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http://stroke.ahajournals.org/content/31/9/2080.long
- Graeme J. Hankey, MD, FRCP, FRACP;
- Konrad Jamrozik, MBBS, DPhil, FAFPHM;
- Robyn J. Broadhurst, BA, BSc;
- Susanne Forbes, RN;
- Peter W. Burvill, MD, FRANZCP;
- Craig S. Anderson, MBBS, PhD, FRACP, FAFPHM;
- Edward G. Stewart-Wynne, MBChB, FCP(SA), FRACP
+ Author Affiliations
- Correspondence to Dr Graeme J. Hankey, Stroke Unit, Department of Neurology, Royal Perth Hospital, GPO Box X2213, Perth, Western Australia 6001. E-mail gjhankey@cyllene.uwa.edu.au
Abstract
Background and Purpose—Few
community-based studies have examined the long-term survival and
prognostic factors for death within 5 years after an
acute first-ever stroke. This study aimed to
determine the absolute and relative survival and the independent
baseline prognostic
factors for death over the next 5 years among
all individuals and among 30-day survivors after a first-ever stroke in a
population
of Perth, Western Australia.
Methods—Between February 1989
and August 1990, all individuals with a suspected acute stroke or
transient ischemic attack of the
brain who were resident in a geographically
defined region of Perth, Western Australia, with a population of 138 708
people,
were registered prospectively and assessed
according to standardized diagnostic criteria. Patients were followed up
prospectively
at 4 months, 12 months, and 5 years after the
index event.
Results—Three hundred seventy
patients with first-ever stroke were registered, and 362 (98%) were
followed up at 5 years, by which
time 210 (58%) had died. In the first year after
stroke the risk of death was 36.5% (95% CI, 31.5% to 41.4%), which was
10-fold
(95% CI, 8.3% to 11.7%) higher than that
expected among the general population of the same age and sex. The most
common cause
of death was the index stroke (64%). Between 1
and 5 years after stroke, the annual risk of death was approximately 10%
per
year, which was approximately 2-fold greater
than expected, and the most common cause of death was cardiovascular
disease
(41%). The independent baseline factors among
30-day survivors that predicted death over 5 years were intermittent
claudication
(hazard ratio [HR], 1.9; 95% CI, 1.2 to 2.9),
urinary incontinence (HR, 2.0; 95% CI, 1.3 to 3.0), previous transient
ischemic
attack (HR, 2.4; 95% CI, 1.4 to 4.1), and
prestroke Barthel Index <20/20 (HR, 2.0; 95% CI, 1.2 to 3.2).
Conclusions—One-year survivors
of first-ever stroke continue to die over the next 4 years at a rate of
approximately 10% per year, which
is twice the rate expected among the general
population of the same age and sex. The most common cause of death is
cardiovascular
disease. Long-term survival after stroke may be
improved by early, active, and sustained implementation of effective
strategies
for preventing subsequent cardiovascular events.
Outcome at 5 Years
Absolute Risks for All Patients
Table 1⇓ and Figure 1⇓
show that the 5-year cumulative risk of death was 60.1% (95% CI, 54.7%
to 65.5%). The risk of death was greatest in the first
year after stroke (36.5%; 95% CI, 31.5% to
41.4%) and particularly in the first 30 days after stroke (23.5%; 95%
CI, 19.1%
to 27.9%). Beyond the first year,
approximately 10% of survivors continued to die each year.
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