Abstract 149: Can Prevention of Risk Factors Pre-Stroke Reduce 30-Day Post-Stroke Mortality?
Introduction: Studies of short-term survival after stroke generally identify patients in the hospital, providing limited insights about the association between pre-stroke risk factors and outcomes. We hypothesized that pre-stroke risk factors will be related to 30-day case fatality.
Methods: We prospectively studied the association of Framingham Stroke Risk Score (FSRS) factors on 30-day mortality following incident ischemic stroke (IS) among 28,253 stroke-free participants, aged 45+ in REGARDS, a national population based cohort enrolled 2003-2007. Suspect IS events were physician-reviewed. Logistic regression evaluated the association of pre-stroke risk factors with 30-day case-fatality after adjustment for age, race, sex and region of country. The six FSRS factors (hypertension, diabetes, cigarette smoking, atrial fibrillation, left ventricular hypertrophy, heart disease) were considered as predictors of case-fatality (individually, as a composite FSRS, and cumulative number present).
Results: Of 792 incident IS events, 67 (8.5%) people died within 30-days. Age was strongly associated with case-fatality (p < 0.0001), with a strong association for oldest age groups relative to those <65 years (see table). Race, sex and region were not associated with case fatality. After adjustment for demographic factors, individual risk factors were positively but nonsignificantly associated with higher case fatality. Higher FSRS was associated with higher case fatality (test for trend p = 0.014), with increased fatality for the top two vs. the lowest tertile. Likewise, higher fatality was seen for those with more risk factors (test for trend p = 0.025), with a notable increase for those with 3+ cumulative risk factors.
Conclusions: Individuals with higher pre-stroke risk factor burden were more likely to have a higher 30-day mortality following infarction. Prevention of risk factors could reduce the incidence of stroke and improve mortality following stroke.
Author Disclosures: V.J. Howard: None. J.H. Lichtman: None. D.O. Kleindorfer: None. B.M. Kissela: None. A.M. Anderson: None. K.C. Albright: None. J.D. Rhodes: None. M.S. Safford: None. G. Howard: None.
- © 2015 by American Heart Association, Inc.