Abstract T MP93: High 1- to 5-Year Mortality and Morbidity in Stable Patients Without Early Complications After Stroke or TIA
Introduction: Stroke prevention efforts are increasingly focused on early risk after TIA/stroke to facilitate initiation of risk-modifying therapies. Few clinics can follow patients for years after an event, yet even stable patients may remain at high risk.
Hypothesis: Patients discharged from hospitals with TIA/stroke who survive 90 days without complications, will remain at high risk of adverse outcomes for years after their event.
METHODS: We analyzed data from the Registry of the Canadian Stroke Network. We identified all patients discharged from hospital with a diagnosis of TIA or ischemic stroke from 2003-2011. We excluded patients with any event within 90 days of discharge: any hospitalization, stroke, TIA, myocardial infarct (MI), death, long-term care (LTC) admission. A composite outcome of stroke, MI, death or LTC admission was examined from 1 to 5 years after the first 90 days.
RESULTS: 30% of patients (n=10, 293) were excluded for events in the first 90 days. Of the remaining 70% (n=24,011) event-free at 90 days, 53% were male and mean age was 69.9 +/- 14.1. 61% had ischemic stroke and 39% TIA. 86% were mild (Canadian Neurological Scale (CNS)>=8), 9.9% were moderate (CNS 5-7) and 4.1% were severe (CNS 0-4). The combined outcome (stroke, MI, LTC or death) occurred in 9.4% of this “mild” group one year AFTER the highest risk period was over and in 35% by 5 years. Death was the most common event (1 year: 5.4%; 5 years: 26.8%), followed by stroke (1 year: 2.6%; 5 years: 7.9%). Among those who survived the first year, the event rate remained at 5% per year at both 3- and 5-years.
CONCLUSIONS: Patients who survive the initial 90-day period after TIA/stroke without events are similar to those seen routinely in stroke clinics. These patients remain at high risk of negative outcomes: almost 10% patients have died, or had a stroke, MI or LTC admission in the first year and 5% more occur per year, up to 5 years. Strategies for efficient and effective long-term follow-up to modify these risks are needed for stroke clinic patients.
Author Disclosures: R.H. Swartz: None. J. Fang: None. M.K. Kapral: None.
- © 2014 by American Heart Association, Inc.