| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2000;31:2080.)
© 2000 American Heart Association, Inc.
Original Contributions |
Five-Year Survival After First-Ever Stroke and Related Prognostic Factors in the Perth Community Stroke Study
From the Stroke Unit, Department of Neurology, Royal Perth Hospital (Western Australia) (G.J.H., E.G.S-W.); Departments of Medicine (G.J.H.), Public Health (K.J., R.J.B., S.F.), and Psychiatry and Behavioral Science (P.W.B.), University of Western Australia, Perth; and Faculty of Medicine and Health Science, University of Auckland (New Zealand) (C.S.A.).
Correspondence to Dr Graeme J. Hankey, Stroke Unit, Department of Neurology, Royal Perth Hospital, GPO Box X2213, Perth, Western Australia 6001. E-mail gjhankey{at}cyllene.uwa.edu.au
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.
Key Words: Australia • death • prognosis • stroke • survival
This article has been cited by other articles:
 |
|
 |
|
  P. Amarenco and P. G. Steg Stroke is a coronary heart disease risk equivalent: implications for future clinical trials in secondary stroke prevention Eur. Heart J., July 1, 2008; 29(13): 1605 - 1607. [Full Text] [PDF]
|
|
|
|
|
|
C. P. Nelson, P. C. Lambert, I. B. Squire, and D. R. Jones Relative survival: what can cardiovascular disease learn from cancer? Eur. Heart J., April 1, 2008; 29(7): 941 - 947. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. van Helvoort-Postulart, C. D. Dirksen, P. J. Nelemans, A. A. Kroon, A. G. H. Kessels, P. W. de Leeuw, G. B. C. Vasbinder, J. M. A. van Engelshoven, and M. G. M. Hunink Renal Artery Stenosis: Cost-effectiveness of Diagnosis and Treatment Radiology, August 1, 2007; 244(2): 505 - 513. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Bravata, S.-Y. Ho, T. P. Meehan, L. M. Brass, and J. Concato Readmission and Death After Hospitalization for Acute Ischemic Stroke: 5-Year Follow-Up in the Medicare Population Stroke, June 1, 2007; 38(6): 1899 - 1904. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Gongora-Rivera, J. Labreuche, A. Jaramillo, P. G. Steg, J.-J. Hauw, and P. Amarenco Autopsy Prevalence of Coronary Atherosclerosis in Patients With Fatal Stroke Stroke, April 1, 2007; 38(4): 1203 - 1210. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. T. Meenan, S. Saha, R. Chou, K. Swarztrauber, K. Pyle Krages, M. C. O'Keeffe-Rosetti, M. McDonagh, B. K. S. Chan, M. C. Hornbrook, and M. Helfand Cost-Effectiveness of Echocardiography to Identify Intracardiac Thrombus among Patients with First Stroke or Transient Ischemic Attack Med Decis Making, March 1, 2007; 27(2): 161 - 177. [Abstract] [PDF]
|
|
|
|
|
|
E. Touze, J.-L. Mas, J. Rother, S. Goto, A. T. Hirsch, Y. Ikeda, C.-S. Liau, E. M. Ohman, A. J. Richard, P. W. F. Wilson, et al. Impact of Carotid Endarterectomy on Medical Secondary Prevention After a Stroke or a Transient Ischemic Attack: Results from the Reduction of Atherothrombosis for Continued Health (REACH) Registry Stroke, December 1, 2006; 37(12): 2880 - 2885. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Dhamoon, R. R. Sciacca, T. Rundek, R. L. Sacco, and M.S.V. Elkind Recurrent stroke and cardiac risks after first ischemic stroke: The Northern Manhattan Study Neurology, March 14, 2006; 66(5): 641 - 646. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. van Hartingsveld, C. Lucas, G. Kwakkel, and R. Lindeboom Improved Interpretation of Stroke Trial Results Using Empirical Barthel Item Weights Stroke, January 1, 2006; 37(1): 162 - 166. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Touze, O. Varenne, G. Chatellier, S. Peyrard, P. M. Rothwell, and J.-L. Mas Risk of Myocardial Infarction and Vascular Death After Transient Ischemic Attack and Ischemic Stroke: A Systematic Review and Meta-Analysis Stroke, December 1, 2005; 36(12): 2748 - 2755. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R Fogelholm, K Murros, A Rissanen, and S Avikainen Long term survival after primary intracerebral haemorrhage: a retrospective population based study J. Neurol. Neurosurg. Psychiatry, November 1, 2005; 76(11): 1534 - 1538. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Martinez-Garcia, R. Galiano-Blancart, P. Roman-Sanchez, J.-J. Soler-Cataluna, L. Cabero-Salt, and E. Salcedo-Maiques Continuous Positive Airway Pressure Treatment in Sleep Apnea Prevents New Vascular Events After Ischemic Stroke Chest, October 1, 2005; 128(4): 2123 - 2129. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. L. Paul, J. W. Sturm, H. M. Dewey, G. A. Donnan, R. A.L. Macdonell, and A. G. Thrift Long-Term Outcome in the North East Melbourne Stroke Incidence Study: Predictors of Quality of Life at 5 Years After Stroke Stroke, October 1, 2005; 36(10): 2082 - 2086. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. McLaren, S. Kerr, L. Allan, I. N. Steen, C. Ballard, J. Allen, A. Murray, and R. A. Kenny Autonomic Function Is Impaired in Elderly Stroke Survivors Stroke, May 1, 2005; 36(5): 1026 - 1030. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. M. Coull Statin Therapy After Acute Ischemic Stroke in the Heart Protection Study: Is the Role in Recurrent Stroke Prevention Now Defined? Stroke, September 1, 2004; 35(9): 2233 - 2234. [Full Text] [PDF]
|
|
|
|
|
|
C. S. Anderson, K. N. Carter, W. J. Brownlee, M. L. Hackett, J. B. Broad, and R. Bonita Very Long-Term Outcome After Stroke in Auckland, New Zealand Stroke, August 1, 2004; 35(8): 1920 - 1924. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein, G. P. Samsa, D. B. Matchar, and R. D. Horner Charlson Index Comorbidity Adjustment for Ischemic Stroke Outcome Studies Stroke, August 1, 2004; 35(8): 1941 - 1945. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Sandercock, E. Berge, M. Dennis, J. Forbes, P. Hand, J. Kwan, S. Lewis, R. Lindley, A. Neilson, and J. Wardlaw Cost-Effectiveness of Thrombolysis With Recombinant Tissue Plasminogen Activator for Acute Ischemic Stroke Assessed by a Model Based on UK NHS Costs Stroke, June 1, 2004; 35(6): 1490 - 1497. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Hardie, G. J. Hankey, K. Jamrozik, R. J. Broadhurst, and C. Anderson Ten-Year Risk of First Recurrent Stroke and Disability After First-Ever Stroke in the Perth Community Stroke Study Stroke, March 1, 2004; 35(3): 731 - 735. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Kiyohara, M. Kubo, I. Kato, Y. Tanizaki, K. Tanaka, K. Okubo, H. Nakamura, and M. Iida Ten-Year Prognosis of Stroke and Risk Factors for Death in a Japanese Community: The Hisayama Study Stroke, October 1, 2003; 34(10): 2343 - 2347. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Adams, M. I. Chimowitz, J. S. Alpert, I. A. Awad, M. D. Cerqueria, P. Fayad, and K. A. Taubert Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association Circulation, September 9, 2003; 108(10): 1278 - 1290. [Full Text] [PDF]
|
|
|
|
|
|
R. J. Adams, M. I. Chimowitz, J. S. Alpert, I. A. Awad, M. D. Cerqueria, P. Fayad, and K. A. Taubert Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association Stroke, September 1, 2003; 34(9): 2310 - 2322. [Full Text] [PDF]
|
|
|
|
|
|
P. Cherian, G. J. Hankey, J. W. Eikelboom, J. Thom, R. I. Baker, A. McQuillan, J. Staton, and Q. Yi Endothelial and Platelet Activation in Acute Ischemic Stroke and Its Etiological Subtypes Stroke, September 1, 2003; 34(9): 2132 - 2137. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Hardie, G. J. Hankey, K. Jamrozik, R. J. Broadhurst, and C. Anderson Ten-Year Survival After First-Ever Stroke in the Perth Community Stroke Study Stroke, August 1, 2003; 34(8): 1842 - 1846. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Fox Poststroke patients: implications for the cardiologist Eur. Heart J. Suppl., July 1, 2003; 5(suppl_E): E4 - E10. [Abstract] [PDF]
|
|
|
|
|
|
D. M. Bravata, S.-Y. Ho, L. M. Brass, J. Concato, J. Scinto, and T. P. Meehan Long-Term Mortality in Cerebrovascular Disease Stroke, March 1, 2003; 34(3): 699 - 704. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Bak, S. H. Sindrup, T. Alslev, O. Kristensen, K. Christensen, and D. Gaist Cessation of Smoking After First-Ever Stroke: A Follow-Up Study Stroke, September 1, 2002; 33(9): 2263 - 2269. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Hallstrom, B. Norrving, and A. Lindgren Stroke in Lund-Orup, Sweden: Improved Long-Term Survival Among Elderly Stroke Patients Stroke, June 1, 2002; 33(6): 1624 - 1629. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. G. Vickrey, T. S. Rector, S. L. Wickstrom, P. M. Guzy, E. M. Sloss, P. B. Gorelick, S. Garber, D. F. McCaffrey, M. D. Dake, and R. A. Levin Occurrence of Secondary Ischemic Events Among Persons With Atherosclerotic Vascular Disease Stroke, April 1, 2002; 33(4): 901 - 906. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Stavem and O.M. Ronning Survival of unselected stroke patients in a stroke unit compared with conventional care QJM, March 1, 2002; 95(3): 143 - 152. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Bronnum-Hansen, M. Davidsen, and P. Thorvaldsen Long-Term Survival and Causes of Death After Stroke Stroke, September 1, 2001; 32(9): 2131 - 2136. [Abstract] [Full Text] [PDF]
|
|