The following is a summary of “Stroke Subtype and Risk of Subsequent Hospitalization: The Atherosclerosis Risk in Communities Study,” published in the January 2024 issue of Neurology by Sloane et al.
Researchers started a retrospective study to investigate the evolving risk factors and causes behind the first readmission after incident strokes, analyzed by stroke subtype and time since the initial event.
They followed up with Atherosclerosis Risk in Communities (ARIC) study participants (n = 1,412) with a first-ever stroke for all-cause readmission after the incident stroke. Analyzing first readmission risk involved employing Cox and Fine-Gray models, adjusting for sociodemographic and cardiometabolic factors, and considering stroke subtypes (cardioembolic, thrombotic/lacunar, and hemorrhagic, [intracerebral and subarachnoid]).
The results showed 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% with cardioembolic stroke, and 78% with hemorrhagic stroke). Half of the readmissions reported main cardiovascular and cerebrovascular diagnoses. Throughout the follow-up, compared with cardioembolic stroke, readmission risk was lower for thrombotic/lacunar stroke (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. However, no statistically significant difference among subtypes was observed when changing for atrial fibrillation and competing risk of death. Thrombotic/lacunar stroke, compared with cardioembolic 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 linked with lower risk during 1 month–1 year (HR 0.60, 95% CI 0.41–0.87). No significant difference between subtypes in readmission risk during later periods was observed.
They concluded despite subtype or time since stroke, most patients readmitted over 26 years, often due to cardiovascular/cerebrovascular issues.
Source: neurology.org/doi/10.1212/WNL.0000000000208035
