Key result
Stroke subtypes show no significant difference in all-cause readmission risk after incident stroke.
Why the study?
Risk of readmission after stroke differs by subtype and etiology, prompting examination of the risk and cause of first readmission by stroke subtype over the years following incident stroke.
Does stroke subtype affect the risk of subsequent all-cause hospitalization in patients with first-ever stroke?
Cohort (n=1,412)
Yes
Does stroke subtype affect the risk of subsequent all-cause hospitalization in patients with first-ever stroke?
Effect estimate: HR 0.82 (95% CI 0.71-0.95)
Absolute Event Rate: 83% vs 77%
While cardioembolic stroke initially appears to confer a higher risk of readmission, this difference is not statistically significant when accounting for atrial fibrillation and the competing risk of death.
No support for subtype-based readmission predictions after first stroke; leaves open the impact of competing mortality in long-term observational data.
BACKGROUND AND OBJECTIVES: Risk of readmission after stroke differs by stroke (sub)type and etiology, with higher risks reported for hemorrhagic stroke and cardioembolic stroke. We examined the risk and cause of first readmission by stroke subtype over the years post incident stroke. METHODS: Atherosclerosis Risk in Communities (ARIC) study participants (n = 1,412) with first-ever stroke were followed up for all-cause readmission after incident stroke. Risk of first readmission was examined by stroke subtypes (cardioembolic, thrombotic/lacunar, and hemorrhagic [intracerebral and subarachnoid]) using Cox and Fine-Gray proportional hazards models, adjusting for sociodemographic and cardiometabolic risk factors. RESULTS: Among 1,412 participants (mean [SD] age 72.4 [9.3] years, 52.1% women, 35.3% Black), 1,143 hospitalizations occurred over 41,849 person-months. Overall, 81% of participants were hospitalized over a maximum of 26.6 years of follow-up (83% of participants with thrombotic/lacunar stroke, 77% of participants with cardioembolic stroke, and 78% of participants with hemorrhagic stroke). Primary cardiovascular and cerebrovascular diagnoses were reported for half of readmissions. Over the entire follow-up period, compared with cardioembolic stroke, readmission risk was lower for thrombotic/lacunar stroke (hazard ratio [HR] 0.82, 95% CI 0.71-0.95) and hemorrhagic stroke (HR 0.74, 95% CI 0.58-0.93) in adjusted Cox proportional hazards models. By contrast, there was no statistically significant difference among subtypes when adjusting for atrial fibrillation and competing risk of death. Compared with cardioembolic stroke, thrombotic/lacunar stroke was associated with lower readmission risk within 1 month (HR 0.66, 95% CI 0.46-0.93) and during 1 month-1 year (HR 0.78, 95% CI 0.62-0.97), and hemorrhagic stroke was associated with lower risk during 1 month-1 year (HR 0.60, 95% CI 0.41-0.87). There was no significant difference between subtypes in readmission risk during later periods. DISCUSSION: Over 26 years of follow-up, 81% of stroke participants experienced a readmission. Cardiovascular and cerebrovascular diagnoses at readmission were most common across stroke subtypes. Though cardioembolic stroke has previously been reported to confer higher risk of readmission, in this study, the readmission risk was not statistically significantly different between stroke subtypes or over different periods when accounting for the competing risk of death.
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Sloane et al. (2024) conducted a cohort in First-ever stroke (n=1,412). Thrombotic/lacunar and hemorrhagic stroke vs. Cardioembolic stroke was evaluated on First all-cause readmission after incident stroke (HR 0.82, 95% CI 0.71-0.95). Readmission risk after incident stroke was not statistically significantly different between stroke subtypes when accounting for the competing risk of death over a maximum of 26.6 years of follow-up.
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