Three-Year Survival and Recurrence After Stroke in Malmö, Sweden

Background and Purpose-With the exception of atrial fibrillation (AF), little scientific attention has been given the associations between cardiac arrhythmias and incidence of stroke. We sought to study whether atrial and ventricular arrhythmias assessed during a 24-hour ambulatory ECG registration are associated with incidence of stroke. Methods-The population-based cohort "Men Born in 1914" was examined with 24-hour ambulatory ECG registrations at 68 years of age. Four hundred two men without previous myocardial infarction or stroke were included, and 236 of them had hypertension (Ն160/95 mm Hg or treatment). Fourteen-year rates of stroke (fatal and nonfatal) and all-cause mortality were updated from national and regional registers. Frequent or complex ventricular arrhythmias was defined as Lown class 2 to 5. A high frequency of atrial ectopic beats (AEB) was defined as the fifth quintile (ie, Ն218 AEB per 24 hours). Results-Fifty-eight men suffered a first stroke during the follow-up. Stroke rates (per 1000 person-years) among men with AF (nϭ14), with frequent AEB (nϭ77), and without AF or frequent AEB (nϭ311) were 34.5, 19.5, and 11.6, respectively. The corresponding values among men with hypertension were 40.7, 32.3, and 14.7, respectively. Frequent AEB (compared with absence of AF and frequent AEB) was significantly associated with stroke among all men (relative riskϭ1.9; 95% CI, 1.02 to 3.4; Pϭ0.04) and among hypertensive men (relative riskϭ2.5; 95% CI, 1.3 to 4.8; Pϭ0.009) after adjustments for potential confounders. The increased stroke rates among men with Lown class 2 to 5 did not reach statistical significance. Conclusions-A high frequency of AEB is associated with an increased incidence of stroke.

Section: Discussionmentioning

confidence: 82%

Cardiac Arrhythmias and Stroke

Engström

Hedblad

Juul‐Möller

et al. 2000

“…Studies of stroke-survival prognoses among white Americans 20 and Canadians 11 showed diabetes to be a significant predictor of mortality independent of heart diseases. Similarly, analysis of stroke registry data in Sweden 10 showed that the presence of diabetes was a significant predictor of both mortality and recurrence in stroke patients during the period 1989 -1992. However, whether subjects had continuous treatment for diabetes was not considered in these 3 studies.…”

Section: Discussionmentioning

confidence: 94%

Predictors of Survival Among Elders Suffering Strokes in Taiwan

Wang

Pan

Lee

et al. 2000

Background and Purpose-Cerebrovascular disease was the leading cause of death in Taiwan from 1963 to 1982. Deaths due to stroke now rank second only to cancer, with more deaths resulting from strokes than from any other single pathology. It is important to understand stroke prognosis among elderly stroke survivors, with respect to survival and attendant predictive factors, because aged population in Taiwan is growing rapidly. The aim of the present study was to discern factors affecting survival in stroke patients from a nationally representative elderly sample. Methods-A total of 99 stroke survivors, from a representative national sample of elders aged Ն65 years on December 31, 1988, whose strokes occurred in the period 1989 -1993, were followed for mortality until July 1, 1995. Personal data were gathered through home interviews conducted by well-trained community nurses, and mortality data were obtained from the national census office by using identification card numbers. Cox proportional hazards regression analysis and the stepwise technique were used to search for important prognostic factors of survival. Results-Women experienced a higher mortality rate (139.8 per 1000 person-years) than men (126.4 per 1000 person-years), as age-adjusted for World Health Organization world-population figures. Stroke patients who received continuous treatment for diabetes experienced mortality risks similar to those of patients without diabetes and much lower risks than those with discontinuous diabetes treatment. Cognitive impairment was also an independent predictor of survival (relative risk 2.69, PϽ0.05). In addition, patients with both cognitive and mobility impairments had a 2-to 3-fold greater risk of mortality than those with only a single abnormality. Conclusions-This first report on the various prognostic factors related to survival of elderly stroke patients in Taiwan's Chinese population emphasized the benefit of continuous diabetes treatment in improving survival chances. These stroke patients should also be monitored for cognitive and mobility impairments and undergo rehabilitation. (Stroke.

