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(Stroke. 2009;40:1585.)
© 2009 American Heart Association, Inc.

Original Contributions

Causes of Death by Level of Dependency at 6 Months After Ischemic Stroke in 3 Large Cohorts

Karsten Bruins Slot, MD; Eivind Berge, MD, PhD; Peter Sandercock, DM, FRCPE; Steff C. Lewis, PhD; Paul Dorman, MD; Martin Dennis, MD, FRCPE on behalf of the Oxfordshire Community Stroke Project, the Lothian Stroke Register, and the International Stroke Trial (UK)

From Ullevaal University Hospital (K.B.S., E.B.), Department of Internal Medicine, Oslo, Norway; University of Edinburgh (P.S., S.C.L., M.D.), Division of Clinical Neurosciences, Edinburgh, UK; Newcastle General Hospital (P.D.), Department of Neurology, Newcastle-upon-Tyne, UK.

Correspondence to Karsten Bruins Slot, MD, Department of Internal Medicine, Ullevaal University Hospital, NO-0407 Oslo, Norway. E-mail karsten.bruins.slot{at}medisin.uio.no

Background and Purpose— We assessed the influence of functional status at 6 months after ischemic stroke on cause of death during long-term follow-up in 3 prospective cohorts.

Methods— The cohorts were 7710 patients from the Oxfordshire Community Stroke Project, Lothian Stroke Register, and International Stroke Trial. Functional status was assessed at 6 months after stroke onset. Causes of death were identified from death certificates, and were also classified into "stroke-related" or "other" causes. We calculated the relative risk with 95% CI to assess the association between dependency level and cause of death. We also performed a multivariable regression analysis to adjust for other relevant factors.

Results— Six months after stroke onset 5961 (78%) patients were still alive. At the end of follow-up period, 1620 (47%) patients who were functionally dependent at 6 months after stroke onset had died vs 711 (28%) independent patients. Dependent patients had a relative risk of dying from stroke of 1.70 (95% CI, 1.44–2.00) compared to independent patients. Overall, dependent patients had a relative risk of 1.68 (95% CI, 1.49–1.91) of dying from stroke-related causes. Dependency remained significantly (P<0.01) associated with stroke-related causes of death in a multivariable regression analysis.

Conclusion— Stroke-related deaths continue to be a problem during the years after an ischemic stroke, especially in patients who are functionally dependent at 6 months after onset. Better acute treatments to reduce dependency and adequate secondary prevention remain high priorities.

Key Words: cerebral infarct • epidemiology • mortality • outcome