Abstract Body:
Introduction: Outpatient follow-up within thirty days of discharge home after an ischemic stroke is associated with reduced readmission rates. Current guidelines emphasize a primary care-based approach to follow-up care but provide little information regarding neurology-specific follow-up. This study aims to examine the rates of follow-up with non-neurology care providers and neurologists, and their association with patient outcomes.
Methods: We conducted a retrospective cohort study using electronic health records collected of patients discharged home after admission on the neurovascular service from a tertiary care hospital from October 2020 to October 2023 who were then subsequently contacted via guideline-recommended seven-day phone call. Clinical demographics, follow-up with either a non-neurology care provider (e.g., primary care provider, cardiologist, endocrinologist) or neurologist, emergency department (ED) presentations, and mortality were analyzed using a Chi-square analysis.
Results: We identified a total of 246 patients for this review, 232 (94.3%) of whom attended follow-up with a non-neurologist compared to 182 (74.0%) with a neurologist an average of 33.9 days and 77.5 days from hospital discharge, respectively. A total of 127 (51.6%) patients presented to the ED within the follow-up timeframe, with 31 (12.6%) patients presenting prior to any follow-up appointment. There was a noted difference in the ED presentation rate between patients who did not attend a neurology appointment (36/62, 58.1%) compared to those that did attend (91/182, 41.9%), however this was not statistically significantly different. Of the 16 (6.9%) deaths in the cohort, they occurred significantly disproportionately in the patients without a neurology follow-up appointment (8/62, 12.9%; p = 0.02).
Conclusion: Our findings suggest that patients who do not attend a neurology-specific follow-up appointment after stroke may have worse outcomes, including higher mortality rates. Further research is needed to develop interventions that improve neurology follow-up rates, with the goal of reducing ED visits, hospital readmissions, and mortality in patients with stroke.