Improving the One-Year Mortality of Stroke Patients: An 18-Year Observation in a Teaching Hospital

Abstract

Long-term follow-up and comparison of serial changes in the one-year mortality after stroke are important in assessing the quality of stroke management. This study determined the one-year survival rate and prognostic factors of hospitalized hemorrhagic and ischemic stroke patients from 1991 to 2008 in a teaching hospital in Taiwan. We also evaluated the improvements in the one-year mortality after stroke during an 18-year study period. Patients admitted for cerebral hemorrhage (n = 3,678) and cerebral infarction (n = 16,010), identified from an in-patient electronic database, were linked to the National Death Registry of Taiwan. Actuarial analysis was used to determine the one-year survival rates, and Cox proportional hazard regression model was used to investigate the predictors for the one-year mortality of stroke patients. For patients with cerebral hemorrhage and infarction and who were admitted from 1991 to 2008, the one-year survival rates were 71% and 84%, respectively. In addition, stroke patients who also suffered from myocardial infarction, chronic renal illness, and pneumonia and had high Charlson comorbidity index scores showed increased risks of mortality due to cerebral hemorrhage and infarction. Compared with the patients admitted from 1991 to 1996, those admitted from 1997 to 2002 and from 2003 to 2008 showed 15%-20% and 20%-25% reduction in one-year mortality risk in cerebral hemorrhage and infarction, respectively. This result demonstrates the continuous quality improvement of stroke management in the hospital from 1991 to 2008. Further reduction in one-year mortality can be achieved by early recognition and prompt treatment of certain comorbidities.

Multimorbidities Are Associated to Lower Survival in Ischaemic Stroke: Results from a Brazilian Stroke Cohort (EMMA Study)

“…In fact, most frequencies of comorbidities prior to the index event exceeded the rates previously described in previous stroke cohorts [11,12,14,26,27]. A quarter of our patients were classified as having a very severe burden of comorbidities (CCI), which resulted in the maximum mortality risk along the follow-up.…”

“…Two large and more representative population-based studies also revealed positive and consistent findings regarding survival and multimorbidity in stroke populations [11,12]. …”

“…The age- and gender-adjusted mortality risk ratio was 1.83 (95% CI 1.66-2.02) for those stroke patients with Charlson index between 2 and 4 points and 4.94 (95% CI 4.07-6.01) for those who scored higher than 4 [11]. Although we did not use the same CCI categories, death risk ratios were also increased in the group with a very severe burden of comorbidities (≥3 points) reaching 3 times risk up to the 9-year observation period.…”

“…Despite the high burden of clinical comorbidities associated to cerebrovascular disease [3,7,8,9,] few prospective studies reported the prognostic value of comorbidities in long-term stroke survival [10,11,12]. In this context, the Charlson Comorbidity Index (CCI) [13] is one of the most often used comorbidity score employed in longitudinal studies to evaluate prognosis [11,12,14,15,16,17,18,19,20].…”

“…In this context, the Charlson Comorbidity Index (CCI) [13] is one of the most often used comorbidity score employed in longitudinal studies to evaluate prognosis [11,12,14,15,16,17,18,19,20]. A modified version of Charlson index was adapted by Goldstein et al [14] for predicting functionality at hospital discharge and 1-year mortality in ischaemic stroke (IS) patients.…”