Follow-Up in Primary Care After Ischemic Stroke - Insights From the Nor-COAST Study

Background: There is limited information on follow-up routines for adequate poststroke care after discharge from hospital. Purpose: This study aimed to assess the likelihood of general practitioner (GP) follow-up within 18 months after an ischemic stroke and to identify clinical factors influencing follow-up frequency. Patients and Methods: Home-dwelling patients admitted to St. Olavs University Hospital with ischemic stroke between 2015 and 2017 were included. Follow-up was assessed by linkage to administrative health data, tracking GP visits over the 18-month period post discharge. Results: In total, 278 of the 302 patients included (92%) had at least one consultation, with a mean time to first consultation of 64 days (SD 96). Of these 278 patients, the cumulative probability of a consultation within 30, 90, 365, and 540 days was 56%, 81%, 96%, and 100%, respectively. The mean number of consultations during the 18-month follow-up was 6.2 (SD 6.7). Factors associated with a lower probability of consultation within the first 90 days included use of home care services (HR 0.56, 95% CI 0.41-0.77), disability (HR 0.70, 95% CI 0.61-0.79), frailty (HR 0.82, 95% CI 0.72-0.94), and cognitive impairment (HR 0.85, 95% CI 0.75-0.97). Additionally, older age (coefficient -0.09 per year, 95% CI -0.16 to -0.02), use of home care services (coefficient -2.34, 95% CI -4.52 to -0.15), and cognitive impairment (coefficient -0.77, 95% CI -1.46 to -0.09) were associated with fewer consultations. Conclusion: Most patients had at least one GP consultation within 18 months poststroke. However, vulnerable patients with advanced age, frailty, disability, and cognitive impairment may be at risk of suboptimal follow-up after ischemic stroke.