Death and rehospitalization after transient ischemic attack or acute ischemic stroke: One-year outcomes from the adherence evaluation of acute ischemic stroke-longitudinal registry

Daiwai M. Olson, Margueritte Cox, Wenqin Pan, Ralph L. Sacco, Gregg C. Fonarow, Richard Zorowitz, Kenneth A. Labresh, Lee H. Schwamm, Linda Williams, Larry B. Goldstein, Cheryl D. Bushnell, Eric D. Peterson

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Longitudinal data directly comparing the rates of death and rehospitalization of patients discharged after transient ischemic attack (TIA) versus acute ischemic stroke (AIS) are lacking. Methods: Data were analyzed from 2802 patients (TIA n = 552; AIS n = 2250) admitted to 100 U.S. hospitals participating in the Get With The Guidelines-Stroke and the Adherence Evaluation of Acute Ischemic Stroke-Longitudinal registry. The primary composite outcome was the adjusted rate of all-cause death and rehospitalization over 1 year after discharge. Four additional single or combined outcomes were explored. Results: Compared with AIS, TIA patients were older (median 69 v 66 years; P =.007) and more likely female (53.3% v 44.2%; P <.0001). Secondary prevention medication use after hospital discharge was less intensive after TIA, with underuse for both conditions. All-cause death or rehospitalization at 1 year was similar for TIA and AIS patients (37.7% v 34.6%; P =.271); the frequency for TIA patients was higher after covariate adjustment (hazard ratio [HR] 1.19; 95% confidence interval [CI] 1.01-1.41). One-year all-cause mortality was similar among those with TIA compared to AIS patients (3.8% v 5.7%; P =.071; adjusted HR 0.86; 95% CI 0.52-1.42). All-cause rehospitalizations were higher for TIA compared to AIS patients (36.4% v 33.0%; P =.186; adjusted HR 1.20; 95% CI 1.02-1.42), but similar for stroke rehospitalizations (10.1% v 7.4%; P =.037; adjusted HR 1.38, 95% CI 0.997-1.92). Conclusions: Patients with TIA have similar or worse 12-month postdischarge risk of death or rehospitalization as compared with those with AIS. Outcomes after TIA and AIS might be improved with better adherence to secondary preventive guidelines.

Original languageEnglish
JournalJournal of Stroke and Cerebrovascular Diseases
Volume22
Issue number7
DOIs
StatePublished - Oct 2013

Fingerprint

Transient Ischemic Attack
Registries
Stroke
Confidence Intervals
Cause of Death
Guideline Adherence
Mortality
Secondary Prevention
Guidelines

Keywords

  • Acute stroke
  • stroke care
  • stroke management
  • transient ischemic attack

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Rehabilitation
  • Cardiology and Cardiovascular Medicine

Cite this

Death and rehospitalization after transient ischemic attack or acute ischemic stroke : One-year outcomes from the adherence evaluation of acute ischemic stroke-longitudinal registry. / Olson, Daiwai M.; Cox, Margueritte; Pan, Wenqin; Sacco, Ralph L.; Fonarow, Gregg C.; Zorowitz, Richard; Labresh, Kenneth A.; Schwamm, Lee H.; Williams, Linda; Goldstein, Larry B.; Bushnell, Cheryl D.; Peterson, Eric D.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 22, No. 7, 10.2013.

