title: One-year all-cause mortality after stroke: a prediction model.
abstract: OBJECTIVE
  By using data from Department of Veterans Affairs (VA) national databases, this article presents and internally validates a 1-year all-cause mortality prediction index after hospitalization for acute stroke.
  
  
  METHODS
  An observational cohort.
  
  
  METHODS
  VA medical centers.
  
  
  METHODS
  Veterans with a diagnosis of a new stroke who were discharged between October 1, 2006, and September 30, 2008.
  
  
  METHODS
  Death due to any cause that occurred between the index hospital discharge date and the 1-year anniversary of that date.
  
  
  RESULTS
  Within 1-year after discharge, 1542 (12.3%) of the total 12,565 patients had died. Seventeen risk factors known at the point of hospital discharge remained in the predictive model of 1-year postdischarge mortality after backward selection, including advanced age, admission from extended care, type of stroke, 8 comorbid conditions, 4 types of procedures that occurred during the index hospitalization, hospital length of stay (longer than 3 weeks), and discharge location. We assigned a score to each variable in the final model and a risk score was determined for each patient by adding up the points for all risk factors present. According to these risk scores, the patients were divided into approximate quartiles that yielded low, moderate, high, and highest mortality likelihood strata. The risk of 1-year mortality ranged from 2.24% in the lowest quartile to 29.50% in the highest quartile in the derivation cohort and from 2.11%-30.77% in the validation cohort. Model discrimination demonstrated an area under the receiver operating characteristic curve of 0.785 in the derivation cohort and 0.787 in the validation cohort. The Hosmer-Lemeshow goodness of fit indicated that the model fit was adequate (P = .69).
  
  
  CONCLUSIONS
  When using readily available data, a simple index that stratifies stroke patients at hospital discharge according to low, moderate, high, and highest likelihood of all-cause 1-year mortality is feasible and can inform the postdischarge planning process, depending on level of risk.
authors.affiliation: Veterans Affairs Medical Center, Albany, NY; Physical Medicine and Rehabilitation, Albany Medical College, VAMC (117), 113 Holland Avenue, Albany, NY 12208(∗). Electronic address: barbara.bates@va.gov.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Bates
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA(†).
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA(‡).
authors.forename: Pui L
authors.initials: PL
authors.lastname: Kwong
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA(§).
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.affiliation: Veterans Affairs Medical Center Gainesville, FL, Division of Health Policy and Outcomes Research, Department of Epidemiology and Health Policy Research, University of Florida, Gainesville, FL(‖).
authors.forename: Diane Cowper
authors.initials: DC
authors.lastname: Ripley
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA(¶).
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Stineman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D004502:Education, Medical, Continuing; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016019:Survival Analysis; D014481:United States