Siobhan L Crichton1, Benjamin D Bray2, Christopher McKevitt1, Anthony G Rudd1, Charles D A Wolfe3. 1. Division of Health and Social Care Research, King's College London, London, UK NIHR Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, London, UK. 2. Farr Institute of Health Informatics, University College London, London, UK. 3. Division of Health and Social Care Research, King's College London, London, UK NIHR Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, London, UK National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, London, UK.
Abstract
BACKGROUND: The 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. METHODS: Data 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. FINDINGS: Of 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. CONCLUSIONS: One 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND: The 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. METHODS: Data 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. FINDINGS: Of 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. CONCLUSIONS: One 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Mary Stuart; Alexander W Dromerick; Richard Macko; Francesco Benvenuti; Brock Beamer; John Sorkin; Sarah Chard; Michael Weinrich Journal: Neurorehabil Neural Repair Date: 2019-07-11 Impact factor: 3.919
Authors: Tharshanah Thayabaranathan; Nadine E Andrew; Monique F Kilkenny; Rene Stolwyk; Amanda G Thrift; Rohan Grimley; Trisha Johnston; Vijaya Sundararajan; Natasha A Lannin; Dominique A Cadilhac Journal: Qual Life Res Date: 2018-08-04 Impact factor: 4.147
Authors: Mary Lyons; Craig Smith; Elizabeth Boaden; Marian C Brady; Paul Brocklehurst; Hazel Dickinson; Shaheen Hamdy; Susan Higham; Peter Langhorne; Catherine Lightbody; Giles McCracken; Antonieta Medina-Lara; Lise Sproson; Angus Walls; Dame Caroline Watkins Journal: Eur Stroke J Date: 2018-05-08