Stroke survival after discharge from an acute-care hospital

Background and Purpose: Survival after a stroke is likely to be best for pa tients well enough to be sent home but the relative risk of dying if patien ts do not qualify for a home discharge has not been well studied. We invest igated the survival prognosis after an initial stroke depending on the faci lity to which the patient was discharged after an acute initial stroke. Met hods: All patients were enrolled between July 1, 1987, and August 1, 1989, and were followed up to 4 years (mean of 24 months) until death, second str oke, or the end of the study. Results: Among 662 patients who were discharg ed alive after hospitalization with an initial stroke, 128 (19%) went to a nursing home, 17 (3%) to a short-term hospital, 140 (21%) to a rehabilitati on facility, and 375 (57%) went home (discharge destination unknown for 2 p atients). Compared to patients sent home after taking age, sex, selected ba seline comorbidities, length of hospital stay, and neurological deficits in to consideration, results from Cox proportional hazards model indicated tha t patients sent to a nursing home had 2.6 times greater risk of dying (95% CI = 1.81-4.15) while those who were discharged to a rehabilitation facilit y had a death hazards ratio of 1.1. Conclusions: Mortality was greatest in the early months after discharge and decreased thereafter. Since the analys is was adjusted for age, sex, comorbidity, length of hospital stay, and num ber of neurological deficits, quality of care in a nursing home setting may account for the mortality difference but other factors such as social supp ort network and living will instructions also need to be investigated.