scholarly journals Stroke hospitalization and case-fatality in the United States, 1988–1997

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 320-320
Author(s):  
Jing Fang ◽  
Hillel Cohen ◽  
Michael H Alderman
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Ischemic Stroke ◽  
Case Fatality ◽  
The United States ◽  
Hospital Death ◽  
Stroke Mortality ◽  
Hospital Case ◽  
Hospitalization Rates ◽  
The Us

23 Age-adjusted stroke mortality in the US has declined in recent decades. However, little is known about stroke morbidity. Using the National Hospital Discharge Survey data from 1988 to 1997, we examined the change in stroke hospitalization and case-fatality in the US. During the 10 years, age-adjusted stroke hospitalization rate increased 22% (from 381 to 463/100,000, p=0.048). By regions, stroke hospitalization rates overall were 641, 600, 562 and 438 for the South, Midwest, Northeast, and West respectively (p<0.05), and were increased in all regions during the 10 years. Overall, 58% of stroke hospitalizations were due to ischemic stroke, 13% due to hemorrhagic stroke, and 29% were classified as other stroke. The hospitalization rates were 74.8 and 332.4 per 100,000 respectively for hemorrhagic and ischemic strokes and the increase rate in 10 years were 13.5% (p=0.214) and 31.5% (p=0.044) respectively. During 10 years, stroke patients with diabetes, hypertension and congestive heart failure increased 17.4% (p=0.17), 34% (p=0.05), and 31% (p=0.091) respectively. The average length of hospital stay reduced from 11.1 to 6.2 days (decrease of 44.1%), with an average annual percentage decrease of 6.1% (p=0.012). Although the total number of patients hospitalized for stroke increased during this period, the total person-days in hospital decreased 22% (p=006). In-hospital death among stroke decreased steadily from 12.7% to 7.6% (decrease of 40%, p=0.04). In-hospital case-fatality was estimated by stratifying patients on age, gender, region, type of stroke, and other co-morbidity. Case-fatality rate was substantially higher among patients with hemorrhagic than ischemic stroke (28.0% vs 5.8%, p<0.01); among patients with congestive heart failure than those without (17.9% vs 8.5%). In addition, patients of old age (≥75 years), men, those living in the Northeast had higher case-fatality rates than those younger, women and living in elsewhere. In conclusion, the declining of age-adjusted stroke mortality in the US has not been found to be related to the decrease in incidence. However, the observed reduction in hospital case-fatality might contribute to the decline of stroke mortality.

scholarly journals THU0442 GOUT AND HEART FAILURE IN THE US: A NATIONAL PERSPECTIVE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 458.2-458
Author(s):  
G. Singh ◽  
M. Sehgal ◽  
A. Mithal
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Confidence Intervals ◽  
Burden Of Illness ◽  
Average Length ◽  
Private Insurance ◽  
Significant Risk ◽  
Case Fatality ◽  
The United States ◽  
The Us

Background:Heart failure (HF) is the eighth leading cause of death in the US, with a 38% increase in the number of deaths due to HF from 2011 to 2017 (1). Gout and hyperuricemia have previously been recognized as significant risk factors for heart failure (2), but there is little nationwide data on the clinical and economic consequences of these comorbidities.Objectives:To study heart failure hospitalizations in patients with gout in the United States (US) and estimate their clinical and economic impact.Methods:The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. We examined all inpatient hospitalizations in the NIS in 2017, the most recent year of available data, with a primary or secondary diagnosis of gout and heart failure. Over 69,800 ICD 10 diagnoses were collapsed into a smaller number of clinically meaningful categories, consistent with the CDC Clinical Classification Software.Results:There were 35.8 million all-cause hospitalizations in patients in the US in 2017. Of these, 351,735 hospitalizations occurred for acute and/or chronic heart failure in patients with gout. These patients had a mean age of 73.3 years (95% confidence intervals 73.1 – 73.5 years) and were more likely to be male (63.4%). The average length of hospitalization was 6.1 days (95% confidence intervals 6.0 to 6.2 days) with a case fatality rate of 3.5% (95% confidence intervals 3.4% – 3.7%). The average cost of each hospitalization was $63,992 (95% confidence intervals $61,908 - $66,075), with a total annual national cost estimate of $22.8 billion (95% confidence intervals $21.7 billion - $24.0 billion).Conclusion:While gout and hyperuricemia have long been recognized as potential risk factors for heart failure, the aging of the US population is projected to significantly increase the burden of illness and costs of care of these comorbidities (1). This calls for an increased awareness and management of serious co-morbid conditions in patients with gout.References:[1]Sidney, S., Go, A. S., Jaffe, M. G., Solomon, M. D., Ambrosy, A. P., & Rana, J. S. (2019). Association Between Aging of the US Population and Heart Disease Mortality From 2011 to 2017. JAMA Cardiology. doi:10.1001/jamacardio.2019.4187[2]Krishnan E. Gout and the risk for incident heart failure and systolic dysfunction. BMJ Open 2012;2:e000282.doi:10.1136/bmjopen-2011-000282Disclosure of Interests: :Gurkirpal Singh Grant/research support from: Horizon Therapeutics, Maanek Sehgal: None declared, Alka Mithal: None declared

