(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
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