Five-year mortality and related prognostic factors after inpatient stroke rehabilitation: a European multi-centre study.
OBJECTIVE
To determine 5-year mortality and its association with baseline characteristics and functional status 6 months post-stroke for patients who received inpatient rehabilitation.


METHODS
A prospective rehabilitation-based cohort study.


METHODS
A total of 532 consecutive stroke patients from 4 European rehabilitation centres.


METHODS
Predictors were recorded on admission. Barthel Index was assessed at 6 months (BI6mths) and patients were followed for 5 years post-stroke. Survival probability was computed using Kaplan-Meier analysis and compared across 3 BI6mths-classes (0-60, 65-90, 95-100) (log-rank test). Significant independent predictors were determined using multivariate Cox regression analysis (hazard ratio (HR)).


RESULTS
Five-year cumulative risk of death was 29.12% (95% confidence interval (CI): 22.86-35.38). Age (HR=1.06, 95% CI: 1.04-1.09), cognitive impairment (HR=1.77, 95% CI: 1.21-2.57), diabetes mellitus (HR=1.68, 95% CI: 1.16-2.41) and atrial fibrillation (HR=1.52, 95% CI: 1.08-2.14) were independent predictors of increased mortality. Hyperlipidaemia (HR=0.66, 95% CI: 0.46-0.94), and higher BI6mths (HR=0.98, 95% CI: 0.97-0.99) were independent predictors of decreased mortality. Five-year survival probability was 0.85 (95% CI: 0.80-0.89) for patients in BI6mths-class: 95-100, 0.72 (95% CI: 0.63-0.79) in BI6mths-class: 65-90 and 0.50 (95% CI: 0.40-0.60) in BI6mths-class: 0-60 (p<0.0001).


CONCLUSIONS
Nearly one-third of rehabilitation patients died during the first 5 years following stroke. Functional status at 6 months was a powerful predictor of long-term mortality. Maximum functional independence at 6 months post-stroke should be promoted through medical interventions and rehabilitation. Future studies are recommended to evaluate the direct effect of rehabilitation on long-term survival.
Department of Medical Sociology and Health Sciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium. Liesbet.De.Wit@vub.ac.be
Liesbet
L
De Wit
Koen
K
Putman
Hannes
H
Devos
Nadine
N
Brinkmann
Eddy
E
Dejaeger
Willy
W
De Weerdt
Walter
W
Jenni
Nadina
N
Lincoln
Birgit
B
Schuback
Wilfried
W
Schupp
Emmanuel
E
Lesaffre
D000368:Aged; D004185:Disability Evaluation; D005060:Europe; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007297:Inpatients; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome