Survival, causes of death and recurrence up to 3 years after stroke: A population-based study.
outcome
recurrent stroke
stroke
survival
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
revised:
24
07
2021
received:
02
06
2021
accepted:
26
07
2021
pubmed:
31
7
2021
medline:
2
4
2022
entrez:
30
7
2021
Statut:
ppublish
Résumé
Up-to-date population-based information about long-term survival, causes of death and recurrence after stroke is needed. Four hundred consecutive individuals in a population-based cohort of first-ever stroke between 2015 and 2016 in Lund, Sweden, were followed up to 3 years regarding (i) survival (Swedish Population Register); (ii) causes of death (Swedish Causes of Death Register); and (iii) stroke recurrence (interview and medical chart review). Index and recurrent ischaemic stroke cases were classified using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) and Oxfordshire Community Stroke Project; and comorbidities were classified using the Charlson Comorbidity Index. Cox regression was used to determine predictors for 3-year mortality. Survival rates were compared with three local studies over a 30-year timespan. Amongst 400 first-ever stroke patients, 265 (66%) survived 3 years post-stroke. Age (hazard ratio [HR] 1.09; 95% confidence interval [CI] 1.06-1.11), stroke severity (HR 1.11; 95% CI 1.08-1.13) and comorbidities (HR 1.36; 95% CI 1.22-1.53) were independently related to 3-year mortality. Amongst index ischaemic stroke patients, survival was lowest amongst those with cardio-aortic embolism (51/91; 56%). Cerebrovascular disease (54/135; 40%) and ischaemic heart disease (25/135; 19%) were the most common causes of death. Within 3 years, 30 (8%) had recurrent stroke. Amongst patients with index ischaemic stroke, 16/29 (55%) had a different TOAST pathogenetic mechanism or hemorrhagic stroke upon recurrence. Stroke survival improved between 1983-1985 and 2015-2016 (p = 0.002), but no significant change was observed between 2001-2002 and 2015-2016 (p = 0.48). Stroke survival rates are relatively high, but their improvement over recent decades may be slowing down, possibly due to the composition of the first-ever stroke population. The common occurrence of changed pathogenetic mechanisms between first-ever and recurrent stroke highlights the value of reassessment in recurrent stroke.
Sections du résumé
BACKGROUND AND PURPOSE
Up-to-date population-based information about long-term survival, causes of death and recurrence after stroke is needed.
METHODS
Four hundred consecutive individuals in a population-based cohort of first-ever stroke between 2015 and 2016 in Lund, Sweden, were followed up to 3 years regarding (i) survival (Swedish Population Register); (ii) causes of death (Swedish Causes of Death Register); and (iii) stroke recurrence (interview and medical chart review). Index and recurrent ischaemic stroke cases were classified using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) and Oxfordshire Community Stroke Project; and comorbidities were classified using the Charlson Comorbidity Index. Cox regression was used to determine predictors for 3-year mortality. Survival rates were compared with three local studies over a 30-year timespan.
RESULTS
Amongst 400 first-ever stroke patients, 265 (66%) survived 3 years post-stroke. Age (hazard ratio [HR] 1.09; 95% confidence interval [CI] 1.06-1.11), stroke severity (HR 1.11; 95% CI 1.08-1.13) and comorbidities (HR 1.36; 95% CI 1.22-1.53) were independently related to 3-year mortality. Amongst index ischaemic stroke patients, survival was lowest amongst those with cardio-aortic embolism (51/91; 56%). Cerebrovascular disease (54/135; 40%) and ischaemic heart disease (25/135; 19%) were the most common causes of death. Within 3 years, 30 (8%) had recurrent stroke. Amongst patients with index ischaemic stroke, 16/29 (55%) had a different TOAST pathogenetic mechanism or hemorrhagic stroke upon recurrence. Stroke survival improved between 1983-1985 and 2015-2016 (p = 0.002), but no significant change was observed between 2001-2002 and 2015-2016 (p = 0.48).
CONCLUSIONS
Stroke survival rates are relatively high, but their improvement over recent decades may be slowing down, possibly due to the composition of the first-ever stroke population. The common occurrence of changed pathogenetic mechanisms between first-ever and recurrent stroke highlights the value of reassessment in recurrent stroke.
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
4060-4068Subventions
Organisme : NINDS NIH HHS
ID : R01 NS114045
Pays : United States
Informations de copyright
© 2021 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Références
GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;48:439-458.
Li L, Scott CA, Rothwell PM, Oxford Vascular Study. Trends in stroke incidence in high-income countries in the 21st century: population-based study and systematic review. Stroke. 2020;51:1372-1380.
Aked J, Delavaran H, Norrving B, Lindgren A. Temporal trends of stroke epidemiology in southern Sweden: a population-based study on stroke incidence and early case-fatality. Neuroepidemiology. 2018;50:174-182.
Appelros P. Secular trends of stroke epidemiology in Örebro, Sweden, 2017 compared to the trends in 1999: a population-based study. Cerebrovasc Dis. 2019;48:149-156.
Katan M, Luft A. Global burden of stroke. Semin Neurol. 2018;38:208-211.
Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020;76:2982-3021.
Crichton SL, Bray BD, McKevitt C, Rudd AG, Wolfe CD. Patient outcomes up to 15 years after stroke: survival, disability, quality of life, cognition and mental health. J Neurol Neurosurg Psychiatry. 2016;87:1091-1098.
Sennfält S, Norrving B, Petersson J, Ullberg T. Long-term survival and function after stroke. Stroke. 2018;50(1):53-61. doi:https://doi.org/10.1161/STROKEAHA.118.022913
Romain G, Mariet A-S, Jooste V, et al. Long-term relative survival after stroke: the Dijon Stroke Registry. Neuroepidemiology. 2020;54:498-505.
Aked J, Delavaran H, Norrving B, Lindgren A. Completeness of case ascertainment in Swedish hospital-based stroke registers. Acta Neurol Scand. 2020;141:148-155.
Brønnum-Hansen H, Davidsen M, Thorvaldsen P. Long-term survival and causes of death after stroke. Stroke. 2001;32:2131-2136.
Mohan KM, Wolfe CD, Rudd AG, Heuschmann PU, Kolominsky-Rabas PL, Grieve AP. Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis. Stroke. 2011;42:1489-1494.
Flach C, Muruet W, Wolfe CDA, Bhalla A, Douiri A. Risk and secondary prevention of stroke recurrence. Stroke. 2020;51:2435-2444.
Mochalina N, Isma N, Svensson PJ, et al. Ischemic stroke rates decline in patients with atrial fibrillation as anticoagulants uptake improves: a Swedish cohort study. Thromb Res. 2017;158:44-48.
Sudlow CL, Warlow CP. Comparing stroke incidence worldwide: what makes studies comparable? Stroke. 1996;27:550-558.
Hatano S. Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ. 1976;54:541-553.
Lyden P. Using the National Institutes of Health Stroke Scale: a cautionary tale. Stroke. 2017;48:513-519.
Kasner SE, Chalela JA, Luciano JM, et al. Reliability and validity of estimating the NIH Stroke Scale Score from medical records. Stroke. 1999;30:1534-1537.
Adams HP, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. Stroke. 1993;24:35-41.
Bamford J, Sandercock P, Dennis M, Warlow C, Burn J. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet. 1991;337:1521-1526.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373-383.
Quan H, Li B, Couris CM, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173:676-682.
Brooke HL, Talbäck M, Hörnblad J, et al. The Swedish cause of death register. Eur J Epidemiol. 2017;32:765-773.
Coull AJ, Rothwell PM. Underestimation of the early risk of recurrent stroke: evidence of the need for a standard definition. Stroke. 2004;35:1925-1929.
Subic A, Zupanic E, von Euler M, et al. Stroke as a cause of death in death certificates of patients with dementia: a cohort study from the Swedish dementia registry. Curr Alzheimer Res. 2019;15:1322-1330.
Norrving B, Löwenhielm P. Epidemiology of stroke in Lund-Orup, Sweden, 1983-85. Incidence of first stroke and age-related changes in subtypes. Acta Neurol Scand. 1988;78:408-413.
Hallström B, Norrving B, Lindgren A. Stroke in Lund-Orup, Sweden: improved long-term survival among elderly stroke patients. Stroke. 2002;33:1624-1629.
Hallström B, Jönsson AC, Nerbrand C, Norrving B, Lindgren A. Stroke incidence and survival in the beginning of the 21st century in southern Sweden: comparisons with the late 20th century and projections into the future. Stroke. 2008;39:10-15.
Wafa HA, Wolfe CDA, Bhalla A, Wang Y. Long-term trends in death and dependence after ischaemic strokes: a retrospective cohort study using the South London Stroke Register (SLSR). PLoS Med. 2020;17:e1003048.
Vangen-Lönne AM, Wilsgaard T, Johnsen SH, Carlsson M, Mathiesen EB. Time trends in incidence and case fatality of ischemic stroke: the Tromsö study 1977-2019. Stroke. 2015;46:1173-1179.
Peisker T, Koznar B, Stetkarova I, Widimsky P. Acute stroke therapy: a review. Trends Cardiovasc Med. 2017;27:59-66.
Yang Q, Tong X, Schieb L, et al. Vital signs: recent trends in stroke death rates-United States, 2000-2015. MMWR Morb Mortal Wkly Rep. 2017;66:933-939.
Alpérovitch A, Bertrand M, Jougla E, et al. Do we really know the cause of death of the very old? Comparison between official mortality statistics and cohort study classification. Eur J Epidemiol. 2009;24:669.
Friberg N, Ljungberg O, Berglund E, et al. Cause of death and significant disease found at autopsy. Virchows Arch. 2019;475:781-788.