Stroke subtype as a predictor of nursing home placement: Northern Manhattan Stroke Study

T. Rundek, A. Hartmann, H. Mast, X. Chen, R. Gan, V. Demarin, R. L. Sacco

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2 Scopus citations

Abstract

The aim of this study was to determine whether stroke subtype is a predictor of nursing home placement after acute care hospitalization. As a part of the Northern Manhattan Stroke Study, 573 patients who survived first acute ischemic stroke were prospectively followed to assess their destination after discharge from acute care. Cases were stratified according to stroke subtype into lacunar, characterized by focal neurologic symptoms or brain image evidence of a small deep infarction and no source of cardioembolism; and non-lacunar, which included infarction due to extracranial or intracranial atherosclerosis, embolism from a commonly accepted cardiac source, cryptogenic infarction, conflicting mechanisms, and stroke from other unusual causes. There were 40% of lacunar (n=228, mean age 67.9±12.1 yrs, 50% men, 53% Hispanic, 32% black and 13% whites); and 60% of non-lacunar infarcts (n=345, mean age 70.4±12.4 yrs, 44% men, 47% Hispanic, 32% black and 20% whites). Discharge destinations were compared between these two groups and multivariate logistic regression was used to determine the relationship between stroke subtype and discharge destination. Immediately after hospital discharge, 410 (72%) patients went home, 97 (17%) to a rehabilitation facility, and 54 (9%) to a nursing home. Among patients with lacunar stroke, 76% went home, 17% to rehab, and 5% to a nursing home, while among those with non-lacunar stroke 69% went home, 17% to rehab, and 12% to a nursing home (p=0.02). After adjustment for race-ethnicity, education, receiving assistance at home prior to stroke, and cardiac disease (atrial fibrillation, myocardial infarction, congestive heart disease and coronary artery disease), predictors of nursing home placement were age over 65 (RR 2.3, 95% CI 1.1-5.0), and presentation with a non-lacunar stroke subtype (RR 2.0, 95% CI 1.1-3.6). Older patients and those with non-lacunar strokes are more likely to be discharged to a nursing home than home. This data are important for physicians and health care managers for early planning of post- discharge care, calculating direct costs, and estimating health resource utilization for ischemic stroke.

Original languageEnglish (US)
Pages (from-to)175-180
Number of pages6
JournalActa Clinica Croatica
Volume37
Issue number3
StatePublished - Jan 1 1998

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Keywords

  • Cerebral infarction, diagnosis
  • Cerebrovascular disorders, epidemiology
  • Hospitalization, statistics and numerical data
  • Nursing homes

ASJC Scopus subject areas

  • Medicine(all)

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