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Long-term mortality after acute stroke

Long-term mortality after acute stroke. Stroke is a leading cause of mortality : 6 million fatal events annually worldwide . Mainly affects elderly , but 10% of strokes are in patients younger than 50 years .

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Long-term mortality after acute stroke

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  1. Long-term mortality after acute stroke • Stroke is a leading cause of mortality: 6 million fatal eventsannuallyworldwide. • Mainly affects elderly, but 10% of strokes are in patients youngerthan 50 years. • Prognosis of stroke isusuallyconsideredbenign in the young population whencomparedwitholder patients who have a higher short-term rate of mortality. • But… thereis no direct evaluation of the impact of stroke in patients youngerthan 50 yearsoldcomparedwithage-matchedindividualsfromthe generalpopulation.

  2. The FUTURE study • Follow-Up of Transient ischemic attack and stroke patients and Unelucidated Risk factor Evaluation (FUTURE): a prospective cohort study.1 • Objective: to investigate long-term mortality and cause of death after acute stroke in adults aged 18 through 50 years and to compare this with age and sex-matched mortality rates in the Netherlands. • 959 Consecutives’ patients with first-ever transient ischemic attack (TIA, n=262), ischemic stroke (n=606), and intracerebral hemorrhage (ICH, n=91), followed up over a mean duration of 11.1 years. Population distribution 1- Rutten-Jacobs LC, Arntz RM, Maaijwee NA et al. Long-term mortality after stroke among adults aged 18 to 50 years. JAMA. 2013;309(11):1136-1144.

  3. Observed rate of death in the FUTURE study • During follow-up, 192 patients died. • Case-fatality • 43 Patients died during the first 30 days, providing a 30-day case-fatality rate of 0.4% after TIA, 3.6% after ischemic stroke, and 22% after ICH. • Long-term mortality in 30-day survivors • Cumulative mortality over 20 years in young patients were respectively 24.9% (95% confidence interval [CI], 16-33.7) after TIA, 26.8% (95% CI, 21.9-31.8) after ischemic stroke, and 13.7% (95% CI, 3.6-23.9) after ICH.

  4. Long-termconsequence of stroke on death rate • Mortality after ischemic stroke remained increased compared with the expected mortality during the entire follow-up: • For TIA: 24.9% (95% CI, 16-33.7) vs 8.5% • For ischemic stroke: 26.8% (95% CI, 21.9-31.8) vs 7.6% • For ICH: 13.7% (95% CI, 3.6-23.9) vs 5.6% • The standardized mortality ratio (SMR) reflected the increased mortality observed in all subgroups compared with expected values.

  5. Conclusion • Patients experiencing a stroke between the ages of 18 and 50 years remain at significantly higher risk of death compared with the general population during the 20 following years. • Half of the deaths were attributable to a vascular event, suggesting that the underlying disease causing stroke at a young age continues to be active throughout life. • Among stroke subtypes, cardioembolic stroke (part of the ischemic stroke group) was the most important predictor of mortality.

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