title: Predictors of poor hospital discharge outcome in acute stroke due to atrial fibrillation.
abstract: Atrial fibrillation (AF) is a frequent cause of acute ischemic stroke that results in severe neurological disability and death despite treatment with intravenous thrombolysis (intravenous recombinant tissue plasminogen activator [rtPA]). We performed a retrospective review of a single-center registry of patients treated with intravenous rtPA for stroke. The purposes of this study were to compare intravenous rtPA treated patients with stroke with and without AF to examine independent predictors of poor hospital discharge outcome (in-hospital death or hospital discharge to a skilled nursing facility, long-term acute care facility, or hospice care). A univariate analysis was performed on 144 patients receiving intravenous rtPA for stroke secondary to AF and 190 patients without AF. Characteristics that were significantly different between the two groups were age, initial National Institutes of Health Stroke Scale score, length of hospital stay, gender, hypertension, hyperlipidemia, smoking status, presence of large cerebral infarct, and hospital discharge outcome. Bivariate logistic regression analysis indicated that patients with stroke secondary to AF with a poor hospital discharge outcome had a greater likelihood of older age, higher initial National Institutes of Health Stroke Scale scores, longer length of hospital stay, intubation, and presence of large cerebral infarct compared with those with good hospital discharge outcome (discharged to home or inpatient rehabilitation or signed oneself out against medical advice). A multivariate logistic regression analysis showed that older age, longer length of hospital stay, and presence of large cerebral infarct were independent predictors of poor hospital discharge outcome. These predictors can guide nursing interventions, aid the multidisciplinary treating team with treatment decisions, and suggest future directions for research.
authors.affiliation: Questions or comments about this article may be directed to Melissa J. Tian, MSN RN CCRC, at mtian@wpahs.org. She is a Manager of Neurology Research, Alleghney General Hospital, Pittsburgh, PA. Ashis H. Tayal, MD, is an Associate Professor and Director of Stroke Program, Alleghney General Hospital, Pittsburgh, PA. Elizabeth A. Schlenk, PhD RN, is an Associate Professor, University of Pittsburgh School of Nursing, Pittsburgh, PA.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Tian
authors.forename: Ashis H
authors.initials: AH
authors.lastname: Tayal
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Schlenk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000401:mortality / Q000451:nursing*; D002544:Cerebral Infarction / Q000209:etiology / Q000401:mortality / Q000451:nursing*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D009735:Nursing Homes; D010351:Patient Discharge; D063868:Patient Outcome Assessment; D010360:Patient Transfer; D011994:Recombinant Proteins / Q000008:administration & dosage; D012189:Retrospective Studies; D018570:Risk Assessment; D015912:Thrombolytic Therapy / Q000451:nursing*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator