Background and Purpose--Limited information exists on the long-term outcome from stroke. We aimed to determine survival and health status at 21-year follow-up of patients who participated in a population-based stroke incidence study undertaken in Auckland, New Zealand.

Methods--During 12 months beginning March 1, 1981, half of all residents of Auckland with acute first-ever or recurrent stroke (n=680) were assessed and followed up prospectively during the next 2 decades. In 2002, their vital status and health-related quality of life (HRQoL) using the 36-item short-form questionnaire (SF-36) were determined by telephone interviews. Kaplan-Meier survival probabilities for the stroke cohort were compared with life table estimates for the New Zealand population. The SF-36 profile of 21-year stroke survivors was compared with a standardized New Zealand population.

Results--Overall, 626 of the original cohort had died and 4 were lost to follow-up, leaving 50 (7%) individuals (57% male; mean age 70 years) available in 2002, of whom 12% were residents of an institutional care facility and 19% required help with everyday activities. The stroke cohort had nearly twice the mortality rate of the New Zealand population, but the SF-36 profile of very long-term stroke survivors was broadly similar to the general population.

Conclusions--Because stroke is generally a disease of older people and has a high case fatality, it is not surprising that <1 in 10 people survive 2 decades after onset. However, of those who do, their HRQoL profile suggests that they meld relatively successfully within the general population, despite ongoing disability and a higher mortality risk.