Long-Term Mortality After Stroke Among Adults Aged 18 to 50 Years

May 20, 2013
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Authors:
Rutten-Jacobs LC, Arntz RM, Maaijwee NA, et al.
Citation:
JAMA 2013;309:1136-1144.
Summary By:
Hitinder S. Gurm, MBBS, FACC

Study Questions:

What is the long-term mortality and cause of death after acute stroke in adults ages 18-50 years, and how does this compare with nationwide age- and sex-matched mortality rates?

Methods:

The authors reported the long-term results of the FUTURE (Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation) study, a prospective cohort study of prognosis after transient ischemic attack (TIA), ischemic stroke, or hemorrhagic stroke in adults ages 18-50 years admitted to Radboud University Nijmegen Medical Centre, the Netherlands, between January 1, 1980, and November 1, 2010. The survival status of 959 consecutive patients with a first-ever TIA (n = 262), ischemic stroke (n = 606), or intracerebral hemorrhage (n = 91) was assessed. Mean follow-up duration was 11.1 years.

Results:

Among patients who survived 30 days after the index event, cumulative 20-year risk of death was 24.9% (95% confidence interval [CI], 16.0%-33.7%) for TIA, 26.8% (95% CI, 21.9%-31.8%) for ischemic stroke, and 13.7% (95% CI, 3.6%-23.9%) for intracerebral hemorrhage. Compared with age- and sex-matched controls, an increased mortality was observed in stroke patients with standardized mortality ratio for TIA of 2.6 (95% CI, 1.8-3.7) , 3.9 (95% CI, 3.2-4.7) for ischemic stroke, and 3.9 (95% CI, 1.9-7.2) for intracerebral hemorrhage. For ischemic stroke, cumulative 20-year mortality among 30-day survivors was higher in men than in women (33.7% vs. 19.8%).

Conclusions:

The authors concluded that stroke survivors remain at an exaggerated risk of long-term mortality.

Perspective:

This study corroborates prior work demonstrating increased mortality among stroke survivors. The leading cause of death in this cohort was cardiovascular disease, and further studies are warranted to assess if systematic approaches to risk factor modification can help improve the long-term outcome of these patients.

Keywords: Cause of Death, Prognosis, Stroke, Intracranial Hemorrhages, Follow-Up Studies, Ischemic Attack, Transient, Netherlands, Risk Factors, Confidence Intervals, Cerebral Hemorrhage


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