title: Causes of death by level of dependency at 6 months after ischemic stroke in 3 large cohorts.
abstract: OBJECTIVE
  We assessed the influence of functional status at 6 months after ischemic stroke on cause of death during long-term follow-up in 3 prospective cohorts.
  
  
  METHODS
  The cohorts were 7710 patients from the Oxfordshire Community Stroke Project, Lothian Stroke Register, and International Stroke Trial. Functional status was assessed at 6 months after stroke onset. Causes of death were identified from death certificates, and were also classified into "stroke-related" or "other" causes. We calculated the relative risk with 95% CI to assess the association between dependency level and cause of death. We also performed a multivariable regression analysis to adjust for other relevant factors.
  
  
  RESULTS
  Six months after stroke onset 5961 (78%) patients were still alive. At the end of follow-up period, 1620 (47%) patients who were functionally dependent at 6 months after stroke onset had died vs 711 (28%) independent patients. Dependent patients had a relative risk of dying from stroke of 1.70 (95% CI, 1.44-2.00) compared to independent patients. Overall, dependent patients had a relative risk of 1.68 (95% CI, 1.49-1.91) of dying from stroke-related causes. Dependency remained significantly (P<0.01) associated with stroke-related causes of death in a multivariable regression analysis.
  
  
  CONCLUSIONS
  Stroke-related deaths continue to be a problem during the years after an ischemic stroke, especially in patients who are functionally dependent at 6 months after onset. Better acute treatments to reduce dependency and adequate secondary prevention remain high priorities.
authors.affiliation: Department of Internal Medicine, Ullevaal University Hospital, Oslo, Norway. karsten.bruins.slot@medisin.uio.no
authors.forename: Karsten Bruins
authors.initials: KB
authors.lastname: Slot
authors.forename: Eivind
authors.initials: E
authors.lastname: Berge
authors.forename: Peter
authors.initials: P
authors.lastname: Sandercock
authors.forename: Steff C
authors.initials: SC
authors.lastname: Lewis
authors.forename: Paul
authors.initials: P
authors.lastname: Dorman
authors.forename: Martin
authors.initials: M
authors.lastname: Dennis
mesh_terms: D000367:Age Factors; D000368:Aged; D002545:Brain Ischemia / Q000150:complications*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012044:Regression Analysis; D012737:Sex Factors; D020521:Stroke / Q000209:etiology* / Q000401:mortality*; D013534:Survival; D006113:United Kingdom / Q000453:epidemiology