Spending time at home following ischemic stroke may improve cardiovascular outcomes

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After a case-mix adjustment, hospitals that are smaller, have higher annual ischemic stroke admission volume and are located in rural settings are more likely to have patients spend time at home within 90 days of suffering an ischemic stroke, according to a recent analysis.

Spending more time at home was also associated with lower rates of major adverse cardiovascular events and all-cause mortality.

Lead researcher Emily C. O’Brien, PhD, of the Duke Clinical Research Institute and Duke University Medical Center, and colleagues published their results online Sept. 13 in Stroke.

The researchers noted that patients often cite “home-time” as an important outcome for them following a stroke. They defined “home-time” as time spent alive at home without recurrent stroke and without being hospitalized for complications.

They identified 156,887 patients from the Get With The Guidelines-Stroke (GWTG-Stroke) registry who survived an ischemic stroke and linked the data to Medicare claims. The trial was part of the PROSPER study, which the Patient-Centered Outcomes Research Institute funded. The GWTG-Stroke registry is sponsored in part by Medtronic.

All of the patients in the study were at least 65 years old and were enrolled in fee-for-service Medicare. They were discharged from 989 hospitals between 2007 and 2011.

The median unadjusted hospital mean home-times were 59.5 days during the first 90 days and 270.2 days during the first year. The unadjusted mean 90-day home-times ranged from 30.9 to 78.1 days, while the unadjusted mean one-year home-times ranged from 178.7 to 327.7 days.

Patients who were discharged from hospitals with the lowest home-times were more likely to be older, women and black. They also had higher rates of stroke, atrial fibrillation, heart failure, diabetes and hypertension.

The researchers found that increasing hospital bed size adjusting for annual ischemic stroke volume was associated with less home-time at 90 days and one year, although increasing annual ischemic stroke volume was associated with more home-time days. Hospitals located in rural settings and in the Midwest, South and West also had longer home-time at 90 days and one year.

The researchers cited a few limitations of the study, including that they could not account for time spent in facilities such as private nursing homes that the Centers for Medicare & Medicaid Services does not reimburse. They also only included Medicare beneficiaries who were at least 65 years old, so the results might not be generalizable to other populations. In addition, they excluded hospitals with fewer than 25 patients with stroke discharged during the study period.

Further, they noted that home-time could be influenced by factors that they did not account for such as patient’s access to inpatient rehabilitation and skilled nursing facilities, ability to pay for post-stroke services and availability of community resources. They also mentioned that socioeconomic status, marital status and social support systems could have played a role in how much time patients spent at home.