Predictors of unplanned hospital readmissions and emergency department revisits in patients with acute ischemic stroke

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Objectives We aim to identify factors associated with emergency department (ED) revisits and hospital readmissions after acute ischemic stroke (AIS) diagnosis and to determine if early outpatient follow-up can reduce readmissions. Methods We retrospectively identified all AIS patients discharged from a hospital network, from October 1, 2022 to March 31, 2024. Baseline characteristics, inpatient metrics and post-discharge outpatient follow-up were assessed to identify factors associated with ED revisits and readmissions to the healthcare system within 90-days. Results Of 1,973 patients, 464 (23.5%) had ED visits within 90 days and 263 (13.3%) had hospital readmission within 90 days. The median age was 68 [IQR 58, 77]. In multiple logistic regression analyses, factors independently associated with 90-day ED visit were history of heart failure (HF) (OR 1.46, 95% CI 1.11–1.93; p = 0.007), diabetes mellitus (DM) (OR 1.41, 95% CI 1.12–1.77; p = 0.003), atrial fibrillation (AF) (OR 1.47, 95% CI 1.13–1.92, p = 0.004) and an increasing Charlson comorbidity index (CCI) score (OR 1.10, 95% CI 1.03–1.18), p = 0.003). Factors associated with 90-day readmission were HF (OR 1.51, 95% CI 1.08–2.11, p = 0.015), DM (OR 1.50, 95% CI 1.13–2.01, p = 0.006), AF (OR 1.40, 95% CI 1.00–1.94, p = 0.047) and increasing CCI score (OR 1.12, 95% CI 1.03–1.21, p = 0.006). Discharge to inpatient rehabilitation or skilled nursing facility (vs. home or home health) were associated with 90-day ED revisits and hospital readmissions. Patients who completed early (<30 days) outpatient stroke clinic follow-up had a lower likelihood of 90-day readmission (OR 0.68, 95% CI 0.52–0.90; p = 0.006). Conclusion Patients with certain comorbidities including HF, DM, AF and those with a higher CCI score have a higher likelihood of a 90-day ED revisit and hospital readmission. Unplanned hospital readmissions may be preventable with early outpatient visits in a dedicated stroke clinic after discharge for AIS patients.

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