Postacute Discharge Destination and Major Adverse Cardiovascular Events Among Patients With Intracerebral Hemorrhage.

Abstract

Studies evaluating health system factors associated with major adverse cardiovascular events (MACE) among intracerebral hemorrhage (ICH) survivors are lacking. We evaluate differences in MACE incidence across postacute ICH care settings-inpatient rehabilitation facilities (IRF), home, or skilled nursing facilities (SNF). Using data from Florida, New York, Maryland, Washington, and Georgia, we identified adult ICH survivors discharged to home, IRF, or SNF (April 2016-December 2018). Multivariable logistic models, adjusted for sociodemographic factors, treatment intensity, comorbidities, and frailty, estimated adjusted odds ratios (aORs) and 95% CI for the association between discharge disposition (IRF versus home; IRF versus SNF) and MACE (a composite of acute stroke, acute myocardial infarction, systemic embolism, and vascular death), recurrent ICH, acute ischemic stroke, acute myocardial infarction, vascular death, and all-cause mortality within 1 year. Cardiovascular outcomes were ascertained using <i>International Classification of Diseases, Tenth Revision</i> codes. We assessed interaction between age and discharge disposition, performing stratified analyses for patients <65 and ≥65 years when the interaction was significant. Among 58 591 patients with ICH (mean age [SD], 68.1 [16.0] years; 47.1% female), 17 647 ICH survivors discharged home (46.4%), to IRF (25.5%), or to SNF (28.1%) were included. Within 1 year, 1302 (7.4%) patients experienced MACE, with rates for recurrent ICH, acute ischemic stroke, acute myocardial infarction, vascular death, and mortality at 2.5%, 3.2%, 0.6%, 1.3%, and 3.5%, respectively. In fully adjusted models, patients discharged to IRF had significantly lower odds of MACE (versus home: aOR, 0.84 [CI, 0.71-0.98]; versus SNF: aOR, 0.79 [CI, 0.67-0.93]), with a significant discharge disposition-age interaction (<i>P</i>=0.047). In stratified analysis, IRF discharge (versus home) was only significantly associated with MACE in patients aged <65 years (aOR, 0.70 [CI, 0.54-0.92]), not in those aged ≥65 years (aOR, 0.94 [CI, 0.77-1.15]). Patients discharged to IRF had significantly lower odds of recurrent ICH (versus SNF: aOR, 0.60 [CI, 0.45-0.80]), vascular death (versus SNF: aOR, 0.70 [CI, 0.49-0.99]), and all-cause mortality (versus SNF: aOR, 0.63 [CI, 0.50-0.79]). IRF care (versus SNF and home) was associated with lower odds of MACE. Further research is needed to determine specific components of IRF care contributing to better outcomes.