One-year recurrence of stroke and death in Lebanese survivors of first-ever stroke: Time-to-Event analysis

Abstract

BackgroundTo date, despite the application of secondary prevention worldwide, first-ever stroke survivors remain at imminent risk of stroke recurrence and death in the short and long term. The present study aimed to assess the cumulative risk rates and identify baseline differences and stroke characteristics of Lebanese survivors.MethodsA prospective longitudinal study was conducted among survivors ≥18 years old who were followed-up for 15 months through a face-to-face interview. Kaplan–Meier method was used to calculate the cumulative rates of stroke mortality and recurrence. Cox-regression univariate and multivariable analyses were performed to identify the predictors of both outcomes.ResultsAmong 150 subjects (mean age 74 ± 12 years; 58.7% men vs. 44.3% women; 95.3% with ischemic stroke vs. 4.3% with intracerebral hemorrhage), high cumulative risk rates of stroke recurrence (25%) and death (21%) were highlighted, especially in the acute phase. Survival rates were lesser in patients with stroke recurrence compared to those without recurrence (Log rank test p < 0.001). Older age was the main predictor for both outcomes (p < 0.02). Large artery atherosclerosis was predominant in patients with stroke recurrence and death compared to small vessel occlusion (p < 0.02). Higher mental component summary scores of quality of life were inversely associated with stroke recurrence (p < 0.01). Lebanese survivors exhibited the highest percentages of depression and anxiety; elevated Hospital Anxiety and Depression Scale (HADS) scores were seen in those with stroke recurrence and those who died (≥80% with mean HADS scores ≥8). Lower Mini-Mental State Examination scores at the acute phase increased the risk of both outcomes by 10% (p < 0.03). Three out of 13 mortalities (23.1%) were presented with early epileptic seizures (p = 0.012). High educational level was the protective factor against stroke recurrence (p = 0.019). Administration of intravenous thrombolysis decreased the risk of both outcomes by 10% (p > 0.05).ConclusionHigher rates of stroke recurrence and death were observed in the first year following a stroke in Lebanon. Various factors were identified as significant determinants. Thus, health care providers and officials in Lebanon can use these findings to implement effective preventive strategies to best address the management of these factors to reduce the stroke burden and improve the short and long-term prognosis of stroke survivors.

Impact of depression on stroke outcomes among stroke survivors: Systematic review and meta-analysis

“…Of these, nine reported all-cause mortality while one study reported a suicide rate. The studies were from the USA [69,77,78,83,86,89,[92][93][94], England [19,82], Australia [74,88], Denmark [84], Norway [90], Brazil [76], the Netherlands [79], Germany [85], Finland [87], Italy [91], Sweden and Finland [81], Lebanon [95], and South Korea [75,80]. The sample size ranged from 84 to 152,243 participants and the age of the participants ranged from 18 to 74 years.…”

Characteristics of risk factors for ischemic stroke recurrence and death in Western China: a retrospective study

“…Patients with recurrent stroke have poor quality of life, high disability rates, and severe cognitive impairment 16 . The risk factors for stroke, recurrence, and mortality not only help medical staff to carry out targeted treatment management strategies but also have important reference value for monitoring disease trends and planning public health interventions 17 . At present, there is a lack of reliable evidence on the independent risk factors for one-year recurrence of and death by IS at home in China to guide patients in choosing appropriate stroke recurrence prevention services.…”