Predictors for 5-year survival in a prospective cohort of elderly stroke patients

Objectives - To examine predictors for 5-year survival in elderly stroke patients. Materials and Methods - Prospective cohort study of 186 consecutive acute stroke patients aged >= 65 years admitted to Bankstown-Lidcombe Hospital, Australia 03/2002 to 03/2003. All subjects were followed up in 2007/8, at 5 years post-stroke, for outcome measures. Logistic regression analysis was performed to predict 5-year survival using covariables, including functional status, age, stroke type and severity and vascular risk factors. Patients lost to follow-up (n = 20) were excluded from the analyses. Results - One hundred patients (60%) were dead at study end. Predictors for survival in final logistic regression model were as follows: Glasgow Coma Scale (GCS) on admission (OR 1.49, 95% CI 1.1-2.0, P = 0.01), preadmission functional independence measure (FIM) score (OR 1.04, 95% CI 1.0-1.1, P = 0.01), age (OR 0.93, 95% CI 0.87-0.98, P = 0.01) and atrial fibrillation (OR 0.43, 95% CI 0.19-0.95, P = 0.04). For 5-year survivors, mean Modified Rankin Scale was 3.1 +/- 1.5, total FIM score 85 +/- 32, mini-mental state examination (MMSE) 22 +/- 8 and Hospital Anxiety and Depression (HAD) scores 5.4 +/- 3.4 and 5.2 +/- 3.9, respectively. FIM cognition score was significantly lower at 5 years when compared to baseline (24 +/- 8 vs 29 +/- 8, P < 0.05) (all scores expressed as mean +/- SD). In contrast, MMSE, HAD and total FIM scores were not significantly different at 5 years when compared to baseline. Conclusions - The study identified lower GCS on admission, lower preadmission FIM score, age and atrial fibrillation as negative predictors for 5-year survival following stroke.