Long-Term Outcomes of Acute Ischemic Stroke in Patients Aged 80 Years and Older

Abstract

PurposeShort life expectancy influences decision-making when treating very old patients with acute ischemic stroke (AIS). We investigated mortality and survival duration in very old AIS patients (≥ 80 years) who received hospital care.Patients and MethodsMortality data were obtained from medical records, structured telephone inquiries, death certificates from the Korean National Statistical Office, and social security data 5 ± 1.9 years after stroke onset. Age, gender, vascular risk factors, and functional outcomes from modified Rankin scales (MRS) at discharge were analyzed as predictors of mortality.ResultsAmong 134 patients, 92 (68.7%) died. On Kaplan-Meier analysis, duration of survival of patients aged 80 - 84 years was longer than those aged 85 - 89 or 90 - 94 (24 ± 6.4, 8 ± 7.3, 7 ± 2.0 months, respectively, p = 0.002). Duration of survival of patients discharged in a state of MRS 0 - 1 was longer than the remaining groups at 47 ± 4.8 months (p < 0.001). In Cox proportional hazard analysis, age and MRS at discharge were independent predictors of mortality.ConclusionLong-term outcomes of very old patients with AIS are not uniformly grave, therefore predictors of mortality and estimated duration of survival should be considered during decision- making for treatment.

Predictors for 5-year survival in a prospective cohort of elderly stroke patients

“…The 5-year survival rate was 40%. In this study, increasing age was inversely associated with 5-year survival after the index stroke which is in keeping with other studies (10,16,17,19). Higher (14,16) and lower survival rates have been reported in other studies (8,9,11,12,14), but this is likely to be due to differences in study design such as the inception cohorts (first-ever vs all strokes, lower mean age) and setting (community vs hospital setting).…”

Prognostic factors for long‐term poor outcomes after acute ischemic stroke in very old age (>80 years) patients: Total cholesterol level might differently influence long‐term outcomes after acute ischemic stroke at ages above 80 years

“…However, in the present study, although CE and UD had a trend of increment of poor outcomes than other subtypes, subtypes of ischemic stroke itself had no significant influence on the long‐term outcome after AIS in patients aged >80 years. Furthermore, a hospital‐based study showed that stroke subtypes were not a predictor of long‐term outcome after AIS in very old age . We do not know the exact cause for this phenomenon.…”

“…Therefore, it is very important to know the differences in related factors regarding outcomes after acute ischemic stroke (AIS) in this growing population. Previous studies have shown that those patients differ from younger patients with ischemic stroke as to the cause of the ischemic stroke, the severity of the stroke and the outcome …”

“…However, most previous studies were carried out on a relatively small number of subjects, and did not show the long‐term functional outcome at 90 days after stroke occurrences in patients aged >80 years . Also, there were little data on which to evaluate the different impacts on outcomes according to the various risk factors between patients aged <80 years and >80 years.…”

Cost-effectiveness analysis of stroke management under a universal health insurance system

“…It was also reported that the net difference in utilities between the normal population and stroke survivors had widened gradually with advanced age, which may be associated with older survivors experiencing non-stroke related disability [46]. Although age alone might not be the only prohibiting factor for active advanced treatment, the grave prognosis should be considered during the decision-making process on the treatment of very old stroke patients to establish a practical treatment approach [47].…”