on December 5, 2002
Published online before print December 5, 2002, doi: 10.1161/01.STR.0000047852.05842.3C
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Submitted on July 10, 2002
From the Departments of Neurology and Geriatrics, Örebro University Hospital, Örebro (P.A.), and the Department of Neurotec, Division of Geriatric Medicine, Karolinska Institutet, Stockholm (P.A., I.N., M.V.), Sweden. * To whom correspondence should be addressed. E-mail: peter.appelros{at}orebroll.se.
Background and Purpose—The purpose of this study was to define predictors of poor outcome after a first-ever stroke. We studied risk factors and stroke severity at baseline in relationship to death, dependency, and stroke recurrence within a year after the event. Methods—The study included a community-based cohort of first-ever stroke patients. Subarachnoid hemorrhage was not included. All patients (n=377) were subjected to investigations regarding risk factors. Stroke severity was evaluated with the National Institutes of Health Stroke Scale, and dependency was defined according to the modified Rankin Scale. Multivariate regression models were used to analyze predictors of survival, dependency, and stroke recurrence. The following independent variables were used: age, sex, cohabitation status, cigarette smoking, dementia, hypertension, ischemic heart disease, heart failure, atrial fibrillation, diabetes mellitus, transitory ischemic attack, peripheral atherosclerosis, and stroke severity. Results—The 1-year mortality was 33%. After 1 year, 37% of the survivors were dependent; 9% of survivors had a recurrent stroke within a year. Dementia, age, stroke severity, and atrial fibrillation were associated with death within a year. Dependency was associated with age, stroke severity, and heart failure. Stroke recurrence was predicted by age and dementia. Conclusions—In addition to age and stroke severity, heart diseases and dementia before the stroke seem to have an impact on mortality and recurrence after 1 year. Finding and, when possible, treating these prestroke conditions may affect stroke morbidity and mortality favorably.
Accepted on August 16, 2002
Poor Outcome After First-Ever Stroke. Predictors for Death, Dependency, and Recurrent Stroke Within the First Year
Peter Appelros MD*;
Key words: atrial fibrillation • cognitive disorders • heart failure, congestive • prognosis • stroke
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