title: Impact of Multiple Chronic Conditions in Patients Hospitalized with Stroke and Transient Ischemic Attack.
abstract: BACKGROUND
  The prevalence and clinical impact of chronic conditions (CCs) have increasingly been recognized as an important public health concern. We evaluated the prevalence of coexisting CCs and their association with 30-day mortality and readmission in hospitalized patients with stroke and transient ischemic attack (TIA).
  
  
  METHODS
  In a retrospective study of patients aged ≥18 years hospitalized for first-ever stroke and TIA, we assessed the prevalence of coexisting CCs and their predictive value for subsequent 30-day mortality and readmission.
  
  
  RESULTS
  Study cohort comprised 6771 patients, hospitalized for stroke (n = 4068) and TIA (n = 2703), 51.4% men, with mean age of 68.2 years (standard deviation: ±15.6), mean number of CCs of 2.9 (±1.7), 30-day mortality rate of 8.6% (entire cohort), and 30-day readmission rate of 9.7% (in 2498 patients limited to Olmsted and surrounding counties). In multivariable models, significant predictors of (1) 30-day mortality were coexisting heart failure (HF) (odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.09-1.92), cardiac arrhythmia (OR: 1.74, 95% CI: 1.40-2.17), coronary artery disease (CAD) (OR: 1.64, 95% CI: 1.29-2.08), cancer (OR: 1.67, 95% CI: 1.31-2.14), and diabetes (HR: 1.28, 95% CI: 1.01-1.62); and (2) 30-day readmission (n = 2498) were CAD (OR: 1.50, 95% CI: 1.09-2.07), cancer (OR: 1.46, 95% CI: 1.01-2.10), and arthritis (OR: 1.62, 95% CI: 1.09-2.40).
  
  
  CONCLUSIONS
  In patients hospitalized with stroke and TIA, CCs are highly prevalent and influence 30-day mortality and readmission. Optimal therapeutic and lifestyle interventions for CAD, HF, cardiac arrhythmia, cancer, diabetes, and arthritis may improve early clinical outcome.
authors.affiliation: Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota. Electronic address: Yousufuddin.mohammed@Mayo.edu.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Yousufuddin
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Bartley
authors.affiliation: Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mouaz
authors.initials: M
authors.lastname: Alsawas
authors.affiliation: Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Sheely
authors.affiliation: Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota.
authors.forename: Jessica
authors.initials: J
authors.lastname: Shultz
authors.affiliation: Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Takahashi
authors.affiliation: Division of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Young
authors.affiliation: Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota; Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
authors.forename: M Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D000071069:Multiple Chronic Conditions / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D010359:Patient Readmission; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D013997:Time Factors
keywords: Trend; chronic condition; mortality; readmission; stroke