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(Stroke. 2003;34:699.)
© 2003 American Heart Association, Inc.

Original Contributions

Long-Term Mortality in Cerebrovascular Disease

Dawn M. Bravata, MD; Shih-Yieh Ho, PhD; Lawrence M. Brass, MD; John Concato, MD; Jeanne Scinto, PhD, MPH Thomas P. Meehan, MD, MPH

From the Medical Service (D.M.B., J.C.), Clinical Epidemiology Unit (D.M.B., J.C.), and Neurology Service (L.M.B.), Veterans Affairs Connecticut Healthcare System, West Haven; Departments of Internal Medicine (D.M.B., J.C., T.P.M.) and Neurology (L.M.B.), Yale University School of Medicine, New Haven, Conn; University of Connecticut School of Public Health, Storrs (S-Y.H.); Section of Geriatrics, University of Connecticut Health Center School of Medicine, Farmington (J.S.); and Qualidigm, Middletown, Conn (S-Y.H., J.S., T.P.M.).

Reprint requests to Dawn M. Bravata, MD, Yale University School of Medicine, Robert Wood Johnson Clinical Scholars Program, 333 Cedar St, Room IE-61 SHM, PO Box 208025, New Haven, CT 06520-8025. E-mail Dawn.Bravata{at}yale.edu

Background and Purpose— Stroke is the third leading cause of death in the United States, yet data are limited about the temporal pattern of mortality among patients with cerebrovascular disease. The objectives of this study were to identify predictors of 6-month mortality and to evaluate 5-year mortality in patients with cerebrovascular disease.

Methods— Our population included fee-for-service Medicare beneficiaries aged 65 years who were discharged with an acute ischemic stroke, transient ischemic attack (TIA), or carotid stenosis (International Classification of Diseases, Ninth Revision, Clinical Modification codes 433 to 436) from Connecticut acute care hospitals in 1995. This cohort was followed through 2000 by means of part A Medicare claims and Social Security Administration mortality data.

Results— Among 5123 patients, 4781 survived their hospitalization and were followed for an average of 3.4 years; 670 (14.0%) died within 6 months of discharge, and 2517 (52.6%) died within 5 years. Predictors of 6-month mortality included older age, male sex, increasing comorbidity, discharge not to home, and prior admission within a year of the index hospitalization. The annual mortality rates for year 1 after discharge differed depending on the discharge diagnosis of the index hospitalization: carotid stenosis, 10.6%; TIA, 14.8%; and acute ischemic stroke, 26.4%. The 5-year cumulative mortality rates were as follows: carotid stenosis, 38.3%; TIA, 49.6%; and acute ischemic stroke, 60.0%.

Conclusions— Mortality after acute ischemic stroke, TIA, and carotid stenosis is substantial. Rates and patterns of mortality differ according to patients’ discharge diagnoses.

Key Words: cerebral ischemia • cohort studies • mortality • risk factors

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