Abstract DP298: Lack of Dedicated Neurology Follow-Up After a Stroke is Associated with Increased Mortality

Introduction: Timely outpatient follow-up after stroke is crucial to address risk factors and prevent recurrence. While guidelines recommend early primary care contact, the role of dedicated neurology follow-up in post-stroke outcomes remains less defined. This study examined whether dedicated neurology follow-up after stroke hospitalization was associated with lower emergency department (ED) use and mortality. Methods: We conducted a retrospective cohort study of 185 patients discharged from a neurovascular service between July 2024 and January 2025 at a tertiary care center. We recorded all outpatient follow-up within six months and categorized patients into three groups: no follow-up (FU None), follow-up with non-neurology providers only (FU Non-neuro), and follow-up with a neurologist (FU Neuro). Sociodemographic and clinical characteristics were extracted from electronic health records. Outcomes included all-cause ED visits, stroke-related ED visits, and mortality. Associations were analyzed using chi-square and two-tailed t-tests. Results: Among the 185 patients, 38 (20.5%) were characterized as FU None, 38 (20.5%) FU Non-neuro, and 109 (58.9%) FU Neuro. As compared to those with follow up (n = 147), FU none patients were more likely to be non-English speaking (47.4% vs 27.9%, p = 0.02), older (mean age 78.6 vs 70.0 years, p = 0.003), be on Medicare (p = 0.03), and experience mortality (21.1% vs 4.1%, p < 0.001) and/or stroke-related ED visits (28.9% vs 15.0%, p = 0.04) during the follow-up period. Among those with any follow-up, mortality was significantly higher in patients who only saw a non-neurologist (10.5%) compared to those seen by a neurologist (1.8%) (p = 0.02). As compared to FU Neuro, those in FU Non-neuro were more likely to be Black or Latinx (p = 0.001) and have higher pre- and post-stroke functional disability scores (p = 0.02 and p = 0.04, respectively). No significant differences were found in ED visits between these two groups. Conclusions: Lack of neurology-specific follow-up was associated with significantly higher mortality, despite no observed differences in ED utilization. Moreover, disparities in specialty access by race and functional status echo national concerns regarding inequities in long-term stroke care. While primary care remains foundational to long-term stroke management, our findings underscore the importance of neurology-specific follow-up in improving post-stroke survival and highlight critical gaps in follow-up access.