Case-fatality and functional status three months after first-ever stroke in Vietnam

• Published in: Journal of the neurological sciences Vol. 365; pp. 65 - 71
• Main Authors: Pham, Tran L, Blizzard, Leigh, Srikanth, Velandai, Thrift, Amanda G, Lien, Nguyen T.K, Thang, Nguyen H, Gall, Seana L
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.06.2016
• Subjects: Adult; Age Factors; Aged; Brain Ischemia - mortality; Case-fatality; Cohort Studies; Comorbidity; Disability Evaluation; Female; First-ever; Follow-Up Studies; Functional status; Humans; Male; Middle Aged; Neurology; Recovery of Function; Severity of Illness Index; Sex Factors; Stroke; Stroke - mortality; Tertiary Care Centers; Time Factors; Vietnam; Vietnam - epidemiology; Case-fatality; Functional status; Stroke; Vietnam; First-ever
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2016.03.013

Abstract Background To provide novel information on outcomes after first-ever stroke in Vietnam, case-fatality and functional status were assessed 3 months after stroke onset. Methods First-ever stroke patients admitted to the stroke unit of a tertiary teaching hospital in Ho Chi Minh City, Vietnam were recruited, examined and interviewed. Functional status was assessed on the modified Rankin Scale (mRS) at admission and again at 3 months. Result We recruited 450 consecutive first-ever stroke patients (99.6% participation, 47.9% female, mean age 62.5 [SD 14.0] years, 76.2% ischaemic stroke). Three-month observed case-fatality was 10.4%. Under plausible assumptions about deaths among non-recruited participants, the estimated case-fatality would be higher (16.4%) Those who had died were mostly older patients compromised by comorbidities and pre-existing disability, and who had severe impairment or severe disability due to stroke at the time of admission. At 3-month follow-up of 376 patients, 34% had least severe disability (mRS = 0/1), 39% had intermediate disability and 28% had most severe disability (mRS = 4/5). Those with least severe disability were mostly men younger than 65 years of age and principally with ischemic stroke. Those with most severe disability were predominantly women aged ≥ 65 years and those with severe disability, mainly attributable to intracerebral haemorrhage. At 3 months, 50% had better functional status than at stroke onset, and 27% had poorer function. Conclusion Case-fatality was relatively low in this study, possibly because of cultural preferences for end-of-life care at home. The dependency burden was relatively high, placing pressure on the healthcare system and society.