Very Long-Term Outcome After Stroke in Auckland, New Zealand

Abstract

Background and Purpose-Limited information exists on the long-term outcome from stroke. We aimed to determine survival and health status at 21-year follow-up of patients who participated in a population-based stroke incidence study undertaken in Auckland, New Zealand. Methods-During 12 months beginning March 1, 1981, half of all residents of Auckland with acute first-ever or recurrent stroke (nϭ680) were assessed and followed up prospectively during the next 2 decades. In 2002, their vital status and health-related quality of life (HRQoL) using the 36-item short-form questionnaire (SF-36) were determined by telephone interviews. Kaplan-Meier survival probabilities for the stroke cohort were compared with life table estimates for the New Zealand population. The SF-36 profile of 21-year stroke survivors was compared with a standardized New Zealand population. Results-Overall, 626 of the original cohort had died and 4 were lost to follow-up, leaving 50 (7%) individuals (57% male; mean age 70 years) available in 2002, of whom 12% were residents of an institutional care facility and 19% required help with everyday activities. The stroke cohort had nearly twice the mortality rate of the New Zealand population, but the SF-36 profile of very long-term stroke survivors was broadly similar to the general population. Conclusions-Because stroke is generally a disease of older people and has a high case fatality, it is not surprising that Ͻ1 in 10 people survive 2 decades after onset. However, of those who do, their HRQoL profile suggests that they meld relatively successfully within the general population, despite ongoing disability and a higher mortality risk. (Stroke.

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

“…Survival after first or recurrent stroke has been reported to be <10% after 20 years, the risk factors for death were age, previous stroke, subtype of stroke, and different stroke features (Anderson et al., 2004). Lower mortality rates for patients with TIA versus stroke after one year were reported by a study in Japan after hospital discharge (7% for stroke patients and 3.5% for TIA patients) (Kimura et al., 2005).…”

Functional Status and Patient-Reported Outcome 10 Years After Stroke

“…Among the 145 individuals, 73% were independent in activities of daily living (Barthel index score 95-100), 13% had minor dependence (score 60-90), and 14% had major dependence (score 0-55). The assessment of functional status showed that 71% scored ≤2 on mRS, that is, they had no or only slight disability, whereas 14% had moderate disability (mRS score 3) and 15% were more severely disabled (mRS score [4][5]. No significant sex differences in functional status were observed.…”

Self-Reported Long-Term Needs After Stroke

“…Currently, data largely come from short-term cohort studies with limited follow-up (usually up to 1 year) and subject to selection bias because they are not population-based. In population-based studies, quality of life has been assessed between 2 and 21 years after stroke, [7][8][9][10][11][12] activities of daily living up to 21 years in Auckland, 7 up to 5 years in Perth, Australia, 13 and 5 years in south London. 14 Clinically defined outcomes may be of limited use in assessing long-term need after stroke and developing services to meet needs.…”