Nandakumar Nagaraja, MD

Jones S, Sen S, Lakshminarayan K, Wayne R. Poststroke Outcomes Vary by Pathogenic Stroke Subtype in TheAtherosclerosis Risk in Communities Study. Stroke. 2013

Stroke patients are at risk of recurrent stroke and stroke related medical complications such as pneumonia and UTI which result in hospital readmissions. Determining the etiology of stroke helps in instituting appropriate stroke secondary prevention strategies to prevent recurrent strokes. Stroke related medical complications can by minimized with good nursing care. 
Jones and colleagues in a recent article evaluated the long term stroke outcomes by etiologic subtype in the Atherosclerosis Risk in Communities Study, a population based study. Based on the National Survey of Stroke classification patients were categorized as thrombotic, lacunar, cardioembolic, ICH or SAH. Patients with ICH had highest mortality followed by cardioembolic strokes but it was lower for lacunar infarcts. Higher all-cause hospital readmissions were seen for cardioembolic strokes and lower for lacunar infarcts. About 70% of recurrent strokes were of the same subtype except for lacunar strokes (28%). This probably indicates that either the patient failed or was not compliant with the stroke secondary prevention strategies. 

Patients with lacunar strokes had lower mortality and hospital readmissions but higher rate of non lacunar (72%) recurrent strokes. So there is probably a window of opportunity during the follow up of lacunar stroke patients to identify new risk factors such as cardioembolic or atherosclerotic large artery disease and provide appropriate management before they have a stroke from non lacunar etiology.

Because patients with cardioembolic strokes have higher rates of all-cause readmission it is important to make sure that these patients are on appropriate stroke secondary prevention medications and have good discharge planning with follow up. This may reduce the readmissions and health care cost to the society and improve the quality of life of the patient.