Research Article: Estimates of Outcomes Up to Ten Years after Stroke: Analysis from the Prospective South London Stroke Register

Date Published: May 17, 2011

Publisher: Public Library of Science

Author(s): Charles D. A. Wolfe, Siobhan L. Crichton, Peter U. Heuschmann, Christopher J. McKevitt, André M. Toschke, Andy P. Grieve, Anthony G. Rudd, Peter Sandercock

Abstract: Charles Wolfe and colleagues collected data from the South London Stroke Register
on 3,373 first strokes registered between 1995 and 2006 and showed that between
20% and 30% of survivors have poor outcomes up to 10 years after
stroke.

Partial Text: The World Health Organization’s Global Burden of Disease analyses rely on
routine mortality and limited disability data throughout most countries worldwide.
These data have persistently highlighted stroke as the fourth leading cause of
disability-adjusted life years (DALYs) lost (stroke accounts for 6.3% DALYs,
equating to 83.61 million DALYs in low and middle income countries and 9.35 million
DALYs in high income countries) [1]. To estimate DALYs, a range of data sources, including
disease registers, epidemiological studies, and health surveys, are utilised, yet
the data that inform the DALY estimates for long-term planning are not at all
comprehensive.

A total of 3,373 patients with first-ever stroke between 1 January 1995 and 31
December 2006 were registered in the SLSR. The sociodemographic data, pathological
stroke subtype data, and case fatality rates are presented in Table 1. Mean age was 70.3 y (standard deviation
14.6), and 49.3% were female (Table 1). Most patients were white (72.7%), followed by black
(Black African and Black Caribbean) (19.1%), while other or unknown ethnicity
was recorded in less than 10%. The majority of patients were classified as
independent by the BI prior to stroke (77.8%). Ischaemic strokes were
observed in 76.5%, primary intracerebral haemorrhage in 13.8%, and
subarachnoid haemorrhage in 5.7%. The Glasgow Coma Score dichotomised to
<13 or ≥13, as a standardised measure of stroke severity, showed no change over time after adjusting for age, gender, ethnicity, and subtype of stroke. This study analyses a population-based cohort of stroke patients followed for up to 10 y. It not only provides population estimates, to our knowledge for the first time, on the longer term outcomes in a diverse inner city population but highlights that stroke is truly a lifelong condition among survivors with ongoing poor outcomes. A major observation is that after 3–12 mo the outcomes remain relatively constant. There are some differences in the rates of the different outcomes between sociodemographic groups that are largely unexplained, but the effect of age on poorer outcomes indicates a challenge to be faced in future years [36]. Source: http://doi.org/10.1371/journal.pmed.1001033

 

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