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Comparative Study
. 2008 Feb 16;336(7640):376-9.
doi: 10.1136/bmj.39456.688333.BE. Epub 2008 Jan 29.

Impact of functional status at six months on long term survival in patients with ischaemic stroke: prospective cohort studies

Karsten Bruins Slot  1 , Eivind Berge, Paul Dorman, Steff Lewis, Martin Dennis, Peter Sandercock; Oxfordshire Community Stroke Project, the International Stroke Trial (UK); Lothian Stroke Register
Affiliations
Comparative Study

Impact of functional status at six months on long term survival in patients with ischaemic stroke: prospective cohort studies

Karsten Bruins Slot et al. BMJ. .

Abstract

Objective: To estimate the impact on long term survival of functional status at six months after ischaemic stroke.

Design: Prospective cohort study. Settings Three cohorts: Oxfordshire community stroke project, Lothian stroke register, and the first international stroke trial (in the United Kingdom).

Participants: 7710 patients with ischaemic stroke registered between 1981 and 2000 and followed up for a maximum of 19 years.

Main outcome measures: Functional status at six months after stroke assessed with modified Rankin scale or "two simple questions." Mortality during follow-up. Survival analysis with Kaplan-Meier curves, log rank test, and Cox's regression model.

Results: In a combined analysis of all three cohorts, among patients who survived to assessment six months after the index stroke, the subsequent median length of survival among those independent in daily living and those dependent was 9.7 years (95% confidence interval 8.9 to 10.6) and 6.0 years (5.7 to 6.4), respectively. In a combined analysis of the Oxfordshire and Lothian cohorts, subsequent median survival fell progressively from 12.9 years (10.0 to 15.9) for patients with a Rankin score of 0-1 at six months after the stroke to 2.5 years (1.4 to 3.5) for patients with a Rankin score of 5. All previously stated differences in median survival were significant (log rank test P<0.001). The influence of functional outcome on survival remained significant (P<0.05) in each cohort after adjustment for relevant covariates (such as age, presence of atrial fibrillation, visible infarct on computed tomography, subtype of stroke) in a Cox's regression model.

Conclusion: Functional status six months after an ischaemic stroke is associated with long term survival. Early interventions that reduce dependency at six months might have positive effects on long term survival.

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Conflict of interest statement

Competing interests: None declared.

Figures

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Fig 1 Oxfordshire cohort. Long term survival of patients in each category of functional status (Rankin score 0-5) from assessment at six months after index stroke
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Fig 2 Lothian cohort. Long term survival of patients in each category of functional status (Rankin score 0-5) from assessment at six months after index stroke
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Fig 3 International stroke trial cohort. Long term survival of patients who were alive and dependent or independent from assessment at six months after randomisation
See this image and copyright information in PMC

Comment in

References

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