4.7 Article

Survival, causes of death and recurrence up to 3 years after stroke: A population-based study

Journal

EUROPEAN JOURNAL OF NEUROLOGY
Volume 28, Issue 12, Pages 4060-4068

Publisher

WILEY
DOI: 10.1111/ene.15041

Keywords

outcome; recurrent stroke; stroke; survival

Funding

  1. Swedish Research Council [2019-01757]
  2. CaNVAS project - NIH [1R01NS114045-01]
  3. Swedish Government (Avtal om Lakarutbildning och Medicinsk Forskning, ALF)
  4. Swedish Heart and Lung Foundation
  5. Region Skane
  6. Skane University Hospital
  7. Freemasons Lodge of Instruction EOS, Lund
  8. Lund University
  9. Sparbanksstiftelsen Fars och Frosta
  10. Formas [2019-01757] Funding Source: Formas
  11. Swedish Research Council [2019-01757] Funding Source: Swedish Research Council

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The study aimed to provide up-to-date population-based information on long-term survival, causes of death, and recurrence after stroke. The results showed relatively high stroke survival rates, with a potential slowdown in improvement over recent decades. The common occurrence of changed pathogenetic mechanisms between first-ever and recurrent stroke highlights the value of reassessment in recurrent stroke.
Background and purpose Up-to-date population-based information about long-term survival, causes of death and recurrence after stroke is needed. Methods Four hundred consecutive individuals in a population-based cohort of first-ever stroke between 2015 and 2016 in Lund, Sweden, were followed up to 3 years regarding (i) survival (Swedish Population Register); (ii) causes of death (Swedish Causes of Death Register); and (iii) stroke recurrence (interview and medical chart review). Index and recurrent ischaemic stroke cases were classified using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) and Oxfordshire Community Stroke Project; and comorbidities were classified using the Charlson Comorbidity Index. Cox regression was used to determine predictors for 3-year mortality. Survival rates were compared with three local studies over a 30-year timespan. Results Amongst 400 first-ever stroke patients, 265 (66%) survived 3 years post-stroke. Age (hazard ratio [HR] 1.09; 95% confidence interval [CI] 1.06-1.11), stroke severity (HR 1.11; 95% CI 1.08-1.13) and comorbidities (HR 1.36; 95% CI 1.22-1.53) were independently related to 3-year mortality. Amongst index ischaemic stroke patients, survival was lowest amongst those with cardio-aortic embolism (51/91; 56%). Cerebrovascular disease (54/135; 40%) and ischaemic heart disease (25/135; 19%) were the most common causes of death. Within 3 years, 30 (8%) had recurrent stroke. Amongst patients with index ischaemic stroke, 16/29 (55%) had a different TOAST pathogenetic mechanism or hemorrhagic stroke upon recurrence. Stroke survival improved between 1983-1985 and 2015-2016 (p = 0.002), but no significant change was observed between 2001-2002 and 2015-2016 (p = 0.48). Conclusions Stroke survival rates are relatively high, but their improvement over recent decades may be slowing down, possibly due to the composition of the first-ever stroke population. The common occurrence of changed pathogenetic mechanisms between first-ever and recurrent stroke highlights the value of reassessment in recurrent stroke.

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