Abstract P699: Trends in Ischemic Stroke Risk Factors and Outcomes in a Rural Population in the United States

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Durgesh Chaudhary ◽  
Ayesha Khan ◽  
Shima Shahjouei ◽  
Mudit Gupta ◽  
Clare Lambert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Rural Population ◽  
The United States ◽  
Stroke Recurrence ◽  
Stroke Mortality ◽  
One Year ◽  
The One

Introduction: The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the trends in stroke risk factors and outcomes among a rural population in the United States between 2004 and 2018. Methods: We built a comprehensive stroke database called “Geisinger NeuroScience Ischemic Stroke (GNSIS)” for this study. Clinical data were extracted from multiple sources, including electronic health records and quality data. Results: Our cohort comprised of 8,561 consecutive ischemic stroke patients (mean age: 70.1±13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The rate of hypertension, diabetes, dyslipidemia, and history of stroke increased significantly over the fifteen years window. The one-year recurrence and mortality rates were 6.3% and 15.8%, respectively. Although the one-year stroke recurrence increased from 2004 to 2018 (Cochran-Armitage test Z = -3.66, p<0.001), the one-year stroke mortality rate decreased significantly (Cochran-Armitage test Z = 2.39, p=0.008). Age >65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Fine-Gray competing risk model, diabetes mellitus and age <65 years was found to be associated with one-year ischemic stroke recurrence. In the logistic regression, chronic kidney disease (CKD), diabetes, and prior ischemic stroke were predictors of one-year recurrence while age >65 years, atrial fibrillation or flutter, CKD, heart failure, prior hemorrhagic and ischemic stroke, history of neoplasm, myocardial infarction, and rheumatic diseases were predictors of one-year mortality. Conclusion: Although stroke mortality has decreased, stroke recurrence and several vascular risk factors have significantly increased in our rural population between 2004-2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes mellitus and age less than 65 years were predictors of ischemic stroke recurrence.

Abstract T P137: Temporal Trends in Hospitalization for Ischemic Stroke in the United States, 2000-2010

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Nerses Sanossian ◽  
May A Kim-Tenser ◽  
Lucas Ramirez ◽  
Natalie Valle ◽  
Steven Cen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Black Women ◽  
Temporal Trends ◽  
The United States ◽  
Population Based ◽  
Older Individuals ◽  
Hospitalization Rates ◽  
The Us ◽  
Age Adjusted Rates ◽  
Age And Sex

