Background: The rates and determinant of recurrent ischemic stroke in post hospitalization period have not been studied at a national level.
Objective: To determine the rates and predictors of recurrent ischemic stroke related hospitalization within 1 year post hospitalization in a nationwide cohort of patients admitted for ischemic stroke in United States.
Methods: The study population included patients in the 2013 Nationwide Readmissions Database (NRD) over the age of 18 years with a principal diagnosis of acute ischemic stroke (ICD9 = 433x1 & 434x1) who survived the initial hospitalization. Cox proportional hazards analysis was used to identify the relative risk (RR) of recurrent ischemic stroke related hospitalization based on age, gender, selected cardiovascular risk factors, and carotid revascularization procedure during initial hospitalization.
Results: There were 503, 050 patients admitted for primary diagnosis of ischemic stroke; mean age (±SD), 70.7± 13.3 years; and 49.6% were women. Of these 18534 (3.7%) were readmitted to the hospital with principal diagnosis of ischemic stroke during one year follow up. In the Cox proportional hazards analysis adjusting age, gender, and medical comorbidities, independent factors associated with ischemic stroke related readmissions were diabetes (relative risk [RR], 1.31; 95% confidence interval [CI], 1.25-1.36; P < .0001), hypertension (RR, 1.27; 95% CI, 1.19-1.35; P < .0001), atrial fibrillation (RR, 0.87; 95% CI, 0.82-0.92; P < .0001) carotid stent placement (RR, 0.38; 95% CI, 0.31-0.47; P < .0001) and carotid endarterectomy (RR, 0.23; 95% CI, 0.21-0.26; P < .0001).
Conclusion: Patients with ischemic stroke undergoing carotid revascularization during the initial hospitalization have significantly lower risk of readmission related to another ischemic stroke