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Health Risks Rise for Medicare Patients in Year After Stroke
Date:12/16/2010

roke patients at the top-performing hospitals died within 30 days, compared with 17.8 percent of stroke patients treated at the worst-performing hospitals.

Moreover, there has been no improvement in death or rehospitalization rates after stroke among Medicare patients between 2003 and 2006, the study found.

"Increased efforts to prevent strokes are critical," Fonarow said. "For patients presenting with acute stroke, this is an important need to better implement hospital, transition-of-care and outpatient strategies aimed at avoiding those deaths and rehospitalizations that are preventable."

Commenting on the study, Dr. Ralph L. Sacco, chairman of neurology at the University of Miami Miller School of Medicine and president of the American Heart Association, said that though the death and rehospitalization rates seem high, the patients in the study were older and many had other medical problems, such as heart disease, diabetes or heart failure.

"That's probably in keeping with a Medicare population," he said. "We recognize that stroke patients have other comorbidities that can lead to rehospitalization."

According to the study, people were rehospitalized for conditions that included atrial fibrillation, a prior stroke or heart attack, heart disease and diabetes. "This is not a healthy group," Sacco said.

He noted that guidelines have concentrated on in-hospital care, but new guidelines are being developed to improving outpatient care after a stroke. The goal of these guidelines is to reduce deaths and rehospitalizations, he said.

"Better adherence, compliance and medical management are needed post-discharge," Sacco said.

And, he added, people such as those in the study may not have a long life expectancy, but they deserve a good quality of life in the time they have remaining. "Anything we can do to avoid rehospitalization and improve quality of life after stroke would be helpful," he said.

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