Oral Presentation Smart Strokes Annual Scientific Meeting 2024

Characterising Hospital Admissions Prior to Stroke Death (106868)

Jennie Carson 1 , Lee Nedkoff 1 2 , Judy Katzenellenbogen 1 , Charley Budgeon 1 , Monique Kilkenny 3 4 , Muideen Olaiya 4
  1. Cardiovascular Epidemiology Research Centre, University of Western Australia, Nedlands, WA
  2. Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
  3. Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria
  4. Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria

Introduction: Traditionally, incident (first-ever) stroke case fatality studies are focused on hospitalised cases identified through admissions data rather than mortality. We aimed to understand the a) distribution of incident cases before stroke death by hospitalisations admissions and death data and b) investigate hospital admission and comorbidity patterns associated with fatal incident strokes.

Methods: We used linked morbidity and mortality data from WA, and a 15-year lookback period, to identify all incident strokes between 2000-2020. Fatal cases were stratified into three groups, 1) admitted to hospital following a stroke and died ≤28 days, 2) non-stroke hospitalisation, with stroke as the underlying cause of death (UCoD) within 28 days, and 3) stroke death with no hospitalisations within 28 days prior. Descriptive statistics were used to characterise the cohort.

Results: Among 45,488 incident strokes (mean age=72.4 years/males=51%), crude case fatality was 25% (18% male/27% female). Fatalities were distributed as: Group-1 (60%), Group-2 (9%), and Group-3 (31%). Females represented 59% of incident stroke deaths and were, on average, 4.8 (95%CI: 4.2-5.4) years older than males. Group-1 experienced 75% in-hospital mortality; 56% had acute stroke as UCoD. In Group-2, 55% died in the hospital with a median stay of 4 days, compared to 2 days for those discharged before death. Frequent principal diagnoses were injuries, dialysis, and pneumonitis. In Group-3, 10% were admitted to hospital within the year before death, with a median 307 days to the last admission.

Conclusion: A high proportion of stroke deaths occur without recent hospital care, demonstrating a need for better identification of patients at high risk in primary care and other pre-hospital settings.

Relevance to clinical practice or patient experience: Stratification of fatal incident strokes improved the characterisation of hospital admissions and diagnosis patterns This methodology shows potential for better identifying of at-risk individuals, thereby progressing primary prevention efforts.