Readmissions for Cardiac Disease Within 30 Days of Hospitalization for Cerebral Infarction: An Evaluation of the Stroke–Heart Syndrome Using the Nationwide Readmission Database

TL;DR

This study finds that 2.4% of patients who had a stroke were readmitted to the hospital for new heart issues within 30 days, with factors like elective admission and cancer increasing the risk.

Contribution

The study provides new insights into the stroke–heart syndrome by identifying specific predictors of cardiac readmissions after cerebral infarction.

Findings

2.4% of patients were readmitted for new cardiac events within 30 days of stroke hospitalization.

Elective admission and cancer were the strongest predictors of readmission for cardiac issues.

Palliative care was associated with a significantly reduced risk of readmission.

Abstract

Background: The stroke–heart syndrome refers to incident cardiac complications post stroke. This study aims to evaluate the stroke–heart syndrome by determining the rate and predictors of readmission for cardiac disease within 30 days of hospitalization for cerebral infarction. Methods: Data from the United States Nationwide Readmissions Database (2018 to 2020) were analyzed to identify rates and factors associated with 30-day readmissions for heart disease following cerebral infarction, excluding patients with atrial fibrillation, heart failure and myocardial infarction during admission with cerebral infarction. Results: There were 3,115,850 hospital admissions for cerebral infarction, and 75,440 admissions (2.4%) were readmitted with new onset cardiac events within 30 days of discharge. This included 36,310 (1.4%) readmissions for heart failure, 35,900 (1.1%) readmissions for atrial fibrillation, 17,465 (0.5%) readmissions for acute myocardial infarction, 810 (0.03%) readmissions for ventricular arrhythmias and 700 (0.02%) readmissions for Takotsubo syndrome. Readmitted patients were older (median age of 73 years vs. 68 years, p < 0.001) and had a longer length of stay for initial admission (median of 4 days vs. 3 days, p < 0.001). The most significant predictors of readmission were elective admission (OR 2.00, 95%CI 1.89–2.13, p < 0.001), cancer (OR 1.91, 95%CI 1.81–2.01, p < 0.001), chronic kidney disease (OR 1.80, 95%CI 1.73–1.87, p < 0.001), previous myocardial infarction (OR 1.59, 95%CI 1.50–1.69, p < 0.001) and liver failure (OR 1.34, 95%CI 1.06–1.68, p = 0.013). Palliative care was linked to a reduced odds of readmission (OR 0.36, 95%CI 0.31–0.41, p < 0.001). Conclusions: New cardiac-related hospital readmissions within 30 days after ischemic stroke occur in 2.4% of patients, with elective admission and cancer being a strong predictor of readmissions.

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