A retrospective cohort study within all acute-care Veterans Affairs (VA) hospitals was performed to identify first time ischemic stroke admissions. We sought information on anterior/posterior circulation strokes so patients with missing stroke location were excluded. Patient demographics, past medical history, medical illness severity, and receipt of carotid imaging were included in a logistic regression model evaluating death within one year of discharge.

During fiscal years 2016-8, 19,423 patients with ischemic stroke were cared for at 132 hospitals. After excluding patients with missing stroke location or stroke in the prior 30 days, 3773 patients (mean age 70 years, 97% men) from 119 VA centers were available for analysis. Higher age (odds ratio (OR) 1.06, p<0.001), history of atrial fibrillation (OR 1.36, p=0.027), concomitant myocardial infarction (OR 1.82, p<0.01), number of admissions (OR 1.15, p=0.016), Apache score (OR 1.04, p<0.001), and history of dementia (OR 2.36, p<0.001) were associated with increased odds of death. History of hypertension (OR 0.65) or hyperlipidemia (OR 0.49), posterior circulation stroke (OR 0.73), and performance of carotid imaging (OR 0.71)  were associated with a reduced risk of death.

Across a national health system, several factors were associated with an increased risk of death in the first following ischemic stroke. Among modifiable factors, increased attention to cardiac care and prevention of concomitant myocardial infarction represent potential areas for improving outcomes. Further study is needed to determine if carotid imaging improves outcomes or whether carotid imaging is preferentially performed in healthier patients.