This article is more than 5 years old. Information may no longer be current.
Poor functional outcome may persist a decade after early stroke
Click Here to Manage Email Alerts
Approximately one in eight patients who experienced ischemic stroke or intracerebral hemorrhage between the age of 18 and 50 years could not function independently or needed assistance with daily activities 10 years after the event, according to a new report.
As part of the FUTURE study, researchers evaluated 722 patients aged 18 to 50 years who were hospitalized at a single facility in the Netherlands for acute stroke between January 1980 and November 2010. Long-term functional outcome was assessed using the modified Rankin Scale and the Instrumental Activities of Daily Living scale according to stroke subtype, and patients were followed for a mean of 9 years. Surviving patients also underwent follow-up assessment between November 2009 and January 2012.
At follow-up, poor functional outcome (modified Rankin scale ≥2) was observed in 32% of all patients. Specifically, poor outcome was reported in 16.8% of patients with a transient ischemic attack, 36.5% with ischemic stroke and 49.3% with intracerebral hemorrhage. Poor functional outcome (Instrumental Activities of Daily Living scale <8) was observed in 10.8% of patients with TIA, 14.6% with ischemic stroke and 18.2% with intracerebral hemorrhage.
During follow-up, at least one incident stroke was reported in 10.6% of patients with initial TIA, 14.3% with ischemic stroke and 7.5% with intracerebral hemorrhage (P=.167). Patients with recurrent stroke were significantly more likely to have a poor functional outcome according to both evaluated scales than patients with no recurrent stroke (P<.001 for both).
Researchers also noted that poor outcome according to the modified Rankin scale was more likely to occur among patients with an earlier index stroke (56% for an event before 1990, 39.5% 1990-2000 and 18.3% after 2000; P<.001). Incident stroke was more common among patients who had an index stroke before 1990 (17% vs. 10.1% for after 1990; P=.036). No difference in Instrumental Activities of Daily Living score was observed according to index event.
Among patients with ischemic stroke, NIH Stroke Scale score at admission and incident stroke were identified as significant risk factors for poor outcome as measured by both modified Rankin Scale and Instrumental Activities of Daily Living scale (P<.001 for both). Other factors linked to risk for poor outcome according to the modified Rankin Scale included age at baseline (P=.002), incident CVD (P<.001) and duration of follow-up (P=.007).
“We showed that, even 10 years after a young stroke, about one out of eight survivors with an [ischemic stroke] or [intracerebral hemorrhage] was not able to function independently,” the researchers wrote. “In [transient ischemic attack] patients this was one out of 15 survivors. … Also, there was a clear relationship between the occurrence of one or more incident strokes and poor long-term functional outcome, stressing the importance of optimal preventive strategies in this population.”
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts