We sought to investigate the nationwide incidence, predictors, and outcomes of 30-day readmissions due to acute ischemic stroke (AIS) after hospitalization for transient ischemic attack (TIA) in the United States.

There exists an early increased risk of AIS after TIA. Understanding the predictors of early stroke in patients presenting with TIA can help devise targeted interventions and procedures to mitigate this risk.

The Nationwide Readmissions Database, from January 2010 to September 2015, was used to identify index hospitalizations with primary diagnosis of TIA. Incidence and reasons of 30-day nonelective readmissions were investigated. Independent predictors of readmissions due to AIS were analyzed using multivariable logistic regression. 

During the study period, there were 778,124 weighted hospitalizations due to TIA with age ≥18, survival to discharge, and known discharge disposition (mean±SD age: 70.5±14.4; female 58.6%). The 30-day all cause non-elective readmission rate was 8.7% and the most common cause of readmission was AIS or TIA (19.6%). Advanced age, male gender, Medicaid or self-pay status, and comorbidities including previous history of cerebrovascular event, hypertension, diabetes, and illicit drug use were independently associated with increased odds of readmissions due to AIS. History of migraine and psychiatric disorders were inversely associated with AIS readmissions. Longer length of stay and higher total charges during index TIA hospitalization were also independently associated with lower odds of 30-day AIS readmissions. On average, there was 0.02% annual increase in 30-day readmission due to AIS between 2010 and 2015. Among AIS readmissions, 4.1% had in-hospital mortality and 58.4% had discharge disposition other than to home.

Recurrent TIA or AIS is the most common cause of 30-day readmission after an initial encounter for TIA. A more thorough and prolonged admission may decrease the chances of readmission. Inverse association with migraine and psychiatric history probably reflects a non-vascular etiology for the index TIA.