Trends in Long-Term Mortality and Morbidity in Patients with No Early Complications after Stroke and Transient Ischemic Attack

Abstract

Background: Advances in acute management and secondary prevention have reduced mortality and early recurrent risk after stroke and transient ischemic attack (TIA). However, whether improved outcomes are sustained long term among those without early adverse complications is not clear. We describe trends in long-term mortality and morbidity in patients with ischemic stroke or TIA who are clinically stable at 90 days.

Methods: This is a longitudinal cohort registry study (2003-2013) of patients presenting to stroke centers in Ontario, Canada, with a stroke or TIA, with no hospitalization, stroke, myocardial infarction (MI), institutionalization, or death within 90 days (N = 26,698). Primary outcomes were 1-, 3-, and 5-year age-adjusted composite rates of death, stroke or MI, and institutionalization, and secondary analyses evaluated outcomes individually. Trend tests were used to evaluate change over time.

Results: One-year adjusted composite rates decreased from 9.3% in 2003 to 7.4% in 2012 (trend test P = .02). Significant decreases in 3-year (P < .001) and 5-year (P = .002) composite rates were also observed. Rates of recurrent stroke decreased at 1 and 3 years (P < .01), but not 5 years (P = .21), whereas death rates declined across follow-up times. Conversely, rates of institutionalization increased at 3 and 5 years (P < .01).

Conclusions: Long-term mortality and morbidity post stroke and TIA have declined, confirming trends for improved long-term outcomes for patients clinically stable during the initial high-risk period. However, increased long-term rates of institutionalization also suggest that stroke and TIA patients are at risk of long-term functional decline, despite improved clinical outcomes. Further studies evaluating challenges for sustaining functional gains after stroke and TIA are required.

Keywords: Stroke; longitudinal cohort study; morbidity; mortality; temporal trends; transient ischemic attack.