Abstract DP148: Post-Acute Inpatient Rehabilitation and Major Adverse Cardiovascular Events After Acute Ischemic Stroke: A Multi-State Analysis

Background: Inpatient rehabilitation facilities (IRFs) are central to post-stroke recovery, yet large-scale analyses of the association of post-cute IRF care with major adverse cardiovascular events (MACE) among acute ischemic stroke (AIS) survivors are lacking. We evaluated the association between discharge to IRF, compared to home (with or without home health services) or skilled nursing facilities (SNFs), and the 1-year risk of MACE and other vascular outcomes. Methods: We identified adult AIS survivors (≥18 years) from statewide inpatient and emergency department databases of Florida, New York, Maryland, Washington, and Georgia (2016–2019). We fit multivariable Cox regression models to evaluate the association of IRF care with the 1-year risk of experiencing MACE (a composite of AIS, intracerebral hemorrhage [ICH], vascular death [VD], and acute myocardial infarction [AMI]), VD, and all-cause mortality. Fine-Gray models, with death as a competing risk, were used for 1-year recurrent AIS (r-AIS), ICH, and AMI. Adjusted hazard ratios (aHR), sub-distribution hazard ratios (aSHR), and 95% CIs are reported. Results: Among 316,499 AIS survivors (median age [IQR]: 71 [61–81] years; 49.1% female), 63.6% were discharged home, 16.0% to IRF, and 20.4% to SNF. Patients discharged home (53.5%) or to IRF (51.4%) were predominantly male (vs. SNF: 42.3%). Median age was lower for home (68 years) and IRF (70 years) than SNF (80 years). Medicare was most common among SNF discharges (86%), while private insurance was more frequent in home (22.9%) and IRF discharges (17.6%) than SNF (6.3%). At 1 year, 6.7% of AIS patients experienced MACE, and 6.6%, 0.3%, 0.9%, 0.5%, and 2.0% experienced r-AIS, ICH, AMI, VD, and mortality, respectively. IRF discharge was associated with a lower risk of MACE (aHR, 95% CI: 0.79, 0.75–0.82 vs. home; 0.76, 0.73–0.80 vs. SNF), r-AIS (aSHR, 95% CI: 0.78, 0.74–0.81 vs. home; 0.76, 95% CI 0.72–0.80 vs. SNF), AMI (aSHR, 95% CI: 0.84, 0.75–0.94 vs. home; 0.89, 0.78–1.01 vs. SNF), ICH (aSHR, 95% CI: 0.81, 0.66–0.99 vs. SNF), VD (aHR 95% CI: 0.83, 0.71–0.98 vs. SNF) and all-cause mortality (aHR 95% CI: 0.65, 0.60–0.70 vs. SNF). Conclusions: Post-acute IRF care represents a modifiable target to reduce adverse vascular events after AIS. However, only 16% of survivors receive IRF care, with marked age, sex, and insurance disparities. Expanding access to IRFs potentially offers an opportunity to improve population-level outcomes among AIS survivors.