Patient outcomes up to 15 years after stroke: survival, disability, quality of life, cognition and mental health

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 87; no. 10; pp. 1091 - 1098
• Main Authors: Crichton, Siobhan L, Bray, Benjamin D, McKevitt, Christopher, Rudd, Anthony G, Wolfe, Charles D A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.10.2016
• Subjects: Activities of daily living; Activities of Daily Living - classification; Aged; Aging; Anxiety; Anxiety Disorders - diagnosis; Anxiety Disorders - mortality; Anxiety Disorders - psychology; Cognitive ability; Cognitive Dysfunction - diagnosis; Cognitive Dysfunction - mortality; Cognitive Dysfunction - psychology; Data collection; Disability Evaluation; Epidemiology; Female; Follow-Up Studies; Heart attacks; Hospitals; Humans; Kaplan-Meier Estimate; Male; Mental depression; Mental health; Middle Aged; Minority & ethnic groups; Population; Quality of life; Quality of Life - psychology; Questionnaires; Registries; Stroke; Stroke - diagnosis; Stroke - mortality; Stroke - psychology; Studies; Survival Analysis; Treatment Outcome
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp-2016-313361

BackgroundThe global epidemiological shift of disease burden towards long-term conditions means understanding long-term outcomes of cardiovascular disease is increasingly important. More people are surviving stroke to experience its long-term consequences, but outcomes in people living more >10 years after stroke have not been described in detail.MethodsData were collected for the population-based South London Stroke Register, with participants followed up annually until death. Outcomes were survival, disability, activity, cognitive impairment, quality of life, depression and anxiety.FindingsOf 2625 people having first-ever stroke, 262 (21%) survived to 15 years. By 15 years, 61% (95% CI 55% to 67%) of the survivors were male, with a median age of stroke onset of 58 years (IQR 48–66). 87% of the 15-year survivors were living at home and 33.8% (26.2% to 42.4%) had mild disability, 14.3% (9.2% to 21.4%) moderate disability and 15.0% (9.9% to 22.3%) severe disability. The prevalence of disability increased with time but 1 in 10 of the 15-year survivors had lived with moderate-severe disability since their stroke. At 15 years, the prevalence of cognitive impairment was 30.0% (19.5% to 43.1%), depression 39.1% (30.9% to 47.9%) and anxiety 34.9% (27.0% to 43.8%), and survivors reported greater loss of physical than mental quality of life.ConclusionsOne in five people live at least 15 years after a stroke and poor functional, cognitive and psychological outcomes affect a substantial proportion of these long-term survivors. As the global population of individuals with cardiovascular long-term conditions grows, research and health services will need to increasingly focus on preventing and managing the long-term consequences of stroke.