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Hospitalization Rates and Other Trends in Stroke Care Described in New Federal Report

STUMP, ELIZABETH

doi: 10.1097/01.NT.0000324686.95983.1b
Article

The hospitalization rate for ischemic stroke among patients aged 45 and older declined by 34 percent between 1997 and 2005, although hospitalizations for hemorrhagic stroke remained relatively stable during those years, according to data from the Agency for Healthcare Research and Quality (AHRQ) released in May. But according to one stroke expert who spoke to Neurology Today, those results appear rather high and should be approached cautiously.

The AHRQ report found that in 1997, 54 of every 10,000 Americans aged 45 or older were hospitalized for ischemic stroke, while 36 of every 10,000 were admitted for ischemic stroke in 2005.

S. Claiborne Johnston, MD, PhD, associate professor of neurology at the University of California-San Francisco (UCSF), and director of the UCSF Stroke Service, said: “Most data from population-based studies, which should produce more reliable estimates, suggest that stroke rates are declining only slightly, not by the 34 percent in 10 years suggested here.” It could suggest changes in coding or that more strokes are being managed in the outpatient setting, he added, but that would require further study.

Stroke, the third-leading cause of death and leading cause of disability in America, led to about 892,300 hospital admissions, totaling $8.5 billion in hospital costs, in 2005. Strokes accounted for 95 percent of all admissions for cerebrovascular disease: ischemic stroke (46.2 percent), hemorrhagic stroke (12.8 percent), transient cerebral ischemia (20.5 percent), and occlusion or stenosis of the cerebral arteries (15.8 percent).

Among other findings, in 2005, 25.1 percent of hemorrhagic stroke patients died in the hospital, while only 5.9 percent of ischemic stroke patients died. This trend is not surprising, Dr. Johnston said, because “hemorrhagic stroke is just more devastating.”

Dr. Johnston questioned the reliability of the data — culled from the Healthcare Cost and Utilization Project (HCUP) 2005 Nationwide Inpatient Sample, a database of hospital inpatient stays representative of all community hospitals around the US — because it is based on discharge diagnostic coding that is used for billing purposes, often completed by medical records analysts.

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The findings “must be confirmed in population-based studies with detailed collection of data from cases identified in a variety of settings and not just those admitted to hospitals and billed as strokes,” he said.

Most importantly, he said, the take-home message for neurologists is that stroke continues to be common, a higher burden, expensive, and deadly. •

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REFERENCE

• Hospital Stays for Stroke and Other Cerebrovascular Diseases, 2005. C. Allison Russo, M.P.H., Roxanne M. Andrews, Ph.D. May 2008 HCUP Statistical Brief #51. To access the report, go to www.hcup-us.ahrq.
    ©2008 American Academy of Neurology