Exploring key risk factors for loss to follow-up after hospitalization for acute stroke

A significant proportion of stroke patients are lost to follow-up (LTFU) after discharge, which may increase risks of morbidity, mortality, and unnecessary hospitalization. We aimed to identify predictors of post-discharge LTFU in acute stroke patients from a large academic hospital system.

Using the American Heart Association's Get With the Guidelines registry, we conducted a retrospective analysis of acute stroke patients hospitalized at the Mount Sinai Hospital from January 2016 to December 2020. Our primary outcome was post-discharge LTFU (i.e. no ambulatory encounters within 12 months post-discharge). We used the least-absolute square and shrinkage operator (LASSO) for variable selection, then used multiple logistic regression to model the association of selected predictors with our primary outcome.

We identified 2,597 patients, of whom 878 (33.8%) were LTFU. Patients LTFU were more likely to be male (52.9% vs. 47.4%, p = 0.0088), admitted for intracerebral hemorrhage (12.1% vs. 8.9%, p = 0.0047), discharged to skilled nursing facilities (19.8% vs. 17.0%, p < 0.001), and transferred from another hospital (48.0% vs. 40.7%, p = 0.0030). These patients were more likely to have a discharge modified Rankin Scale (mRS) score of 4-5 (35.2% vs. 30.2%, p = 0.0060) and had a higher mean discharge NIHSS score (6.1 vs. 4.9, p < 0.001). In the adjusted analysis, patients who self-paid (adjusted odds ratio (aOR) 3.8, 95%CI 1.3-11.4), were discharged to acute care facilities (aOR 5.3, 95%CI 1.5-18.4), or had a mRS of 5 (aOR 2.4, 95%CI 1.0-5.7) had significantly increased odds of LTFU. Patients with Medicare coverage (aOR 0.60, 95%CI 0.40-0.92), discharge to inpatient rehabilitation (aOR 0.54, 95%CI 0.34-0.86), family history of stroke (aOR 0.37, 95%CI 0.18-0.76) had significantly decreased odds of LTFU.

In this study, we identified clinical characteristics and discharge dispositions associated with LTFU after stroke.