Abstract Details

Title Acute Stroke Interventions and Outcomes for Nursing Home Residents Compared to Age-matched Community-dwelling Adults

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S6 - Stroke Pathophysiology and Prediction (5:18 PM-5:30 PM)

Poster/Presentation
Number 010

Background

Nursing facilities often care for individuals following acute hospitalizations or requiring long-term nursing care, many of whom are older and have multiple chronic illnesses. Little is known about the care and outcomes for NH residents acutely hospitalized for ischemic stroke.

Objective

To identify differences in healthcare utilization and outcomes after acute ischemic stroke for nursing home (NH) residents compared to age-matched controls from the community.

Design/Methods We conducted a retrospective cohort study using statewide inpatient data for acute ischemic stroke hospitalizations from California, Florida, and New York, 2018-2020. We identified individuals as NH residents based on the Uniform Billing 04 form point of origin code. NH residents were one-to-one age-matched with patients admitted from the community using coarsened exact matching. We performed conditional logistic regression adjusting for sex, race and ethnicity, insurance payer, and comorbidities to compare the use of intravenous thrombolysis, endovascular thrombectomy (EVT), invasive mechanical ventilation (IMV), tracheotomy, and gastrostomy, and to assess mortality as defined by inpatient death or discharge to hospice.

Results There were 6,523 NH residents hospitalized for acute stroke one-to-one matched on age to stroke hospitalizations from the community. NH residents were less likely to receive thrombolytics (aOR [adjusted odds ratio] = 0.75, 95% CI 0.67-0.83) or undergo EVT (aOR = 0.50, 95% CI 0.42-0.60). Conversely, NH residents exhibited greater odds of invasive mechanical ventilation (aOR = 1.18, 95% CI 1.05-1.33) and gastrostomy placement (aOR = 1.35, 95% CI [1.16-1.56]), but no difference in tracheostomy (aOR 0.59, 95% CI 0.35-1.00). Mortality was greater among NH residents (aOR = 1.50, 95% CI 1.30-1.72).

Conclusions

In the setting of acute stroke, NH residents are less likely to receive reperfusion therapy but more likely to undergo intensive care interventions with an elevated risk of poor outcomes.

Authors/Disclosures
Wasim Zatar PRESENTER	Mr. Zatar has nothing to disclose.
Adam Kelly, MD, FAAN (University of Rochester)	Dr. Kelly has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Grand Rounds/Included Health. Dr. Kelly has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology. Dr. Kelly has received personal compensation in the range of $500-$4,999 for serving as a Question writer for various educational offerings with American Academy of Neurology.
Benjamin P. George, MD (U of Rochester, Dept of Neurology)	Dr. George has nothing to disclose.