The Risk Evaluation Of Readmission Of Acute Ischemic Stroke And Transient Ischemic Attack

PART1 Analysis of risk factors for short term recurrence of acute ischemic stroke and transient ischemic attack[Objective]:Through the retrospectively analyze of patients with acute ischemic stroke(acute ischmic stroke,AIS)and transient ischemic attack(transient ischemic attack,TIA)of two years,to study the recurrence of patients included for 1 month and 1 year,the risk factors of AIS/TIA which lead to readmission were analyzed.[Methods]:A retrospective analysis from May 1,2013 to April 30,2015 for AIS/TIA patients who were admitted.Analysis of demographic characteristics,causes of readmission,risk factors for recurrent ischemic stroke.The readmission rate of patients with recurrent ischemic stroke during the above period was analyzed.[Results]:1 month after discharge,the overall readmission rate was 16.7%(n=160),the main causes of readmission including infectious diseases(19.9%),coronary heart disease(17.8%)and ischemic stroke recurrence(16.3%)(n=26).1 years after discharge,the readmission rate of patients was 29.2%(n=281),of the 1 years'readmission,the main causes including infection(13.6%),coronary heart disease(16.7%)and ischemic stroke recurrence(20.3%)(n=57).About the 26 patients with recurrent ischemic stroke within 1 month,the patient demographics and readmission risk factors were shown in table 1.Among them,the age of 46-60 and 61-70 were 9 and 10,respectively,accounting for more than 73.1%of patients with recurrent disease,and more male patients.Patients with diabetes accounted for 19,accounting for up to 73.1%.In 1 year after discharge,there are 57 cases of recurrence of ischemic stroke patients,patient demographic information and readmission risk factors in Table 1:in the age of 46-60 and 61-70,there are 19 and 21 patients respectively,which occupied the 70.1%recurrent patients,male patients were more than female;39 patients with high blood pressure,The proportion reached 68.4%.In the first month after discharge of the recurrence patients,the below 5 items:male(61.5%),diabetes(73.1%),hypertension(80.8%),high-LDL(80.8%),admission NHISS score<8 points(65.4%),were accounted for more than 50%,these are the main relapse factors in short time;we also found that,smoking(42.3%),hyperuricemia(42.3%),large artery atherosclerosis(42.3%),aspirin resistance(42.3%),clopidogrel resistance(46.2%)and other factors plays a more important role in the etiology of recurrent stroke;we also found that in 1 month after discharge,no cases come back for routine referral review.Because of the recurrence of stroke in patients discharged from hospital who were readmitted within 1 year,male(57.9%),smoking(57.9%),hypertension(68.4%),pathological type of large artery atherosclerosis(50.9%)and the NHISS score on admission<8(71.9%)accounted for more than 50%;and diabetes(38.6%)and high LDL(47.4%),clopidogrel resistance(49.1%)also occupy a larger role in patients with recurrent of AIS/TIA in a year.About the patients,compliance,a total of 47.4%patients do not obey correct medication,including drug withdrawal and intermittent medication;and about the referral in every quarter,only 11(19.3%)in accordance with the requirements of the referral review in the recurrent patients.[conclusion]:1,Patients with acute ischemic stroke and transient ischemic attack in a month and a year,the recurrence rate is high;2,The factors that influence the recurrence of ischemic stroke and transient ischemic attack include age,male,diabetes,hypertension,high LDL and hyperuricemia;3,Large artery atherosclerosis play an important role in recurrent patients;4,Aspirin and/or clopidogrel resistance increases the chances of recurrence;patients with drug withdrawal,intermittent medication,low compliance had an higher recurrence.PART 2 Study on the relationship between patient compliance and recurrence of acute ischemic stroke and transient ischemic attack?[Objective]:Study from a large number of cases,information about the compliance of patients,acquire two groups'(normal referral review and non referral review)recurrence rate,thus found the relationship beteween the patients' compliance and the recurrent of acute ischemic stroke and transient ischemic attack,further guidance to patients and doctors?nurses in second prevention system.[Methods]:A retrospective analysis,patients from May 1,2013 to April 30,2015.who were admitted for AIS/TIA and discharge after the treatment,the first discharge diagnosis with the disease encoding.Including patients who was readmitted in 1 year after discharge.Patients were asked to follow up with the patient's clinic,either in a follow-up system,or by telephone,or in patients who were hospitalized again.Contact by telephone and outpatient registration,determine medication,patient referral review,to determine the compliance of patients.For patients admitted to hospital,they were identified by medical history.They were asked about how they use the 3 drugs:the Aspirin Enteric-coated Tablets,Atorvastatin Calcium Tablets and the Clopidogrel.[Results]:There are 57 cases in 1 years due to ischemic stroke or transient ischemic attack relapse readmitted.And regular follow-up review,regular follow-up patients accounted for only 17%,a total of 10 people were referral review in accordance with the requirements,the rate of this recurrence group was 10/291,accounting for 3.43%.For the rest of the ischemic stroke relapse was 47,without referral review,accounting for 47/673,accounted for 6.98%.The comparison of 10/291 and 47/673,P=0.011,there was significant difference,indicating ischemic stroke within 1 year,in the review process can find problems in time,adjust the treatment as soon as possible,improve patients' compliance,reduce the recurrence of stroke patients,can effectively reduce the readmission rate.The patients who have an regular follow-up got a longer readmission interval than those who donot have an regular follow-up,&(CI95,13.3-52.4,P=0.002),the difference was statistically significant,indicating a good follow-up can delay readmission for recurrent stroke,can effectively prevent the recurrence of stroke.There was no significant difference in NHISS score between the two groups in the first admission.Patients