LOS ANGELES – During the first 5 years following a stroke, elderly patients have a unique pattern of comorbidity and hospitalization. This pattern sets them apart from similarly aged people who didn’t experience a stroke as well as from elderly patients who have had acute myocardial infarction, based on a review of more than 5,700 age- and gender-matched Medicare beneficiaries.
Following a stroke, Medicare patients showed a substantially higher rate of hospitalizations for hip fracture or pneumonia, compared with matched people without a history of stroke. These findings indicate that these excess events in stroke survivors "are not just due to age or the effects of acute hospitalization," Dr. Kamakshi Lakshminarayan said at the International Stroke Conference.
The analysis also showed that during the first year following a stroke or MI, the rate of any acute care hospitalization reached 49% in the poststroke patients and 55% in the post-MI patients, strikingly higher than the 20% rate among the matched elderly people with no history of either event.
The first year following a stroke or MI is when the rate of acute care hospitalization "peels away from the general Medicare population. This is where we need to intervene" to reduce the incidence of the complications that lead to hospitalizations, said Dr. Lakshminarayan, a stroke epidemiologist at the University of Minnesota in Minneapolis.
She and her associates studied 823 Medicare patients aged 65-84 years who had a validated, acute ischemic stroke during 2000 that led to hospitalization at any of 19 Minnesota hospitals. The researchers assembled two comparison groups of Medicare beneficiaries who matched the stroke group by age, sex, and race, including 823 patients with an acute MI treated at the same 19 hospitals, and 4,115 matched people from Minnesota with no history of stroke or recent MI.
The stroke and MI patients matched up fairly closely for their cumulative 30-day, 1-year, and 5-year mortality, although the stroke patients had significantly higher rates of death following hospital discharge at both 1 year and 5 years after the initial hospitalization. Cumulative mortality in both postevent groups dwarfed the rate among the people who had neither a stroke nor MI. At 1 year, cumulative mortality ran 24% in the stroke patients, 22% in the MI patients, and 4% in the general population. At 5 years, the rates ran 49%, 44%, and 24%, respectively.
The difference between poststroke and post-MI patients showed up in several types of hospitalizations. Poststroke patients had substantially more rehospitalizations for a subsequent stroke: an 18% rate over 5 years, compared with 7% in the post-MI patients. But the post-MI patients held a decided edge in the rate of a subsequent MI: 25% over 5 years, compared with a 6% rate among the poststroke patients during the 5 years following their index event. The post-MI patients also had similarly large and statistically significant increases in their rate of heart failure and dysrhythmias. The overall, 5-year rate of hospitalization for any vascular cause ran 38% in the poststroke patients, 49% in patients who had an initial MI, and 19% in the general elderly population.
The 5-year rate of hospitalization for pneumonia reached the highest level in the stroke patients, at 20%, which was significantly greater than the 10% rate in the general population, but not a statistically significant difference over the 15% rate in patients with a history of MI. Poststroke patients also showed a high 5-year rate of hospitalization for hip fracture of 10%, which is twice the U.S. rate among women aged 65 years or older (based on published data) and also double the general Medicare population’s rate in Dr. Lakshminarayan’s study. At 5 years, 4% of the post-MI patients had a hip fracture.
Dr. Lakshminarayan said that she had no disclosures.