stroke that he says are preventable.