Doctor's follow-up after stroke in the south of Sweden: An observational study from the Swedish stroke register (Riksstroke)

Abstract

Introduction: Information on follow-up practices after stroke in clinical routine are sparse. We studied the probability of doctor's follow-up within 90, 120, 180, and 365 days after hospital discharge, and how patient characteristics were associated with the probability of follow-up, in a large unselected stroke cohort.

Patients and methods: Data on patients living in southern Sweden, hospitalized with acute ischemic stroke or intracerebral hemorrhage 1 January 2008 to 31 December 2010, were obtained from the Swedish stroke register (Riksstroke) and merged with administrative data on doctor's visits during the year following stroke.

Results: Complete data were registered in 8164 patients. The cumulative probability of a doctor's follow-up was 76.3% within 90 days, 83.6% within 120 days, 88.7% within 180 days, and 93.1% within 365 days. Using Cox regression calculating hazard ratios (HR), factors associated with 90-day follow-up were: female sex HR = 1.066 (95%CI: 1.014-1.121), age: ages 65-74 HR = 0.928 (95%CI: 0.863-0.999), ages 75-84 HR = 0.943 (95%CI: 0.880-1.011), ages 85 + HR = 0.836 (95%CI: 0.774-0.904), pre-stroke dependency in activities of daily living (ADL): HR = 0.902 (95%CI = 0.819-0.994), prior stroke HR = 0.902 (95%CI: 0.764-0.872), and severe stroke HR = 0.506 (95%CI: 0.407-0.629). In patients discharged to assisted living, the following factors were associated with lower follow-up probability: living alone pre-stroke HR = 0.836 (95%CI: 0.736-0.949), and pre-stroke dependency HR = 0.887 (95%CI: 0.775-0.991).

Discussion: This study was based on hospital administrative data of post-stroke doctor's visits, but may be confounded by attendance for other conditions than stroke.

Conclusions: One in four stroke patients was not followed up within three months after hospital discharge. Vulnerable patients with high age, pre-stroke ADL dependency, and prior stroke were less likely to receive doctor's follow-up.

Keywords: Stroke; cohort; follow-up; stroke organization; transition of care.

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.

Panel (a) shows vascular risk factor profile (diabetes, hypertension and atrial fibrillation) at discharge in 5135 stroke patients who were followed up within 90 days and 1636 patients not followed up within 90 days. Data were missing in 0.6%. Panel (b) compares number of risk factors between patients who were, and were not followed up within 90 days.