Causes and Predictors for Hospital Readmission after Ischemic Stroke

Background: Readmission after stroke is frequent, but limited data are available in Europe. This study aimed at assessing frequencies, causes, and factors associated with early and late unplanned readmissions within 1 year after discharge from ischemic stroke hospitalization. Methods: All surviving ischemic stroke patients admitted to the Department of Neurology, Haukeland University Hospital, Norway, between July 1, 2007, and June 30, 2012, were followed from discharge until August 1, 2012. Information on readmissions was collected by medical chart reviews. Logistic regression was performed to assess factors associated with early (<= 90 days) and late (91-365 days) readmission. Results: Of 1175 patients discharged alive, 18.8% were readmitted within 90 days, and 24.5% were readmitted between day 91 and 365. Most frequent causes were infections, recurrent ischemic stroke, other cardiovascular events, and events related to index stroke. Early readmission was associated with older age, impaired physical function, atherosclerotic etiology of index stroke, and a higher risk factor burden. Late readmission was associated with older age and prior myocardial infarction. Early readmitted patients had shorter length of index admission, poorer physical function and higher frequencies of atherosclerotic etiology of index stroke, atrial fibrillation, and complications with infection during the index admission compared to patients readmitted late. Conclusions: Readmission after ischemic stroke is frequent, especially in the early period after discharge. Diagnoses and predictors varied according to time point for readmission, reflecting different underlying mechanisms for causes of readmission. Causes of early readmission may include a prothrombotic state and disposition for recurrent infections.