Long-term stroke survival and recurrence rates show need for improvements in care


By Michael Woodhead

21 Apr 2022

Despite advances in stroke prevention and treatment, Australia still has high long term rates of recurrence and mortality after an acute stroke, new figures show.

In one of the few studies to analyse long term outcomes after stroke, population data from 313,162 patients who had first stroke hospitalisation between 2008 and 2017 showed that only 36.4% of patients survived beyond 10 years, and 26.8% had another stroke.

Published in the journal Stroke, the results showed that compared with the general population, an acute stroke was associated with a loss of 5.5 years of life expectancy, or 33% of the predicted life expectancy, and was more pronounced in patients with a haemorrhagic stroke in whom the loss was 7.4 years, or 38.5% of predicted life expectancy.

The overall post-stroke survival probability was 79.4% at 3 months, 73.0% at 1 year, 52.8% at 5 years, and 36.4% at 10 years.

Cumulative incidence of stroke recurrence was 7.8% at 3 months, 11.0% at 1 year, 19.8% at 5 years, and 26.8% at 10 years.

Haemorrhagic stroke was associated with greater mortality (Hazard Ratio [HR], 2.02) and recurrent stroke (HR 1.63) compared with ischaemic stroke.

Other factor associated with increased mortality were female sex (HR 1.10]) and increasing age (≥85 years versus 18–54 years: HR 7.36).

Several risk factors including atherosclerotic coronary and non-coronary vascular disease, cardiac arrhythmia, and diabetes were associated with increased risk of mortality and recurrent stroke.

Study co-author Dr Kathryn Colebourne, senior stroke consultant at The Prince Charles Hospital, Brisbane, said these findings reinforce the need for concerted efforts to improve acute stroke care.

“We need stroke networks of care to rapidly identify patients who have had a stroke, provide them with access to important and time-sensitive treatment, such as thrombolysis, a clot busting medication, and endovascular therapy, a specialised procedure to remove blood clots in the vessels to the brain,” she said.

“We also need dedicated stroke units to provide multidisciplinary care for these patients which is known to reduce death and disability after a stroke.”

Study leader and UQ epidemiologist, Dr Yang Peng, a research fellow with the Prince Charles Hospital Northside Clinical Unit said that in the last two decades early mortality after stroke had declined by about half due to risk factor reduction and interventions such as thrombolysis, endovascular therapy, antithrombotic agents, and multidisciplinary stroke units.

However the long term data showed there should still be a focus on lifestyle and risk factor modifications for secondary prevention, given the number of patients who will have a recurrent stroke.

“Very few population studies have explored the long-term outcomes of stroke,” he said.“This information is crucial for patients to understand their prognosis, and for health professionals seeking to improve stroke care and preventative measures.”

The study was funded by the National Heart Foundation of Australia.

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