Recurrent Stroke and Early Mortality in an Urban Medical Unit in Cameroon

Abstract

Background: Data on stroke mortality in recurrent strokes in the context of limited acute stroke care and secondary stroke prevention within Africa are very scant. We investigated the risk of in-hospital death in patients with recurrent stroke in the medical department of the Yaoundé Central Hospital in Cameroon.

Methods: Admission and discharge registries, and patient files for the period 1999-2012, were reviewed for evidence of admission for stroke, recurrent stroke, and in-hospital death. Mortality was compared between recurrent and first-ever stroke overall, and heterogeneities across major subgroups were assessed via interaction tests.

Results: Out of 1678 participants included in the final analytic sample, 243 (14.5%) had recurrent stroke. Our first-ever stroke participants were older (median age 65.0 years versus 62.0 years, P = .024), had a worse stroke risk profile (prevalent diabetes 17.5% versus 12.0%, P = .018; atrial fibrillation 3.7% versus 1.1%, P = .002; hypertension 91.7% versus 63.9%, P < .0001), and were smokers. Sixty-five deaths (20.6%) occurred among participants with recurrent stroke and 281 (19.6%) among first-ever stroke participants (P = .013). The adjusted odds ratio of mortality from recurrent stroke was 1.43 (95% CI: 1.03-1.99).

Conclusion: Stroke survivors have a 43% higher risk of dying after a recurrent stroke compared to those with first-ever stroke, against a background of unfavorable stroke risk profile.

Keywords: Stroke; case-fatality rates; recurrent stroke; resource-limited environments; sub-Saharan Africa.