Abstract
Introduction: It has not yet been established whether the risk factors for readmissions of stroke survivors differ from those that contribute to the occurrence of this medical condition. This umbrella review aimed to (1) identify modifiable risk factors for 30-day and 1-year readmission after stroke and (2) develop an evidence-informed illustrative model describing their relationships with readmission.
Methods: This umbrella review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A systematic search of PubMed, Web of Science, Cochrane Library, CINAHL, and Scopus was conducted for studies published up to June 2024. Two reviewers independently screened titles, abstracts, and full texts for eligibility and extracted the relevant data using a standardized data extraction form. Any disagreements were resolved through discussion until consensus was reached.
Results: Thirty-one systematic reviews and meta-analyses were included. Hypertension (30-day OR=1.10–2.14; 1-year OR=1.18–2.60), atrial fibrillation (30-day OR=1.26–2.13; 1-year OR=0.57–2.40), diabetes mellitus (30-day OR=1.15–1.40; 1-year OR=0.91–1.40), and treatment non-adherence were the main modifiable risk factors associated with post-stroke readmission. An evidence-informed illustrative model was developed to illustrate the interrelationships among these factors and their contribution to readmission risk.
Conclusion: Addressing modifiable cardiovascular risk factors and improving treatment adherence are essential to reducing hospital readmissions after stroke. The developed evidence-informed illustrative model highlights the interrelationships among hypertension, atrial fibrillation, diabetes mellitus, treatment adherence, and post-discharge support, providing a framework for targeted interventions to reduce readmission.