Readmissions for Cardiac Disease Within 30 Days of Hospitalization for Cerebral Infarction: An Evaluation of the Stroke-Heart Syndrome Using the Nationwide Readmission Database.
Chun Shing Kwok, Adnan I Qureshi, Josip Andelo Borovac, Maximilian Will, Konstantin Schwarz, Mark Hall, Paul Mann, Eric Holroyd, Gregory Y H Lip
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Abstract
Background: The stroke-heart syndrome refers to incident cardiac complications post stroke. This study aims to evaluate the stroke-heart syndrome by determining the rate and predictors of readmission for cardiac disease within 30 days of hospitalization for cerebral infarction.
Methods: Data from the United States Nationwide Readmissions Database (2018 to 2020) were analyzed to identify rates and factors associated with 30-day readmissions for heart disease following cerebral infarction, excluding patients with atrial fibrillation, heart failure and myocardial infarction during admission with cerebral infarction.
Results: There were 3,115,850 hospital admissions for cerebral infarction, and 75,440 admissions (2.4%) were readmitted with new onset cardiac events within 30 days of discharge. This included 36,310 (1.4%) readmissions for heart failure, 35,900 (1.1%) readmissions for atrial fibrillation, 17,465 (0.5%) readmissions for acute myocardial infarction, 810 (0.03%) readmissions for ventricular arrhythmias and 700 (0.02%) readmissions for Takotsubo syndrome. Readmitted patients were older (median age of 73 years vs. 68 years, p < 0.001) and had a longer length of stay for initial admission (median of 4 days vs. 3 days, p < 0.001). The most significant predictors of readmission were elective admission (OR 2.00, 95%CI 1.89-2.13, p < 0.001), cancer (OR 1.91, 95%CI 1.81-2.01, p < 0.001), chronic kidney disease (OR 1.80, 95%CI 1.73-1.87, p < 0.001), previous myocardial infarction (OR 1.59, 95%CI 1.50-1.69, p < 0.001) and liver failure (OR 1.34, 95%CI 1.06-1.68, p = 0.013). Palliative care was linked to a reduced odds of readmission (OR 0.36, 95%CI 0.31-0.41, p < 0.001).
Conclusions: New cardiac-related hospital readmissions within 30 days after ischemic stroke occur in 2.4% of patients, with elective admission and cancer being a strong predictor of readmissions.
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