Long-term survival after first-ever stroke: the Oxfordshire Community Stroke Project.
OBJECTIVE
There have been relatively few community-based studies of long-term prognosis after acute stroke. This study aimed to provide precise estimates of the absolute and relative risks of dying in an unselected cohort of patients with a first-ever stroke.


METHODS
Six hundred seventy-five patients were registered by a community-based stroke register (the Oxfordshire Community Stroke Project) and prospectively followed up for up to 6.5 years. Their relative risk of death was calculated using age- and sex-specific mortality rates for Oxfordshire.


RESULTS
During the first 30 days, 129 (19%) patients died. Patients who survived at least 30 days after a first-ever stroke thereafter had an average annual risk of death of 9.1%, 2.3-fold the risk in people from the general population. Although the absolute (about 15%) and relative (about threefold) risks of death were highest in these 30-day survivors over the first year after the stroke, they were at increased risk of dying over the next few years (range of relative risk for individual years, 1.1-2.9). Predictably, older patients had a worse absolute survival but, relative to the general population, stroke also increased the relative risk of dying in younger patients. During the first 30 days stroke accounts for most deaths; after this time nonstroke cardiovascular disease becomes increasingly important and is the most common cause of death after the first year.


CONCLUSIONS
These data highlight the importance of long-term secondary prevention of vascular events in stroke patients, targeted as much at the cardiovascular as at the cerebrovascular circulation.
Department of Clinical Neurosciences, Western General Hospital, Edinburgh, U.K.
M S
MS
Dennis
J P
JP
Burn
P A
PA
Sandercock
J M
JM
Bamford
D T
DT
Wade
C P
CP
Warlow
D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate; D006113:United Kingdom