Poor outcomes after stroke

January 01, 0001

Poor outcomes after stroke

Data were collected from the population-based South London Stroke Register, a prospective population-based register documenting all first in a lifetime strokes since 1 January 1995 in a multi-ethnic inner city population. The outcomes assessed are reported as estimates of need and included disability, inactivity, cognitive impairment, anxiety and depression and mental and physical domain scores of the Medical Outcomes Study 12-item short form (SF-12) health survey. Between 1995 and 2006, 3,373 first-ever strokes were registered.

20%-30% of survivors had a poor outcome over 10 years of follow-up. The highest rate of disability was observed 7 days after stroke and remained at around 110 per 1,000 stroke survivors from 3 months to 10 years. Rates of inactivity and cognitive impairment both declined up to 1 year (280/1,000 and 180/1,000 survivors, respectively); thereafter rates of inactivity remained stable till year eight, then increased, whereas rates of cognitive impairment fluctuated till year eight, then increased. Anxiety and depression showed some fluctuation over time, with a rate of 350 and 310 per 1,000 stroke survivors, respectively. SF-12 scores showed little variation from 3 months to 10 years after stroke. Inactivity was higher in males at all time points, and in white compared to black stroke survivors, although black survivors reported better outcomes in the SF-12 physical domain. No other major differences were observed by gender or ethnicity. Increased age was associated with higher rates of disability, inactivity, and cognitive impairment.

The researchers concluded: "Between 20% and 30% of stroke survivors have a poor range of outcomes up to 10 years after stroke. Such epidemiological data demonstrate the sociodemographic groups that are most affected longer term and should be used to develop longer term management strategies that reduce the significant poor outcomes of this group, for whom effective interventions are currently elusive."

The ten years is because this is the limit of the study, but the outcomes are ongoing.

For the full abstract, click here.

PLoS Med 8(5):e1001033
© 2011 Wolfe et al
Estimates of Outcomes Up to Ten Years after Stroke: Analysis from the Prospective South London Stroke Register. Charles D. A. Wolfe, Siobhan L. Crichton, Peter U. Heuschmann et al. Correspondence to Charles Wolfe: [email protected]

Category: N. Neurological. Keywords: outcomes, estimates, stroke, register, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 10 June 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.