Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

Objective: To assess the extent to which increased disability following ischaemic stroke influences 5-year mortality and institutionalization in pre-morbidly disabled patients. Background: Patients with pre-morbid disability – typically defined as a modified Rankin Scale score (mRS) ≥2 or ≥3 – are often excluded from trials of acute ischaemic stroke therapies. Decisions to use such therapies in pre-morbidly disabled patients will partly depend on whether long-term clinical outcomes of patients who accumulate greater disability following their stroke differ markedly from those of patients who retain their pre-morbid disability. Design/Methods: In a population-based, prospective cohort of 3-month survivors of ischaemic stroke (Oxford Vascular Study, OXVASC; 2002–2014), we tracked mortality and institutionalization (admission to nursing or residential care home) through overlapping methods of interview-based assessments of patients/carers and ongoing searches of health records. We used Cox regressions – adjusted for age, sex, and initial NIHSS(National Institutes of Health Stroke Scale) score – to compare outcomes of 1-year and 5-year mortality and/or new post-stroke institutionalization in survivors with pre-morbid mRS of 2–4 (excluding severe pre-stroke disability, mRS 5), based on the degree of change in mRS (ΔmRS) from pre-stroke to 3-months post-stroke. Results: Among 1,425 3-month survivors, 420(29.5%) had pre-morbid mRS 2–4; only 2 received thrombolysis. ΔmRS independently predicted 1-year mortality in pre-morbidly disabled patients (adjusted hazard-ratio[aHR] versus no change for ΔmRS 1: 2.52, 95%CI 1.47–4.30, p=0.001; ΔmRS 2: 3.22,1.66–6.24, p=0.001; ΔmRS 3: 4.27,1.40–13.02, p=0.011). Similar results were seen for 5-year mortality/institutionalization (aHR for ΔmRS 1: 1.72,1.30–2.27, p<0.001; ΔmRS 2: 2.19,1.50–3.19, p<0.001; ΔmRS 3: 3.56,1.69–7.47, p=0.001). Results were similar on examining pre-morbid mRS 2, 3, 4 separately (e.g. 5-year institutionalization aHR for pre-morbid mRS 3 with ΔmRS 1: 2.13,1.25–3.64, p=0.006; ΔmRS 2: 3.55,1.76–7.15, p<0.001). Conclusions: Pre-morbidly disabled patients who accumulate additional post-stroke disability have worse mortality and institutionalization outcomes. This justifies trialling or administering acute stroke therapies in patients with mild-moderate disability to potentially mitigate further post-stroke disability.

Type

Conference paper

Publication Date

10/04/2018

Volume

90