Eva Gaynor1, Daniela Rohde2, Margaret Large3, Lisa Mellon4, Patricia Hall3, Linda Brewer5, Orla Conway4, Anne Hickey4, Kathleen Bennett4, Eamon Dolan6, Elizabeth Callaly7, David Williams5. 1. Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland. 2. Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: danielamrohde@rcsi.ie. 3. Clinical Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland. 4. Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland. 5. Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland. 6. Department of Geriatric Medicine, Connolly Hospital Blanchardstown, Dublin, Ireland. 7. Department of Geriatric Medicine, Mater Misercordiae University Hospital, Dublin, Ireland.
Abstract
BACKGROUND: The aim of this study was to examine predictors of mortality in patients 5 years after ischemic stroke, focusing on cognitive impairment, vulnerability, and vascular risk factors assessed at 6 months post stroke. MATERIALS AND METHODS: Patients from the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) cohort were followed up 5 years post ischemic stroke. Vascular risk factors, cognitive impairment, and vulnerability were assessed at 6 months post stroke. Cognitive impairment was assessed using a cutoff score lower than 26 on the Montreal Cognitive Assessment (MoCA). Vulnerability was defined as a score of 3 or higher on the Vulnerable Elders Scale (VES). Mortality and date of death were ascertained using hospital records, death notifications, and contact with general practitioners. Predictors of mortality were explored using multivariate Cox proportional hazards models. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) are presented. RESULTS: Sixty-three of 256 patients (24.6%) assessed at 6 months post stroke had died within 5 years. Cognitive impairment (HR [95% CI]: 2.19 [1.42-3.39]), vulnerability (HR [95% CI]: 5.23 [2.92-9.36]), atrial fibrillation (AF) (HR [95% CI]: 2.31 [1.80-2.96]), and dyslipidemia (HR [95% CI]: 1.90 [1.10-3.27]) were associated with increased risk of 5-year mortality. DISCUSSION: Vulnerability, cognitive impairment, AF, and dyslipidemia at 6 months were associated with increased risks of mortality 5 years post ischemic stroke. CONCLUSION: Identification and management of these risk factors should be emphasized in poststroke care.
BACKGROUND: The aim of this study was to examine predictors of mortality in patients 5 years after ischemic stroke, focusing on cognitive impairment, vulnerability, and vascular risk factors assessed at 6 months post stroke. MATERIALS AND METHODS:Patients from the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) cohort were followed up 5 years post ischemic stroke. Vascular risk factors, cognitive impairment, and vulnerability were assessed at 6 months post stroke. Cognitive impairment was assessed using a cutoff score lower than 26 on the Montreal Cognitive Assessment (MoCA). Vulnerability was defined as a score of 3 or higher on the Vulnerable Elders Scale (VES). Mortality and date of death were ascertained using hospital records, death notifications, and contact with general practitioners. Predictors of mortality were explored using multivariate Cox proportional hazards models. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) are presented. RESULTS: Sixty-three of 256 patients (24.6%) assessed at 6 months post stroke had died within 5 years. Cognitive impairment (HR [95% CI]: 2.19 [1.42-3.39]), vulnerability (HR [95% CI]: 5.23 [2.92-9.36]), atrial fibrillation (AF) (HR [95% CI]: 2.31 [1.80-2.96]), and dyslipidemia (HR [95% CI]: 1.90 [1.10-3.27]) were associated with increased risk of 5-year mortality. DISCUSSION: Vulnerability, cognitive impairment, AF, and dyslipidemia at 6 months were associated with increased risks of mortality 5 years post ischemic stroke. CONCLUSION: Identification and management of these risk factors should be emphasized in poststroke care.
Authors: Rui She; Zhongrui Yan; Yanlei Hao; Zuoji Zhang; Yifeng Du; Yajun Liang; Davide L Vetrano; Joost Dekker; Bo Bai; Joseph T F Lau; Chengxuan Qiu Journal: Front Aging Neurosci Date: 2022-09-09 Impact factor: 5.702
Authors: Daniela Rohde; Eva Gaynor; Margaret Large; Lisa Mellon; Kathleen Bennett; David J Williams; Linda Brewer; Patricia Hall; Elizabeth Callaly; Eamon Dolan; Anne Hickey Journal: PLoS One Date: 2019-10-17 Impact factor: 3.240