Study reveals “staggering” statistics on Medicare patients who will die or be readmitted within one year of stroke

This post was authored by Brian Nash and posted to The Eye Opener on December 22nd, 2010.

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Today I came across an excellent post in theheart.org entitled “Death and readmission rates after stroke “staggering” for Medicare Patients.” As a general comment, if you are not familiar with this online journal, I would strongly recommend you register (it’s free). They post a number of excellent pieces on a consistent basis.

Dr. Gregg Fonarow and colleagues did a study examining the outcomes for 91,134 Medicare patients, who had suffered an ischemic stroke between April 1, 2003 and December 31, 2006. The researchers themselves described their findings as “staggering.” Here is the essential finding:

Almost two-thirds of Medicare beneficiaries discharged from the hospital after suffering an ischemic stroke die or are readmitted within a year.

Does the type of hospital make a difference?

While ostensibly not the major focus of the study, Dr. Fonarow’s research team did examine data to determine if the outcomes were significantly better if the patient was seen for the initial acute ischemic stroke at an academic center versus a non-academic (e.g. community hospital). The finding in this regard was not what I expected.

Rates were only slightly lower for academic hospitals than nonacademic centers. “That was surprising,” said Fonarow. “Whether a hospital was academic or bedside or, more important, a joint commission primary stroke center really did not make a large difference in outcomes.”

The impact on the healthcare system is obvious and alarming

I don’t claim to have any expertise in statistical analysis or application of such data to a system-wide root cause analysis. That being said, does it really take a statistician or┬ámathematician to grasp the import of this “staggering” data? If you or someone you know is on Medicare and has suffered an acute ischemic stroke, there is a 2 out of 3 chance you (or the person you know) will be readmitted or die within one year of suffering that stroke!

The big questions: Why and What can be done?

Dr. Fonarow readily admits that the data he collected does not lend itself to the ultimate answers. What he does note, however, is that while further studies are clearly warranted, since more than one-half of the cases for readmission analyzed involved non-cardiovascular causes, “there’s room for better secondary-prevention efforts.”

“When you looked at causes of readmission, in many cases it was not a recurrent stroke or cardiovascular event but other comorbid conditions, such as pneumonia, falls, and GI bleeds,” he said. “It shows you that when caring for someone after a stroke, managing these comorbid conditions and related risks is going to be critical.”

He added that the period after discharge for an ischemic stroke offers a “window of opportunity” for interventions to reduce the burden of post-ischemic stroke morbidity and mortality.

The information shared by Dr. Fonarow is unequivocally “staggering.” One can only hope that further system-wide studies are performed soon to identify what improvements can and need be made in the delivery of health care to this population to reduce such loss of life and burden on the healthcare system secondary to readmissions.

What’s your reaction to Dr. Fonarow’s study? Are you aware of any data that is known for death and readmission rates in the non-Medicare population? If there is a significant difference in death and readmission rates between Medicare and non-Medicare patients, what is being done in the non-Medicare population that can be adopted for all patient populations?

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One Response to “Study reveals “staggering” statistics on Medicare patients who will die or be readmitted within one year of stroke”

  1. TheresaNo Gravatar says:

    Mr. Nash,

    It seems that most of the research to date has been done on the front-end of treating an acute stroke — first diagnosing whether the stroke is ischemic or hemorrhagic, then initiating the so-called “clot-busters” within 3 hours of onset of symptoms. Unfortunately, that rarely gets done. Why? People wait to seek treatment, or they stroke while asleep and awake with signs and symptoms of stroke. I have known people who have waited 2 to 3 days before seeking treatment; sometimes it’s intentional while other times it’s related to an elderly person living alone and unable to get to the phone.
    The AHA/ASA recently published new guidelines on stroke prevention. We are doing a better job in that respect with overall decreased incidence of stroke in both men and women with improved management of blood pressure, high cholesterol, carotid endarterctomies and stenting, etc. We still need to do a better job at smoking prevention, managing obesity, increasing daily exercise routines in everyone and improving our diets!
    Very little research has been done on the back-end of strokes — a.k. after someone has a stroke! This is very interesting yet very alarming data! Having worked in the ER for many years, I can appreciate the “complications” of ischemic stroke that often lead to re-admissions and even death. Those with resultant bladder dysfunction often get urinary tract infections and urosepsis. Those with dysphagia often have trouble controlling their oral secretions resulting in aspiration pneumonia and sepsis. Those with hemiplegia do fall very often sustaining fractures (e.g. hip, femur, shoulder/humerus, vertebral, ribs, etc.) which often require surgical intervention or significant immobility; these elderly people cannot handle the demands of anaesthesia, surgery and recovery, let alone the immobility. They become fearful of more falls, withdrawing from social activities and losing even more muscle tone and strength. They develop skin breakdown and decubitus ulcers, some of which are never felt due to sensory loss. It is an awful downward spiral effect.

    Bottom line is that we have a ways to go in both stroke prevention and post-CVA treatment of patients. We need to identify potential complications based on a stroke patient’s extent of injury and provide prophylactic interventions to attempt to avoid these complications. Families need to be more involved and not simply ship their loved one to a “nursing home”. Nursing homes are a whole other topic reserved for another day!

    Thanks for sharing….

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