Background: Recent population-based studies have revealed declining ischemic stroke hospitalization rates in the US, particularly among whites, but no study has assessed recent nationwide trends in race/ethnic-, age- and sex-specific stroke hospitalization rates in the US. Aims: To assess temporal trends in race/ethnic-, age-, and sex-specific rates of hospitalization for ischemic stroke in the US. Methods: Temporal trends in hospitalization for ischemic stroke (ICD-9 codes 433.x1, 434, 436) from 2000 to 2010 were assessed among adults ≥25 years using the Nationwide Inpatient Sample. Age-, sex-, and race/ethnic-specific stroke hospitalization rates were calculated using the weighted number of hospitalizations as the numerator and the US civilian population as the denominator. Age-adjusted rates were standardized to the 2000 US Census population. Results: From 2000 to 2010, age-adjusted stroke hospitalization rates decreased from 169 to 138 per 100,000 (overall rate reduction 18.3%). The decline in stroke hospitalizations was driven by the ≥65 age group, with the sharpest decline among 65-84 year olds (Figure). Sex-specific rates showed higher age-adjusted rates in women, with a steeper reduction in women than in men (from 228 to 180 vs. 183 to 157 per 100,000). Race/ethnic-specific trends revealed that hospitalizations decreased for whites and Hispanics but increased for blacks (from 144 to 193 per 100,000 in black men and from 191 to 211 per 100,000 in black women). Discussion: Although overall stroke hospitalizations have decreased in the US, the reduction has been more pronounced among older individuals, whites and Hispanics. Renewed efforts at targeting risk factor control among blacks and middle-aged individuals may be warranted. Figure 1.

The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study

2014 ◽  
Vol 121 (4) ◽  
pp. 950-960 ◽  
Author(s):  
Fred Rincon ◽  
Krystal Hunter ◽  
Christa Schorr ◽  
R. Philip Dellinger ◽  
Sergio Zanotti-Cavazzoni
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Brain Injury ◽  
Brain Injuries ◽  
Multivariable Analysis ◽  
Case Fatality ◽  
The United States ◽  
Hospital Death ◽  
Hospital Case ◽  
Risk Of Death

Object Fever and hypothermia (dysthermia) are associated with poor outcomes in patients with brain injuries. The authors sought to study the epidemiology of dysthermia on admission to the intensive care unit (ICU) and the effect on in-hospital case fatality in a mixed cohort of patients with brain injuries. Methods The authors conducted a multicenter retrospective cohort study in 94 ICUs in the United States. Critically ill patients with neurological injuries, including acute ischemic stroke (AIS), aneurysmal subarachnoid hemorrhage (aSAH), intracerebral hemorrhage (ICH), and traumatic brain injury (TBI), who were older than 17 years and consecutively admitted to the ICU from 2003 to 2008 were selected for analysis. Results In total, 13,587 patients were included in this study; AIS was diagnosed in 2973 patients (22%), ICH in 4192 (31%), aSAH in 2346 (17%), and TBI in 4076 (30%). On admission to the ICU, fever was more common among TBI and aSAH patients, and hypothermia was more common among ICH patients. In-hospital case fatality was more common among patients with hypothermia (OR 12.7, 95% CI 8.4–19.4) than among those with fever (OR 1.9, 95% CI 1.7–2.1). Compared with patients with ICH (OR 2.0, 95% CI 1.8–2.3), TBI (OR 1.5, 95% CI 1.3–1.8), and aSAH (OR 1.4, 95% CI 1.2–1.7), patients with AIS who developed fever had the highest risk of death (OR 3.1, 95% CI 2.5–3.7). Although all hypothermic patients had an increased mortality rate, this increase was not significantly different across subgroups. In a multivariable analysis, when adjusted for all other confounders, exposure to fever (adjusted OR 1.3, 95% CI 1.1–1.5) or hypothermia (adjusted OR 7.8, 95% CI 3.9–15.4) on admission to the ICU was found to be significantly associated with in-hospital case fatality. Conclusions Fever is frequently encountered in the acute phase of brain injury, and a small proportion of patients with brain injuries may also develop spontaneous hypothermia. The effect of fever on mortality rates differed by neurological diagnosis. Both early spontaneous fever and hypothermia conferred a higher risk of in-hospital death after brain injury.

30 Day Readmissions in Patients with Pulmonary Embolism in the United States

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3540-3540
Author(s):  
Smit Patel ◽  
Kathan Dilipbhai Mehta ◽  
Keyur Patel ◽  
Smith Giri ◽  
Hong Wang ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Pulmonary Embolism ◽  
The United States ◽  
Readmission Rates ◽  
The Us ◽  
National Estimates ◽  
Comorbidity Index ◽  
The Cost

