Morbidity and mortality among elderly Americans with different stroke subtypes

The long-term outcomes of hemorrhagic stroke (HS), which includes subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), are not well understood relative to ischemic stroke (IS). This analysis was undertaken to assess short and long-term survival and morbidity of patients with hemorrhagic stroke, as well as risk factors associated with these outcomes. American Medicare beneficiaries >65 y of age in whom SAH, ICH, or IS was diagnosed were identified and followed over 4 y through the use of longitudinal claims data. Primary endpoints consisted of survival, recurrence of stroke, and readmission. A survival analysis estimated long-term survival. Logistic regression and Cox proportional hazards models identified factors associated with recurrence and death. A total of 11,430 patients with SAH (3.0%), ICH (17.1%), or IS (79.9%) were identified. At stroke onset, about 45% of SAH and ICH cohorts had congestive heart failure, about 50% had diabetes, and more than 90% had hypertension. In comparison, 30% of the IS cohort had congestive heart failure, 32%, diabetes, and 75%, hypertension. Acute in hospital mortality rates were 31.9%, 25.6%, and 6.8% for SAH, ICH, and IS, respectively; estimated median survival through 4 y was 256 d for SAH, 353 d for ICH, and 533 d for IS. The recurrence rate was highest among patients with SAH. Those with HS tended to be younger than those with IS and had a greater number of comorbidities at the time of stroke. Among the elderly, patients with HS have a substantially worse prognosis than do those with IS, which highlights the need for more effective treatment of patients with HS.