Stroke: coma, cardiac failure, urinary incontinence, severe paresis and atrial fibrillation increased the risk of death within 12 months.

Clinical bottom line (level 1b)

  1. More than a third of patients with stroke died within 12 months.
  2. Almost a third of patients with a cerebral infarction died within 12 months.
  3. Patients who had a stroke were at increased risk of death within 12 months if were: comatose, had cardiac failure, had urinary incontinence, had severe paresis, had atrial fibrillation.
  4. Patients who had a cerebral infarction were at increased risk of death within 12 months if they had: cardiac failure, urinary incontinence, atrial fibrillation, an un partnered marital status, or claudication.
  5. 47% of patients with subarachnoid/primary intracerebral stroke died within 12 months, and 42% with embolic stroke did.
Anderson et al: Stroke 1994; 25: 1935-1944
Expires November 2002

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: community based, Australia

492 patients (aged range 13 to 96 years; mean 73, 52% male) final diagnosis of a stroke. 371 patients were used in the test sample and 171 were used in the validation set.


Multivariate analysis was used to adjust for confounding factors.

100% followed for 12 months
Outcomes studied:
  • death with any stroke
  • death with cerebral infarction
  • death with subarachnoid/primary intracerebral stroke
  • death with embolic stroke

The evidence

outcome time to outcome number of patients/total number %
(95% CI)
death with any stroke 12 months 187/492 38.0%
(33.7% to 42.3%)
death with cerebral infarction 12 months 97/349 27.8%
(23.1% to 32.5%)
death with subarachnoid/primary intracerebral stroke 12 months 35/75 46.7%
(35.4% to 58.0%)
death with embolic stroke 12 months 23/55 41.8%
(28.8% to 54.9%)

prognostic factor for
death with any stroke 		time to outcome adjusted RR
(95% CI)		 NNF+
(95% CI)
comatose 12 months 3.04
(1.10 to 8.41) 		2
(1 to 50)
cardiac failure 12 months 6.51
(2.81 to 15.1) 		2
(1 to 7)
urinary incontinence 12 months 3.90
(1.43 to 10.6) 		1
(0 to 5)
severe paresis 12 months 4.91
(1.56 to 15.5) 		1
(0 to 7)
atrial fibrillation 12 months 1.96
(1.10 to 3.51) 		9
(3 to 85)

prognostic factor for
death with cerebral infarction 		time to outcome adjusted RR
(95% CI)		 NNF+
(95% CI)
cardiac failure 12 months 6.65
(2.35 to 18.8) 		1
(0 to 3)
urinary continence 12 months 7.32
(2.52 to 21.3) 		1
(0 to 2)
atrial fibrillation 12 months 2.30
(1.03 to 5.12) 		3
(1 to 120)
un partnered marital status 12 months 2.42
(1.08 to 5.43) 		3
(1 to 45)
claudication 12 months 2.17
(1.01 to 4.66) 		3
(1 to 360)

  • 24% of patients died within 28 days.
  • Similar results were found in the validation set of patients.
  • Coma was not an independent factor for death in patients who have had a cerebral infarction. RR = 2.6 (95% CI 0.8 to 8.3)

Comments

  1. Numbers needed to follow for cerebral infarction are overestimated, as the control rate used was for the overall death from cerebral infarction.
  2. Patients were from a varied background so these results could be misleading in the wrong context.
  3. Lack of explanation of the models used for multivariate analysis weakens the study findings.

Citation

  1. Anderson CS, Jamrozik KD, Broadhurst RJ, et al: Predicting survival for 1 year among different subtypes of stroke: Results from the Perth Community Stroke Study. Stroke 1994; 25: 1935-1944
Search Terms: stroke in Best Evidence
Contributor: Nick Shenker and Clare Wotton, November 1999
Reviewer: Ross Lawrenson

Clinical Question.
    Patient stroke
    Intervention or Exposure presence of prognostic factors
    Comparison absence of factors
    Outcome predicting 1 year survival