Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2013 Oct 3:13:133.
doi: 10.1186/1471-2377-13-133.

5-year survival and rehospitalization due to stroke recurrence among patients with hemorrhagic or ischemic strokes in Singapore

Yan Sun  1 , Sze Haur Lee, Bee Hoon Heng, Vivien S Chin
Affiliations
Multicenter Study

5-year survival and rehospitalization due to stroke recurrence among patients with hemorrhagic or ischemic strokes in Singapore

Yan Sun et al. BMC Neurol. .

Abstract

Background: Stroke is the 4th leading cause of death and 1st leading cause of disability in Singapore. However the information on long-term post stroke outcomes for Singaporean patients was limited. This study aimed to investigate the post stroke outcomes of 5-year survival and rehospitalization due to stroke recurrence for hemorrhagic and ischemic stroke patients in Singapore. The outcomes were stratified by age, ethnic group, gender and stroke types. The causes of death and stroke recurrence were also explored in the study.

Methods: A multi-site retrospective cohort study. Patients admitted for stroke at any of the three hospitals in the National Healthcare Group of Singapore were included in the study. All study patients were followed up to 5 years. Kaplan-Meier was applied to study the time to first event, death or rehospitalization due to stroke recurrence. Cox proportional hazard model was applied to study the time to death with adjustment for stroke type, age, sex, ethnic group, and admission year. Cumulative incidence model with competing risk was applied for comparing the risks of rehospitalization due to stroke recurrence with death as the competing risk.

Results: Totally 12,559 stroke patients were included in the study. Among them, 59.3% survived for 5 years; 18.4% were rehospitalized due to stroke recurrence in 5 years. The risk of stroke recurrence and mortality increased with age in all stroke types. Gender, ethnic group and admitting year were not significantly associated with the risk of mortality or stroke recurrence in hemorrhagic stroke. Male or Malay patient had higher risk of stroke recurrence and mortality in ischemic stroke. Hemorrhagic stroke had higher early mortality while ischemic stroke had higher recurrence and late mortality. The top cause of death among died stroke patients was cerebrovascular diseases, followed by pneumonia and ischemic heart diseases. The recurrent stroke was most likely to be the same type as the initial stroke among rehospitalized stroke patients.

Conclusions: Five year post-stroke survival and rehospitalization due to stroke recurrence as well as their associations with patient demographics were studied for different stroke types in Singapore. Specific preventive strategies are needed to target the high risk groups to improve their long-term outcomes after acute stroke.

PubMed Disclaimer

Figures

Figure 1
Figure 1
5-year survival by stroke subtype by Kaplan-Meier analysis.
Figure 2
Figure 2
5-year rehospitalization due to stroke recurrence by stroke subtype by cumulative incidence analysis with competing risk.
Figure 3
Figure 3
Recurrent stroke types for patients admitted with the three stoke types.
Figure 4
Figure 4
The top 10 causes of death for patients admitted with the three stroke types.
See this image and copyright information in PMC

References

    1. World Health Organization. Fact sheet: the 10 leading causes of death by broad income groups 2004. 2004. Retrieved from http://www.who.int/mediacentre/factsheets/fs310_2008.pdf.
    1. Mackenzie A, Perry L, Lockhart E, Cottee M, Cloud G, Mann H. Family carers of stroke survivors: needs, knowledge, satisfaction and competence in caring. Disabil Rehabil. 2007;29:111–121. doi: 10.1080/09638280600731599. - DOI - PubMed
    1. Cadilhac DA, Carter RC, Thrift AG. Why invest in a national public health program for stroke? an example using Australian data to estimate the potential benefits and cost implication. Health Policy. 2007;83:287–294. doi: 10.1016/j.healthpol.2007.02.001. - DOI - PubMed
    1. Kolominsky-Rabas PL, Heuschmann PU, Marschall D. Lifetime cost of ischemic stroke in Germany: results and national projections from a population-based stroke registry: the Erlangen stroke project. Stroke. 2006;37:1179–1183. doi: 10.1161/01.STR.0000217450.21310.90. - DOI - PubMed
    1. US Department of Health and Human Services, National Center for Health Services. CDC and prevention. National Vital Stat Rep. 2007;55:10.

Publication types