Abstract Details

Title Healthcare Utilization Prior to Fatal Stroke Admission: Nationally Representative Data

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-040

Objective Our objective was to examine healthcare use prior to fatal ischemic stroke (IS) admission, and to compare results to fatal intracerebral hemorrhage (ICH) and fatal myocardial infarction (MI).

Background Stroke and post-stroke complications are associated with a high burden of healthcare utilization, accounting for increased readmission rates, length of stay (LOS), and costs. However, there is limited data on healthcare utilization prior to fatal stroke.

Design/Methods The 2013 Nationwide Readmissions Database is a national database of readmissions for all payers and the uninsured with data on >14 million U.S. admissions. We used validated ICD-9 codes to identify fatal IS, ICH, and MI admissions. Using weighted methods, we summarized demographics and hospitalization characteristics at the time of fatal admission, examined primary diagnoses for admissions within 30 days before fatal admission, and summarized number of admissions before fatal admission.

Results

Among 22243 fatal IS, 15849 ICH, and 30784 MI admissions, mean age was 76.7, 71.5, and 75.3 years; mean LOS was 7, 4.4, and 5.3 days, respectively. 29.7% and 27.9% of patients with fatal IS and fatal MI had >2 hospitalizations in 2013, respectively, compared to 22.0% for fatal ICH. Among hospitalizations within 30 days before fatal IS admission, 20.3% had a primary diagnosis of cerebrovascular disease. Within 30 days prior to fatal ICH and MI admissions, 22.0% and 20.5% had prior hospitalizations for cerebrovascular disease and ischemic heart disease, respectively.

Conclusions

Successive admissions for similar diagnoses before fatal events may reveal inadequacy of secondary prevention in high-risk patients. More repeat admissions before fatal IS and MI admissions compared to ICH may reflect differences in thrombotic versus bleeding risk factor profiles. Further study of comprehensive healthcare utilization before fatal IS may improve outcomes.

Authors/Disclosures
Sarah A. Levy, MD (Icahn School of Medicine At Mount Sinai) PRESENTER	Dr. Levy has received research support from NYU FACES.
Laura K. Stein, MD, MPH (Mount Sinai School of Medicine)	The institution of Dr. Stein has received research support from American Heart Association.
Mandip S. Dhamoon, MD, MPH	Dr. Dhamoon has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Faegre Baker Daniels LLP. Dr. Dhamoon has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Wellstar Health System Inc. Dr. Dhamoon has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Fabiani Cohen & Hall, LLP. Dr. Dhamoon has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Kramer, Dillof, Livingston & Moore. Dr. Dhamoon has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Robins Kaplan. Dr. Dhamoon has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Parker Waichman LLP. Dr. Dhamoon has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Heidell, Pittoni, Murphy & Bach, LLP.

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