High case-fatality rates in the Warsaw stroke registry

We studied 1-year survival in 297 patients with first-even-in-lifetime ischemic stroke (FEL-IS) selected from a population-based study of stroke in the Mokotow district of Warsaw. Case fatality rates were 29% at 30 days and 51% at 1 year. These case fatality rates are significantly higher than in other industrialized countries. Early deaths were primarily caused by neurological sequelae of stroke or complications of immobility, whereas late deaths (>30 days) were primarily caused by stroke recurrence or complications of immobility. Predictors of survival were analyzed by life table methods. Adverse predictors of 1-year survival included greater age, low activities of daily living scores, atrial fibrillation, greater weakness, congestive heart failure, and untreated hypertension. Patients with stroke recurrence were more likely to die in the first year. We hypothesize that stroke severity contributes to high case-fatality rates by increasing death caused by both direct neurological sequelae and complications of immobility. Medical comorbidity probably contributes to high case-fatality rates in Poland by increasing stroke recurrence rates and by increasing deaths caused by immobility. We hypothesize that high case-fatality rates in Poland could be reduced by improved rehabilitation of stroke patients to avoid deaths caused by immobility and by better control of medical comorbidity in stroke patients.