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Systematic review and meta-analysis finds 14.2% 30-day readmission rate after ischemic strokeOne in seven stroke survivors returns to the hospital within 30 days

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Key Takeaway
Consider using identified risk factors to stratify patients for readmission prevention after ischemic stroke.

This systematic review and meta-analysis pooled data from 1,274,267 patients with ischemic stroke across North American and Asian settings to estimate rates and risk factors for unplanned readmission. The primary outcome was the rate of unplanned readmission at various time points.

The pooled 30-day readmission rate was 14.2% (95% CI 11-18%), with a 90-day rate of 13.9% and a 12-month rate of 30.3%. Readmission rates varied by region: 11.7% in North America and 17.2% in Asian settings. Factors associated with increased likelihood of readmission included atrial fibrillation (OR 1.34), heart failure (OR 1.59), diabetes (OR 1.29), prior stroke (OR 1.50), longer hospital stay (OR 1.03 per unit increase), and higher NIHSS score (OR 1.13). The most common causes of readmission were infection (25.1%), recurrent stroke (21.8%), and cardiac events (13.7%).

The authors noted substantial heterogeneity across studies (I2 > 90%), which limits the precision of pooled estimates. The analysis provides an evidence-based foundation for identifying high-risk patients and developing targeted interventions, but causal inferences should be avoided given the observational nature of the included studies.

Imagine waking up from a stroke only to face a return to the hospital within a month. A new analysis of over 1.2 million patients in North America and Asia reveals that 14.2% of people are sent back to the hospital within 30 days. This is a significant burden for families and healthcare systems alike.

The data shows that certain health conditions make a return much more likely. People with atrial fibrillation, heart failure, or diabetes face higher odds of being readmitted. Even a longer stay in the hospital increases the chance of returning. The study also found that the risk varies by region, with higher rates seen in Asian settings compared to North America.

Why do people return so quickly? Infection was the leading cause, accounting for over a quarter of all readmissions. Recurrent strokes and heart events were also major reasons. The researchers note that the studies combined had high differences in how they were done, which means the exact numbers might vary. However, the message is clear: identifying high-risk patients early could help prevent these painful and costly returns.

What this means for you:
Infection and heart problems drive most early returns to the hospital after a stroke.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedMay 2026
View Original Abstract ↓
To systematically evaluate the rate and risk factors for unplanned readmission in patients with ischemic stroke (IS), providing an evidence-based foundation for developing targeted prevention strategies. We systematically searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang, Weipu Data and SinoMed databases for studies on the rate and risk factors of unplanned readmission in IS patients from their inception to July 30, 2025. Two researchers independently conducted literature screening, quality assessment, and data extraction. Meta-analysis was performed. A total of 44 studies involving 1,274,267 patients were included. The pooled rate of 30-day readmission was 14.2% (95% CI 11–18%), increasing to 13.9% at 90 days and 30.3% at 12 months, with substantial heterogeneity across studies (I2 > 90%). Readmission rates were lower in North America (11.7%) and higher in Asian settings (17.2%). Atrial fibrillation (OR 1.34), heart failure (OR 1.59), diabetes (OR 1.29), and prior stroke (OR 1.50) were associated with increased likelihood of 30-day readmission. Longer hospital stay (OR 1.03 per unit increase) and greater stroke severity (NIHSS OR 1.13) were also associated with higher readmission risk. Infection (25.1%), recurrent stroke (21.8%), and cardiac events (13.7%) were the most consistently reported causes. This meta-analysis clarifies and updates the rate and core risk factors for unplanned readmission in ischemic stroke patients. It provides an evidence-based foundation for systematically identifying high-risk patients, developing risk assessment tools, and implementing targeted interventions, holding significant value for guiding clinical practice. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251157352, identifier CRD420251157352.
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