with regularly follow-up have a low proportion of readmission,have a smaller NHISS score,have a longer readmission interval,the difference was statistically significant,*(CI95,2.96-6.64,P=0.000),shows that regularly follow-up,control general situation and risk factors in the early diagnosis of the patients after discharge,according to the treatment data of the second prevention,reduce the recurrence of ischemic stroke,reduce the severity of recurrent ischemic stroke.Patients without regularly follow-up had a higher NHISS score average,there was no significant difference with the first admission,#(CI95,0.27-3.27,P=0.092).That means without regularly follow-up,there is no adjustment of treatment,so the patients at admission time remains a serious disease,NHISS score did not get a decrease,do not achieve good second prevention.The average of NHISS in patient without regularly follow-up,is higher than the other group(CI95,2.33-4.86,P=0.000),the difference was statistically significant,indicating a regularly follow-up is good control of the severity of disease,can reduce the harm of the second episodes of ischemic stroke,can be a good way of second prevention?[Conclusion]:1,The recurrence of acute ischemic stroke and transient ischemic attack is related to patients with poor compliance,including non regularly follow-up and withdrawal medicines;2,Most of the recurrence of patients have drug withdrawal and other irregular medication;3,A regularly follow-up and regular medication can give patients benefit,can reduce the recurrence rate;4,The compliance of patients discharged from hospital is an important aspect of the prognosis of patients;5,Although some patients with good compliance,but there are still relapse(case 1 and case 6),may be associated with aspirin and clopidogrel resistance to the drug,the need for further research and analysis.PART 3 Study on the relationship between platelet aggregation and acute ischemic stroke and TIA recurrence[Objective]:To detect the patients'platelet aggregation during in the use of aspirin or clopidogrel,reflecting the inhibitory function of platelet of aspirin and/or clopidogrel.Compare the rate of recurrence between patients whose inhibitory of platelet were up to grade and whose were not.in the assessment of aspirin and/or clopidogrel resistance to the recurrence of AIS/TIA.[Methods]:A retrospective analysis,patients from May 1,2013 to April 30,2015.who were admitted because of AIS/TIA and discharged after the treatment,the first discharge diagnosis with the disease encoding.Including patients who were readmitted in 1 year after discharge.Determination of platelet aggregation rate were measured by PL-11 platelet function analyzer and reagents,through the statistical analysis to detect the relationship between platelet aggregation and the recurrence of acute ischemic stroke and TIA.[Results]:There are 16 patients with aspirin or clopidogrel resistance in patients who were readmitted in one month because of the the recurrence of AIS/TIA.There are 10 patients with no aspirin or clopidogrel resistance,compared with 16/964 and 10/964(P=0.079,four chi square test),no statistical differences between the two groups.Of the 26 patients after discharge,17 patients had two weeks' double oral antiplatelet,considering the difference at 1 months was not statistically significant,may be related to the double oral antiplatelet.There are 57 patients were readmitted in 1 year due to AIS/TIA recurrence,in which there are 42 patients with aspirin and/or clopidogrel resistance,and the other 15 patients without.Compared with 42/964 and 15/964,P<0.01,there is significant differences between the two groups.The results showed that the recurrence rate of AIS/TIA within 1 years was significantly higher than that in patients without drug resistance.There is no significant difference in NHISS score between the two groups.Patients without CR or AR,have less readmission proportion,less NHISS score,and longer readmission interval,the difference was statistically significant,indicating that AR or CR can lead to lower the effect of drug treatment of second prevention.To add the checking of platelet aggregation may be good choice for the second prevention,to reduce the ischemic stroke.At the time of hospital readmission,the time of readmission in the group with no AR or CR,was longer than the group with AR or CR.The difference was statistically significant(CI95,77.5-123.6,&).It is suggested that platelet function is of great significance in the patients with cerebral ischemic stroke,and it is of great clinical significance to carry out the detection of platelet function and to carry out individual antithrombotic therapy.Patients readmitted because of the recurrence of ischemic stroke,The NHISS score in the drug resistant group is higher than the group without drug resistant,(CI95,0.14-3.99,P=0.039)the difference was statistically significant,indicating that drug resistance leads to reduced the effect of antiplatelet aggregation in second prevention,resulting in patients with recurrent stroke,increased readmission.Patients with drug resistant,the readmission NHISS score was not significantly decreased(CI95,1.19-1.59,*P=0.768)than the first admission.Although patients taking antiplatelet drugs,but not good enough to reduce the risk of recurrent stroke,resulting in patients with relapse,the severity of the disease keep the same with the first admission.Patients without drug resistant,the readmission NHISS score was significantly decreased(CI95,0,.12-3.97,#P=0.038)than the first admission,which indicate that effective antiplatelet therapy can control the disease,can reduce the severity of stroke recurrence.[conclusion]:1,Early double antiplatelet aggregation can reduce the short-term(1 months)recurrence rate;2,Patients with the presence of aspirin and/or clopidogrel resistance in patients with AIS/TIA,the recurrence rate was significantly increased within 1 years;3,Patients with the presence of aspirin and/or clopidogrel resistance in patients with AIS/TIA,the disease recurrence earlier,also with severe onset;4,The Platelet function testing,and according to the results to carry out the individual antithrombotic therapy,may be good to the second prevention of AIS/TIA.