Impact of Multiple Chronic Conditions in Patients Hospitalized with Stroke and Transient Ischemic Attack

• Published in: Journal of stroke and cerebrovascular diseases 2017-06, Vol.26 (6), p.1239-1248
• Main Authors: Yousufuddin, Mohammed, MD, MSc, Bartley, Adam C., MS, Alsawas, Mouaz, MD, Sheely, Heather L., BSN, Shultz, Jessica, BSN, Takahashi, Paul Y., MD, Young, Nathan P., DO, Murad, M. Hassan, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiovascular; Chi-Square Distribution; chronic condition; Comorbidity; Female; Hospital Mortality; Humans; Ischemic Attack, Transient - diagnosis; Ischemic Attack, Transient - epidemiology; Ischemic Attack, Transient - mortality; Ischemic Attack, Transient - therapy; Logistic Models; Male; Middle Aged; Minnesota - epidemiology; mortality; Multiple Chronic Conditions - epidemiology; Multiple Chronic Conditions - mortality; Multiple Chronic Conditions - therapy; Multivariate Analysis; Neurology; Odds Ratio; Patient Admission; Patient Readmission; Prevalence; Prognosis; readmission; Retrospective Studies; Risk Assessment; Risk Factors; stroke; Stroke - diagnosis; Stroke - epidemiology; Stroke - mortality; Stroke - therapy; Time Factors; Trend
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2017.01.015

Background The prevalence and clinical impact of chronic conditions (CCs) have increasingly been recognized as an important public health concern. We evaluated the prevalence of coexisting CCs and their association with 30-day mortality and readmission in hospitalized patients with stroke and transient ischemic attack (TIA). Methods In a retrospective study of patients aged ≥18 years hospitalized for first-ever stroke and TIA, we assessed the prevalence of coexisting CCs and their predictive value for subsequent 30-day mortality and readmission. Results Study cohort comprised 6771 patients, hospitalized for stroke (n = 4068) and TIA (n = 2703), 51.4% men, with mean age of 68.2 years (standard deviation: ±15.6), mean number of CCs of 2.9 (±1.7), 30-day mortality rate of 8.6% (entire cohort), and 30-day readmission rate of 9.7% (in 2498 patients limited to Olmsted and surrounding counties). In multivariable models, significant predictors of (1) 30-day mortality were coexisting 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 (2) 30-day readmission (n = 2498) were CAD (OR: 1.50, 95% CI: 1.09-2.07), cancer (OR: 1.46, 95% CI: 1.01-2.10), and arthritis (OR: 1.62, 95% CI: 1.09-2.40). Conclusions In patients hospitalized with stroke and TIA, CCs are highly prevalent and influence 30-day mortality and readmission. Optimal therapeutic and lifestyle interventions for CAD, HF, cardiac arrhythmia, cancer, diabetes, and arthritis may improve early clinical outcome.