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Long-term morbidity and mortality in patients without early complications after stroke or transient ischemic attack.

Abstract Secondary prevention after stroke and transient ischemic attack (TIA) has focused on high early risk of recurrence, but survivors of stroke can have substantial long-term morbidity and mortality. We quantified long-term morbidity and mortality for patients who had no early complications after stroke or TIA and community-based controls.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title cmaj : canadian medical association journal = journal de l'association medicale canadienne
Publication Year Start




PMID- 28739847
OWN - NLM
STAT- In-Process
DA  - 20170725
LR  - 20170725
IS  - 1488-2329 (Electronic)
IS  - 0820-3946 (Linking)
VI  - 189
IP  - 29
DP  - 2017 Jul 24
TI  - Long-term morbidity and mortality in patients without early complications after
      stroke or transient ischemic attack.
PG  - E954-E961
LID - 10.1503/cmaj.161142 [doi]
AB  - BACKGROUND: Secondary prevention after stroke and transient ischemic attack (TIA)
      has focused on high early risk of recurrence, but survivors of stroke can have
      substantial long-term morbidity and mortality. We quantified long-term morbidity 
      and mortality for patients who had no early complications after stroke or TIA and
      community-based controls. METHODS: This longitudinal case-control study included 
      all ambulatory or hospitalized patients with stroke or TIA (discharged from
      regional stroke centres in Ontario from 2003 to 2013) who survived for 90 days
      without recurrent stroke, myocardial infarction, all-cause admission to hospital,
      admission to an institution or death. Cases and controls were matched on age, sex
      and geographic location. The primary composite outcome was death, stroke,
      myocardial infarction, or admission to long-term or continuing care. We
      calculated 1-, 3- and 5-year rates of composite and individual outcomes and used 
      cause-specific Cox regression to estimate long-term hazards for cases versus
      controls and for patients with stroke versus those with TIA. RESULTS: Among
      patients who were initially stable after stroke or TIA (n = 26 366), the hazard
      of the primary outcome was more than double at 1 year (hazard ratio [HR] 2.4, 95%
      confidence interval [CI] 2.3-2.5), 3 years (HR 2.2, 95% CI 2.1-2.3) and 5 years
      (HR 2.1, 95% CI 2.1-2.2). Hazard was highest for recurrent stroke at 1 year (HR
      6.8, 95% CI 6.1-7.5), continuing to 5 years (HR 5.1, 95% CI 4.8-5.5), and for
      admission to an institution (HR 2.1, 95% CI 1.9-2.2). Survivors of stroke had
      higher mortality and morbidity, but 31.5% (1789/5677) of patients with TIA
      experienced an adverse event within 5 years. INTERPRETATION: Patients who survive
      stroke or TIA without early complications are typically discharged from secondary
      stroke prevention services. However, these patients remain at substantial
      long-term risk, particularly for recurrent stroke and admission to an
      institution. Novel approaches to prevention, potentially embedded in community or
      primary care, are required for long-term management of these initially stable but
      high-risk patients.
CI  - (c) 2017 Canadian Medical Association or its licensors.
FAU - Edwards, Jodi D
AU  - Edwards JD
AD  - Sunnybrook Research Institute (Edwards, Swartz), Toronto, Ont.; Canadian
      Partnership for Stroke Recovery (Edwards), Ottawa, Ont.; Department of Medicine, 
      Division of General Internal Medicine (Kapral), Institute of Health Policy,
      Management and Evaluation (Kapral), and Department of Medicine, Neurology
      (Swartz), University of Toronto; Institute for Clinical Evaluative Sciences
      (Kapral, Fang), Toronto, Ont.
FAU - Kapral, Moira K
AU  - Kapral MK
AD  - Sunnybrook Research Institute (Edwards, Swartz), Toronto, Ont.; Canadian
      Partnership for Stroke Recovery (Edwards), Ottawa, Ont.; Department of Medicine, 
      Division of General Internal Medicine (Kapral), Institute of Health Policy,
      Management and Evaluation (Kapral), and Department of Medicine, Neurology
      (Swartz), University of Toronto; Institute for Clinical Evaluative Sciences
      (Kapral, Fang), Toronto, Ont.
FAU - Fang, Jiming
AU  - Fang J
AD  - Sunnybrook Research Institute (Edwards, Swartz), Toronto, Ont.; Canadian
      Partnership for Stroke Recovery (Edwards), Ottawa, Ont.; Department of Medicine, 
      Division of General Internal Medicine (Kapral), Institute of Health Policy,
      Management and Evaluation (Kapral), and Department of Medicine, Neurology
      (Swartz), University of Toronto; Institute for Clinical Evaluative Sciences
      (Kapral, Fang), Toronto, Ont.
FAU - Swartz, Richard H
AU  - Swartz RH
AD  - Sunnybrook Research Institute (Edwards, Swartz), Toronto, Ont.; Canadian
      Partnership for Stroke Recovery (Edwards), Ottawa, Ont.; Department of Medicine, 
      Division of General Internal Medicine (Kapral), Institute of Health Policy,
      Management and Evaluation (Kapral), and Department of Medicine, Neurology
      (Swartz), University of Toronto; Institute for Clinical Evaluative Sciences
      (Kapral, Fang), Toronto, Ont. [email protected]
LA  - eng
PT  - Journal Article
PL  - Canada
TA  - CMAJ
JT  - CMAJ : Canadian Medical Association journal = journal de l'Association medicale
      canadienne
JID - 9711805
COI - Competing interests: None declared.
EDAT- 2017/07/26 06:00
MHDA- 2017/07/26 06:00
CRDT- 2017/07/26 06:00
PHST- 2017/03/06 [accepted]
AID - 189/29/E954 [pii]
AID - 10.1503/cmaj.161142 [doi]
PST - ppublish
SO  - CMAJ. 2017 Jul 24;189(29):E954-E961. doi: 10.1503/cmaj.161142.