Background and Objective: Follow-up in outpatient stroke clinic after hospitalization for ischemic stroke is an integral aspect of the management of stroke patients. This study sought to investigate predictors of risk of not following up in outpatient stroke clinic.
Methods: We reviewed consecutive acute ischemic stroke patients admitted to an urban academic medical center from 4/2013 to 4/2014. On discharge, all stroke patients except those going to long term acute care received notice of scheduled follow-up stroke clinic appointment date; they also received a phone call 2-3 days prior to the appointment. Univariate analysis examined the relationship between race, ethnicity, marital status, insurance type, and living arrangement with stroke clinic follow up status. Multivariate analysis was performed with logistic regression controlling for significant factors found in our previous study including discharge location, previously documented diagnosis of depression and outpatient physicians at same institution.
Results: Among 355 acute ischemic stroke patients, 49% were female and mean age was 65 years. The follow-up rate in stroke clinic was 53%. In univariate analysis, race, ethnicity, marital status, employment status, and insurance type (i.e. self-pay) were not significantly associated with compliance with stroke clinic follow-up. In logistical regression, patients who lived alone were significantly less likely to follow up in stroke clinic compared with those living with family (OR=2.18, 95% CIs=[1.18, 4.03], p=0.01) as were patients who were depressed, (OR=5.99, CIs =[1.47, 24.4], p=0.01) who did not have other doctors at the same institution, (OR=2.23 CIs = [1.31, 3.70] p=0.003] and who were discharged to a facility other than home or acute rehab (OR=4.38, CIs [1.74, 11.03], p=0.003).
Conclusions: Institutions taking care of patients with ischemic strokes should be aware that certain patients may be less likely to follow up in clinic and merit additional efforts in order to ensure that they are not lost to follow up.