Nearly Two-Thirds of Medicare Stroke Victims Return
to Hospital or Die Within One Year
Death or rehospitalization rates for Medicare
beneficiaries with acute stroke didn’t improve from 2003 to 2006
Dec.
20, 2010 – Although the latest statistics from the Centers for Disease
Control and Prevention shows the number of deaths caused by strokes has
dropped from third to fourth place among causes of U.S. deaths, a new
study finds nearly two-thirds of Medicare beneficiaries -primarily
senior citizens - discharged from hospitals after ischemic stroke die or
are readmitted within one year.
Stroke is the
second leading cause of hospital admissions among older adults in the
United States, according to American Heart Association/American Stroke
Association statistics.
Stroke is now
the fourth leading cause of death in the United States, down from the
third place ranking it has held for decades, according to preliminary
2008 death statistics released this month by CDC's National Center for
Health Statistics.
There were
133,750 deaths from stroke in 2008. Age-adjusted death rates from stroke
declined 3.8 percent between 2007 and 2008.
Ischemic stroke,
which occurs as a result of an obstruction within a blood vessel
supplying blood to the brain, accounts for 87 percent of all strokes.
Only a few
contemporary studies have examined the full burden of hospital
readmission and death after ischemic stroke, said Gregg C. Fonarow,
M.D., study lead author and professor of cardiovascular medicine at the
University of California-Los Angeles. The report is in Stroke:
Journal of the American Heart Association.
Fonarow and
colleagues studied ischemic stroke mortality and rehospitalization rates
at 30 days and one year for Medicare beneficiaries and examined how
those varied by hospital.
“We looked at
readmission in addition to mortality because it is expensive to the
healthcare system and may represent a potentially preventable, adverse
event for patients,” Fonarow said.
They analyzed
outcome data from 91,134 Medicare beneficiaries treated at 625 hospitals
participating in the American Heart Association/American Stroke
Association’s Get With The Guidelines®-Stroke initiative between April
2003 and December 2006.
“The
Get With The Guidelines-Stroke
database linked to Medicare data provided a very valuable opportunity to
analyze outcomes for ischemic stroke patients from all regions of the
country and from a broad group of acute care hospitals,” said Fonarow,
immediate past chair of the Get With The Guidelines Steering Committee.
“Clinical data, coupled with long-term outcome data, was not previously
available for Medicare beneficiaries at the national level.”
The researchers
found:
● In-hospital
death rates for ischemic stroke patients are nearly 15 percent within 30
days of admission and more than 30 percent within one year of admission.
● The post
discharge death or readmission rates are 61.9 percent within one year
after discharge.
● When ranked
according to outcome – by death or rehospitalization rates – the 30-day
death rate after admission for hospitals that were in the top performing
was 9.8 percent, compared with 17.8 percent for the worst performing.
● No
improvements in death or rehospitalization rates for Medicare
beneficiaries with acute stroke occurred from 2003 to 2006.
“These findings
underscore the need for quality improvement interventions and systems of
care that will improve early, intermediate, and long-term outcomes of
patients with acute ischemic stroke,” Fonarow said. “Standardizing
evidence-based practices that focus on reducing the risks of preventable
deaths or readmissions for ischemic stroke patients may be critical.”
Findings from
Get With The Guidelines-Stroke help define the frequency, timing and
variation for hospital readmission. This should help clinicians,
investigators and policymakers identify opportunities to apply targeted
quality improvement and preventive strategies after ischemic stroke,
Fonarow said. Participation in
Get With The Guidelines-Stroke
can assist hospitals with their stroke performance improvement efforts.
“Most of the
variation in outcomes was unexplained by patient and hospital
characteristics,” Fonarow said. “This suggests that other factors,
including treatment provided, systems of care, care transitions and
outpatient follow-up, may explain much of the variation in outcomes.”
A limitation of
the study is that it includes only patients in fee-for-service Medicare
and doesn’t include patients enrolled in managed care, the uninsured and
patients younger than 65
Note: Co-authors
are: Eric E. Smith, M.D., M.P.H,; Mathew J. Reeves, Ph.D.; Wenqin Pan,
Ph.D.; DaiWai Olson, Ph.D.; Adrian F. Hernandez, M.D., M.H.S.; Eric D.
Peterson, M.D., M.P.H.; and Lee H. Schwamm, M.D. Author disclosures are
on the manuscript.
Helpful Stroke Information from American Heart Association
Know the Signs of a Stroke
Stroke is a medical emergency. Know these warning
signs of stroke and teach them to others. Every second counts:
► Sudden numbness or weakness of the face, arm
or leg, especially on one side of the body
► Sudden confusion, trouble speaking or
understanding
► Sudden trouble seeing in one or both eyes
► Sudden trouble walking, dizziness, loss of
balance or coordination
► Sudden, severe headache with no known cause
If you or someone with you has one or more of these
signs, don't delay! Immediately call 9-1-1 or the emergency medical
services (EMS) number so an ambulance (ideally with advanced life
support) can be sent for you.
Also, check the time so you'll know when the first
symptoms appeared. It's very important to take immediate action. If
given within three hours of the start of symptoms, a clot-busting drug
called tissue plasminogen activator (tPA) can reduce long-term
disability for the most common type of stroke. tPA is the only
FDA-approved medication for the treatment of stroke within three hours
of stroke symptom onset.
A TIA or
transient ischemic attack is a "warning stroke" or "mini-stroke" that
produces stroke-like symptoms but no lasting damage. Recognizing and
treating TIAs can reduce your risk of a major stroke. The usual TIA
symptoms are the same as those of stroke, only temporary. The short
duration of these symptoms and lack of permanent brain injury is the
main difference between TIA and stroke.
Let's Talk About Stroke, TIA and Warning Signs
Stroke is the No. 3 cause of death and a leading
cause of serious long-term disability in America. This fact sheet will
answer the following questions in regards to stroke, TIA and warning
signs:
► What is a stroke?
► What is a TIA?
► Why should I care about stroke? It seems hopeless.
► What are the warning signs of stroke?
► How can I learn more?
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Stroke is the No. 3 cause of death and a leading
cause of serious long-term disability in America. This fact sheet will
answer the following questions in regards to stroke, TIA and warning
signs: