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.