Functional outcome 3 months after stroke predicts long-term survival

Area of Science:

• Neurology
• Public Health
• Gerontology

Background:

• Traditional stroke survival analyses begin at stroke onset or admission, including early mortality.
• This approach can bias long-term prognosis assessments.
• Observing 3-month survivors offers a more robust analysis of long-term outcomes.

Purpose of the Study:

• To investigate the impact of disability levels 3 months post-stroke on long-term survival.
• To compare the prognostic significance of functional outcome with other known risk factors.

Main Methods:

• Utilized data from Riks-Stroke (Swedish stroke quality register) and Swedish population registers.
• Analyzed 15,959 stroke patients (2001-2002) with no prior stroke, independent pre-stroke, and experiencing ischemic or hemorrhagic stroke.
• Employed multiple Cox regression to identify predictors of long-term survival.

Main Results:

• Impaired functional outcome, measured by modified Rankin Scale (mRS) grades 3-5, independently predicted poorer survival (HRs 1.7-3.8).
• Higher mRS grades indicated significantly increased mortality risk compared to lower grades.
• Other significant predictors included male sex, advanced age, diabetes, smoking, hypertension therapy, atrial fibrillation, and depressed mood.

Conclusions:

• Disability level at 3 months post-stroke is a stronger predictor of long-term survival than many established factors.
• Interventions improving functional status in the acute phase can positively impact long-term survival.
• Focusing on functional recovery is crucial for improving overall stroke patient prognosis.