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Frequency and predictors of stroke death in 5,888 participants in the Cardiovascular Health Study
W T Longstreth1, C Bernick, A Fitzpatrick
1Departments of Neurology and Epidemiology, University of Washington, Seattle, USA. wl@u.washington.edu
Insights
Stroke-related deaths are common in older adults. Poor walking performance and certain stroke types, like hemorrhagic or cardioembolic, increase mortality risk.
Area of Science:
- Gerontology
- Epidemiology
- Neurology
Background:
- Limited population-based studies exist on stroke mortality in the elderly.
- The Cardiovascular Health Study (CHS) provides a valuable dataset for examining stroke outcomes in older adults.
Purpose of the Study:
- To investigate the incidence and predictors of stroke-related mortality in elderly individuals.
- To identify specific stroke types and subtypes associated with higher fatality rates.
Main Methods:
- Analysis of data from 5,888 participants (aged 65+) in the Cardiovascular Health Study.
- Long-term follow-up for fatal and nonfatal cardiovascular and cerebrovascular events, with adjudicated outcomes.
- Classification of strokes by type and subtype, and assessment of pre-stroke functional status (timed walk).
Main Results:
- Over 7 years, 7.7% of participants experienced stroke, with a stroke mortality rate of 3.2 per 1,000 person-years.
- Hemorrhagic stroke and cardioembolic ischemic stroke were the most lethal subtypes.
- Poor performance on a timed walk was an independent predictor of death after any stroke, and particularly after ischemic stroke, along with African American race.
Conclusions:
- Stroke death is a significant concern in the elderly population studied.
- Functional status (slow walking) and race are critical factors influencing stroke survival.
- Identifying high-risk individuals and stroke types can inform targeted interventions and improve outcomes.
Background:
Few population-based studies have examined in detail issues of stroke-related deaths in elderly people.
Methods:
Participants in the Cardiovascular Health Study (CHS) are 65 years of age or older, have had extensive baseline evaluations, and have been followed-up for fatal and nonfatal cardiovascular and cerebrovascular disease outcomes. Investigators adjudicated these outcomes and classified strokes by types and subtypes.
Results:
Over 7 years, 1,310 (22.2%) of 5,888 participants died, and 455 (7.7%) experienced incident stroke. For the 5,888, stroke mortality was 3.2 per 1,000 person-years. For the 455, it was 36.1 per 1,000 person-years, with the most lethal type being hemorrhagic and the ischemic subtype being cardioembolic. After controlling for age and stroke type, the only other independent predictor of death after any stroke was poor performance on a timed walk measured before the incident stroke. Considering only ischemic stroke, the independent predictors of death were African American race and poor performance on timed walk.
Conclusion:
In CHS, death attributable to stroke is common. As in other studies, the most lethal stroke type was hemorrhagic, and ischemic stroke subtype, cardioembolic. Slow walking, possibly a measure of frailty, was associated with an increased risk of death of stroke. Finally, African Americans faced a greater risk of death than others after an ischemic stroke.