“…There was wide variation in definition of stroke recurrence used, ranging from any focal neurological deficit lasting for Ͼ24 hours occurring after an initial stroke 3,5,14,19 to an exclusion period of 28 days, only after which further strokes were considered a recurrence. 25, 26 Coull and Rothwell previously demonstrated the effect of different definitions of stroke recurrence on estimates of risk of recurrence 90 days after first stroke in the Oxford Vascular Study and Oxford Community Stroke Project cohorts. 27 They found that the risk of recurrence in Oxford Vascular Study and Oxfordshire Community Stroke Project, respectively, ranged from 18.3% to 14.5% when including all stroke recurrences occurring 24 hours after initial stroke, and from 5.9% to 4.8% using the definition used in the Monitoring Trends and Determinants in Cardiovascular Disease study and other population-based studies.…”

Section: Discussionmentioning

confidence: 99%

“…It is known that strokes with an atherosclerotic origin recur earlier than other stroke subtypes; therefore, by excluding recurrent strokes occurring in the first weeks after initial stroke, artificially lower risk of stroke recurrence may be reported. 25 The studies included in this review have a combined study period encompassing 50 years (Table). Temporal trends in stroke management and, in particular, the advent and increasing importance given to secondary prevention after initial stroke may be another important contributory factor of variation in risk of recurrence during this period.…”

Section: Discussionmentioning

confidence: 99%

Risk and Cumulative Risk of Stroke Recurrence

Mohan

Wolfe

Rudd

et al. 2011

563

231

Background and Purpose-Estimates of risk of stroke recurrence are widely variable and focused on the shortterm. A systematic review and meta-analysis was conducted to estimate the pooled cumulative risk of stroke recurrence. Methods-Studies reporting cumulative risk of recurrence after first-ever stroke were identified using electronic databases and by manually searching relevant journals and conference abstracts. Overall cumulative risks of stroke recurrence at 30 days and 1, 5, and 10 years after first stroke were calculated, and analyses for heterogeneity were conducted. A Weibull model was fitted to the risk of stroke recurrence of the individual studies and pooled estimates were calculated with 95% CI. Results-Sixteen studies were identified, of which 13 studies reported cumulative risk of stroke recurrence in 9115survivors. The pooled cumulative risk was 3.1% (95% CI, 1.7-4.4) at 30 days, 11.1% (95% CI, 9.0 -13.3) at 1 year, 26.4% (95% CI, 20.1-32.8) at 5 years, and 39.2% (95% CI, 27.2-51.2) at 10 years after initial stroke. Substantial heterogeneity was found at all time points. This study also demonstrates a temporal reduction in 5-year risk of stroke recurrence from 32% to 16.2% across the studies. Conclusions-The cumulative risk of recurrence varies greatly up to 10 years. This may be explained by differences in case mix and changes in secondary prevention over time However, methodological differences are likely to play an important role and consensus on definitions would improve future comparability of estimates and characterization of groups of stroke survivors at increased risk of recurrence. (Stroke. 2011;42:1489-1494.)Key Words: frequency Ⅲ predictors Ⅲ recurrence Ⅲ stroke P atients surviving an initial stroke are known to be at significantly increased risk for further strokes compared to the general population. 1 However, studies show considerable variation in the estimation of risk of stroke recurrence in both the early years and in the long-term after first stroke. 2 For example, the cumulative risk of stroke recurrence up to 5 years after initial stroke has been reported in population-based studies as 19% in Manhattan, 29% in Rochester, 30% in Oxfordshire, and 32% in Perth. [3][4][5][6] Accurate identification of the time at which stroke survivors are at increased risk for stroke recurrence is important for modifiable risk factors to target and to help reduce the risk of recurrence occurring. The aim of this systematic review and meta-analysis is to estimate the pooled cumulative risk of stroke recurrence at time points ranging from 30 days to 10 years after first-ever stroke. Materials and Methods Search Strategy and Selection CriteriaThis review included studies from hospital-based or communitybased stroke registers reporting the risk of stroke recurrence at any time point after first-ever stroke irrespective of study design and setting or language. Ovid Medline (1950 -November 2009), EMBASE (1950 -November 2009, and the Web of Science were searched using both medical subject heading terms ...