Postacute Discharge Destination and Major Adverse Cardiovascular Events Among Patients With Intracerebral Hemorrhage

Area of Science:

• Neurology
• Cardiology
• Health Services Research

Background:

• Limited data exists on health system factors influencing major adverse cardiovascular events (MACE) in intracerebral hemorrhage (ICH) survivors.
• Evaluating MACE incidence across different post-acute care settings for ICH survivors is crucial.

Purpose of the Study:

• To compare MACE incidence among ICH survivors discharged to inpatient rehabilitation facilities (IRFs), home, or skilled nursing facilities (SNFs).
• To identify associations between discharge disposition and cardiovascular outcomes, recurrent ICH, and mortality within one year.

Main Methods:

• Analysis of adult ICH survivors from five US states (April 2016-December 2018).
• Multivariable logistic regression models adjusted for sociodemographic factors, treatment intensity, comorbidities, and frailty.
• Stratified analyses based on age (<65 and ≥65 years) due to significant interaction with discharge disposition.

Main Results:

• IRF discharge was associated with significantly lower odds of MACE compared to home (aOR, 0.84) and SNF (aOR, 0.79).
• The association between IRF discharge and lower MACE odds was significant for patients <65 years (aOR, 0.70) but not for those ≥65 years (aOR, 0.94).
• IRF discharge also showed lower odds of recurrent ICH (vs. SNF: aOR, 0.60), vascular death (vs. SNF: aOR, 0.70), and all-cause mortality (vs. SNF: aOR, 0.63).

Conclusions:

• Inpatient rehabilitation facility care is associated with reduced odds of MACE, recurrent ICH, vascular death, and all-cause mortality compared to SNF and home care.
• Further research is needed to pinpoint specific components of IRF care that drive these improved outcomes.