Recurring symptoms in reversible cerebral vasoconstriction syndrome impact readmissions

Almost 14% of patients with reversible cerebral vasoconstriction syndrome had non-elective hospital readmissions within 90 days of discharge, according to an analysis of more than 1,100 hospitalizations in 2016 and 2017.

A significant proportion of readmissions resulted from “ongoing/recurrent symptoms or neurologic sequelae” associated with reversible cerebral vasoconstriction syndrome (RCVS), according to the researchers. The findings, which were published in Neurology, indicate that an early post-discharge follow-up plan may be necessary for patients with RCVS.

“RCVS is characterized by severe thunderclap headaches associated with reversible segmental multifocal cerebral vasoconstriction that can last up to 3 months,” the researchers wrote. “Although most patients have a benign clinical course, neurological complications may appear after discharge from the initial hospitalization. The common complications include recurrent thunderclap headache, transient neurological deficits, ischemic or hemorrhagic stroke and seizures, with the highest risk of occurrence during the first 4 weeks of symptom onset.”

However, the risk for early readmission following an inpatient hospitalization for RCVS remains unknown, according to Aayushi Garg, MD, a third-year resident in the department of neurology at the University of Iowa Hospitals and Clinics, and colleagues. The researchers aimed to determine the rate and etiologies of 90-day readmissions following hospitalization for RCVS. They also evaluated the predictors and outcomes for these 90-day readmissions.

Garg and colleagues identified hospitalizations due to RCVS using the Nationwide Readmissions Database 2016-2017. They conducted a survival analysis and used multivariable Cox proportional hazards regression to evaluate the characteristics related to readmission.

The researchers identified 1,157 hospitalizations related to RCVS during the study period (mean age of patients, 48.6 years; 76.4% women). Of these, 164 patients (14.2%) experienced non-elective readmissions within 90 days of discharge. The most frequent reasons for readmission included acute cerebrovascular events (18.9%), ongoing or recurrent symptoms of RCVS (13.4%), infections (11.6%) and headache (9.8%). Independent predictors of 90-day readmission included diabetes, a history of tobacco use, opioid use and greater length of index hospitalization.

The mean length of stay for readmissions was 5.2 days, with a mean cost per hospitalization of $14,214, according to the findings from Garg and colleagues. While there was no in-hospital mortality, 37.2% of patients were not discharged to home.

The baseline demographic characteristics of the study population aligned with those in the current literature, according to the researchers, with a predominance of female patients in the current study. However, Garg and colleagues noted “a much higher prevalence” of comorbidities, including hypertension and hyperlipidemia, than previously reported, “presumably secondary to selection bias,” as the study population was limited to the inpatient setting.

“Interestingly, the history of migraine, anxiety and depression was common in our patients and might correlate with the use of vasoactive and serotonergic drugs, a well-established trigger for RCVS,” the researchers wrote.

The results of the study “have important clinical implications,” according to Garg and colleagues.

“Unplanned readmission is an important quality metric for hospitals. In addition, we found that a significant minority of those who are readmitted have adverse discharge disposition. Furthermore, we showed for the first time that patients with diabetes and a history of tobacco and opioid use seem to be at an increased risk of readmission,” the researchers wrote. “The exact reason for these findings is unclear and future studies are needed to further explore the characteristics of these patients at a high risk of clinical worsening and readmissions.”