Time Course of Evolution of Disability and Cause-Specific Mortality After Ischemic Stroke: Implications for Trial Design

Outcome in stroke trials is often based on a 3-month modified Rankin scale (mRS). How 3-month mRS relates to longer-term outcomes will depend on late recovery, delayed stroke-related deaths, recurrent strokes, and nonstroke deaths. We evaluated 3-month mRS and death/disability at 1 and 5 years in a...

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Bibliographic Details
Published in:Journal of the American Heart Association 2017-06, Vol.6 (6)
Main Authors: Ganesh, Aravind, Luengo-Fernandez, Ramon, Wharton, Rose M, Gutnikov, Sergei A, Silver, Louise E, Mehta, Ziyah, Rothwell, Peter M
Format: Article
Language:English
Subjects:
Aged
Brain Ischemia - mortality
Brain Ischemia - physiopathology
Brain Ischemia - rehabilitation
Cause of Death - trends
Cerebrovascular Circulation - physiology
cerebrovascular disease/stroke
clinical trial design
Clinical Trials as Topic - methods
Disability Evaluation
Disabled Persons - rehabilitation
Disabled Persons - statistics & numerical data
Female
Follow-Up Studies
health economics
Humans
longitudinal cohort study
Male
Original Research
Population Surveillance
Recovery of Function
Retrospective Studies
stroke recovery
Survival Rate - trends
Time Factors
United Kingdom - epidemiology
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Summary:Outcome in stroke trials is often based on a 3-month modified Rankin scale (mRS). How 3-month mRS relates to longer-term outcomes will depend on late recovery, delayed stroke-related deaths, recurrent strokes, and nonstroke deaths. We evaluated 3-month mRS and death/disability at 1 and 5 years in a population-based cohort study. In 3-month survivors of ischemic stroke (Oxford Vascular Study; 2002-2014), we related 3-month mRS to disability (defined as mRS >2) at 1 and 5 years and/or death rates (age/sex adjusted). Accrual of disability and index-stroke-related and nonstroke deaths in each poststroke year was categorized according to 3-month mRS. Among 1606 patients with acute ischemic stroke, 181 died within 3 months, but 126 index-stroke-related deaths and 320 other deaths occurred during the subsequent 4866 patient-years of follow-up up to 5 years. Although 69/126 (54.8%) post-3-month index-stroke-related deaths occurred after 1 year, mRS>2 at 1 year strongly predicted these deaths (adjusted hazard ratio=21.94, 95%CI 7.88-61.09, 2 was a strong independent predictor of death at both 1 year (adjusted hazard ratio=6.67, 95%CI 4.16-10.69,
ISSN:2047-9980
2047-9980
DOI:10.1161/jaha.117.005788