Long-Term Survival, Stroke Recurrence, and Life Expectancy After an Acute Stroke in Australia and New Zealand From 2008–2017: A Population-Wide Cohort Study

Abstract

BACKGROUND: Data on long-term outcomes following an acute stroke are sparse. We assessed survival, risk of recurrent stroke and loss in life expectancy following an acute stroke using population-wide data from Australia and New Zealand. METHODS: We included all adults with the first stroke hospitalization during 2008 and 2017 at all public and most private hospitals. Patients were followed up to 10 years after the stroke by linkage to each region’s Registry of Deaths and subsequent hospitalizations. Flexible parametric survival modeling was used to estimate all-cause mortality, stroke recurrence, and loss in life expectancy. Competing risk model was used when estimating the risk of stroke recurrence. RESULTS: Three hundred thirteen thousand one hundred sixty-two patients were included (mean age 73.0±14.6 y, 52.0% males) with ischemic stroke (175 547, 56.1%) being the most common, followed by hemorrhagic stroke (77 940, 24.9%) and unspecified stroke (59 675, 19.1%). The overall survival probability was 79.4% at 3 months, 73.0% at 1 year, 52.8% at 5 years, and 36.4% at 10 years. Cumulative incidence of stroke recurrence was 7.8% at 3 months, 11.0% at 1 year, 19.8% at 5 years, and 26.8% at 10 years. Hemorrhagic stroke was associated with greater mortality (hazard ratio, 2.02 [95% CI, 1.99–2.04]) and recurrent stroke (hazard ratio, 1.63 [95% CI, 1.59–1.67]) compared with ischemic stroke. Female sex (hazard ratio, 1.10 [95% CI, 1.09–1.11]) and increasing age (≥85 years versus 18–54 years: hazard ratio, 7.36 [95% CI, 7.15–7.57]) were also associated with increased mortality. Several risk factors including atherosclerotic coronary and noncoronary vascular disease, cardiac arrhythmia, and diabetes were associated with increased risk of mortality and recurrent stroke. Compared with the general population, an acute stroke was associated with a loss of 5.5 years of life expectancy, or 32.7% of the predicted life expectancy, and was pronounced in patients with a hemorrhagic stroke (7.4 years and 38.5% of predicted life expectancy lost). CONCLUSIONS: In this population-wide study, death and recurrence of stroke were common after an acute stroke and an acute stroke was associated with considerable loss in life expectancy. Further improvements in treatment and secondary prevention of stroke are needed to reduce these risks.

Comparison of Stroke Recurrence, Cardiovascular Events, and Death Among Patients With Pregnancy-Associated vs Non–Pregnancy-Associated Stroke

“…In our study, the highest incidence rate of recurrence was observed for ICH in both pregnancy-associated and non–pregnancy-associated stroke, which is consistent with the literature highlighting higher stroke recurrence after ICH than other strokes . Of note, the recurrent cerebrovascular event after a first ICH was most often another ICH, thus indicating a common underlying cause of both episodes.…”

The lifetime burden following stroke: Long term impact of stroke on survival and quality of life

“…Such differences were even more evident in both loss-of-LE and the loss-of-QALE between men and women with hemorrhagic stroke, as reported by a study from Australia and New Zealand. 30 Especially, the loss-of-QALE was bigger in men with statistical significance (p = 0.049). The major reason for the above discrepancy may arise from the different distributions of age and calendar year of diagnosis in the comparison of long-term follow-up data.…”

Five-Year Outcomes After Endovascular Treatment for Large Vessel Occlusion Stroke

“…In a large national cohort of stroke patients from Australia and New Zealand, about half of patients hospitalized with a stroke survived at 5 years, and only a third at 10 years. Around one-fifth of patients had a stroke recurrence by 5 years, and 25% by 10 years ( Peng et al, 2022 ). Compared with our study from Chinese population, an acute stroke reduced the life expectancy long-term functional outcomes.…”

“…Recently, the data from real-world studies with large sample have shown that patients treated with endovascular therapy had longer survival times, attributable a lower risk of death within 0–90 days and extended follow-up to 2 years ( Beyeler et al, 2022 ). Despite these promising finding, much of our understanding about stroke outcomes comes from studies with relatively short follow-up time and the long-term prognosis after a stroke are sparse ( Rutten-Jacobs et al, 2013 ; Ekker et al, 2019 ; Peng et al, 2022 ). Acute stroke trials have largely assessed short-term (90 days) primary outcomes following treatment ( Yarbrough et al, 2015 ; Campbell et al, 2016 ; Goyal et al, 2016 ) and information on long-term outcomes may be useful for clinical practice and health care policy decision-making, particularly in developing countries which have a higher stroke burden, but more limited health care resources.…”