Hospitalization within the first year after stroke: the Dijon stroke registry

This population-based study aimed to identify unplanned hospitalization within the first year after stroke to determine factors associated with it and consequences on survival.

All first-ever acute strokes occurring in Dijon, France, from 2009 to 2011, were prospectively collected from a population-based registry. Demographics and clinical data, including stroke severity measured by the National Institutes of Health Stroke Scale and disability after stroke, were recorded. For each patient, the first unplanned hospitalization that occurred within 1 year after stroke was retrieved by linking data with the national French Hospital Discharge Database. Predictors of hospitalization and survival at 1 year were identified using logistic regression models.

Among the 613 patients recorded, 94 (15.3%) were excluded because of early death. Of the 519 remaining patients, 167 (32.2%) were hospitalized at 1 year. Subsequent hospitalization led to in-hospital death for 16 (9.6%) patients. In multivariable analyses, only a history of hypertension and atrial fibrillation were associated with hospitalization. In stratified analyses, the National Institutes of Health Stroke Scale score was associated with a higher risk of hospitalization (odds ratio, 1.13; 95% confidence interval, 1.03-1.22; P=0.006), whereas only a trend was noted for disability (odds ratio, 2.26; 95% confidence interval, 0.82-6.22; P=0.113) in patients who returned home after the index stroke. Hospitalization was negatively associated with being alive at 1 year (odds ratio, 0.36; 95% confidence interval, 0.19-0.66; P<0.01).

Stroke survivors are at high risk of hospitalization after the episode, and subsequent admission is associated with poor survival, thus highlighting the need for follow-up interventions after discharge to prevent readmission.