Abstract 142: Disability Trajectories Before And After Vascular Events: The Cardiovascular Health Study
Background: Stroke may contribute to long-term functional decline apart from its acute effects on neurological function. Few studies have compared long-term disability trajectories before and after vascular events or considered the natural history of aging-related decline. We hypothesized that the increase in long-term disability would be steeper post-event than pre-event for stroke but not myocardial infarction (MI).
Methods: In the Cardiovascular Health Study, 5888 Medicare eligible participants were followed for a mean of 13 years for vascular events and had annual disability assessments with an activities of daily living (ADL) and instrumental ADL scale, modified from the National Center for Health Statistics Supplement on Aging (range 0-12, scored by number of ADLs and IADLs which the participant could not perform, analyzed continuously). During follow-up, 382 participants had ischemic stroke and 395 had MI with >=1 post-event disability assessment. Generalized estimating equations models adjusted for baseline demographics, vascular risk factors, arthritis, cognition, and social support and included a test for different slopes of disability before and after event.
Results: Participants had a mean of 4 disability assessments each pre- and post-stroke and MI. Stroke (0.88, 95% CI 0.57-1.20, p<0.0001) was associated with a greater acute increase in disability than MI (0.20, 0.06-0.35, p=0.006). The annual increase in disability before stroke (0.06 points per year, 0.002-0.12, p=0.04) more than tripled after stroke (0.15 additional points per year, 0.004-0.30, p=0.04). The annual increase in disability before MI (0.04 points per year, 0.004-0.08, p=0.03) did not change significantly after MI (0.02 additional points per year, -0.07-0.11, p=0.7).
Conclusions: In this large population-based study, a trajectory of increasing disability became significantly steeper after stroke but not after MI. This worsening trajectory could be due to delayed cell dysfunction in the brain surrounding stroke, long-term inflammatory profile changes, progressive cardiovascular impairment, or silent recurrent infarcts. Stroke may be considered an ongoing, chronic condition with effects on function instead of a single discrete event.
Author Disclosures: M.S. Dhamoon: None. W.T. Longstreth: None. T.M. Bartz: None. M.S.V. Elkind: None.
- © 2015 by American Heart Association, Inc.