Stroke: age, smoking and atrial fibrillation increased the risk of death.

Clinical bottom line (level 1b)

  1. A sixth of patients who had a stroke died within 30 days.
  2. Patients who had a stroke were at increased of death at 30 days, if they: smoked, had atrial fibrillation, and by increasing age.
Lin et al: Stroke 1996; 27: 1760-1764
Expires November 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: population based cohort of 5070 patients, USA

501 patients (aged mean 73 years, 57% female) initial ischaemic stroke (intracranial bleed ruled out by CT scan or other technique)

Excluded if
  • stroke severity could not be determined



    • Factors studied:
  • mortality
  • age (10 years interval)
  • smoking
  • atrial fibrillation




    • Multivariate analysis was used to adjust for confounding factors

    100% followed for 30 days
    Outcomes studied:
  • mortality

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    mortality 30 days 82/501 16.4%
    (13.1% to 19.6%)

    prognostic factor for
    mortality     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    age (10 years interval) ? 1.66
    (1.27 to 2.17)
    smoking 30 days 149/501
    (29.7%)     		1.87
    (1.07 to 3.27)     		7
    (4 to 70)
    atrial fibrillation 30 days 103/501
    (20.6%)     		1.84
    (1.04 to 3.27)     		9
    (4 to 154)

    • Barthel index scores (functional status score where 0 = incapacitated to 100 = fully independent) at 3 months (p=0.05)
      • Stroke with AF - mean Barthel Index 49.7 (SE 10.4)
      • Stroke without AF - mean Barthel Index 79.5 (SE 4.4)

    Comments

    1. Patients with atrial fibrillation were slightly older than those without (81 vs 78 years).

    Citation

    1. Lin H-J, Wolf PA, Kelly-Hayes M, et al: Stroke severity in atrial fibrillation: The Framingham Study. Stroke 1996; 27: 1760-1764
    Search Terms: stroke in Best Evidence
    Contributor: Nick Shenker and Clare Wotton, November 1999
    Reviewer: Grahame Hankey

    Clinical Question.
    Patient stroke
    Intervention or Exposure presence of atrial fibrillation
    Comparison no atrial fibrillation
    Outcome mortality