Research output: Contribution to journalArticle

Olson, Daiwai M. ; Cox, Margueritte ; Pan, Wenqin ; Sacco, Ralph L. ; Fonarow, Gregg C. ; Zorowitz, Richard ; Labresh, Kenneth A. ; Schwamm, Lee H. ; Williams, Linda ; Goldstein, Larry B. ; Bushnell, Cheryl D. ; Peterson, Eric D. / Death and rehospitalization after transient ischemic attack or acute ischemic stroke : One-year outcomes from the adherence evaluation of acute ischemic stroke-longitudinal registry. In: Journal of Stroke and Cerebrovascular Diseases. 2013 ; Vol. 22, No. 7.
@article{fc2564dec594454ab874a94e5bd36f9d,
title = "Death and rehospitalization after transient ischemic attack or acute ischemic stroke: One-year outcomes from the adherence evaluation of acute ischemic stroke-longitudinal registry",
abstract = "Background: Longitudinal data directly comparing the rates of death and rehospitalization of patients discharged after transient ischemic attack (TIA) versus acute ischemic stroke (AIS) are lacking. Methods: Data were analyzed from 2802 patients (TIA n = 552; AIS n = 2250) admitted to 100 U.S. hospitals participating in the Get With The Guidelines-Stroke and the Adherence Evaluation of Acute Ischemic Stroke-Longitudinal registry. The primary composite outcome was the adjusted rate of all-cause death and rehospitalization over 1 year after discharge. Four additional single or combined outcomes were explored. Results: Compared with AIS, TIA patients were older (median 69 v 66 years; P =.007) and more likely female (53.3{\%} v 44.2{\%}; P <.0001). Secondary prevention medication use after hospital discharge was less intensive after TIA, with underuse for both conditions. All-cause death or rehospitalization at 1 year was similar for TIA and AIS patients (37.7{\%} v 34.6{\%}; P =.271); the frequency for TIA patients was higher after covariate adjustment (hazard ratio [HR] 1.19; 95{\%} confidence interval [CI] 1.01-1.41). One-year all-cause mortality was similar among those with TIA compared to AIS patients (3.8{\%} v 5.7{\%}; P =.071; adjusted HR 0.86; 95{\%} CI 0.52-1.42). All-cause rehospitalizations were higher for TIA compared to AIS patients (36.4{\%} v 33.0{\%}; P =.186; adjusted HR 1.20; 95{\%} CI 1.02-1.42), but similar for stroke rehospitalizations (10.1{\%} v 7.4{\%}; P =.037; adjusted HR 1.38, 95{\%} CI 0.997-1.92). Conclusions: Patients with TIA have similar or worse 12-month postdischarge risk of death or rehospitalization as compared with those with AIS. Outcomes after TIA and AIS might be improved with better adherence to secondary preventive guidelines.",
keywords = "Acute stroke, stroke care, stroke management, transient ischemic attack",
author = "Olson, {Daiwai M.} and Margueritte Cox and Wenqin Pan and Sacco, {Ralph L.} and Fonarow, {Gregg C.} and Richard Zorowitz and Labresh, {Kenneth A.} and Schwamm, {Lee H.} and Linda Williams and Goldstein, {Larry B.} and Bushnell, {Cheryl D.} and Peterson, {Eric D.}",
year = "2013",
month = "10",
doi = "10.1016/j.jstrokecerebrovasdis.2012.11.001",
language = "English",
volume = "22",
journal = "Journal of Stroke and Cerebrovascular Diseases",
issn = "1052-3057",
publisher = "W.B. Saunders Ltd",
number = "7",

}

TY - JOUR

T1 - Death and rehospitalization after transient ischemic attack or acute ischemic stroke

T2 - One-year outcomes from the adherence evaluation of acute ischemic stroke-longitudinal registry

AU - Olson, Daiwai M.

AU - Cox, Margueritte

AU - Pan, Wenqin

AU - Sacco, Ralph L.

AU - Fonarow, Gregg C.

AU - Zorowitz, Richard

AU - Labresh, Kenneth A.

AU - Schwamm, Lee H.

AU - Williams, Linda

AU - Goldstein, Larry B.

AU - Bushnell, Cheryl D.

AU - Peterson, Eric D.

