Effects of Transferring to the Rehabilitation Ward on Long-Term Mortality Rate of First-Time Stroke Survivors: A Population-Based Study

Chien-Min Chen, Yao-Hsu Yang, Chia-Hao Chang, Pau-Chung Chen

To assess the long-term health outcomes of acute stroke survivors transferred to the rehabilitation ward. Long-term mortality rates of first-time stroke survivors during hospitalization were compared among the following sets of patients: patients transferred to the rehabilitation ward (RR), patients receiving rehabilitation without being transferred to the rehabilitation ward (NtR), and patients receiving no rehabilitation (NoR). We conducted a five-year, nationwide, population-based, retrospective, cohort study, using data from the Longitudinal Health Insurance Database 2005 in Taiwan. A total of 11,419 patients with stroke from 2005 to 2008 were initially assessed for eligibility. After propensity score matching, 390 first-time stroke survivors were included. None. The Cox proportional hazards regression model was used to assess differences in 5-year post-stroke mortality rates. Based on adjusted hazard ratios (HR), the NtR (adjusted HR = 2.20; 95% confidence interval (CI): 1.36-3.57) and NoR (adjusted HR = 4.00; 95% CI: 2.55-6.27) groups had significantly higher mortality risk than the RR group. Mortality rate of these stroke survivors was affected by age ≥ 65 years (compared to age < 45 years, adjusted HR = 3.62), men (adjusted HR = 1.49), ischemic stroke (adjusted HR = 1.55), stroke severity (Stroke Severity Index (SSI) ≥20, compared to SSI <10, adjusted HR = 2.68), and comorbidity (Charlson-Deyo Comorbidity Index (CCI) ≥3, compared to CCI = 0, adjusted HR = 4.23). First-time stroke survivors transferred to the rehabilitation ward had a 5-year mortality rate 2.2 times lower than those who received rehabilitation without transfer to the rehabilitation ward and 4 times lower than those who received no rehabilitation.