Long-term survival after stroke: 30 years of follow-up in a cohort, the Copenhagen City Heart Study

Abstract

Background and purpose: Only few have studied long-term survival after stroke. Such knowledge is essential for the evaluation of the current and future burden of stroke. The present study presents up to 30 years of follow-up of patients after a first-ever stroke.

Methods: Participants in the Copenhagen City Heart Study who experienced a first-ever stroke from 1978 to the end of 2001 were followed to the end of 2007. Stroke events were validated using the World Health Organization's definition of stroke. Linkage to the Danish Civil Registration System enabled identification of participants who died before the end of 2007. The National Register of Causes of Death provided cause of death. Survival in stroke patients was compared with survival in participants in the Copenhagen City Heart Study who did not suffer a stroke, and with survival in the general Danish population. Cox regression analyses adjusting for age and gender were used to compare survival in six consecutive 4-year periods starting with 1978-1982.

Results: Of 2,051 patients with first-ever stroke 1,801 died during follow-up. Causes of death were cerebrovascular disease in 37%, other cardiovascular diseases in 28%, cancer in 12%, and other causes in 23%. The most important determinant for long-term survival was age at time of stroke. In the 65- to 72-year age group 11% survived 15 years after stroke. In the age group <65 years 28% survived 15 years. For all age groups survival was poorer in stroke patients than in non-stroke controls. Long-term survival improved steadily over time. Life expectancy after stroke increased up to 4 years from 1978 to the end of 2001, exceeding the increase of life expectancy in the general population. Slightly longer survival was found in women than in men when adjusted for age at stroke onset.

Conclusion: In this cohort long-term survival after stroke gradually improved over three decades from 1978. The gain in remaining lifetime after stroke exceeded that of the general population.