5-year survival and rehospitalization due to stroke recurrence among patients with hemorrhagic or ischemic strokes in Singapore

Abstract

BackgroundStroke is the 4th leading cause of death and 1st leading cause of disability in Singapore. However the information on long-term post stroke outcomes for Singaporean patients was limited. This study aimed to investigate the post stroke outcomes of 5-year survival and rehospitalization due to stroke recurrence for hemorrhagic and ischemic stroke patients in Singapore. The outcomes were stratified by age, ethnic group, gender and stroke types. The causes of death and stroke recurrence were also explored in the study.MethodsA multi-site retrospective cohort study. Patients admitted for stroke at any of the three hospitals in the National Healthcare Group of Singapore were included in the study. All study patients were followed up to 5 years. Kaplan-Meier was applied to study the time to first event, death or rehospitalization due to stroke recurrence. Cox proportional hazard model was applied to study the time to death with adjustment for stroke type, age, sex, ethnic group, and admission year. Cumulative incidence model with competing risk was applied for comparing the risks of rehospitalization due to stroke recurrence with death as the competing risk.ResultsTotally 12,559 stroke patients were included in the study. Among them, 59.3% survived for 5 years; 18.4% were rehospitalized due to stroke recurrence in 5 years. The risk of stroke recurrence and mortality increased with age in all stroke types. Gender, ethnic group and admitting year were not significantly associated with the risk of mortality or stroke recurrence in hemorrhagic stroke. Male or Malay patient had higher risk of stroke recurrence and mortality in ischemic stroke. Hemorrhagic stroke had higher early mortality while ischemic stroke had higher recurrence and late mortality. The top cause of death among died stroke patients was cerebrovascular diseases, followed by pneumonia and ischemic heart diseases. The recurrent stroke was most likely to be the same type as the initial stroke among rehospitalized stroke patients.ConclusionsFive year post-stroke survival and rehospitalization due to stroke recurrence as well as their associations with patient demographics were studied for different stroke types in Singapore. Specific preventive strategies are needed to target the high risk groups to improve their long-term outcomes after acute stroke.

Predictors of Socioeconomic Burden and Cost-Effectiveness of Hospital Cares for Ischemic Stroke

“…In keeping with previous studies, advanced age could lead to severe stroke and have a deleterious impact on its prognosis [12][13][14][15][16][17][18]. Notably, rare studies indicated initial pulse rate as an important mortality predictor for ischemic stroke.…”

“…NIHSS score at admission have been determined as other predictive factors for severe stroke and death of ischemic stroke patients [13][14][15][16][17][18]. Therefore, it is obviously important to recognize the most considerable economic and mortality predictors of stroke.…”

“…In several studies, advanced age has been noted as a considerable prognostic factor for re-hospitalization and death of stroke patients [12][13][14][15][16][17][18]. Additionally, in a multi-center prospective study evaluated 15,831 ischemic stroke patients, the mortality rate of patients with atrial fibrillation (AF) within 28 days after admission was 11.3%, comparable to the non-AF group (3.4%) [15].…”

Acute Stroke Through the Perspective of a County Hospital: Problems and Opportunities

“…Literatürdeki çalışmalar incelendiğinde, üst basamak merkezlerde yapılmış çalışmalarda bir yıllık mortalite oranlarının %25-30 civarında olduğu görülmektedir (22,23,24). Bu çalışmada ise birinci yıl sonundaki mortalite oranı %45 olarak hesaplanmıştır.…”

Combining levodopa and virtual reality-based therapy for rehabilitation of the upper limb after acute stroke: pilot study Part II

“…(1,2) As one in three affected persons remains permanently impaired due to persistent motor deficits, research is necessary to develop more effective treatments that can increase quality of life for these patients. (3) Early rehabilitation is crucial in maximising functional recovery, (4,5) yet the optimal treatment strategy is still not well defined.…”