Abstract Introduction: Pulmonary Embolism (PE) is an important cause of the morbidity and mortality in the United States (US). National estimates of 30-day readmissions in PE patients in the US are unknown. The objective of our study was to estimate readmission rates and identify causes, predictors and cost of readmissions in PE patients. Methods: We used National Readmission Dataset (NRD - the year 2013), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality which represents one of the largest random sample of discharges from all hospitals, excluding rehabilitation and long-term acute care hospitals. NRD is designed to generate the national estimates of readmission analysis. NRD contains approximately unweighted 14 million discharges and weighted 36 million discharges. Discharge weights were utilized to generate the national estimates. The patients with PE were identified by primary discharge diagnosis with ICD9-CM code 415.1. All cause unplanned 30-day readmission rates were calculated for patients admitted between January and November 2013 by excluding elective readmissions. Deyo's modification of Charlson comorbidity index was used to define the severity of co-morbid conditions. Using SAS version 9.3, survey procedures were implemented to adjust for stratified cluster design of NRD with DOMAIN, STRATA, CLUSTER and WEIGHT statement. A p-value of less than 0.05 was considered significant. The independent predictors of unplanned 30-day readmissions were identified by logistic regression. The cost of readmission was calculated by multiplying total charges with the cost to charge ratio provided by HCUP. Results: The NRD contained 73,754 unique PE patients with 141,678 admissions (weighted N = 332,736) in 2013. After excluding elective readmissions, all cause 30-day readmission rate was 12.8%. The top causes of unplanned readmissions were pulmonary heart disease (11.1%), septicemia (6.6%), pneumonia (5.4%), congestive heart failure (4.4%), phlebitis (3.3%), gastrointestinal hemorrhage (3.1%), nonspecific chest pain (2.6%), respiratory failure (2.6%), cardiac dysrhythmias (2.5%), COPD and bronchiectasis (2.4%). The multivariate predictors for higher 30 day unplanned readmissions were Charlson comorbidity index (OR 1.13, p<0.0001), large bedside hospitals (OR 1.2, p<0.0001), metropolitan teaching hospitals (OR 1.14, p<0.0001), Medicaid payer (OR 1.37, p<0.0001), discharge on home health care (OR 1.45, p<0.0001), discharge against medical advice (OR 3.49, p<0.0001), any bleeding complications (OR 1.17, p=0.003), congestive heart failure (OR 1.51, p<0.0001), chronic pulmonary disease (OR 1.49, p<0.0001), cancer (OR 1.81, p<0.0001), operating room procedures (OR 1.48, p<0.0001), and septic shock (OR 1.27, p<0.0001). The multivariate predictors for lower 30 day unplanned readmissions were higher age (OR 0.99, p<0.0001), non-metropolitan hospitals (OR 0.84, p<0.0001), elective admission (OR 0.81, p=0.015), private payer including HMO (health maintenance organization) (OR 0.73, p<0.0001), saddle PE (OR 0.65, p<0.0001), and thrombolysis (OR 0.77, p=0.002). The estimated total cost of unplanned 30-day readmissions in PE patients was $1.02 billion for 2013. Conclusions: The unplanned 30-day readmission rates and the cost are high in PE patients in the US. Further research is needed to identify preventable readmissions, strategies to cut down the readmissions and eventually reduce the cost of readmissions in patients admitted with PE. Disclosures No relevant conflicts of interest to declare.

A real-world assessment of the burden associated with hospitalizations in US patients with heart failure and left ventricular ejection fraction (LVEF) greater than 40%

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Lahoz ◽  
R Studer ◽  
G Farries ◽  
C Proudfoot ◽  
S Suminska ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Disease ◽  
The United States ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Funding Source ◽  
Private Company ◽  
Ventricular Ejection Fraction ◽  
Hospitalization Rates ◽  
The Us