PY - 2013/10

Y1 - 2013/10

N2 - Background: Longitudinal data directly comparing the rates of death and rehospitalization of patients discharged after transient ischemic attack (TIA) versus acute ischemic stroke (AIS) are lacking. Methods: Data were analyzed from 2802 patients (TIA n = 552; AIS n = 2250) admitted to 100 U.S. hospitals participating in the Get With The Guidelines-Stroke and the Adherence Evaluation of Acute Ischemic Stroke-Longitudinal registry. The primary composite outcome was the adjusted rate of all-cause death and rehospitalization over 1 year after discharge. Four additional single or combined outcomes were explored. Results: Compared with AIS, TIA patients were older (median 69 v 66 years; P =.007) and more likely female (53.3% v 44.2%; P <.0001). Secondary prevention medication use after hospital discharge was less intensive after TIA, with underuse for both conditions. All-cause death or rehospitalization at 1 year was similar for TIA and AIS patients (37.7% v 34.6%; P =.271); the frequency for TIA patients was higher after covariate adjustment (hazard ratio [HR] 1.19; 95% confidence interval [CI] 1.01-1.41). One-year all-cause mortality was similar among those with TIA compared to AIS patients (3.8% v 5.7%; P =.071; adjusted HR 0.86; 95% CI 0.52-1.42). All-cause rehospitalizations were higher for TIA compared to AIS patients (36.4% v 33.0%; P =.186; adjusted HR 1.20; 95% CI 1.02-1.42), but similar for stroke rehospitalizations (10.1% v 7.4%; P =.037; adjusted HR 1.38, 95% CI 0.997-1.92). Conclusions: Patients with TIA have similar or worse 12-month postdischarge risk of death or rehospitalization as compared with those with AIS. Outcomes after TIA and AIS might be improved with better adherence to secondary preventive guidelines.

AB - Background: Longitudinal data directly comparing the rates of death and rehospitalization of patients discharged after transient ischemic attack (TIA) versus acute ischemic stroke (AIS) are lacking. Methods: Data were analyzed from 2802 patients (TIA n = 552; AIS n = 2250) admitted to 100 U.S. hospitals participating in the Get With The Guidelines-Stroke and the Adherence Evaluation of Acute Ischemic Stroke-Longitudinal registry. The primary composite outcome was the adjusted rate of all-cause death and rehospitalization over 1 year after discharge. Four additional single or combined outcomes were explored. Results: Compared with AIS, TIA patients were older (median 69 v 66 years; P =.007) and more likely female (53.3% v 44.2%; P <.0001). Secondary prevention medication use after hospital discharge was less intensive after TIA, with underuse for both conditions. All-cause death or rehospitalization at 1 year was similar for TIA and AIS patients (37.7% v 34.6%; P =.271); the frequency for TIA patients was higher after covariate adjustment (hazard ratio [HR] 1.19; 95% confidence interval [CI] 1.01-1.41). One-year all-cause mortality was similar among those with TIA compared to AIS patients (3.8% v 5.7%; P =.071; adjusted HR 0.86; 95% CI 0.52-1.42). All-cause rehospitalizations were higher for TIA compared to AIS patients (36.4% v 33.0%; P =.186; adjusted HR 1.20; 95% CI 1.02-1.42), but similar for stroke rehospitalizations (10.1% v 7.4%; P =.037; adjusted HR 1.38, 95% CI 0.997-1.92). Conclusions: Patients with TIA have similar or worse 12-month postdischarge risk of death or rehospitalization as compared with those with AIS. Outcomes after TIA and AIS might be improved with better adherence to secondary preventive guidelines.

KW - Acute stroke

KW - stroke care

KW - stroke management

KW - transient ischemic attack

UR - http://www.scopus.com/inward/record.url?scp=84886065456&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84886065456&partnerID=8YFLogxK

U2 - 10.1016/j.jstrokecerebrovasdis.2012.11.001

DO - 10.1016/j.jstrokecerebrovasdis.2012.11.001

M3 - Article

C2 - 23273788

AN - SCOPUS:84886065456

VL - 22

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

SN - 1052-3057

IS - 7

ER -