Mortality and Predictors of Death 1 Month and 3 Years after First-Ever Ischemic Stroke: Data from the First National Acute Stroke Israeli Survey (NASIS 2004)

Abstract

Background: Despite declining age-adjusted stroke mortality rates, the disease remains the third most common cause of death in Israel. Based on a national survey, we examined mortality rates during the first 3 years after a first-ever acute ischemic stroke (IS) and the major predictors of short-term (1 month) and long-term (3 years) mortality. Methods: In the National Acute Stroke Israeli Survey (NASIS 2004), data were collected on all hospitalized stroke patients in Israel during a 2-month period. Mortality rates for first-ever IS were assessed at 1 month and 3 years and predictors of death were evaluated using the Cox proportional hazard model. Results: A total of 1,079 first-ever IS patients were included. Survival data were complete for over 99% of patients. Cumulative mortality rates were 9.9% at 1 month and 31.1% at 3 years. Of the survivors at 1 month, 23.5% did not survive for 3 years. At 1 month, the hazard ratio (HR) for death significantly increased with stroke severity. One-month mortality was also associated with a decreased level of consciousness (HR 2.9, 95% CI 1.7–5.1), total anterior circulation infarction (TACI); HR 4.9, 95% CI 1.6–15.2), temperature on admission (HR 1.5, 95% CI 1.1–2.1 per 1°C), age (HR 1.04, 95% CI 1.02–1.07 per year) and glucose levels on admission (HR 1.003, 95% CI 1.001–1.006 per 1 mg/dl). Age-adjusted proportions of diabetes and chronic heart failure were considerably higher in the deceased compared with survivors at 3 years (48 vs. 38 and 21 vs. 9%, respectively). In the multivariate survival analyses, predictors of death at 1 month also predicted death at 3 years; however, history of dementia (HR 1.5, 95% CI 1.0–2.4), diabetes (HR 1.6, 95% CI 1.0–2.4), peripheral artery disease (HR 1.7, 95% CI 1.1–2.8), chronic heart failure (HR 1.6, 95% CI 1.1–2.4) and malignancy (HR 1.7, 95% CI 1.1–2.7) were additional predictors of long-term mortality for patients surviving the first month after stroke. Conclusions: Approximately one third of patients did not survive 3 years after the first-ever IS. While age and markers of severe stroke were the major predictors of death at 1 month, comorbidities and variables associated with atherosclerotic vascular disease predicted long-term mortality. Improved control of these factors can potentially reduce long-term mortality in stroke victims.

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

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External Validation of the iScore for Predicting Ischemic Stroke Mortality in Patients in China

“…Other studies had small sample sizes. 15 Williams and Jiang 24 attempted to develop a To convert glucose to mg/dL, divide by 0.0555. We used χ 2 tests to compare categorical variables and ANOVA or Kruskal-Wallis tests to compare mean and median differences for continuous variables in baseline characteristics.…”

Changes in Functional Outcome Over the First Year After Stroke

“…Few studies have assessed functional outcome in the longer term, and in particular, longitudinal studies with multiple assessment points are scarce. [8][9][10][11] Stroke recovery is heterogeneous but usually follows a common pattern, in which the largest regain of function occurs during the first weeks poststroke.…”