Abstract Background and purpose Heart failure (HF) is one of the leading causes of hospitalization among older adults and is associated with a large burden of disease for the individual, the patient's family, healthcare systems, and society. This study assessed the burden of hospitalizations in patients with HF with LVEF &gt;40% in the United States (US). Methods This retrospective, non-interventional study identified adult patients with incident or prevalent HF in Optum® de-identified Electronic Health Record (EHR) dataset (2007–2018) between 01/01/2013 and 31/12/2017. Optum's longitudinal EHR repository is derived from dozens of healthcare provider organizations in the US, that include more than 700 Hospitals and 7000 Clinics; treating &gt;95 million patients receiving care in the US. Patients were followed for up to 1 year or until last active date whichever occurred first. Comorbidities, all-cause hospitalizations (AcH) and primary cause HF hospitalizations (HFH) were analysed. Results 120,606 patients with HF and LVEF &gt;40% (54% female) with a mean (SD) age of 71 (13) yrs were included, representing 80,324.74 patient-yrs follow-up (days). Common comorbidities were hypertension (91.8%), ischemic heart disease (IHD, 71.4%), atrial fibrillation (AF, 54.8%), renal disease (54.1%), type 2 diabetes (T2D, 50.7%), obesity (44.6%) and anemia (39%). Comorbidities including IHD (72.9% vs. 68.4%), AF (56.4% vs. 51.6%) and T2D (51.1% vs. 49.9%) were more often recorded in patients with LVEF &gt;40-≤60% than &gt;60% cohort while hypertension (91.6% vs. 92.2%), renal disease (53.8% vs. 54.6%), obesity (43.9% vs. 46.1%) and anemia (38.1% vs. 40.9%) had significantly higher frequency in the LVEF &gt;60% cohort. The annualized AcH rate for patients with LVEF&gt;40% was 1.44 and annualized HFH rate was 0.24 with a median length of stay of 3 and 4 days, respectively. Annualized hospitalization rates were significantly higher for women than men (both AcH and HFH). AcH rates were significantly higher and HFH rates were significantly lower for patients with LVEF&gt;60% compared with LVEF &gt;40-≤60. Conclusions This study demonstrates that patients with HF and LVEF &gt;40% experience significant burden from comorbidities and hospitalizations from any-cause and for HF. The hospitalization rates are higher in women (both AcH and HFH) or patients with LVEF &gt;60% (AcH only). Further focus on reduction of hospitalizations and interdisciplinary management of patients with HF should be warranted. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis Pharma AG

Abstract T P361: Is There a ‘Stroke Belt’ for Ischemic Stroke Hospitalization among Children?

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Judith H Lichtman ◽  
Erica C Leifheit-Limson ◽  
Yun Wang ◽  
Virginia J Howard ◽  
Larry B Goldstein
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Rate Ratio ◽  
Census Data ◽  
Case Fatality ◽  
Stroke Mortality ◽  
Southeastern Part ◽  
Hospitalization Rates ◽  
Adults And Children ◽  
Stroke Belt

Background: There are regional variations in adult stroke mortality and hospitalization rates in the US, with higher rates in the Southeastern part of the country (the ‘stroke belt’). At least one study found children in stroke belt states also have higher stroke-related mortality; whether they have higher hospitalization rates is unknown. We compared ischemic stroke hospitalization rates for adults and children in stroke belt and non-stroke belt states. Methods: Ischemic stroke discharges (ICD-9-CM 433, 434, 436) were identified for calendar years 2006 and 2009 in the Kids’ Inpatient Database (N=1,434; age 0-20y) and years 2007 and 2009 in the Nationwide Inpatient Sample (N=221,351; age ≥21y). Age-specific population estimates were obtained from US Census data. Hospitalization rates per 100,000 person-years (PY) were calculated in 5-year age increments and by region. Mixed Poisson regression was used to determine the hospitalization rate ratio between stroke belt and non-stroke belt states within age groups; logistic models estimated odds ratios for in-hospital mortality. Results: Hospitalization rates were higher for adults residing in the stroke belt, but were similar for children (1.2 and 1.4 per 100,000 PY; figure). Although adult hospitalization rates were 32%-52% higher in the stroke belt, after adjustment for age, race, and sex, there was no difference in childhood stroke hospitalizations based on stroke belt residence (rate ratio=0.89, 95% CI 0.70-1.12). In-hospital mortality did not differ by region for any age group. Conclusions: Consistent with prior studies, adults in the stroke belt had higher hospitalization rates than those in non-stroke belt states; however, there was no difference for children. Because higher stroke mortality has been reported for adults and children in the stroke belt, the lack of difference in hospitalization rates and in-hospital mortality may suggest a higher late case-fatality rate for children in the stroke belt.

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